Case Management: An innovative approach to pre –dialysis care- early evaluation.

A Jones, J Jenkins, N Thomas, A Prichard, K Baboolal,

University Hospital of Wales

Problem: The pre dialysis specialist nursing role has evolved over the last 10 years in our unit. Historically a single nurse had responsibility for education, access and anaemia management. More recently several specialist nurses with these distinct areas of responsibility managed the pre dialysis cohort. Increasing patient numbers and following a traditional disease orientated approach however, has resulted in fragmentation of care, duplication of work load and a service which is unable to meet the targets of the National Service Framework.

Purpose: One of the greatest challenges of the NSF is to develop a patient centred multi-disciplinary approach to pre- dialysis care. Expansion and re definition of nursing roles was undertaken in order to streamline care and provide a more patient- centered approach, and by doing so develop a service able to concur with NSF standards.

Design: Senior medical and nursing staffs supported the need to develop the service and were consulted throughout the change process. A change programme including a series of multi-disciplinary workshops were held to redefine existing job profiles to incorporate a case management approach and funding was secured for 2 additional posts. Subsequently 4 new specialist nurse roles were implemented and have been in post for the last 6 months. Each nurse works with two nephrologists case managing patients within a defined geographical area. In addition each nurse has their own area of expertise.

Findings: Early evaluation suggests a positive impact on the patient experience and service delivery. A total of 31 questionnaires following low clearance clinic and 49 following home visits indicate a favourable response to the service. Patients identify with having a named nurse co-ordinating all aspects of their care. Care pathways are being developed in the follow up of late presenters and conservative care management. Also, newly developed visual aids and other educational tools have been beneficial in enhancing the information giving process.

Access to information has improved by rigorous collection of pertinent data on the proton system. Communication has been enhanced by regular feedback to the medical team about patient progress as well as the introduction of other initiatives. These include the implementation of transfer of care documents to dialysis units and weekly multi disciplinary team meetings.

Conclusion: A proactive approach to pre dialysis care is essential if we are to meet the need of growing patients’ numbers. Re defining specialist nursing roles has addressed the problem of fragmented and duplicated care moving away from reductionism to a more holistic approach. Our primary goal has been realized in improving the patient journey, from diagnosis to chosen treatment option.

Relevance: The unique contribution of nursing within this area is widely accepted. This innovative case management approach encompasses the standards set out by the NSF, ensuring a smooth transition into chosen treatment option.