1. Implementing Change to Improve the Paediatric Haemodialysis Experience
Rachel Yeomans
25 February 2016

2. Contents Background and Context Unit Composition
Initial Changes and Progression
Weekly Meetings and Guidelines
Staff Roles
Aspirations
Questions
Implementing Change to Improve the Paediatric Haemodialysis Experience 2
06 May 2019

3. Context
Over the past 18 months the unit has undergone significant changes
A team of core staff has been developed, consisting of:
Four staff nurses
Two sisters
One clinical support worker
One renal consultant
Implementing Change to Improve the Paediatric Haemodialysis Experience
06 May 2019

4. Unit Composition
The unit currently has 13 patients, is open six days a week, and runs a 24 hour on-call service
This service supports patients in all areas, who may require haemodialysis, plasma exchange or peritoneal dialysis
Implementing Change to Improve the Paediatric Haemodialysis Experience
06 May 2019

5. Initial Changes
Introduced monthly reviews with the consultant and senior nurse of all patients
Developed a pro forma for reviews that ensures all appropriate bloods, heights and screens are carried out in a timely manner
Implementing Change to Improve the Paediatric Haemodialysis Experience
06 May 2019

6. Implementing Change to Improve the Paediatric Haemodialysis Experience
06 May 2019

7. Progression Rearranged notes and introduced dividers
Nursing documentation
Medication check with families
MDT results ward round, dietician, nurse and doctor
Feed on unit, binders given on HD if they eat
Manual BPs on all patients, equipment purchased and staff trained
One Alfacalcidol given on the unit to improve adherence and reduce meds at home
Implementing Change to Improve the Paediatric Haemodialysis Experience
06 May 2019

8. Weekly Meetings Weekly meetings with nursing staff
Two results meetings
One transplant work-up update
One service improvement
Implementing Change to Improve the Paediatric Haemodialysis Experience
06 May 2019

9. Guidelines Structured approach to line locks
Tinzaparin anticoagulation
Line sepsis and first line antibiotics
Equipment review
Protocol in place, devised by the pharmacist and renal consultant for the use of Tinzaparin
Implementing Change to Improve the Paediatric Haemodialysis Experience
06 May 2019

10. Staff Roles Aiming for each nurse to acquire additional roles:
Unit leads
Transplant work-up
Infection control and dressings
Student supervision
Family liaison and charities
IQP, administration and unit decoration
Implementing Change to Improve the Paediatric Haemodialysis Experience
06 May 2019

11. Aspirations Improve position in Renal Registry league tables
Electronic monthly reviews, ICE panel
Pharmacy input to monthly reviews
Costing of service – currently in progress
Senior nurses to complete prescribing course
HDF and home haemodialysis and consideration that the unit could become a regional training centre
Implementing Change to Improve the Paediatric Haemodialysis Experience
06 May 2019

12. Questions?
Implementing Change to Improve the Paediatric Haemodialysis Experience
06 May 2019