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Nurse model speeds up service for renal patients

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A nurse-led renal service at a Manchester acute trust has significantly improved the care of patients requiring haemodialysis for chronic kidney disease.

Nurses at Salford Royal NHS Foundation Trust set up the service last June after a local audit found the trust was not meeting recommended guidelines on vascular access for patients requiring long-term haemodialysis.

According to the National Service Framework for Renal Services, lauched in 2004, an arteriovenous (AV) fistula – formed by connecting a vein to an artery – provides the best long-term vascular access for patients requiring dialysis.

The Renal Association recommends that 80% of patients who need long-term dialysis should have an AV fistula, yet the 2008 audit of renal services at Salford found only 67% of patients were having the procedure.

However, latest audit data from January this year revealed a 14% increase in the number of patients having AV fistulas since the introduction of the new nurse-led service. There has also been a significant drop in the number of patients being admitted for complications associated with vascular access – from 44% in 2007 to just 25% in January 2009.

As part of the service, specialist nurses, who have undertaken new skills training, now coordinate the care of all patients requiring surgery for vascular access. This would have previously been done by a mixture of healthcare professionals, led by medical staff. As a result, the service has become less fragmented and smoother for the patient.

The coordination process includes consenting the patient, arranging their discharge, and conducting a two-week post-operative review. The nurses have also been trained in how to perform pre-operative ‘vein-mapping’, a radiological procedure to assess which veins are suitable for an AV fistula.

Earlier in April, the pre-operative part of the service developed further to reduce the need for patients to attend multiple appointments. 

A ‘one-stop-shop’ pre-operative assessment service is now in place, which means patients requiring surgery can be consented, receive vein mapping, see their surgeon and leave with a date for surgery all in one appointment.

Jane Macdonald, lead nurse for renal services at the trust, said: ‘When a patient with chronic kidney disease learns they are going to need dialysis, it is a real turning point.

‘The new service has made the patient’s journey more seamless and consistent as they see the same nurse specialist throughout. It has also liberated surgeons’ time so has been well accepted by them,’ she told Nursing Times.

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