February 7th-9th, 2013 Northern Alberta Renal Program (NARP) Alberta Health Services Program Description: Northern Alberta Renal Program
Population: 170 adults 8 children
Staffing design 4 nephrology services providing PD care • 3 tertiary hospital services and paediatric service • 20 different physicians • majority of patients are shared by University of Alberta Hospital service with nephrologists rotating through every 2 weeks
Case management nursing model • 8.4 Nursing FTE, shared CNE
1 adult Social Worker (shared with home hemo), 0.5 paediatric Social Worker (shared), 4 Dietitians (shared) Patients at a Glance 44% CAPD, 66% APD
PD supplies from 2 vendors: Baxter and Fresenius
66% utilizing icodextrin
Primary renal diagnosis: GN and diabetes 31.4% each
Average age: 56 • 12% > 75 • 3% < 14
Diabetic: 39.5%
Caucasian 69.8%, Asian 11%, Aboriginal 10.5%
Geographic catchment area: Alberta north of Red Deer Northern Alberta Renal Program Peritioneal Dialysis Patient Locations as of June 30, 2012
Fort Chipewyan
Paddle Prairie
NORTH Manning (2) Fort McMurray (2) Brownvale Worsley Cadotte Lake Peace River (2) Fairview Grimshaw Wabasca Girouxville (2) Spirit River Falher Sexsmith High Prairie (2) Grassland Athabasca Bonneyville (2) Clairmont
Grande Prairie (4) Westlock Cold Lake (2) Morinville Clyde Gibbons Fort Assiniboine Edmonton (73) Fort Saskatchewan Grande Cache Spruce Grove St. Albert (3) Stony Plain (3) Sherwood Park (6) Peers Vegreville Hinton (3) Tomahawk EDMONTON Beaumont Leduc County Hay Lakes Drayton Valley Ohaton Wetaskiwin Wainwright Thorsby Camrose (3) Am is k Breton Rollyview Ponoka Bentley (2) Leduc (2) Bittern Hughenden Rocky Mountain House Provost (2) Red Deer (5) Coronation Eckvile Stettler CENTRAL N = 176 Didsbury Saskatchewan (4) NT (1) NU (1) CALGARY
0 100 200 SOUTH
kilometers
Alberta Health Services: Patient/Care-Based Funding: Lei Z: E:\NARP Map Sept 21/2012 Clinical Update
Peritonitis rates: most recent data 3rd quarter 2012 1:33.8 (2nd quarter 1:33.3, 1st quarter 1:29.6)
Dominant method of catheter placement: • adults all have surgically buried catheters • children a mix of buried and open catheters
1 auxiliary hospital (LTC) provides preferential placement of PD patients. • funded for 7 beds
PD nursing staff provide on call service to 2200 h daily including weekends and statutory holidays to patients and healthcare professionals in outlying communities (EDs, rural hospitals). Areas of Focus/Success in the Past 12 Months
NARP orientation for all new staff has increased awareness and knowledge of home dialysis programs.
No shortage of referrals to home dialysis programs!
41 telehealth clinic visits in 2012 improved access for remote patients.
Developed “PD Champions” in ED to dramatically reduce calls back, increase capacity, and improve patient care.
3 posters presented at CANNT conference in Ottawa: ED PD Champions, peritonitis prevention QI project, paediatric PD care.
Development of RN expertise: more writing CNeph(C). Areas of Focus in the Next 12 Months
E-survey of all NARP staff for knowledge and education needs regarding the home dialysis programs.
Group adult modality education class for Renal Insufficiency Clinic patients.
Further QI initiatives: next focus exit sites.
Strategies for growth! New funding for additional 1 FTE nursing for PD (2 FTE nursing for home hemo). Challenges and Opportunities
Greatest Challenge: Children account for up to 20% of nursing workload.
Opportunities: Renal services review; opportunities for collaboration with SARP.
No new development of HD units; home dialysis programs the only capacity in NARP.
Questions? Contact Frances Reintjes, Unit Manager Home Peritoneal and Home Hemodialysis Programs [email protected] 780-407-2948 Enjoy the conference; sorry we can’t be there! Our enduring thanks to Dr. M. Dasgupta.