Discuss one aspect of involving patients you have done or plan to - - PowerPoint PPT Presentation

11:30 – 12:45

• Your local strategy to enable measurement of suitability for

transplant at EGFR <20

• How many donors & recipients have started 18 week clock since

May 1st

• Discuss one aspect of involving patients you have done or plan to

do

• Discuss one method you have done or planning to do to raise

profile of SWTT and its aims

Kidney Quality Improvement Partnership (KQuIP) University Hospitals Plymouth NHS Trust

Leanne Savage, Transplant Liaison Nurse Dr Richard Powell, Renal Registrar Linda Boorer, Transplant Nurse Consultant Dr Imran Saif, Consultant Nephrologist and Director of Transplantation

Local Strategy - Documented Transplant Decision

6/26/2019 Kidney Quality Improvement Partnership | West Midlands Regional Day 3

Current Practice Currently transplant suitability is documented with 89% of all patients with an eGFR <20 having a documented decision either (Yes/No/Under Review) However this is documented in two places – lacks consistency – often different consultants fill out different bits – some consultants not aware that the CKD screen existed

Local Strategy - Documented Transplant Decision

6/26/2019 Kidney Quality Improvement Partnership | West Midlands Regional Day 4

A report is pulled from vital data which identifies which patients have decisions or

• not. Currently used at the CKD/TWL review meetings with each consultlant.

Each CKD patient with a blank is reviewed approximately 6weekly to 2 months. HD, PD patients not re-reviewed routinely in this way. Plan

• To discuss with admin manager whether we can auto populate the fields on vital

data if one field is completed so that it shows in both places.

• To get the drop down options to match the transplant first dashboard options for

consistency (rather than Yes/No/Under Review)

• Continue to pull off this report at each CKD/TWL meeting – updating the options
• nce available
• Revisit decisions periodically for HD/PD patients to ensure status hasn’t changed

i.e those who may now be suitable

• Audit on a quarterly basis?

Patients on 18 Week Pathway Since 1 May 2019

6/26/2019 Kidney Quality Improvement Partnership | West Midlands Regional Day 5

Recipients

• 9 referrals to transplant assessment across the three referrals centres (at the

point of referral to MDT) Donors

• 14 enquiries into living donation where we have sent out information out of

these 14 - 4 have got back in touch

• 8 people have undergone compatibility testing

Where should the clock start for donors? Should it be at the point of enquiry (although not registered sometimes at this stage? or at the point of an initial appointment with the LDC? Or at the point that they are proceeding to work up (following compatibility)?

How We Are Involving Patients

6/26/2019 Kidney Quality Improvement Partnership | West Midlands Regional Day 6

Donors

• Looking at ways to make living donation more accessible
• Currently down to an estimated three visits
• Could the first visit be more convenient for the patient?
• Want to ask patients who have gone through the process whether they

would have preferred a late afternoon/evening appointment to fit better with work commitments?

• Plan – to write a questionnaire and send out to all donors from the

past year to find out their preferences

Raising Our Profile

6/26/2019 Kidney Quality Improvement Partnership | West Midlands Regional Day 7

• Rich has written a piece about the KQuIP project which has been sent the

communications team within the trust.

• Linda and I met with the communications team who want to work with us

to get a piece in the Herald talking about what the unit is doing.

• KQuIP has been discussed within our transplant steering group to ensure

the wider renal team is aware of the project.

eGFR <20- are you suitable for transplant?

• Patients enquiring their own suitability for transplantation.
• Shared care/ responsibility to ensure patient transplant status is

discussed. PD nurses, tx nurses, consultants, more difficult for HDx nurses as satellite units use different documenting systems. How often to review everyone’s status? Every clinic appointment? Every HDx session? Set meetings- monthly?

Outstanding care for people in ways which matter to them

18 week pathway

• 8 potential recipients referred for transplant

since 1st May (Bristol, Portsmouth & Oxford) 2 HDx patients 6 low clearance

• 3 potential donors have made initial contact

with transplant specialist nurses since 1st May

Outstanding care for people in ways which matter to them

Patient involvement

• Peer support from previous transplant recipients and

donors- patient information evenings/ afternoons

• Bristol patient information day
• Ensure patients understand process at every
• pportunity
• Feedback from previous potential donors and recipients

about their work-up experiences

• HDx/ PD nurses to revisit live donation if donor not

available at initial education session

Outstanding care for people in ways which matter to them

Outstanding care for people in ways which matter to them

Aim to create medical day for live donors at DCH

• r Poole

Education to colleagues

Identifying documented transplant decisions at NBT

• Interrogate proton system for all patients eGFR<20 and record:
• Transplant ‘status’
• Cons care status
• Add info from education nurse notes/search clinic letters
• Main issue is that ‘transplant status’ is (in the majority) only recorded for

patients who have undergone a discussion/decision – in future this work will depend on identifying patients where the discussion hasn’t yet happened

6/26/2019 Kidney Quality Improvement Partnership | West Midlands Regional Day 12

• vv

6/26/2019 Kidney Quality Improvement Partnership | West Midlands Regional Day 13

After screening for eGFR<20, there are too many places where info about transplant decision could be

+ letters + education notes …can we change this to make future audit easier?

Anticipated ESRD within a year

• More difficult to screen for electronically. Potential to model eGFR decline to

predict need for RRT (similar work on need for referral with Bristol Health Partners CKD Health Integration Team)

6/26/2019 Kidney Quality Improvement Partnership | West Midlands Regional Day 14

New starters to Pathways from 01/05/2019 to 31/05/2019

• Recipient work-up pathway

16

• Living Donation (LKD 1+2)

14

• (including 1 NDAD)

6/26/2019 Kidney Quality Improvement Partnership | West Midlands Regional Day 15

One aspect involving patients we’ve started (or we are planning to do differently)

• Options for Kidney Care clinic –
• 3-in-one clinic (nephrologist, education nurse, dietitian).
• Runs at Cossham hospital (East Bristol).
• By referral from nephrologist. 3 visits – positive initial feedback
• Patient survey + audit of patients seen in progress.

6/26/2019 Kidney Quality Improvement Partnership | West Midlands Regional Day 16

Pilot electronic ‘ICE’ referral form for transplant recipient referral

• Attempt to make sure all patient data are available at referral.
• Principle approved by NBT nephrology consultant group
• Developing form with IT service
• To pilot at NBT then consider similar options for our referral centres (Dorset,

Gloucester and Exeter)

6/26/2019 Kidney Quality Improvement Partnership | West Midlands Regional Day 17

Raise the profile of South West Team Transplant

• Present work so far, dashboard, launch of ICE request at departmental team

meeting/ regional transplant steering group

• Publicise via BAKPA

6/26/2019 Kidney Quality Improvement Partnership | West Midlands Regional Day 18

KQUIP Homework

With thanks to….

• Lynsey Webb
• Heather Atkins
• Karen Steer
• Lizzie Boult

Currently…… Recorded on Proton correctly – date first seen, date of transplant decision and date started dialysis Data is extracted by The Renal Registry quarterly

• measure and publish transplant decision on new starters

Parameters:- eGFR < 20mL/min/1.73m2

• known to us for 90 days or more
• aged below 75 years

Local strategy to measure number of patients with an eGFR <20

Going forward…our strategy

 Transplant to be discussed at an eGFR of 20 if appropriate  Prepare for this data to be collected accurately via My-Care  Ongoing audit to ensure regulatory data is accurate In May 2019 - **% of patients had a decision recorded on Proton about their transplant status

How many patients have been referred and started the 18 week pathway?

Bristol Plymouth

Since May 2019 2 2 April 2018 – May 2019 27 25

How many LKD’s have been referred and started the 18 week pathway at EKU?

LKD starters

Since May 2019 10 donors for 6 recipients April 2018 – May 2019 52 for 44 recipients

Involving patients….

• KPA – i.e., involved in distributing PREM questionnaire
• Arrange a cream tea educational/social gathering for patients wanting more

information about transplant – 6 monthly basis

Raising the profile….

• KQUIP communication bulletin…. via the RD&E’s Hub
• EKPA newsletter
• EKU staff newsletter

Going Forward…..

RCHT

Emma Johns & Susan Durkin

eGFR strategy

• Immediate

– We reviewed all active (non conservative)CKD patients from existing lists, all 5 consultants emailed lists & encouraged to review / update Tx status. – Raised at face-to-face renal business meeting.

• Medium term

– Software strategy meeting – further meeting planned to finalise drop down menu choices & screen options on vitaldata – allowing quick searches for patients with eGFR <20. – Plymouth & Gloucester ? Others using vitadata ? Any advice?

18 week clock since 1st May 2019

• 9 potential live donors.
• Discussed - When do we start clock? Referral ? First visit?

Tissue typing ? First contact with donor?

• 4 potential recipients (1x DNA appt – re-sent, 1x cancelled

appt wants to re-consider).

• Recipients – clock starts from date of referral.

Patient involvement

• Strengthened links with Deborah and listened to her great

ideas (one show).

• Steve informs us that he is making time in clinics to

specifically discuss recipients / donors experience and encourage them to get involved with the pathway in the future.

Raise profile of SWTT

• Emma planning to cover SWTT in August Trust medical

divisional newsletter.

• Steve has contacted Trust communications officer – planning

a Trust wide summary of SWTT.

• Steve presented at UKKW 2019.