NIPEC Annual ConferenceProfessional Standards Enhancing Person-Centred Care

Assisted Automated Peritoneal Dialysis(aAPD)

Susie MawhinneyPD Nurse BCH

A new treatment choice for patients with End Stage Kidney Disease in Northern Ireland

Presentation Outline• Understand treatment choices for patients

with End stage kidney disease• Why an Assisted Automated Peritoneal dialysis

service was needed• How we started it• What is happening now

Transplantation• No dialysis needed• Close to normal kidney function• Fewer restrictions• Risk of rejection• Medication• Reduced immunity• A transplanted kidney has a finite

lifespan

Haemodialysis• In-centre (mostly) or rarely at home• 3+ sessions a week• Fistula required – Needles• Travel to unit x 3 weekly• In centre HD - Nurses carry out

treatment for patient

Peritoneal Dialysis APD• Home dialysis• Night time treatment• Simple machine• Permanent catheter• Storage required• Fluid heavy to lift

Statistics• Number of patients receiving Renal Replacement

Therapy(RRT) in UK is growing by 5-8% pa

• Older people are the largest and fastest growing group of dialysis patients.

PD: a suitable treatment for the elderly?

Pros• Less travelling involved• Minimises risks of hospital

based infections• Benefits of a home based

therapy• A more gentle form of dialysis

treatment. • More cost effective

Cons• Physically unable • No back up / support

available.

Definition of aAPD• “Assisted Automated Peritoneal Dialysis is a service whereby a

paid carer performs all or part of the dialysis treatment for a PD patient, thereby enabling more patients to receive their treatment in the community” (2)

• The paid carer can be provided directly by the Health Authority, through the network of community nurses, or indirectly by arrangement with a contracted service provider such as Baxter Healthcare (2)

2 Specification for commissioning of the PD pathway NHS Kidney Care 2009

Getting Started• Business plan developed• Recruitment of Health care company to provide Health Care

Assistants( HCAs)• Service level agreement• Training plan devised for HCAs• 3 day training course delivered• 6 month pilot study commenced Dec 2011

• Rolled out to all N.I May 2012.

The aAPD Service

Healthcare Assistant to visit patient daily to:• Remove used bags & empty drain bags• Check drained fluid• Connect new bags & set up machine• Check BP & weight• Carry out exit site care• Record all information• Review stocks• Contact patients PD unit if problems arise.

The service now• 50 patient have availed of service

• Used for – struggling PD patients, new starts, respite and paediatrics

• 22 patients presently using service

• Over 35 Health care assistants trained to cover NI

• BCH PD nurses provide an out of hours on call service for all PD patients

Conclusion• No rise in peritonitis rates

• Pt Satisfaction survey showed all aApd patients would recommend service.

• aAPD now offered as a treatment modality in NI.

Patient CommentsPatient Comments

“ “ I would have to travel to hospital 3 times a week – I would have no life”

“It is a great help – I could not manage on my own”

“ Great service – takes the pressure off the carer”

“HCAs provide moral support for carer and brighten patient’s day”

“Very happy with service”

“HCAs very good at their job and very friendly”

Any questions?