S 30 Short orals

Programme of the session:

O 49
Peritoneal dialysis patients with sensory system impairment
Tünde Szabó Vargáné (Hungary)

O 50
Primary vascular access type and survival in chronic haemodialysis programme
Judit Szemecsko Makula (Hungary)

O 51
The Balanced ScoreCard – A tool for performance management in dialysis care settings
Corina Popescu (Romania)

O 52
Haemodialysis catheter related blood stream infection
Imad Ahmed Amer (United Arab Emirates)

O 53
Application of Lean philosophy for the creation of a connection/disconnection cart for Haemodialysis
Asunción Martinez Miralles (Spain)

O 54
How to improve quality of life? -Identification of malnutrition in kidney patients
Tiina Leminen, Anu Niinisalo (Finland)

O 55
Targeting dry weight-body volume and nutritional status in haemodialysis patients
Ayla Ozerkaya (Turkey)

O 56
Pain assessment in haemodialysis patients
Monica Brazalez Tejerina (Spain)

O 57
‘From clipboard to tablet’ refining the approach to unannounced infection control audits
Natalie Beddows (UK)

Abstracts:

O 49
Peritoneal dialysis patients with sensory system impairment
T. Szabó Vargáné¹, S. Keresztesi^1
1Dialysis Centre Kecskemét, Fresenius Medical Care, Kecskemét, Hungary

Background: The human sensory system is responsible for the acquisition of information enabling us to interact with the outside world. Its impairment could limit an individual’s chance to play an equal role in society.
Objectives: To introduce a special training programme that provides equal opportunities for patients with disabilities to participate in the peritoneal dialysis (PD) programme.
Methods: Five sensory impaired patients (three visually, two hearing impaired) participated in a training which started in February 2011. Training sessions included the following components: visualisation, dexterity, communication.
In visually impaired patients training was not based on visual teaching aids, but verbal communication (constant repetition, questioning).
In patients with hearing loss, visualisation and dexterity were emphasized. Speech impediment, a frequent comorbidity of hearing loss, made communication more difficult. Therefore, training was built on writing, articulation, and sign language.
Results:Acquiring the theoretical and technical basics of PD treatment, our patients were able to safely do an exchange on their own. Once self-care treatment was initiated their nursing care was continued on an individual basis.
Since then, two visually impaired patients do their exchanges independently and the third patient was transferred to HD (time spent in PD: 21 months).
Both hearing impaired patients left the programme, one of them due to transplantation (time spent in PD: 29 months) and the other one was transferred to haemodialysis (time spent in PD: 15 months).
Conclusion/Application to practice: Self-care treatment of PD patients with sensory impairment requires patience, adequate training, and aftercare. However, our experience shows that it does not necessarily increase the rate of complications.

Disclosure: No conflict of interest declared

O 50
Primary vascular access type and survival in a chronic haemodialysis programme
J. Szemecsko Makula¹, I. Szakacs¹, I. Kulcsar^1,2
1B. Braun Avitum Hungary cPlc. Dialysis Centre No. 6, Szombathely, Hungary; ²1st Department of Medicine, Markusovszky Teaching Hospital, Szombathely, Hungary

Background: In recent years the relationship between vascular access and haemodialysed (HD) patients’ survival rate has been investigated in our centre. Observation is ongoing.
Objectives:to justify the significance of the first vascular access in survival of HD patients.
Methods: In our dialysis centre 343 patients were treated with HD from 01.01.2010 to 31.12.2013.
312 had HD primarily and 31 switched to HD from the peritoneal programme (PD). Survival was examined retrospectively until the end of period or until drop-out.
Results:161 out of 312 (51.6%) primary HD patients’ treatment was initiated via arteriovenosus fistula (AVF), 26 (8.3%) patients had permanent canulae (PC), and 125 (40.1%) had temporary canulae (TC), in 85 of these patients an AVF was formed later. Survival of patients treated via AVF from the beginning was 5.1±2.8 years, while in patients converted from TC to AVF it was only 3.0±1.7 years. The shortest survival was observed in the group of patients who switched from TC to PC (2.4±1.6 years).
Simultaneously survival of patients treated via PC from the beginning was 4.8±2.7 years, of those converted from AVF to PC was 6.8 ±3.3 years respectively.
Conclusion/Application to practice:
In accordance with our earlier studies our present results verify that if HD treatment is initiated via TC the prognosis is significantly worse than in case of other primary vascular access. The better solution is to commence with PD, but even administration of primary PC is superior comparing to TC.

Disclosure: No conflict of interest declared

O 51
The Balanced ScoreCard - A tool for performance management in dialysis care settings
C. Popescu¹, M. Preda², C. Miriunis³, M.T. Parisotto^3
1NephroCare, Fresenius Medical Care, Bucharest, Romania; ²NephroCare Clinical Coordination, Fresenius Medical Care, Bucharest, Romania; ³NephoCare Coordination, Fresenius Medical Care, Bad Homburg, Germany

Background: In 2008, the Balanced ScoreCard was introduced in a private dialysis network as a tool to improve operational and economic effectiveness. Key Performance Indicators (KPIs) of the Balanced ScoreCard set the objectives for our activities.
Objectives:
-        To increase the percentage of patients on the transplant waiting list.
-        To reduce the consumption of resources.
Methods:
New KPI’s were implemented:
-       Amount of contaminated waste produced per treatment.
-       Water and electricity consumption per treatment.
-       Percentage of patients on the transplant waiting list.
Results:Employees were trained on the new KPIs and have continuously been monitoring the objectives. Any target deviations were analysed and targeted preventive and corrective measures applied resulting in:
-       Alignment of most clinics to the same consumption pattern.
-       Cost reductions:
• Up to 30% for contaminated waste - determined by comparing the costs at clinic start-up vs. after correct application and implementation of corrective measures
• Up to 50% for water and 10% for electricity consumption - by using eco-friendly products and procedures. Some units met the target KPI without applying corrective measures.
-       Percentage of patients on the transplant waiting list improved significantly: from 13.7% in January 2013 to 49.2% in December 2013.
Conclusion/Application to practice: The Balanced ScoreCard substantiated the improvement and strategy management of our network. The costs for consumed resources decreased and performance of each individual clinic can now be accurately measured.

Disclosure: No conflict of interest declared

O 52
Haemodialysis catheter related blood stream infection
I. Amer^1
1Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates

Background: Intravascular haemodialysis catheters are essential in the management of critically and chronically ill patients suffering from acute injury and chronic renal failure. However, the haemodialysis catheter is often complicated by catheter related-blood stream infections which are associated with increased morbidity, duration of hospitalisation, and additional medical costs.
Objectives:
Objectives are to:
• Identify the causes of vascular catheter infections
• Assess the effectiveness of infection control practice within the dialysis unit
• Develop a standardized surveillance system for monitoring haemodialysis vascular access infections
• Compare infection rates with international rates as identified by the central disease control
• Educate and enhance staff awareness about prevention and control of catheter related infections
• Reduce patient morbidity and mortality rates
Methods: FOCUS PDCA quality improvement methodology.
Results:As per the new changes implemented in Dubai Hospital Renal Unit, improvement has been achieved related to the haemodialysis catheter related blood stream infection. Quality and continuity of patient care, as well as patient’s skills and knowledge for self-care were enhanced. Positive influence on patient/family attitudes was evident, as well as more co-ordination between multidisciplinary teams. Enhanced patients and staff satisfaction was evident and reduced haemodialysis catheter related blood stream infections, below the international rate as identified by central disease control, were noted.
Conclusion/Application to practice: Many catheter related blood stream infections are preventable, and need to be approached systematically at a multidisciplinary level, that emphasize the patient safety and quality of care. Therefore, all the staff involved in the management of the haemodialysis vascular catheter must base their practice on evidence based guidelines and recommendations, as an effective strategy in reducing the risks of catheter related blood stream infections.

Disclosure: No conflict of interest declared

O 53
Application of Lean philosophy for the creation of a connection/ disconnection cart for Haemodialysis
A. Martinez¹, F. Pelliccia², M. T. Parisotto^2
1Nursing Care Coordination, Fresenius Medical Care, Madrid, Spain; ²NephroCare Coordination, Fresenius Medical Care, Bad Homburg, Germany

Background: In order to facilitate the work of staff, avoid continuous movement through the treatment room, eliminate carts in rooms already full of consumables susceptible of contamination and to ensure safety for patients and staff, the idea was born to create a specific and individual cart (one for each shift nurse) to perform haemodialysis processes safely and efficiently.
Objectives:To assess the number of time nurses interrupt their activity to move to where a general cart is located to store material.
Methods: Movement of each nurse in the treatment room while performing her/his daily work was monitored for a one-week period. A room diagram was drawn and marked with the different paths of travel that nurses made, primarily in the two main processes: connection and disconnection. A Spaghetti diagram was drawn, and the monitoring was repeated for the 5 nurses on the shift. The diagrams were analyzed from the perspective of Lean philosophy, identifying all the movements and routes that should be eliminated in order to streamline the process.
Results:We could demonstrate the feasibility of eliminating, from our processes, many activities that do not add value; enabling us to devote optimized time to activities that truly add value to patient care.
Conclusion/Application to practice: The creation of a tool such as the Connection & Disconnection cart has led to a clear improvement in the optimization of time in the field of dialysis. The time saved could be spent in other productive activities while simultaneously increasing the safety of our patients and employees.

Disclosure: No conflict of interest declared

O 54
How to improve quality of life? -Identification of malnutrition in kidney patients
T. Leminen¹, A. Niinisalo^1
1Kidney Ward 11B, Tampere University Hospital, Tampere, Finland

Background: Efficient and right-timed care of kidney patients' nutrition is essential in order to provide a better quality of life, maintaining a good nutrition state, preventing or reducing metabolic disorders and slowing the progression of a kidney disease. Each patient's diet should be individually planned and carried out. A good nutrition state has been proved to decrease patient hospitalisation. By identifying individual risks in time, it is possible to prevent the development of malnutrition in kidney patients.
Planned and multi-professional  screening of malnutrition has been part of daily care in Tampere University Hospital's kidney ward since 2008. Identification of malnutrition is done using The Nutrition Risk Screening 2002 - form (NRS2002). The identification of  patients at risk of malnutrition is done by the nurses and doctors working in the ward.
Methods:An evidence based operational model was designed in the ward in 2011. The model includes a patient's  interview and NRS done by a nurse. The dietician interviews every patient who gets at least 3 points in NRS 2002  Based on the individual results, the patient's diet can be redesigned and  nutritional supplements can be added to the daily diet. Follow-up is planned individually.
Conclusion/Application to practice: Multi -professional teamwork is essential in order to carry out the process.  Preventing malnutrition in treating kidney patients is a great challenge, and the started work must continue.  In the future it would be interesting to improve the  prevention model with our patients. 

Disclosure: No conflict of interest declared

O 55
Targeting dry weight-body volume and nutritional status in haemodialysis patients
A. Uysal Özerkaya¹, A. Yılmaz¹, A. Serbest¹, A. İlaslan^1
1Nasır Dialysis Center, Fresenius Medical Care, Izmir, Turkey

Objectives: Achieving an appropriate dry weight in haemodialysis patients remains challenging. Body composition can be measured with a whole-body bioimpedance spectroscopy (BIS) device which provides data on body volume and the nutritional status.
Methods:133 patients were included in this study (67 female and 66 male). Dry weight (by classical methods), nutritional status (by biochemical parameters) were determined and bioimpedance spectroscopy analysis performed every 6 weeks between September 2012 and August 2013. A total of 979 measurements were performed.
Results: Body Mass Index (BMI) measurements revealed that 84 of 979 were less than 20 (underweight), 318 of 979 between 20-24.9 (normal weight), 295 of 979 between 25-29.9 (overweight), 193 of 979 between 30-34.9 (obese class 1), 85 of 979 between 35-44.9 (obese class 2) and 4 of 979 over 45 (obese class 3). Nutritional recommendations were given to patients according to their BMI status, changes and rapid weight losses were evaluated aetiologically. We found out that patients needed a dry weight increase in 604 of 979 measurements (a total of 917.8 l, average 1.52 kg), dry weight decrease in 350 of 979 measurements (a total of 408.5 l, average 1.17 kg) and no dry weight change in 25 of 979 measurements.
Conclusion/Application to practice:The determination of dry weight and follow-up of nutritional status of haemodialysis patients using bioimpedance spectroscopy analysis was very useful. Blood pressure normalization and body composition changes due to nutritional factors could be determined by regular body composition analysis.
Disclosure: No conflict of interest declared

O 56
Pain assessment in hemodialysis patients.
M. Brazález¹, C. Franco², S. Merino^2
1Kidney Foundation Iñigo Alvarez de Toledo, Medina del Campo, Spain;
²Universitary Clinic Hospital of Valladolid, Valladolid, Spain

Background: Pain is a frequent and multidimensional symptom found in hemodialysis units (HD), with difficult assessment by nursing staff due to its subjectivity.
Objectives:Evaluate the chronic pain suffered by the patients of our units, both during the HD session and beyond.
Methods: Prospective descriptive study with 23 patients of two HD units, with an average age of 63.22 years. Most common diseases of the sample were: diabetes mellitus and ischemic heart disease. The average time on HD treatment was 4.51 years, being the average duration 3:30-4 hours per session.
Parameters under study: intensity, location and influence of pain on activities of daily living. Two validated scales (Visual Analogue Scale and Brief Pain Inventory) and a sociodemographic survey were conducted during the last hour of HD.
Results:Patients surveyed: 91.30% had a mild to moderate pain at the time of the surveys. 82.61% had pain during the last 24 hours. 39.13% had no analgesic treatment prescribed. The majority realized postural changes or distractions for relief. Among those with a scheduled analgesia, paracetamol was the most widely used drug to relieve the symptoms.
Pain was found to be frequently osteoarticular, being located mainly in the sacro-coccygeal region and in both upper and lower limbs. It did not influence significantly on activities of daily living.
82.61% of patients felt that nurses adequately assessed their pain during hemodialysis sessions.
Conclusion/Application to practice: Although the study was initially motivated by verbal complaints of our patients, it shows a lower prevalence of pain than the initially expected.

Disclosure: No conflict of interest declared

O 57
‘From clipboard to tablet’ refining the approach to unannounced infection control audits
N. Beddows¹, N. Ward¹

¹NephroCare Head Office, Fresenius Medical Care, Birmingham, United Kingdom

Background: With an estimated annual cost to the National Health Service of £1 billion and the potential to adversely affect quality of life, the prevention of healthcare-associated infections remains a priority. The Health and Social Care Act (2008) Code of Practice on the prevention and control of infections gives emphasis to the effective application and management of audit to ensure quality improvement.
Objectives:To replace a paper-based infection control audit tool with an electronic system which is ergonomic and has the capacity to provide timely, quantitative measurable data for comparative analysis at local and national level.
Methods: During 2013 the reliability of a secure external audit database was approved and utilised within a number of satellite haemodialysis units across the UK to provide integration of the audit tool into a web-based system.
Results: 2013 saw annual audits extended from < 20% to >90% of clinics, of which a direct influence is the ease of data capture.   Audit results were captured by desktop or tablet device and produced immediate results allowing for the development of local corrective actions.
Conclusion/Application to practice: The electronic audit process provides measurable evidence and assurance to both internal and external sources that an effective process of monitoring infection control standards is executed and therefore has strong relevance to quality of care and application to practice.
Disclosure: No conflict of interest declared

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