Leading change

Renal Nurses at Nottingham University Hospitals NHS Trust (NUH) developed and led a project to strengthen patient engagement in their dialysis services. The project has led to better patient experience and better use of resources.

Where to look

The evidence base suggests that patients who are more engaged with their dialysis treatment have better experience and clinical outcomes. With this in mind the renal nurses recognised unwarranted variation in patient engagement within services at NUH. NUH nurses identified good practice from some dialysis units across the Trust and successfully that led to shared care, however this wasn’t always the same across the Trust’s other dialysis services.

What to change

In NUH’s main unit at Nottingham City Hospital, the nurses noted that only a few patients were actively engaged in their dialysis care. For some, their level of knowledge about their illness and treatment was extremely limited. The renal nurses wanted to provide appropriate support and education in order to encourage patients to increase their understanding of their conditions and treatment and become actively engaged.

How to change

Nursing staff at all levels took ownership of leading the project in the main NUH dialysis unit. These staff identified patients with an interest in being involved in the pilot, and formulated a programme of interventions and changes with them. This was evaluated on a regular basis and changes were amended accordingly. Interventions included:

• Patient coffee mornings to give information on shared care
• A new ‘observation station’ to provide facilities for patients to take their own observations
• One-to-one education and training with patients in dialysis techniques
• Rearrangement of the waiting area environment
• Education of staff to encourage active patient engagement and to skill them in shared care principles.

Adding value

Better outcomes – The team recognise that in the short term it is difficult to measure clinical outcomes but assessment of the impact of engagement on clinical parameters is in progress. The number of dialysis patients undertaking their own blood pressure and pulse observations increased three-fold to almost 50% of the cohort during the first six months of 2017.

Better experience – Patient feedback has been very positive, for example;

• “I feel like I’ve achieved something”
• “This is easy to do”
• “I don’t understand why some of the patients do not do it”
• ‘I feel more in control”
• “I like to get involved and know what is going on”

Staff have also responded positively, including saying, “It makes me happy when they learn” and “It is lovely to see them doing things”.

Better use of resources – Patients doing some of the routine tasks of dialysis has freed up staff time. This has allowed them to spend time and focus on other patient needs. Teaching patients has allowed staff to develop a different and positive relationship with them. Nurses have become care facilitators rather than purely care givers and patients feel empowered and not just recipients of treatment.

Challenges and lessons learnt for implementation

• It is important to be patient and persistent. Change takes time and is often best achieved in small steps. Putting effort into building the team increases the chances of lasting success. Some initial cautiousness from staff and patients were addressed by encouragement and training
• Resource planning is crucial and should be considered early in projects.
• Collecting evaluation data can be challenging however this was addressed by looking at a cohort rather than the whole patient group to begin with.
• Support is crucial to continued success especially as motivation can change when patients felt unwell. Staff were able to offer additional support as well as reminders and reassurance so they could remain in control.

Find out more

For more information contact:

• Kat Kalinowska, Renal Nurse, Katarzyna.kalinowska@nuh.nhs.uk