1. Bringing excellence to life Community Based Peritoneal Dialysis (PD) Clinic: Nurses and Patients’ Experience Charelle S. Serrano Peritoneal Dialysis - Sister Barts and The London NHS Trust London, England

2. Bringing excellence to life Background Definition of Nurse Led Clinic  A clinic or drop in service that is run at set times by a registered nurse.  The nurse has his or her own patient case load.  The service involves an increase in the autonomy of the nursing role.  The clinic requires the patient to fit into set time slot often through an appointment system. (Hatchett, 2003)

3. Bringing excellence to life National Drivers  Making a difference (DOH 1999)  National Service Framework ( 2000)  Reduction in junior doctors hours (DOH 2002)  Modernisation agency ( 2004)  National Institute of Clinical Excellence (NICE 2005)

4. Bringing excellence to life Objectives To identify and evaluate nurses’ and patients’ experiences in attending a community based nurse-led clinic.

5. Bringing excellence to life Method  2 Community based nurse-led clinics were established * Renal Satellite Unit * GP Surgery clinic  8-10 patients attended the nurse-led clinic  Questionnaires were provided to 30 patients attending outreach clinics and 7 senior nurses

6. Bringing excellence to life Why develop a Community Based PD Nurse Led clinic? Patients:  Improve quality of life  Provide invaluable patient centred approach  Freedom from hospital  Expectations and Demands Organisation:  Meet objectives, guidelines/standards  Expand community program  Cost effective service provision  Recruitment and retention

7. Bringing excellence to life Criteria for Community Based PD Nurse-led Clinic: Patients:  Appointment  Suitability  Accessibility Nurses:  Specialist Nurse  Autonomy  Skills

8. Bringing excellence to life Role and Limitations of Outreach clinics Role  Blood tests  Urea Kinetic Modelling (UKM)  Peritoneal Equilibrium tests (PET)  Standard Permeability Test (SPA)  Line changes  Nurse clinics for fluid assessment  Review of problems and medications Limitations  Does not replace Home Visits  Cannot assess Home circumstances  Cannot assess PD exchange technique  Nurse prescribing

9. Bringing excellence to life Results Patients: 90% (n-27) were satisfied with the services rendered  Less hospital visit  Reduced travelling time to and from the clinic  Less time spent in clinic  Nurses have more time for patients  Meeting other patients Nurses:  Job satisfaction  Gained more confidence  Autonomy in clinical decision  Professional growth and development  Developed management skills

10. Bringing excellence to life Outcome for the Organization  Opening of another outreach clinic  Increased hospital capacity for doctor’s clinic  Recruitment and retention of nurses  Reduce cost for hospital transport  Improvement in meeting clinical standards, objectives and guidelines

11. Bringing excellence to life Conclusion Community based nurse-led clinics made significant contribution towards satisfying patient’s demands and nurses experience for these services provided by the unit, thus improving their quality of life.

12. Bringing excellence to life Recommendations  Establish more outreach clinic  Information dissemination  Encourage more nurses to lead/manage outreach clinics

13. Bringing excellence to life Acknowledgements Renal Abstract Peer Group PD Team Dr Stanley Fan Sally Punzalan Jao Ortial Contact: Charelle.Serrano@bartsandthelond on.nhs.uk

14. Bringing excellence to life References  Department of Health “ Making a Difference” 1999  Department of Health “National Service Framework” 2000  Department of Health “Reduction in Junior Doctors” 2002  Hatchett R “Nurse-led Clinics” 2003  Department of Health “Modernisation Agency” 2004  National Institute for Health and Clinical Excellence 2005