Dialysis program wins award for RDNS and Austin Health

A joint submission by RDNS (Royal District Nursing Service) and Austin Health outlining an innovative home peritoneal dialysis program has won Silver (2nd out of 55) in this year’s Innovative Models of Care category in the 2015 Victorian Public Healthcare Awards.

The awards were announced last night (Wednesday 18 November) at an industry function at the MCG in Melbourne.

RDNS executive general manager (clinical governance and client services) Fiona Hearn said the win was testimony to the “unwavering collaborative effort of committed and talented people at Austin Health and RDNS”.

“This demonstrates just how much can be done when two organisations share skills and knowledge and work towards an outcome that helps people who are most in need,” Ms Hearn said.

The award reflects an initiative by Austin Health to improve consumer health outcomes and reduce costs. Austin Health began an innovative program to expand the eligibility for home peritoneal dialysis to a group of consumers who were previously ineligible because they did not have the required level of cognition, dexterity or visual acuity, or did not have carer support A unique alliance with RDNS now supports these consumers with assisted peritoneal dialysis (APD) in their homes.

A pilot project saw 10 consumers identified and 35 RDNS staff initially trained to deliver APD in the home. APD is now standard at Austin Health and is the first program of its kind in Victoria.

The overall objective was to provide options for consumers who were forced into haemodialysis because of a lack of suitable assistance or the ability to self-care.

The specific objectives were to:

· Expand the eligibility criteria for consumers to receive APD support from RDNS nurses

· Use APD as respite care so that those already using PD could stay at home longer.

Haemodialysis requires three five-hour hospital visits per week plus travel time and is a physical roller coaster, with the consumer feeling not well before treatment and washed out after treatment. PD is a daily, gentler form of dialysis that more closely mimics kidney function and results in a better quality of life and reduced costs.

RDNS nurses were trained to provide all aspects of routine care on a daily basis, seven days a week. A key to success was having enough eligible consumers entering the program so nurses could keep their skills current. A known risk factor of peritoneal dialysis is peritonitis. The program has maintained very low peritonitis rates, testament to the success of the training program and the commitment of RDNS nurses to maintain excellent practice.

The first cohort of 10 consumers filled the criteria by:

– Wanting to go on PD but needing nursing assistance
– Living in the Heidelberg and Diamond Creek catchment area
– Having a safe house for nursing home visits.

Evaluation included audits of the number of nurses trained, number of consumers on the program, consumer and nurse satisfaction, peritonitis rates, length of nurse visits and the number and type of nurse support calls.

This expansion of the home dialysis program has delivered ongoing benefits to consumers, families and communities. The service is now standard, with APD offered to all eligible consumers. As of July 2015, RDNS has cared for 10 consumers and has increased the number of nurses trained for APD.

An ageing population and an increase in the incidence of type 2 diabetes means that end-stage kidney disease (ESKD) is set to grow, with 54% more treatments forecast for 2020 compared with 2010 (Cass et al 2010). The options for ESKD are haemodialysis, peritoneal dialysis (PD) at home or a kidney transplant. Haemodialysis is expensive, both in terms of quality of life for the consumer and in costs for both the consumer and the health system. Estimates suggest the use of home dialysis would give net savings of $378 to $430 million (Cass et al 2010).

The award submission stated that the innovative alliance was an opportunity for Austin Health and RDNS to be global leaders in a model that delivers outstanding and specialised care.

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