Friday, 26 September 2008

Innovation in Kidney Care

The British Journal of Renal Medicine has been promoting excellence in kidney care for over a decade – the Journal is sent free of charge to over 3500 kidney care health professionals. Practical articles, insightful commentary on key issues, signposting of resources including the flagship “What I Tell My Patients” series arrive in every issue. John Bradley (Editor and Consultant Renal Physician at Addenbrookes Hospital in Cambridge) and Chris Tidman (Publisher and Managing Director) went one stage further by establishing the Renal Innovation Awards, now in their 5th year. This has shone a light on the work and practice in many kidney units up and down the land. What is evident is a culture of teamwork, problem solving and real desire to improve things for people and families with kidney disease.

It was therefore a great pleasure for me to attend this year's kidney care innovation awards which were sponsored by Shire Pharmaceuticals. The entries gave the judges a tough time marking because they were all good!

A reception and lunch was held at the Institute of Directors on Pall Mall in London to celebrate the awards and John Feehally, immediate past President of the Renal Association gave a memorable talk about his visits to every single adult and paediatric kidney service in the United Kingdom in the years 2004 and 2007. Highly commended projects were:

“Creative Art for Patients during Regular Hospital Haemodialysis Sessions” (Regular Dialysis Unit, Inverclyde Hospital, Greenock); spending 12 hours a week on a dialysis machine can be a demoralising experience for patients. The introduction of an artist and art programme to the Inverclyde Dialysis unit has led not only to a remarkable positive transformation of patents' lives but also a collection of art that has been widely exhibited.

‘Phosgraph: A Novel Method of Improving Patient Compliance and Phosphate Control by Education and Competition (Renal Unit, Southend University Hospital NHS Foundation Trust); control of phosphate can be one of the most difficult aspects of management in CKD - Dr Patrick Harnett and colleagues in Southend developed a simple method to allow patients to compare their phosphate levels with the normal range and their peers. With dietetic input this led to a significant improvement in those with increased phosphate levels

“A Nurse-Led Multidisciplinary Predialysis Clinic Improves Outcomes and Survival of Patients on Dialysis” (Renal Department, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust); starting dialysis is a daunting experience. Sister Annette Dodds and colleagues established a truly Multidisciplinary Team including specialist nurses, dieticians, social workers, vascular surgeon and nephrologists to ensure patients are psychologically and physically prepared for dialysis. There have been some impressive results with, for example, reduced hospital admission and improved haemoglobin levels

Awarded 3rd place (with a prize of £1000) was “Introduction of a Prescribing Decision Tool to Optimise Antibiotic Prescribing on a Busy Renal Ward (Victoria Ward, Royal Berkshire NHS Foundation Trust); Heathcare Associated Infections are particularly prevalent in renal wards, worrying patients, health professionals and the government. Dr Emma Vaux and colleagues at Royal Berkshire have developed a simple antibiotic prescribing test on a busy renal ward, leading to a wide range of improvements in the management of infections in renal patients.

The Barts and The London NHS Trust, a previous winner were placed in 2nd place this year (prize of £2000) with work on “A Patient-Centred Renal Supportive and Palliative Care Service”; Establishing a truly comprehensive supportive care service for patients with ESRF who opt not to have dialysis is challenging. Alistair Chesser and colleagues at Barts and the London NHS Trust have achieved this allowing patients receiving palliative care to improve their quality and length of care and allow patients to die in their preferred place of care.

Dr Eddie O’Riorden, with Renal Nurses Joanne Gregson and Fiona MacDonald accepted the 1st place (and prize of £5000) on behalf of the Department of Renal Medicine, Salford Royal NHS Foundation Trust for “Developing a New Community Dialysis Facility using a Continuous Quality Improvement Approach (Wigan Satellite Dialysis Unit, Boston House, Wigan); dialysis is about more than correcting biochemistry. Dr Janet Hegarty and colleagues have used a quality improvement approach to develop a community based dialysis facility that focuses not just on quality of care, but also patients and staff experience. The results are impressive. Read more about these projects in the forthcoming special edition of the BJRM and see interviews with the successful teams at over the next few months.

Wednesday, 24 September 2008

NICE Guidelines on CKD communications

Chronic Kidney disease affects more than 1 in 10 people. It is a potentially dangerous condition. If kidney disease is not recognised people with the condition may have up to 35 times higher risk of premature death. Kidney disease is a silent killer. People with kidney disease have few or no symptoms until kidney function is severely impaired. It is, however, very easy to detect kidney disease in the early stages – a simple blood test and a urine test for albumin/protein is all that is needed. We know the conditions that can damage the kidneys for example high blood pressure, diabetes or a family history of kidney disease. And the good thing is that we have treatments that can delay or prevent further kidney damage. This NICE guideline on kidney disease will help healthcare professionals identify people in the early stages who can then be treated – it thus has the potential to delay progression of disease and extend the lives of thousands of people.

Monday, 8 September 2008

Pilots helping the National Kidney Care Audit take off

  1. I’ve written about the National Kidney Care Audit on this blog before, and a pilot patient transport survey has just gone really well by all accounts.

    On 15 and 16 October all renal units in England will be carrying out a patient transport survey – please make a note of this in your diaries, if you haven’t already done so. Ahead of this, 12 units in London, Bristol and the North West have just taken part in the pilot, covering almost a thousand patients.

    “It was fine here, we’re quite a small unit so it was easy to give the survey out to patients, monitor them and collect the surveys back in,” the Clinic Manager at the Camden Dialysis Unit Jane Moore commented.

    The units have told us that the pilot went really smoothly and I’m pleased to see that it didn’t disrupt their day to day work. The project team at The NHS Information Centre who are carrying out the audit have taken on board some comments from participants. They will be simplifying the wording of a couple of questions to make them easier to understand – especially for patients whose first language is not English.

    Most importantly, feedback is that the patients were really positive: “the patients are definitely engaging with the audit, especially because most of them use transport services,” Jane Moore said. “It’s always worth being involved in audits because you can have your say. People complain about issues like patient transport, but taking part in the audit will allow you to contribute.”

    I’m very grateful to everyone that took part in the pilot, and would like to pay personal thanks to all the staff and patients at the Bristol Royal Hospital for Children, Royal Liverpool University Hospital, Broadgreen Hospital, Whiston Hospital, Warrington Hospital, St Bartholomew's Hospital, The Royal London Hospital, Camden Dialysis Unit, Whipps Cross University Hospital, the Queen's Hospital Romford and Evelina Children's Hospital. I think the National Kidney Care Audit is an important piece of work that will bring real benefits to kidney services.

    For more information on the audit and how you can sign up to take part, you can visit or e-mail