BC Nephrology Days: Three weeks and counting!

Date & Venue October 2 & 3rd 2008, Vancouver Renaissance Hotel

This year’s Nephrology Days promises to educate, inform and stimulate with two jam-packed days of presentations and interactive sessions. A wide range of topics is on offer, from advanced care planning to disaster preparedness to medication reconciliation. There will also be a presentation by filmmaker David Paperny, producer of a recent TV documentary about the global black market trade in human organs.

We’ve made sure to work in time for connecting with colleagues too, with health professional-specific sessions, generous coffee breaks and a special networking lunch. Finally, don’t forget to visit our poster session, featuring 16 entries in two categories:  information sharing and scientific research. Enter your name in our poster-room draw (located in the spectacular 19th floor Vista Room) for a chance to win a fabulous prize: a one night stay and dinner for two at the Renaissance Vancouver Hotel Harbourside. The winner will be announced at the end of the event.

BC Nephrology Days takes place October 2nd and 3rd at the Renaissance Vancouver Hotel Harbourside. For more information, visit www.bcrenalagency.ca. Special rates for hotel rooms are available until September 12th. Mention BC Nephrology Days when you make your reservation.

Click here to register for BC Nephrology Days 2008.

New operations leader for Providence Health Care

Please join us in welcoming Cecilia Chow to the position of operations leader for Providence Health Care (PHC). As of September 2nd, Cecilia is responsible for the renal program’s six community dialysis units and the home hemodialysis program. Fellow operations leaders Kate Sullivan and Michele Trask manage other aspects of PHC’s renal program, including in-centre dialysis care, vascular access, and the kidney function and transplant programs.

"I’m looking forward to learning about renal care and the renal program, as well as bringing my own set of skills to the operations," says Cecilia, who has spent the last year with the Provincial Health Services Authority (PHSA) strategic planning and transformation support department. Her job involved working with PHSA agencies to identify systems improvement opportunities that would increase patient flow and ultimately lead to better patient outcomes.

"I loved working with the PHSA strategic planning function because I was able to engage with different teams on very specific initiatives," says Cecilia. "On the other hand, it was very project-based, and I’m ready to settle down and get involved with something longer term."

Cecilia trained as a nurse in Winnipeg and worked there as well as in Vancouver in the early 1990s. Her career shifted gears between 1994 and 2002 when she signed on with Telus, doing project management and business development. She returned to healthcare in 2003, and was administrative manager of Children’s and Women’s neonatal program for four years.

"Ultimately, I missed healthcare!" says Cecilia. "But I learned a lot of valuable skills in the private sector that are very beneficial in healthcare."

Among the work she’s most proud of, Cecilia counts the BC Women’s Hospital neonatal revitalization project, the redesign of a website for the BC Bedline (the provincial hospital bed management system), and the development and implementation of a clinical information system for the neonatal intensive care unit.

Welcome to the renal community, Cecilia! 

Financial insight

Health authority renal programs have recently been allocated extra funds for 2008/09 for the critical function of data entry into PROMIS – and in recognition of the time and effort involved.

Data accuracy and completeness are vital to support a range of functions, including individual patient care management, renal unit management, continuous quality improvement and research, outcomes-based planning and funding of renal services.

BCPRA has outlined specific indicators and expected outcomes for each area of funding:

For more information contact Keith Whitmore, Senior Director, Renal Networks: 604 875.7349 or kwhitmore@bcpra.ca

PROMIS update

When Steven Townsend started using PROMIS nine years ago as a renal program unit coordinator, he found it to be a good, solid database for patient demographics. Today, it’s an increasingly valuable tool for many aspects of healthcare practice. And Steven, a PROMIS trainer for the past four months, is helping renal care providers maximize the system’s benefits.

"Initially PROMIS was essentially a patient tracker, listing where people lived, where they dialyzed, when they moved and so on," says Steven, who moved to the Renal Agency after 16 years at St. Paul’s Hospital. "Now we have electronic charting for home hemodialysis, listing of patient co-morbidities and medical history, and medication monitoring – and there’s more to come."

With colleague Sean Qually, Steven offers telephone support for PROMIS users and hosts training sessions for groups and individuals. While the training sessions are mostly offered at St. Paul’s, the PROMIS team recognizes the time and budget challenges associated with travelling to Vancouver every time a session is scheduled.

"One of the things we’re starting to do is train ‘super-users’ who can then train their co-workers," says Steven. "When we broaden this to other locations, we will have these super-users across BC." The super-user program builds on a successful PROMIS train-the-trainer program in Interior Health last year, which saw more than 85 people trained.

The PROMIS team is also exploring the idea of hosting weekly 15-minute sessions on various PROMIS topics that people can log into from around the province through WebEx, an online conferencing program.

For more information about PROMIS, check out the new user-friendly manual posted on the PROMIS site. Or you can call the PROMIS support line (604 806 8868), which is monitored by Sean and Steven from 8am to 6pm Monday through Friday. Information on upcoming PROMIS training sessions will be profiled on the "Welcome to PROMIS" sign-in page and highlighted in Renal News ongoing. 

Just developed: Health authority-specific indicator reports

The BC Renal Agency has recently produced and distributed health authority-specific versions of its "balanced scorecard" that track each renal program and facility through various indicators in the following categories: clients, patients and community; services coordination and delivery; and learning, growth and innovation.

The scorecards – or management indicator reports, as they are called - provide an opportunity to track outcomes and explore any variances, says Renal Agency executive director Dr. Adeera Levin. "When we look at them across programs, they will allow the renal community to compare some of these outcomes and collaborate in maximizing them where possible."

Vancouver Island Health Authority (VIHA) renal manager Anne Gloster is an enthusiastic proponent of the health authority-specific reports.

"Like all health authorities, VIHA has a balanced scorecard with a lot of indicators, but the number of renal-related ones are limited," she says. "When I saw the excellent information in the one BCPRA submits to the Provincial Health Services Authority, I thought it would be really helpful for renal programs to see how they are doing in relation to each other and to the whole – and to learn from each other about how to be the best we can be." 

Ten indicators are tracked under the three categories:

Individual management indicator reports will be sent to programs every six months, with the intent of stimulating discussion and regional action plans as needed. The reports will also be reviewed with the BCPRA executive committee, which includes executive sponsors as well as renal medical and administrative leaders from across all health authority programs. 

CKD guideline revision in the works

A revision of the guideline Chronic Kidney Disease - Identification, Evaluation and Management of Patients will be posted on the Renal Agency and BC Ministry of Health Services websites later this month, with copies distributed to physicians across the province as well.

The revision is simply aimed at making the guideline clearer, says Dr. Adeera Levin, who with colleagues Drs. Catherine Weber, Monica Beaulieu and Gerry Karr, published an article highlighting similar CKD management points in the BC Medical Journal last month (BCMJ, Vol. 50, No. 6, 304-309). Both the revised guideline and the article more clearly explain caveats related to eGFR calculation, including considerations related to age, body type, gender and ethnicity, and diet.

The article and the guideline aim to correct a common misconception that kidney disease must be managed by specialists. In fact, the potential to stop or significantly delay the progression of CKD for the most part depends on the family physician, says Adeera.

"This requires helping GPs identify CKD at earlier stages, and supporting them to manage the condition with the patient and in collaboration with specialists – which is ultimately the purpose of the guideline," she says.

Trust fund dollars support program improvements

Starting in the next issue of Renal News, we’ll highlight projects and purchases made possible through trust fund dollars from provincial contracts negotiated by the Renal Agency. Referred to as "value added funds" and provided through Baxter, Ortho Biotech and Amgen, these dollars support a range of staff and patient education projects, research initiatives, and data management/analysis tasks, as well as enabling the purchase of state-of-the-art equipment.

While a portion of the funds sponsor provincial initiatives, the majority is allocated to health authorities to meet local needs. A range of unique and innovative programs have been funded over the past few years, including medication reconciliation, workflow redesign and telehealth applications. The Baxter fund, focused on peritoneal dialysis, has sponsored the development of teaching materials at both the provincial level – for instance the PD training DVD – and within health authorities.

Stay tuned for details on these and other value-added projects. If you have a project you’d like us to feature, please email us at bcpra@bcpra.ca

Pharmacy and formulary update

ACE inhibitor review: A review of angiotensin-converting enzyme inhibitors – or ACE inhibitors – used in renal care is now complete and will be presented to the pharmacy and formulary review committee soon. ACE inhibitors are a group of pharmaceuticals used primarily in treatment of hypertension and congestive heart failure. It was necessary to review these drugs for use in renal care to ensure the current evidence is represented and to harmonize regional and PharmaCare formularies. The review – the first of its kind – will also serve as a template for reviews of other drug classes.  

Building medication intelligence into PROMIS: In the not-too-distant future, PROMIS will have the capability to recommend dose changes for parenteral irons and erythropoietin and darbepoetin. Currently, in facilities that have implemented the anemia protocol, nurses or pharmacists manually check existing doses and iron bloodwork to develop necessary dose changes. Eventually, with its increased capability PROMIS will provide these recommendations automatically, saving time and improving consistency. Like all initiatives this new capability for PROMIS will require testing before widespread adoption, but when it is finalized this "intelligent" automation of anemia management will be a first in the country.

Another role for PROMIS: The pharmacy and formulary review committee is also taking steps to have lanthanum and sevelamer approved through PROMIS rather than via a paper form submission, as is currently the case.

Information-sharing benefits residential care PD programs

Three facilities in BC – Delta View Campus of Care in Delta, Hawthorne Care Centre in Port Coquitlam, and Three Links Care Centre in Vancouver – are running successful peritoneal dialysis (PD) programs for their residents. These programs were highlighted in a May 2008 workshop sponsored by the Renal Agency with a view to further advancing PD in residential care settings across the province.

Since the workshop, PD programs in the Interior and Northern Health have identified facilities interested in partnering in the provision of PD services for residential care patients. To aid them, as well as to promote a consistent approach to residential PD care, the St Paul’s and Vancouver General Hospital PD programs have made available the policy and procedure manual they developed for the Three Links program.

"The nurse and patient educators from PHC and VCH collaborated with Three Links to create this valuable resource ," says PHC renal program operations leader Michele Trask. "We are happy to share it – there is no point in reinventing the wheel."

Donna Murphy-Burke, BCPRA's coordinator of renal networks, agrees: "Using the information in the manual and adapting it as appropriate for local use will save time and energy – it’s an excellent example of the synergy that the provincial renal network is so well known for."

For more information, contact Michele Trask mtrask@providencehealth.bc.ca or Donna Murphy-Burke dmurphy-burke@bcpra.ca  

Renal Unit at new Abbotsford Hospital headed by Fraser Health nephrologists

Kidney patients and caregivers in Fraser Valley east are celebrating the opening of a much-needed and long-awaited dialysis unit in the new Abbotsford Regional Hospital and Cancer Centre. The unit is the latest of several renal care improvements in the area over the last year, says Dr. Daniel Schwartz, who with colleague Dr. Charles Constantine provides nephrology services to the Abbotsford and surrounding population.

"When I started in July 2007 there was a community dialysis unit, but not much else," says Dr. Schwartz, who runs an outpatient practice and a new pre-dialysis clinic with Dr. Constantine in addition to overseeing the hospital unit.

"Patients had to go to Royal Columbian or Surrey Memorial for acute dialysis care," adds Dr. Constantine, who joined Fraser Health in January 2008.  "Like all community dialysis units, the one in Abbotsford could only accommodate very stable patients." 

Dr. Schwartz trained at the University of Toronto then taught there, as well as working at Sunnybrook Hospital.  Dr. Constantine went to medical school at McGill University and studied nephrology at UBC, then teaching and practicing at Dalhousie University in Halifax.

Both are in no doubt about their chosen career path.  

"Even though I’m a specialist, there is the full spectrum of care to deal with, from chronic kidney disease to dialysis to transplant," says Dr. Schwartz. "It’s one of the few specialties where you have that diversity."  

Dr. Constantine agrees: "I love the complexity of care, the idea of helping patients and families prevent and deal with complications of chronic illness," he says. "There are so many physical and emotional and socio-economic factors that come into play."  

They are also enthusiastic about their roles with the Fraser Health renal program.  

"When I first opened the practice I was overwhelmed by the number of patients needing care that hadn’t been available before," says Dr. Schwartz. "Fraser East now has full outpatient nephrology care, an inter-disciplinary kidney care clinic, an in-centre unit, the community dialysis unit, and plans to provide peritoneal dialysis care in the future as well as expand home hemodialysis."  

The two nephrologists are also connecting with family physicians in the area, providing kidney disease management education and forging partnerships that will enable them to enhance patient care.  
"In my mind, there is the potential to offer world class kidney care in Abbotsford," says Dr. Constantine. "Thanks to the support and commitment we’ve had from the health care and renal communities, this program is set to become a model of excellence."