Posters will be available for viewing in the Exhibit Hall. A Poster Q&A session will be held on Saturday, October 27 between 1300-1400.

 

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P02 Addressing Healthcare Gaps: The Person-Centred Decision-Making Initiative

Elizabeth Carmelina del Rosso, Honours Psychology, Kitchener ON

Purpose: To provide an overview of the development and implementation of the Person-Centred Decision-Making (PCDM) initiative, in Grand River Hospital’s Renal Program.

Description: PCDM conversations ensure that patients receive treatment in accordance with their values, wishes, and goals. Unfortunately, data shows that PCDM conversations often do not take place, or occur late in a patient’s illness trajectory, essentially compromising the standard of care received. In order to provide a truly person-centred level of care, which fully meets the needs of our patients, PCDM conversations must become an integral part of routine care.

In 2017, the Nephrology department at Grand River Hospital established an interdisciplinary team responsible for the implementation of PCDM conversations into routine care. Briefly, this process included: 1) Each patient being asked about their Substitute Decision-Maker(s), and to reflect on their wishes and values; 2) Healthcare providers prompting interaction regarding patient goals, values, and beliefs; 3) Ensuring that informed consent conversations take place and that treatment decisions are aligned with patient goals, values, and beliefs. The goal is that, by 2019, 100% of Chronic Kidney Disease (CKD) patients have a Goals of Care (GOC) conversation.

Evaluations/Outcomes: Qualitative and quantitative data from the development and implementation processes of this initiative will be discussed.

Implications: Incorporating PCDM conversations into routine care will ensure that patients are better equipped to make decisions about their healthcare, and that healthcare providers are delivering a higher standard of care.

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P03 Improved Identification of Hemodialysis Patients at Risk for Falls to Increase Preventative Action Strategies and Patient Safety

Anuradha Sawant, PT PhD, London ON
Sarah Spence, MN, NP-PHC, London ON
Trisha Slinger, RN, BScN, BAHons, CMSN(C), London ON

Purpose: To compare the Renal Fall Risk Assessment Tool (RFRAT), an evidence based fall risk assessment tool developed for people on maintenance hemodialysis (HD), to the Morse Fall Scale (MFS) that is currently used in the outpatient HD units at LHSC.

Method: The RFRAT and MFS were administered by RNs to participants on HD at the University Hospital (UH) HD Unit. The total scores were compared using a one-sample t test.

Results: The RFRAT was completed on 28 participants (n=28). The MFS was completed on 25 of the same participants. The results indicate seven of the 28 participants that were rated at “no risk” or “low risk” for falls on the MFS were either “at risk” or “medium risk” for falls on the RFRAT. The mean MFS was 2.8, SD (2.1), n = 25. The mean RFRAT score was 9.5, SD (2.7), n = 28. The MFS and RFRAT scores were significantly different (p<0.001).

Conclusion: The RFRAT is more likely to detect subtle changes in the mobility of people on HD and identify the risk for falls more accurately than the MFS.

Implications: The RFRAT is more sensitive to detect falls in people on HD and should be routinely used to identify people at risk for falls in LHSC’s HD units. Improving fall risk assessments can lead to increased use of appropriate fall prevention services.

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P04 Vascular Access Link Nurse’s Initiative: A Bold Commitment with Exemplary Results

Bincy Varghese, RN, BSN, C (Neph) C, Surrey BC
Maricar Vergara, RN, BCIT (Neph) C, Surry BC

Dependent on one’s outlook, experience is indeed the best coach in life.

In 2016, the link nurses group was formed by ten frontline staff, who dared to compensate for the absence of a Vascular access RN, on site. The primary aim was to promote a common understanding in the care & management of Arterio-venous fistulas & grafts.

The endeavor has proven to be of vital significance in addressing commonly encountered issues in the unit and in fostering great influences on the way our staff treat a patient’s lifeline.

Thus, in 2017, an additional twenty-five frontline staff have found inspiration with the achievements of the first group, and therefore voluntarily committed themselves to learn from each other’s experiences, enrich each other’s knowledge, harness each one’s skill, & modify the overall perception to vascular access – related issues.

Moreover, with such astonishing attributes, the group has gained the respect and recognition from patients and their families; from the multidisciplinary team and from other members of the health team in different units, within Fraser Health.

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P05 Prevalence of Cardiac Events in Patients with Chronic Kidney Disease

Leonor Cercena, RN BScN, Montreal QC

Purpose: To determine the prevalence of previous or current cardiac events in patients with chronic kidney disease (CKD), this is a common cause of mortality in those patients.

Methods: This retrospective study included 199 patients (118 males and 81 females, mean age 64, range 26 to 95 years) with CKD currently on dialysis in our institution. We looked at these patients’ charts for prior history of cardiac events as defined by previous hospitalization with a discharge diagnosis of myocardial infarction or previous elevation of troponin levels. We also looked at the presence or absence of diabetes.

Results: Eighty-six (43.2%) of the 199 patients had prior cardiac events. One hundred seven patients (53.8%) had diabetes. The study indicated that 53 patients with diabetes of 107 (49.5%) had prior cardiac events. Among those without diabetes, 33 of 92 (35.9%) had prior cardiac events.

Conclusions: A substantial proportion of patients with CKD, particularly if they have diabetes, on hemodialysis had cardiac event in our studied population. Our study suggests that these patients are at high risk for future cardiac events.

Implications for Nephrology Care: Patients with CKD should be screened for coronary artery disease. They should be encouraged to implement

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P06 Enhanced Sliding Short Axis (ESSAX) Technique: An Innovation for a 100% Cannulation Accuracy

Neil A. Penalosa, RN, RGN(UK), BSN(Ph), CNeph(C), Surrey BC

Precision with needle placement has been a long-standing challenge.

With conventional assessment, nursing skills are limited to creating merely an impression or an imagination of the depth, the size, and the direction of the vein.

The Enhanced Sliding Short Axis (ESSAX) technique is an ultrasound-guided method that facilitates monitoring of the needle tip, upon insertion into the Arterio-venous fistula or graft.

ESSAX had revolutionized the way we carry out cannulation, as we treat each vascular life-line with great importance & respect.

The innovation was conceived with the earnest desire to resolve the dilemma on miscannulation.

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P07 NephroTalk; an Interdepartmental Nursing Communication Tool

Michelle Brazier, RN, BScN, CNeph(C), Montreal QC
Anne Pilon, BScN, Montreal QC
Elizabeth Carvalho, RN, CNeph(C), Montreal QC

NephroTalk is an interdepartmental nursing communication tool developed to provide the admitted dialysis patient with a safe transfer of care between the inpatient units and the dialysis department.

The Registered Nurses’ Association of Ontario (RNAO) best practice guidelines (2014) stipulates that using streamlined and standardized communication tools will ensure a clear and accurate transfer of care and prevent omission or duplication of critical information . Furthermore, effective communication is fundamental to the safety and the quality of services rendered within the care continuum. A patient handoff must occur each time there is a nurse or patient transition, and must occur in a structured and formal process.

According to recent literature, 80% of serious medical errors involve miscommunication during the handoff (Starmer, 2014; Huang et al, 2010). Thus clear and accurate communication regarding the patients’ condition is essential for safe continuity of care.

Our poster will detail the communication tool and its’ three segments, the purpose and implications of nephrology practice as well as describe the collaborative method demonstrated during the introductory process of the tool in the clinical setting.

Lastly we will present the evolution of this initiative and future plans to evaluate its’ effectiveness, with hopes to standardize this practice across our organization, the centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’île-de-Montréal (CIUSSS ODIM).

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P08 Visual Education – CVAD (Central Venous Access Device) Video

Linda M. Mills, RN CNeph(C), Hamilton ON
Kelly Sutherland, RN CNeph(C), Hamilton ON

The overall purpose of our project was to decrease or maintain our low catheter related blood stream infection (CRBSI) rates in our hemodialysis population. Our regional program encompasses 521 Hemodialysis (HD) patients across four different sites. 152 nursing staff access 282 CVADs routinely.

Given such a large group of staff, our goal was to identify the educational need related to CVAD care and create an educational tool that was easily accessible without the need for face to face education.

An audit tool was developed to assess current practice and random audits were performed. The evaluation indicated gaps in practice. Educational videos focusing on policy review and updates grounded in recent evidence were developed. Practice points that prevent contamination during initiation and discontinuation procedures were emphasized. Once complete, staff were instructed to review the videos and complete a short post test to indicate completion and new learning.

Post education audits are scheduled for February 2018. A review of both adherence to policy and actual CRBSI rates four months prior and four months post education will be examined.

The result is a self-directed, timely, accessible and efficient method of providing education to a large group of both new and experienced nurses in multiple practice settings to positively impact patient clinical outcomes. This education provided in a visual and auditory format supports adult learning needs and can provide a more effective use of resources to provide education. With proven success, next steps include further educational video development.

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P10 Clinical Use of a Body Composition Monitor to Establish and Troubleshoot Ideal Body Weight in Hemodialysis Patients

Christine Morton, BScN, RN, CNEPH(UK)(NI), Toronto ON

This presentation looks at the body composition monitor (BCM) at St Michael’s Hospital as a beneficial tool in helping optimize the ideal body weight targets for our patient population in Hemodialysis. Optimal volume control can be elusive and is in need of more precision. We focused on two groups of patients; incident patients and those with hard to determine fluctuation in body weight. A routine BCM testing schedule was established for new patients on hemodialysis to accurately establish their target weight in the initial 3 months on HD, typically a time when there is weight and also potential over hydration issues. The second group included HD patients whose ideal body weights were difficult to determine due to other comorbidities.

Hemodialysis nurses at St Michaels Hospital have been managing BCM testing for both groups of patients, this included data interpretation. Results show a smooth transition onto dialysis and helpful advantage when it comes to targeting the ideal body weight for our patients. Implications for nephrology care are significant. Establishing accurate ideal body weight is, by its nature, a moving target that greatly impacts the health and quality of life for patients on hemodialysis. BCM is an important tool that provides information to the physician and multidisciplinary team about a patient’s ideal target weight. Routine testing of body composition enables the healthcare team to monitor the accuracy of the target weight and provide a high quality fluid management strategy.

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P12 Technological Advancements in APD with Remote Patient Monitoring and User Friendly Peritoneal Dialysis Cycler: Impact on Patient Confidence and Clinical Decision Making

Arden Gibson, RN, St. Catharines ON

Home therapy dialysis options for patients living with Chronic Kidney Disease (CKD) in Canada have recently experienced great enhancements using new technology. Our program recently adopted a new ADP cycler that provides home patients with a user friendly, step-by-step experience. This cycler comes with a two-way, web based remote monitoring connection between the patient and the clinic.

This poster will describe two case studies of patients who have utilized new PD technology. The new technology uses two-way web-based remote monitoring to provide data from daily treatments to the PD clinic. Clinic staff can view all aspects of patient treatments and make changes to therapy remotely. The device is also voice-guided, and provides step-by-step animated guidance for therapy set-up and alarm conditions.

Patients express their satisfaction and increased confidence with improved simplicity, ease of use and enhanced comfort level in knowing a nurse can observe their daily treatment and intervene if issues arise.

Hospital PD programs receive information allowing them to observe data and make prescription changes when required and in a timely manner. This timely availability of information allows for more informed clinical decision making. In addition, training time of community nurses supporting PD patients has decreased.

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P13 Supporting Best Practice Dialysis Through the Case Management Model

Janett Black, (CNephC), Alliston ON
Serena Chan, BN, CNephC, Toronto ON

Care delivery to hemodialysis (HD) patients is fraught with fragmentation and is redundant in facilitating quality, co-ordination and continuity of patient care (Curtis, 2013). The lack of integrated frameworks and systematic approach to patient care delivery has resulted in inconsistent patient care in many organizations. HD programs require processes and care delivery models reflective of patient and family engagement through self-management, care continuity and collaborative partnerships to ensure continuous improvement and positive care outcomes. The Case Management (CM) model was introduced at Scarborough and Rouge Hospital’s (SRH) Regional HD program in response to an identified need to improve patient and family engagement and self-management as partners in their care and the need to establish consistency and standardization in dialysis best practices and care among our HD patients. The overall goals of the implementation of the CM model were to:

  • Improve patient engagement and partnership through patient identified goal-setting and self-management practices
  • Sustain consistency in best practice and standards of HD care
  • Improve staff accountability for patient care through interprofessional collaboration and peer mentorship

Evaluation of the CM model demonstrated:

  • Significant improvement in nurses’ adherence to completing CM deliverables in support of the CM goals,
  • Improvements in patient and family engagement and motivation towards patient directed goal-setting and goal attainment
  • Improvements in staff satisfaction related to practice and performance

Implications for practice brought about by experiences in the development and implementation of this model, provides proof of concept and associated successes that can be adopted in other HD or health services programs.

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P14 Creating an Opportunity to Improve Outcomes through a Joint Initiative to Develop a Standardized Preceptor/Mentor Workshop for Hemodialysis (HD) Nurses

Lezlie Lambert-Burd, B.Ad.Ed, BScN, RN., CNeph(C), St. Catharines ON

Can a joint initiative between two partner organizations develop a standard learning opportunity for HD nurses that will improve outcomes for mentors and mentees?

The literature shows that a successful orientation has the capacity to empower nurses, increase retention rates, ensure patient safety, and improve positive patient outcomes (Bally, 2007). Training for preceptors or mentors themselves will support and improve instruction and confidence during orientation for both the preceptor and preceptee (Squillaci, 2015). Furthermore, effective orientation may increase overall job satisfaction, thus improving retention and ultimately reducing program costs (Grindel, 2004).

An opportunity was seized and an integrated project to develop and deliver a preceptor to mentor full day workshop for HD nurses at both partner organizations using a standardized approach was achieved. The aim was to provide nurse preceptor/ mentors with the opportunity to cultivate their knowledge, skills and attitudes/abilities to support new learners and further develop a toolbox of useable resources to support knowledge translation in their precepting roles. A priority goal was to utilize the RNAO Practice Education in Nursing (2016), in the development and implementation of the preceptor/ mentor workshop.

Data was captured both pre and post workshop with a follow up survey at 6 months to assess impact and implementation of new knowledge into practice. The data was able to demonstrate measurable improvement with learning outcomes and staff satisfaction with an integrated workshop experience.

Creating an opportunity for professional development within a program may positively impact healthcare organizations, cultivate collegial learning environments, and ultimately improve nursing care.

References

Bally, J.M.G. (2007). The role of nursing leadership in creating a mentoring culture in acute care environments. Nursing Economics, 25(3), 143-147.

Grindel, C.G. (2004). Mentorship: a key to retention and recruitment. Med. Surg. Nurse, 13(1), 36-37.

Registered Nurses’ Association of Ontario (RNAO), (2016). Practice Education in Nursing. Toronto, ON: Registered Nurses Association of Ontario.

Squillaci, L. (2015). Preceptor training and nurse retention. Project study in partial fulfillment for degree of doctorate of nursing practice. Retrieved from scholarworks http://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=1302&context=dissertations

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P15 Interprofessional Shadowing Between the Hemodialysis Unit and Laboratory

Billie Hilborn, RN, CNephC, BScN, MHSc, Toronto ON
Jhanvi Solanki, RN, MScN, MBA, Toronto ON
Elizabeth McLaney, BA, MEd, BScOT, OT Reg. (Ont), Toronto ON
Anne Marie Phillips, BSc, ART (Hematology), MLT, Toronto ON
Neil Lund-Walker, MLA, Toronto ON
Irene Alao, RN, BScN, Toronto ON
Melissa Adamson, RN, BScN, Toronto ON

Successful collaborative practice between disciplines relies on quality working relationships (Laflamme, 2017). The purpose of this project was to foster high quality, person-centred care by learning together across professions. The two main goals included enhancing the culture of collaboration and interprofessional competencies between the laboratories and nursing with attention to role clarification and interprofessional conflict resolution while supporting ongoing quality improvement.

A shadowing experience was designed for nursing and laboratory services in four dyad pairs, with one pair being from Specimen Management in the Lab and the Hemodialysis Unit. One member from each department spent 2.5 hours shadowing in the other department. A set of questions was prepared for reflection before and after the shadowing, plus another group for asking during the experience.

Anticipated outcomes included improved ability for dyads to describe common work flow tasks and priorities, identify challenges and competing demands for their partner’s profession, and relate the impact of their professions work on their partner’s. This will improve existing relationships and promote interprofessional collaboration between the Laboratories and Hemodialysis Unit.

Implications for Nephrology Practice/Education: When collaboration between the laboratories and Hemodialysis Unit is not optimal there can be negative impact on patient experience such as having repeated specimens drawn for testing, inefficiencies due to repeating work processes and reporting of critical results, wasted resources such as test tubes and reagents, and siloed work that limits improvement opportunities. This project will hopefully promote a positive impact.

References

Laflamme, L. (2017). Enhancing perioperative patient safety: A collective responsibility. Operating Room Nurses Association of Canada (ORNAC) Journal, December, 13-33.

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P16 A First User Experience of New Remote Monitoring Technology in Peritoneal Dialysis – Leveraging Timely Sharesource Data to Effectively Manage Patients at Home and Ease Their Transition Into PD

Karen Eyolfson, RN, CNeph (C), Winnipeg MB
Kim Bomak, RN, BSN, Winnipeg MB

There are many considerations and steps involved when starting a patient on Peritoneal Dialysis. A few big considerations are to smoothen the transition, increase patience confidence in self-management of disease and effectively troubleshoot any clinical or technique issues through the first three months on PD.

Our program was the first in Manitoba to evaluate a new technology in APD cyclers that allows for two-way, web based remote monitoring connection between the patient and the clinic. This remote monitoring software allows for daily overview of patient’s treatments to be visible to the clinic, flag alerts when deviation occurs to the prescribed treatment regime, and for remote patient cycler programing.

Currently we have approx. 12 patients on PD using this new cycler. The initial experience that we would like to outline is: – increased visibility to treatment data, timely identification of potential problems such as low drain alerts, and effective troubleshooting of issues by leveraging the Sharesource data.

The poster will also include some case studies showing the benefits of Sharesource in effectively managing patients at home and easing their transition to PD.

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P17 Renal-Friendly Interactive Cooking Demonstration for Hemodialysis Patients

Kelly Gardner, RD CDE, Oshawa ON
Rommana Captain, RD CDE, Oshawa ON
Allyson Babb, RD CDE, Oshawa ON
Yassamin Gharai, RD CDE, Oshawa ON
Queenie Cheung, RD CDE, Oshawa ON

Description: Hemodialysis patients face many dietary restrictions and are often challenged with preparing meals that are safe and meet their dietary needs. Additional barriers that they encounter are financial and time constraints due to regular dialysis treatments. As a result, they often rely on processed/premade meals which are high in sodium and/or phosphorus. The aim of a renal-friendly cooking demonstration is to help increase patient’s confidence in managing a renal diet. This class is two hours in length, and includes an interactive cooking demonstration of a three course meal led by a chef and an optional 30 minute RD-led grocery store tour which focuses on reading nutritional information on labels. Participants enjoy the meal together and are able to ask questions to the chef and Registered Dietitians (RDs). The recipes are chosen by the chef, given the dietary restrictions (low phosphorus, low sodium), and approved by the RDs. The RDs provide additional food substitution suggestions throughout the class to accommodate high or low potassium diets. This initiative is sponsored by industry donors. With a minimal cost to attend (in order to ensure attendance), the money collected is used to purchase door prizes, such as renal cookbooks and grocery store gift cards.

Results: Thirteen hemodialysis patients and six family members/care providers attended. Participants completed an anonymous post-class evaluation. All participants indicated the class was “helpful” or “useful” or “somewhat useful”, and that the information was “easy to understand”. Almost all participants agreed that it helped them increase their confidence in managing the renal diet. The RDs who attended felt it improved the collaborative relationship with the patients, especially to have contact in a non-clinical setting, and helped foster a sense of community within the hemodialysis unit.

Next Steps: Engage patients by having them select and approve recipes prior to class.

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P18 Clinical Effectiveness and Safety of 4% Tetrasodium EDTA as a Routine Non-antibiotic Antimicrobial Lock Solution in Central Venous Access Devices of Hemodialysis Patients Against the TripleThreat™: A 15-month Canadian Experience

Chantal Lainesse, DVM, PhD, DACVCP, Markham ON
Karen Kelln,

Introduction: The ideal catheter lock solution should be able to prevent the occurrence of the TripleThreat™ of clot, bacterial colonisation and biofilm. Providing an effective barrier for the inside of central venous access devices (CVADs) must be part of the multimodal approach to decrease the risk of catheter related complications such as catheter related bloodstream infections (CRBSI) and occlusions. However, this lock solution should not contribute to increasing the risk of antimicrobial resistance (AMR), higher catheter maintenance cost and/or bleeding episodes. The in vitro effectiveness of a novel non-antibiotic antimicrobial solution of 4% tetrasodium ethylene diamine tetraacetic acid (T-EDTA) was confirmed against biofilms formed by clinically relevant bacteria and fungi. The anticoagulant property of EDTA is well known and trusted. Therefore, the objective was to collect post approval safety and efficacy data from the use of this T-EDTA catheter lock solution in Canadian hemodialysis patients compared to the standard of care.

Methods: Hemodialysis patients were selected across Canada based on their (high, medium or low) risk of CRBSI and alteplase use. Clinical endpoints included reduction of alteplase use, CRBSI, and safety. A return on investment (ROI) model was also used to evaluate cost effectiveness of T-EDTA.

Results: Canadian data collected over the last 15 months show both a clinically relevant decrease in CRBSI and alteplase use when the standard lock solution was replaced by 4% T-EDTA. The ROI model also detected a cost saving in favour of T-EDTA. No hypocalcemia was reported.

Discussion and Conclusion: Results highlight the ability of 4% T-EDTA to reduce bacterial burden and biofilms in CVADs as well as providing well-established anticoagulant activities by significantly reducing the use of alteplase. T-EDTA is a safe and effective catheter lock solution for hemodialysis patients offering cost savings.

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P19 Electronic Medical Record for the Renal Program – The Road to Success

Michelle Hughes, RN, Orillia ON
Krista Lovering
Amanda Sibbio
Lisa Dale

Description: The objective was clear – a vision for a documentation system that could support patients throughout their CKD journey; from Multi-care Kidney Clinic (MCKC) to chosen modality, whether care was given in patient homes or across any one of the six in-facility sites of the Regional Kidney Care Program Simcoe Muskoka (RKCP SM). The decision to purchase the same hemodialysis machine at every site of the program was the first stepping stone towards standardized documentation and a transition to computerized charting. In 2014, a Request for Proposal was initiated. Challenges were noted as the system needed to be developed within three different hospital information systems (HIS) and yet still work uniformly and report together. One vendor was chosen and that’s when the real work began. Sites visits with working groups to understand current work flows and processes helped scope the project. New positions were created and hired to support the project which included a project manager, clinical informatics specialist, and application specialist. We were fortunate to have great collaboration from other centres who allowed our team to come and visit their programs and share resources and lessons learned through their own implementation. A phased approach to Go-Live was decided on to make certain resources were available across sites to ensure success. Training resources and a super user group were developed to support the training of staff. Go-Live was successful across modalities with hemodialysis at the regional centre leading the way. The first satellite site has been successfully launched with other sites to follow quickly throughout the 18 months. Lessons learned to date include struggles with the MCKC clinic flow, scheduling medications, time allotted for back entry of patient data and resources required to support front line staff have all been considered and accounted for with the subsequent Go-Live sites.

Results: Standardized, more visible, consistent and accessible patient information and data across the program.

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P20 Support in the Home for Peritoneal Dialysis: Implementation and Evaluation of Integrated Services

Barbara Wilson, NP, CNeph(C), London ON

There is overwhelming evidence that “support” is a common factor that enables people to do peritoneal dialysis (PD) successfully in the home. Supportive interventions in the home, despite being almost universally recommended, can be inconsistent, poorly defined, articulated, and researched. London Health Sciences Centre (LHSC) has been designated as an Early Adopter of the Ontario Renal Network (ORN) Integrated Dialysis Care (IDC) initiative. The goal of the program is to reduce care gaps in the delivery of health services and improve equity in home care services provided for PD. The model will enlist the use of personal support workers (PSWs) who will be hired by one community agency and trained by the LHSC PD staff to support patients on PD in their home. This presentation will review the processes involved in the design and implementation of the program and the preliminary evaluation. A multi-method evaluation of the program is planned. First, patients and their caregivers will be interviewed and asked about their experiences receiving support for their PD. The PD staff will participate in one focus group exploring their experiences in providing dialysis care using the IDC model. In-home PSWs will complete a survey both before and after their orientation in regards to their knowledge and training in supporting people at home on PD. These findings are of particular interest to PD programs looking to find creative ways to support their patients, improve the patient experience, decrease gaps in care, and attract and retain people on a home therapy.

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P21 Evaluating Expanded Hemodialysis (HDx) therapy in comparison to conventional HD therapy in clinical and patient outcomes aspects

Sandra Lagacé, Resource Nurse, CNeph(C), Moncton NB
Chantal Leblanc, RN

Learning objectives:

  1. Reviewing middle large molecules clearance and its importance.
  2. Discussing 6 months’ evaluation of HDx therapy at Dr. Georges L Dumont Hospital.
  3. Reviewing the results and the implications of HDx therapy on clinical outcomes.

Uremic solutes include large middle molecules (MMs) are poorly removed by conventional high-flux hemodialysis (HD) due to their size (> 15 kiloDaltons [kDa]). Such solutes are associated with inflammation, immune system disorders as well as poor outcomes in dialysis patients. 1–5

Recently, HDx therapy has been introduced to the market. This therapy uses the Middle Cut-Off membrane which has greater effective pore sizes than conventional high-flux membranes, allowing permeability closer to the natural kidney’s glomerular membrane and middle large molecules removal.

The presentation will cover the unmet need of middle large molecules clearance using a conventional HD treatment, the new HDx technology introduction to Dr. Georges L Dumont and its evaluation on ten patients for 6 months.

We will review the methods, results and share our conclusions comparing HDx therapy to conventional HD.

The presentation will be free of any type of corporate solicitation and that there will be no negative reference to another company or their products/services.

References

Assi LK, et al. PloS ONE. 2015; 19 :e0129980.

Hutchinson CA, et al. Mayo Clinic Proc. 2014; 89 :615-622.

Cohen G, et al. J AM Soc Nephrol. 1995; 6:1592-1599.

Cohen G, et al. Kidney Int Suppl. 2001; 78:S48-S52.

Desjardins L, et al. Toxins. 2013; 5 :2058-2073.

Presented by Baxter Corporation

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P22 The Journey Home: Growing a Home Hemodialysis Program Utilizing a Champion Approach While Fostering Relationships Amongst Disciplines

Kelly-Jo Clarke, RN, BScN, CNeph (C)
Kathleen Brown, RN, CNeph(C), Peterborough Regional Health Centre

Introduction: Growing a home hemodialysis (HHD) program is a central focus of the Ontario Renal Network, with an expected target of 24.4% for 2018-2019. We are currently at 24% with a projected growth of 50-75%, and possibly beyond. As a program, we are approaching this goal for growth with our entire renal program in mind. Through collaboration, communication, and creating buy in, we have strategically developed a process for growing our HHD program. This process provides a consistent message through every point of contact throughout the system and serves to re-establish and reinforce the fundamental relationships that are the backbone of any successful dialysis program.

Process: An expression of interest was sent to all members of the Regional Renal Program Multidisciplinary Team seeking HHD Champions. This produced an excellent response from a wide array of team members, thereby creating a solid foundation to approach the task at hand. The strategy is simple: to provide 1:1 education sessions with interested participants, who are from varied disciplines within the program. The objective of the education sessions is to ensure that pertinent information from our newly revised information pamphlet is shared and discussed so that Health Care providers can confidently express the reality of Home Hemo and the benefits that it brings. Further, establishing sound and respectful relationships is another focus of this project, as we believe this to be paramount in order to attain growth and success; gleaning an understanding of the work others do, is just as important as the work itself.

Additionally, we offer personal tours for clinic patients and their families that allow them to see who we are, what we do, and how we can enable and educate them to take control of their health and wellbeing. We encourage “camp days” where our current in-centre and transition unit patients can come and have their dialysis treatments with us in home hemodialysis and learn more about how HHD can positively impact their well-being and improve their quality of life. These opportunities give prospective patients the ability to observe and ask questions of the HHD staff as well as having conversations with current patients in training.

Finally, as a visual prompt, we have incorporated t-shirts, vests, and uniforms that display our home hemo logo coupled with sentiments such as “go home”, “eat more, drink more”, “you can do it” and “improved quality of life”. This serves to highlight the HHD program, not only within the Renal Program itself, but also within the Organization. This has generated interest in what we do, who we are, and has promoted dialogue which ultimately will lend itself to the growth of the program.

Results: Our goal is to improve the longevity and quality of life for our patients, which has been a proven outcome of more frequent dialysis. Also, improving working relationships between disciplines and breaking down the barriers that have been created over time.

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