1. NIPEC Annual Conference Professional Standards Enhancing Person-Centred Care Assisted Automated Peritoneal Dialysis(aAPD) Susie Mawhinney PD Nurse BCH A new treatment choice for patients with End Stage Kidney Disease in Northern Ireland

2. Presentation Outline Understand treatment choices for patients with End stage kidney disease Why an Assisted Automated Peritoneal dialysis service was needed How we started it What is happening now

4. Transplantation No dialysis needed Close to normal kidney function Fewer restrictions Risk of rejection Medication Reduced immunity A transplanted kidney has a finite lifespan

5. Haemodialysis In-centre (mostly) or rarely at home 3+ sessions a week Fistula required – Needles Travel to unit x 3 weekly In centre HD - Nurses carry out treatment for patient

6. Peritoneal Dialysis APD Home dialysis Night time treatment Simple machine Permanent catheter Storage required Fluid heavy to lift

7. Statistics Number of patients receiving Renal Replacement Therapy(RRT) in UK is growing by 5-8% pa Older people are the largest and fastest growing group of dialysis patients.

8. PD: a suitable treatment for the elderly? Pros Less travelling involved Minimises risks of hospital based infections Benefits of a home based therapy A more gentle form of dialysis treatment. More cost effective Cons Physically unable No back up / support available.

9. Definition of aAPD “Assisted Automated Peritoneal Dialysis is a service whereby a paid carer performs all or part of the dialysis treatment for a PD patient, thereby enabling more patients to receive their treatment in the community” (2) The paid carer can be provided directly by the Health Authority, through the network of community nurses, or indirectly by arrangement with a contracted service provider such as Baxter Healthcare (2) 2 Specification for commissioning of the PD pathway NHS Kidney Care 2009

10. Getting Started Business plan developed Recruitment of Health care company to provide Health Care Assistants( HCAs) Service level agreement Training plan devised for HCAs 3 day training course delivered 6 month pilot study commenced Dec 2011 Rolled out to all N.I May 2012.

11. The aAPD Service Healthcare Assistant to visit patient daily to: Remove used bags & empty drain bags Check drained fluid Connect new bags & set up machine Check BP & weight Carry out exit site care Record all information Review stocks Contact patients PD unit if problems arise.

12. The service now 50 patient have availed of service Used for – struggling PD patients, new starts, respite and paediatrics 22 patients presently using service Over 35 Health care assistants trained to cover NI BCH PD nurses provide an out of hours on call service for all PD patients

13. Conclusion No rise in peritonitis rates Pt Satisfaction survey showed all aApd patients would recommend service. aAPD now offered as a treatment modality in NI.

14. Patient Comments “ “ I would have to travel to hospital 3 times a week – I would have no life” “It is a great help – I could not manage on my own” “ Great service – takes the pressure off the carer” “HCAs provide moral support for carer and brighten patient’s day” “Very happy with service” “HCAs very good at their job and very friendly”

15. Any questions?