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 1 st • 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 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 Kidney Quality Improvement Partnership | 6/26/2019 3 West Midlands Regional Day
Local Strategy - Documented Transplant Decision 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 once 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? Kidney Quality Improvement Partnership | 6/26/2019 4 West Midlands Regional Day
Patients on 18 Week Pathway Since 1 May 2019 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)? Kidney Quality Improvement Partnership | 6/26/2019 5 West Midlands Regional Day
How We Are Involving Patients 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 Kidney Quality Improvement Partnership | 6/26/2019 6 West Midlands Regional Day
Raising Our Profile • 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. Kidney Quality Improvement Partnership | 6/26/2019 7 West Midlands Regional Day
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 1 st May (Bristol, Portsmouth & Oxford) 2 HDx patients 6 low clearance • 3 potential donors have made initial contact with transplant specialist nurses since 1 st 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 opportunity • 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
Aim to create medical day for Education to live donors at DCH colleagues or Poole Outstanding care for people in ways which matter to them
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 Kidney Quality Improvement Partnership | 6/26/2019 12 West Midlands Regional Day
After screening for eGFR<20, there are too many places where info about transplant decision could be • vv + letters + education notes … can we change this to make future audit easier? Kidney Quality Improvement Partnership | 6/26/2019 13 West Midlands Regional Day
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) Kidney Quality Improvement Partnership | 6/26/2019 14 West Midlands Regional Day
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) Kidney Quality Improvement Partnership | 6/26/2019 15 West Midlands Regional Day
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. Kidney Quality Improvement Partnership | 6/26/2019 16 West Midlands Regional Day
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) Kidney Quality Improvement Partnership | 6/26/2019 17 West Midlands Regional Day
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 Kidney Quality Improvement Partnership | 6/26/2019 18 West Midlands Regional Day
KQUIP Homework With thanks to…. • Lynsey Webb • Heather Atkins • Karen Steer • Lizzie Boult
Local strategy to measure number of patients with an eGFR <20 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/1.73m 2 - known to us for 90 days or more - aged below 75 years In May 2019 - **% of patients had a decision recorded on Proton about their transplant status 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
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
Going Forward….. 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
RCHT Emma Johns & Susan Durkin
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