S 35 Plenary Session

GUEST SPEAKER
The experience of patients with kidney disease in Lithuania
U. Šakūnienė^1
1Lietuvos asociacija GYVASTIS, Vilnius, Lithuania

Background
I was diagnosed the terminal kidney function failure after the influenza when in 1979. After some years I had to treat by hemodialysis. My mother was my first kidney donor on 1984. My father was my second kidney donor on 1990. I am still living with his kidney and I’m the leader of the association GYVASTIS.
Gyvastis represents the interests of the Lithuanian people who are living after kidney, heart, liver or lung transplantation operations, people who are waiting for transplantation or are on dialysis treatment.
One of the main Gyvastis objectives is to represent its patients and seek for them the best medical support and social security, to raise public awareness of organ donation, to educate patients and give them psychological support.
There are about 2200 kidney patients in Lithuania. 1400 of them are HD patients, 60 – PD and 700 – kidney transplant patients. 120 patients are waiting for kidney transplantation. One of our organization purposes is to reach that kidney transplantation would be officially recognized as a best treatment for kidney patients and the most economical for the government. The first step is to create register of HD, PD and kidney transplant patients. The important solution is raising awareness of life kidney donation for relatives.

BIOGRAPHY OF THE GUEST SPEAKER

O 67
Using multidisciplinary teams (MDTs) to improve quality outcomes
M. Richards¹, D. Marquez¹, A. Rezqallah¹, F. Sharif¹, A. Nundlall¹, R. Britten¹, J. Noble¹, E. Suleiman¹, L. Garcia¹, B. Al Kaddah^1
1Nursing, SEHA Dialysis Services, Abu Dhabi, United Arab Emirates

Background: The best patient outcomes are achieved when professionals work, learn, engage in clinical audit and innovate together. Multiple interventions are more effective than single interventions which often fail. The distribution of guidelines or educational material rarely changes behaviour unless combined with audit, feedback and protocols. There a numerous problems with MDTs relating to gender, cultural differences, perceived status differentials, multiple reporting lines, lack of “buy-in” and supporting organisational structures and resources. These must be addressed for success.
Objectives: To improve performance against agreed key performance indicators (KPIs) across Abu Dhabi.
Methods: KPIs covering vascular access, dialysis frequency, time and dose, haemoglobin, phosphate and albumin, were developed. Monthly MDTs were implemented in quarter 1 of 2013. The teams were led/organised by the senior nursing staff and involved physicians, dieticians, social workers and clinical pharmacists.
Results: In quarter 1 no KPIs were met and there had been no change in performance in the previous year. By the end of Q4 2013 there had been dramatic improvement against all targets with achievement of 5 of 7 KPIs, additionally the performance exceeded international benchmarks (DOPPS Practice Monitor) in 5 areas. The average improvement was an increase of 13% of patients achieving target. Patients prescribed 4 hours of dialysis increased from 73 to 96%.
Conclusion/Application to practice: The introduction of MDTs was successful as they had clear objectives, the right support and “buy-in” from all concerned. Additionally they were combined with a programme of patient and clinician education. The improvement seen was gradual and continues.

Disclosure: No conflict of interest declared

O 68
The importance of art therapy in determining the quality of life in dialysis patients
H. Demirbilek¹, E. Parmaksiz², G. Gokcan², A. Kutan Fenercioglu³, O. Cigerli³, S.Y. Kokturk¹, F.N. Ozdemir Acar^2
1Dialysis Unit, Baskent University Medical Faculty, Istanbul Hospital, Istanbul, Turkey; ²Department of Nephrology, Baskent University Medical Faculty, Istanbul Hospital, Istanbul, Turkey; ³Department of Family Medicine, Baskent University Medical Faculty, Istanbul Hospital, Istanbul, Turkey

Background: Dialysis may cause psycho-social problems and reduce quality of life in Chronic Renal Failure (CRF) patients. In this study, we aimed to ameliorate life quality of CRF patients by providing patients the opportunity to participate in artistic activities.
Material and method: Ten CRF patients with eating disorders, sleep disorders, drug abuse or unnecessary drug use, alcohol abuse, chronic pain, depression, hearing and visual impairment, refusal of treatment and one or more of the criteria of psychosocial non-compliance were included in this study. Two of them were receiving peritoneal dialysis and eight of them were receiving hemodialysis treatment. Five male and five female CRF patients who participated in a theater (skit) activity at their own request were included into the study group. The control group included 4 female and 4 male healthy volunteers who also participated in the same theater (skit) activity at their own request. STAI continuous, STAI-state tests and Social Phobia (SPT) tests were applied to the participants before and 5 months after the art therapy. (Ed. Please describe these tests as the audience will be unclear what they mean).  Statistical analyses were made with the package program NCSS (Number Cruncher Statistical System) 2007 Statistical Software (Utah, USA). Evaluation of the data  was made with descriptive statistical methods (mean, standard deviation), Mann-Whitney U test for comparison of two groups of variables with variant distribution,  chi-square test for comparison of qualitative data and Wilcoxon test for the comparison of  STAI and SPT tests differences at the beginning and 5th month of the therapy. P value <0.05 was accepted as statistically significant.
Results: The study group’s SPT scores at 5th month after therapy were significantly lower than the results before therapy (p=0.028). The study group’s SPT scores at 5th month after therapy were significantly lower compared to the scores of the control group (p=0.001). The difference in SPT scores from the beginning to 5th month after therapy was significantly higher in study group than in control group (p=0.009). The difference in STAI-state scores from the beginning to 5th month after therapy was significantly lower in study group than in control group (p=0.002).  The study group’s STAI-state scores at 5th month after therapy were significantly higher compared to the results of the control group (p=0.003).The study group’s STAI-state scores at 5th month after therapy were significantly higher than the results before therapy (p=0.012).
Conclusion:The significant reduction in SPT results of the study group from the beginning to 5th month of the therapy indicates positive changes in social life. The increase in STAI-state scores of the study group from the beginning to 5th month of the therapy shows the instant concern for the success of the artistic activity. The STAI- continuous score did not show any change because of the continuity of the anxiety before and after the artistic activity.
Key words: Chronic Renal Failure, dialysis, anxiety, stress, art therapy

Disclosure: No conflict of interest declared

O69
Foot problems in dialysis patients
J. Terényi¹, M. Majszterovics¹, M. Molnár^1
1Dialysis Centre Szigetvár, Fresenius Medical Care, Szigetvár, Hungary

Background: In light of an increased morbidity and mortality in dialysis patients, regular examination of the patient’s feet is crucial. Dialysis nurses play an important role in the recognition of these abnormalities.
Objectives:To identify foot problems during regular “foot visits” in our clinic.
Methods: 68 haemodialysis patients and 1 peritoneal dialysis patient (mean age: 62.7 years, diabetics: 31%, smokers: 30%) were examined and any foot abnormalities (dry skin, calluses, fissures, abrasion, ulcers, joint deformities, fungal infection, etc.) documented. Moreover, peripheral pulses were examined and calibrated tune-fork, monofilament tests and neurotests performed.
Results:Intact, well-groomed feet were found only in 16% of patients. Nail fungi were identified in 22%, dry skin and fissures in 24%, abrasion and ulcers in 6% of patients. 40% of neurotest and monofilament tests, 60% of tune-fork tests were positive. In 57% of patients no peripheral pulses were palpable. Patients were educated on proper foot care and referred to specialists.
Conclusion/Application to practice: Foot problems - often in an advanced state - were identified in numerous patients. Regular “foot visits” should become a routine for dialysis patients. Early treatment may prevent the loss of extremities. Peripheral arterial disease and neuropathy are very common in our patients. The examination of neuropathy with simple methods can predict foot abnormalities and high-risk patients can be diagnosed at an early stage and receive adequate treatment in time.

Disclosure: No conflict of interest declared

O 70
Development of an integrated competency framework
C. Poole^1
1NephroCare Head Office, Fresenius Medical Care, Birmingham, United Kingdom
 

Background:Clinical competence is the cornerstone on which quality care is delivered. Competence is a complex multidimensional phenomenon which has internally been agreed as “The combination of skill, knowledge and attitudes, values and technical abilities that underpin safe and effective satellite dialysis care and interventions”
Objectives: The overarching objective was to undertake a full review of 19 current competency documents and to assess how these could be merged/amalgamated/refined/redesigned and possibly removed in their entirety from use whilst maintaining the credibility of a final “integrated competency assessment tool”.
Methods:19 competency documents were reviewed and assessed in terms of their relevance to registered/unregistered healthcare professionals, contemporaneous content, link to internal policies, procedures and best practice.
Results: The critical review led to the development of a “Chronic Haemodialysis Integrated Competency Framework” for registered and non-registered healthcare professionals containing four domains of competence and three annual re-assessment of competence documents for use as a precursor to individual annual staff appraisal.
Conclusion/Application to practice:One of the greatest challenges is ensuring competent nursing workforces who are fit to deliver high quality care to patients within this environment. It is envisaged that the development and application of this integrated competency framework will form the bedrock for assessment of competence from the point of induction for new employees whilst affording the opportunity for reassessment and thus the identification of further training needs.

Disclosure: No conflict of interest declared

To return to your session overview use the "Go Back" button in your Internet browser.