Improving the dialysis access patient journey using a specialist nurse‑led
multidisciplinary approach
M Bracey
Royal Devon &
Exeter Hospital
Problem. Lack of ownership/co‑ordination for
patients requiring dialysis access led to problems with timings of catheter
insertion/removal, insufficient patient education/information, poor staff
awareness across the multi‑disciplinary team and no provision for rapid
access to surgical assessment and theatre time
Purpose. Raise the standards and ensure consistency of
care for patients requiring dialysis access and improve the patients experience
when approaching dialysis dependency.
Design. To employ a dialysis access nurse specialist
to audit current practice, identify specific problems and create action plans.
Findings. More than 50% of patients were delayed on the
ward waiting for either central venous catheter insertions or removals. The
patient journey from nephrology referral to functioning arterio‑ venous
fistula was greater than 6 months. There was no patient priority for primary
assessment by the surgical team leading to delays of 8 weeks and following
surgical review patients requiring radiological interventional vascular pre‑assessment
were waiting more than 12weeks for the procedure. Greater than 40% of patients
having undergone access surgery experienced delayed discharge from hospital.
Actions Implemented.
>
A
nurse training program was developed for the insertion and removal of central
venous catheters.
>
The
multidisciplinary team led by the dialysis access nurse specialist created a
tool to prioritize patients.
>
Colour
Doppler scanning was introduced as a means of pre‑vascular assessment.
>
The
dialysis access nurse specialist became the central point of communication to
co‑ordinate the patients' journey from nephrology referral to functioning
arterio‑venous fistula.
>
The
dialysis access nurse specialist underwent further training to perform post‑
operative assessment and to
discharge the patient from hospital.
Conclusion
and Relevance. With a
dedicated dialysis access nurse specialist implementing specific action plans
the patient journey from nephrology referral to functioning arterio‑venous
fistula can be improved and reduced by,
>
Reducing delays
for central venous catheter insertion /removal with the introduction of a nurse
practitioner.
>
A patient
prioritization tool enables patient to be seen by the surgical team within 2
weeks.
>
Use of colour
Doppler scanning reduces vascular pre‑assessment times to 2 weeks
>
A central point
of communication reduces the patient journey from nephrology referral to
functioning AVF to 3 months.
> Prompt post‑operative discharge including nurse‑led follow‑up at 28 days post surgery