Community Supports & Peritoneal Dialysis October 28, 2019€¦ · 4.Client residing in LTC –home care performs dialysis 5.Client resides in LTC –LTC facility staff perform dialysis

Community Supports & Peritoneal Dialysis

October 28, 2019

Renal Program

1. NSHA Renal Program Structure

2. Renal Plan (org chart)

3. What is Peritoneal Dialysis (PD)

4. Distribution of PD in Nova Scotia

5. Supporting PD in the Community

6. Client Selection Criteria and Home Therapy Supports

7. Supports for PD in community

8. Challenges and Opportunities

NSHA Renal Program Organizational Chart

Senior Director/

Senior Medical Director

David Landry

Dr. Steven Soroka

Renal Program Support

Renal

Consultant

Susan MacNeil

Senior Informatics

Lead

Susan Arklay-

Lehman

Renal

Consultant

Cheryl

Stevenson-Gillis

Angela Shorter

Central/Northern Zone

Renal Manager

Clinical

Leader

Krista Smith

Eastern Zone Renal

Manager

Kelly Ross

Wester Zone Renal

Manager

Clinical

LeaderClinical

Leader

Clinical Pharmacy

Coordinator

Dr. Jo-Anne Wilson

Paula Travers

Administrative Assistant

Nephrology LeaderQuality Leader

Tabassum Quirashi

Renal Plan

Renal Plan

Peritoneal Dialysis

Peritoneal Dialysis is a mode of renal replacement

therapy that:

• Is a well established alternative to hemodialysis

• Best suited to many elderly or disabled

individuals

• Benefit clients medically and quality of life

perspective

• Often eliminates the potential instability

experienced while on hemodialysis

Peritoneal Dialysis Statistics

LTC and Home Care Peritoneal Dialysis Data

Zone

#

Independent

PD Patients

# PD Patients where

family member

does PD

# Home Assisted

PD Patients

# Potential

Home

Assisted PD

Patients

# LTC PD

Patients

# Potential

LTC PD

Patients

LTC Facilities Where

Current PD Patients

Reside

Western16 2 6

Central/Northern43 10 10 3 Northwood-2, Mira-1

Eastern36 2 5 2 1 1 St. Anne Center

TOTAL95 (70%) 14 (10%) 21(15%) 2 4 (3%) 1 137

Peritoneal Dialysis Clients

Three categories:

1. Independent Peritoneal Dialysis (PD)

2. Assisted PD (can be maintained in their own home while having

PD and require assistance from home care)

3. Those requiring placement or respite in a Long

Term Care Facility (LTC)

Continuing Care PD model provided education and supports

under six service delivery models:

1.Client residing in own home – home care providing daily PD

2.Client residing in own home – home care augments existing support

3.Client residing in LTC – client performing own PD under supervision

4.Client residing in LTC – home care performs dialysis

5.Client resides in LTC – LTC facility staff perform dialysis

6.Clients in an acute care setting – LTC or HC service provider to perform

daily PD

In the Past: 2006 Model

Allows people with barriers to self-care

Peritoneal Dialysis an opportunity to be

offered a home-based dialysis modality

Client Selection Criteria (assisted or LTC)

• Peritoneal dialysis is deemed to be the best treatment

option (hemodialysis or conservative care)

• Client agrees to peritoneal dialysis treatment in their

community

• Can utilize cycler method

• Cannot perform own dialysis due to physical or cognitive

impairment or requires supportive environment

• Family support not available or able to manage PD

• Client must meet eligibility criteria for Continuing Care

Renal Program Responsibilities

• Identify potential PD clients

• Provide initial and ongoing education

• Consultant for service provider

• Obtain client consent

• Provide procedures, policies, and protocols

• Provide on call coverage

• Provide Nephrologist support

• Provide routine follow-up care

• Provide PD equipment, solutions, supplies and medications

• Collaborate with attending physician and Continuing Care

Assisted PD at Home and Long Term Care

Challenges and Opportunities

LTC Challenges & Proposed Solutions

Challenges Potential Solutions

1. Placement in LTC can be lengthy

from home or acute care:

Consequences:

a) LOS increased

b) Permanent transfer to hemodialysis

Possible Reasons:

a) Complicated due to fragmented

planning

b) Separate application and assessment

processes (Continuing Care, Home

unit, LTC, DHW, equipment needs)

c) Identify need, time for hiring staff,

training and placement of patient

takes too long

1. A more streamlined, expedited,

flexible, patient centered process is

required to support uptake of

peritoneal dialysis:

a) Strategies to shorten the timeline to

placement, not waiting for bed

available before starting.

b) Collaborative care planning between

Renal Program, Inpatient unit,

Continuing Care and LTC

c) Expedite DHW funding approval

process

d) Staff posting process as soon as

bed is available, prior to funding

approval (perhaps a short

assignment)

e) Contract VON to provide PD services

until LTC staff are hired and trained,

so patient can be placed in timely

fashion

LTC Challenges & Proposed Solutions

Challenge Proposed Solution

2. Patients want to be placed closer to

home (some refuse current locations

and chose hemodialysis)

3. Availability of respite for care givers

that perform peritoneal dialysis daily

and need a break

4. Perception that learning peritoneal

dialysis is difficult

2. Consider approval of all LTC

facilities for peritoneal dialysis on a

as needed basis

3. Respite beds should be available in

facilities were there are peritoneal

dialysis trained staff

4. Training can be completed in ½ day.

Home Unit on call 24/7. New cycler

“Amia” –easy to operate, provides

remote monitoring and

management of therapy from home

dialysis unit

Challenge Proposed Solution

1. Difficulty providing assisted PD in

Eastern Shore and parts of Cape

Brenton due to staffing challenges

1. Utilize DHW funding to increase

continuing care staff in community

2. No respite available for care givers

that perform peritoneal dialysis daily

and need a break

2. Home Care respite should be

available for care givers that perform

peritoneal dialysis

Home Care Challenges & Proposed Solutions

• Burnout is a potentially significant contributor to technique failure and therefore to

patient mortality.

Acute Care Challenges & Proposed Solutions

Challenge Proposed Solution

1. When PD patient is admitted to local

hospital and cannot perform own

dialysis, often they must be

transferred to Halifax or Sydney

1. Acute care works with continuing

care to identify trained staff (LTC or

HC) so the patient can remain in

local hospital

Home Hemodialysis Challenges &

Proposed Future Solutions

Challenge Proposed Solution

1. Home hemodialysis (HHD) patient

requires minimal assistance to set up

equipment, but can perform own

treatment

1. Explore support for HHD

a) train home care staff to provide

assistance to set up equipment

Willingness to work on a case by case basis to

facilitate PD in communities whether at home or

long term care

Peritoneal Dialysis in Communities