1. Shared Care – Its Role in Patient Outcomes
Dr Paul Laboi : Consultant Nephrologist York Sonia Lee : SHAREHD Program Manger – Sheffield
PAUL

2. The Shared Care Vision
For people who receive dialysis at centres to have the information, opportunity and choice to participate in aspects of their treatment and thereby improve their experience and their outcomes.
PAUL

3. Emphasis is on choice - taking part and engaging at a level that suits the patient as an individual.
PAUL

4. Patient Perspective – Why ?
“As a person and a patient, I care deeply about involvement, because I know it helps me as a patient to live more sustainably with my health conditions, and because I know that that, in turn, can help the National Health Service to exist more sustainably, too”
“I need support because self-management is hard work. Maintaining positive behaviours and lifestyle changes, and keeping on top of it all, is not easy. Motivation waxes and wanes, as does my ability to cope.”
PAUL
Anya de Iongh
Patient leader and self-management coach
2014, King’s Fund

5. Creating a Movement SONIA
The SHAREHD programme is a 2 year programme of 12 trusts where we are gathering research data and coming together at learning events to form a collaborative and share ideas and progress QI tests of change
The movement is wider – not restricted to those – anyone interested in progressing and promoting shared care with patients.
Teams and trusts already doing shared care for a number of years either form the Closing the Gap programme of local CQUIN or other initiative. It is built into the Renal Specifications and Kidney Health Delivering Excellence programme so should be offered to all
But making it fun , and part of day to day working rather that something extra is what will make it stick and be ‘the way we do things around here’
The #whyidosharedcare campaign is a way of showing solidarity and that there are 100s of people now involved – this is just a sample of #whyidosharedcare card.
The learning events and SHAREHD programme Wave A and Wave B
4 day Nurse training lead by Tania Barnes
The new 1 day managers course
BRS conference and any other opportunities to show solidarity.
You too can join in – this will continue to grow, and spread in a sustainable fashion. We are not using add additional within a
Use the tools on the website (Denmark have done this_
Book into the courses
Contact me if your trust wants to be in the 3rd wave looking to start next July.

6. The 15 Tasks…. Independent Supervised Not Doing Treatment related task
Measuring your weight (tick the appropriate box)
Measuring your blood pressure and pulse
Measuring your temperature
Washing your hands prior to all procedures
(and arm if fistula or graft)
Lining your dialysis machine
Priming your dialysis machine
Preparing your dressing pack
Programming your dialysis machine
Needling your fistula/graft (one or both needles)
Preparing your tunnelled line
Connecting the lines to your fistula/graft/tunnelled line and commencing dialysis
Responding to your machine alarms
Disconnecting the lines and completing your dialysis
Applying pressure to your needle sites post removal / locking your own tunnelled line
Giving your own anaemia injections (such as epoetin)
Independent
Supervised
Not Doing
SONIA
Dialysis process can be broken into 15 tasks as here
They in shared care terms each tasks can range form not doing at all to full independent.

7. Baseline Research Data - Task Counts
SONIA
The aim of the program is to show an increase in number of patients doing 5 or more tasks.
This is the baseline and as you can see it is nearly 5 already
but this varies from site to site and
Which tasks of the 15 are done also varies wide
Ie its not the same there is variation patient to patient and sits to site.

8. Patient Activation Measures
Assessing Engagement to Share Care
Patient Activation Measures
PAUL
TPCKD and SHAREHD both Health Foundation funded programmes use PAMs

9. Offering the opportunity at every level4 3 2 1
PAUL

10. Patient activation level by task count
PAUL
Correlation of PAM and tasks
Can we influence via education to increase activation

11. Baseline Data – Unexpected Interest in HHD
PAUL

12. 3 Different Trusts – 3 Examples
PAUL to introduce that we now have 3 examples
SUNDERLAND
YORK (Easingwold Satellite)
PDSA Aim: To increase the number of patients taking and recording their own blood pressure pre dialysis.
MANCHESTER
Shared Care took off in satellite unit by training patients to calculate their target weight/ultra filtration ie not a ‘task’ but a fundamental ‘component’ of what and how HD works.
Leads to much wider awareness that just participating ICHD tasks
Can influence choices 24 hours a day including Dietetics
Shared Care and HHD team is joined thereby
Reducing training time required for patients to be competent to ‘go home’
Increases level of flexibility / support for patients is want HHD respite

13. PDSA - Easingwold renal Unit (YORK)
Aim: To increase the number of patients taking and recording their own blood pressure pre dialysis.
Plan:
Start with four patients on our Monday, Wednesday, Friday AM shift.
Make appropriate BP cuffs available.
Create shared care board in entrance to unit.
Use run charts to collect data.
Make all staff aware via staff briefing.
Create leaflet as teaching method along with face to face training.
SOPHIE VIDEO

14. Feedback
Patients reported difficulty locating new blood pressure cuffs as moved by staff.
Staff wanting more information about project and reported technical problems with new cuffs.
Lack of staff engagement – large staff turnaround.
Study and Act
100% uptake of patients as expected given small sample size.
sent to all staff including information on project, link to website and updates on what we are doing in Easingwold.
Renal technicians asked for support regarding technical problems - currently looking into other brands of BP cuffs.
Baskets set up at entrance to unit to make BP cuffs more readily available.
List of patients put up in office so staff are aware of who is involved.
Wall mounted run chart put up in unit for staff to fill in.
SOPHIE VIDEO

15. Run charts At the start of the programme (14/7/17) - 2/40
After 6 weeks (25/08/17) – 18/40
After 9 weeks (15/9/17) – 25/40
Of our 40 patients at Easignwold Sattelite Unit –
10/40 declined to take part
5/40 are unable to take part
SOPHIE VIDEO

16. 3 Different Trusts – 3 Examples
SONIA – Introduce Manchester

17. The Central Hub Dialysis unit
Model of dialysis care - Manchester
Satellite
Fully assisted
care
Shared – care level 1
and above
Self/shared – care level 4
Home
The Central Hub Dialysis unit
Complex and unstable patients
JOHN

18. Prior to SHAREHD
Scoped all the patients for potential shared or independent care.
Established shared care leads on 4 dialysis units. Training also provided on the Home HD training unit.
Patients training targeted for maximum independence.
Shared/self care 33, training 7 = 40 patients.
JOHN

19. Manchester - PDSA Patients to calculate their ultrafiltration
Shared Care took off in a satellite unit by training patients to calculate their ultra filtration ie not a ‘task’ but a fundamental ‘component’ of what and how HD works.
Lead to much wider awareness and improved fluid gains.
Stimulated interest in learning from patients.
The way in - “Do you know what your target weight is?”
JOHN

20. 3 Different Trusts – 3 Examples
SONIA to INTRODUCE Sunderland
SUNDERLAND
PDSA for weight After session
Shared Care and HHD team is joined thereby
Reducing training time required for patients to be competent to ‘go home’
Increases level of flexibility / support for patients is want HHD respite

21. Durham Satellite Unit – 36 patients
Washington Satellite Unit – 54 patients
HHD – 25 patients
33% Satellite patients completing more than 5 of 14 tasks
17% Satellite patients are independent
LAURA

22. Senior nurse support essential for continuity
METHOD
Senior nurse support essential for continuity
Communication, documentation and audit trail
Sub-team of specialised staff to focus on self-care
Dedicated self-care machines
Continuity of Service
Regular evaluation adjustment of practice
Secured finance fore home dialysis machinery
“SHAREHD” – Learning from others
LAURA

23. Be honest (verbal & none verbal) Use good judgment – Safety
Fostering Trust
Listen
Be honest (verbal & none verbal)
Use good judgment – Safety
Be consistent
Have a mutually beneficial attitude
LAURA

24. Shared care - a vehicle for expansion of HHD
LAURA
Shared care - a vehicle for expansion of HHD

25. Impact on Patient Outcomes
Can work in any unit and is available to all patients.
Supports health education and activation not a one way street for people to
“I’ve learnt so much more about dialysis and how my body works from shared care and I now feel as if I’m in the centre of my healthcare.” David from Sheffield
Develops patient self-management skills
PAUL
Health literacy
Develops patient self-management skills which helps support patients and carers to take a greater role in their own care.
Can work within any unit to all patients. Uses existing resources more effectively and increases patient participation
Is not a means to force people to dialyse at home but can allow more people will dialyse independently
EVOLVES HEALTH LITERACY

26. We are recruiting a 3rd SHAREHD Wave starting July 2018 for 6 months
WANT TO GET INVOLVED ??
We are recruiting a 3rd SHAREHD Wave
starting July 2018 for 6 months Or
Use the tools on the Website and get started in your unit
SONIA

27. All Patients, Trusts and Teams welcome
JULY 4th 2018
Marriott Hotel – Leeds
SHARED CARE EVENT
All Patients, Trusts and Teams welcome
SONIA

28. Regional innovation fund
Our partners
Patients and carers
Participating acute health care trusts
Y & H
Regional innovation fund