IAMHD Committee – Profile
In-centre nocturnal dialysis program a first in North America
There has been a significant increase in the number of home-based hemodialysis patients since the launch of a provincial program in 2004. Over the past year, the provincial independent hemodialysis committee (IAMHD -- Innovative Approaches to the Management of Hemodialysis) has turned its sights to increasing facility-based independent options.
Last spring, an independent dialysis unit opened in Prince George, and early in 2009, an in-centre nocturnal hemodialysis program will open at Vancouver General Hospital.
The VGH program was developed for patients who want a more independent option, but are unable to participate in home hemodialysis. The four-month pilot program will offer overnight hemodialysis for four patients, three nights a week. The patients have been fully trained to manage their hemodialysis on their own, although a nurse will participate in the nocturnal sessions as an observer.
"To the best of our knowledge, this is the first program of its kind in North America," says IAMHD committee chair, Dr. Michael Copland, provincial medical director of the Renal Agency’s home hemodialysis program. Although nocturnal dialysis has been offered elsewhere, in other jurisdictions the service is simply an extension of regular daytime hemodialysis programs. Patients at the VGH in-centre nocturnal program, however, "will be completely independent," says Michael.
Michael says the program at VGH is expected to eventually offer independent nocturnal hemodialysis to as many as ten patients, in two shifts over six nights a week. The program was developed in direct response to the relatively large number of patients who would choose home hemodialysis but can’t due to unsuitable circumstances in their home environment.
Like other independent dialysis options available to BC patients, the in-centre nocturnal HD program enables patients to take a leading role in the management of their renal care. The program also provides a cost benefit for the renal system by maximizing the use of existing dialysis equipment.
Electronic charting for home hemodialysis patients
Over the past year, all clinical information for patients involved in the independent dialysis programs within Vancouver Coastal Health and Providence Health Care has been available through an electronic charting system. The new system is fully functional and supports medication reconciliation as well as all lab and clinical records for these patients. It also eliminates the need for multiple charts, which are still often required for other renal patients.
Following the success of the new system for Vancouver-area patients, in early 2009 electronic charting will become available for home hemodialysis patients on Vancouver Island. The system will be rolled out to home hemodialysis patients in other health authorities later in the year, and could eventually be expanded to include other renal patients around the province.
Patient Surveys
BC is a leader in the area of independent therapies available for patients with kidney disease, and efforts are ongoing to increase the number of patients choosing peritoneal dialysis and home hemodialysis in this province.
As part of these efforts, from time to time patient surveys are done to identify possible misconceptions or patient concerns about these therapies. The next of these surveys is scheduled for the coming month. In partnership with the health authority renal programs, the BC Renal Agency will survey all CKD patients with a glomerular filtration rate (GFR) of less than 15 ml/min and all in-centre and community-based hemodialysis patients about their interest in independent therapies. At the same time, all PD patients will receive a survey about their interest in home hemodialysis, as an alternative therapy should they be unable to perform peritoneal dialysis.
In addition to identifying patients who might be interested in independent therapies, these surveys help to determine how effectively independent dialysis options are being communicated to patients during their pre-dialysis educational sessions.
In yet another survey, scheduled for December, patients on home hemodialysis across BC will be asked to rate their satisfaction with Gambro - especially as it relates to the technical support that Gambro provides these patients between the hours of 7:00 am and 11:00 pm, seven days a week. The survey will also assess the learning experience of patients on home hemodialysis.
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