British Columbia updates

Presented by:

Dr. Suneet Singh & Sushila Saunders

Introduction

Current stats in BC

PD assist in BC

Accomplishments this year

Areas of focus

Facing our challenges

# PD Patients in BC: Years 2012-16

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

0

100

200

300

400

500

600

700

800

900

2012(n=3064)

2013(n=3109)

2014(n=3036)

2015(n=3072)

2016(n=3249)

% Dialysis Patients on PD #

Dial

ysis

Pat

ient

s on

PD

CAPD APD %PD

# Pts on Dialysis:

BC PD Program Activity in Year 2016

36

21 29 31

24

34 34 32 24

37 30

24

-21 -22 -31

-24

-35 -27 -24

-31 -34 -28

-32 -25

-40-30-20-10

010203040

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

# Pa

tient

s

New PD Pts

# PD Patients on Jan 1 2016: 802 # PD Patients on Dec 31 2016: 833

Net plus of 31 patients (22 first-time start on PD, 9 returning to PD from Transplant)

BC Annual PD Attrition Rates

050

100150200250300350400450

2012 2013 2014 2015 2016

# PD

Exi

ts/1

000

PD

patie

nt-y

ear

All Reasons

Death

Transplant

TechniqueFailure

All Reasons 21 22 23 23 26 Death 26 26 24 32 30 Transplant 24 29.5 30 25 29.5 Technique Failure 13 14 19 14 22

Median Months on PD:

Catheter Insertion (Bedside vs. Surgical)

50 54 56 50 45 41

50 46 44 50 55 59

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2014 JAN-JUN

(n=193)

2014 JUL-DEC

(n=158)

2015 JAN-JUN

(n=209)

2015 JUL-DEC

(n=204)

2016 JAN-JUN

(n=196)

2016 JUL-DEC

(n=192)

% P

atie

nts

Bedside

BC Peritonitis Rate

0.200.210.220.230.240.250.260.270.280.290.30

# Pe

riton

itis

Epis

odes

/Pat

ient

-Yea

r on

PD

PD assist provincial rollout

As of Feb, 2017, two Health authorities accepting patients for long term or respite PDA • St Pauls: 5 long term • VGH: 6 long term, 1 respite • RCH: 11 long term • ARHCC: 5 long term, 1 respite

Rollout will continue in a phased approach by each HA. External service provider contracted to provide PD assist is Nurse Next Door.

Patient education

PD patient training modules- online, self paced training modules to supplement patient education provided by programs

access via BCPRA website

Provincial renal TB screening BC renal programs routinely screen all incident dialysis patients for TB TB screening questionnaire, Chest xray Interferon Gamma Release Assay (IGRA) blood test (high specificity and sensitive, effective test in immunocompromised populations) Since March 1, 2016

116 PD patients screened 8 reactive IGRA

TB screening guidelines for PD programs – BCPRA website

Provincial standardized PD nursing procedures

The PD RN group leading the work of developing provincial standardized PD nursing procedures: Completed to date: Capping a PD catheter (1) Flushing a PD catheter (3) Exit site procedures (7) Invasive procedures (2) PD Leaks (3)

Development of 10 procedures planned for the next year.

Educational achievements Completion of the British Columbia Institute of

Technology NSNN 7425- Advance PD nursing course Mohammed

Alhaj-hassan Chelsea Bruce Melanie Campbell

Annick Couture

Wendy Harasimiuk Jane Meyer

Margie Kensah

Monique LeBlanc

Anne Schmuck

Kimiko Simpson Karen Walkey

Shelbi Wong

Breanne Crowell Lana Howe Cassandra Ma

Julia Shaefer Bonnie Vaughan

Accomplishments

Publications Bevilacqua MU, Turnbull L, Saunders S, Er L, Chiu H, Hill P, et al. Evaluation of a 12-month pilot of long-term and temporary assisted peritoneal dialysis. Perit Dial Int J Int Soc Perit Dial. 2016 Dec 1;

Submitted for publication

The Value of Patient and Provider Reported Experiences in Evaluating Home-Based Assisted Peritoneal Dialysis. Micheli U. Bevilacqua, Helen Chiu, Sushila Saunders, Linda Turnbull, Paul A. Taylor, Rajinder S. Singh, and Vincent Salyers

Challenges and moving to solutions

Identified in 2016 Outcomes/Updates

Equitable PD catheter access services for all patients in BC Assessment of new technologies

• Advocating at the provincial level for mandatory surgical PD catheter procedures wait times targets for each HA

Evaluation of new PD cyclers

Challenges and moving to solutions

Identified in 2016 Outcomes/Updates

PD programs- changing nursing workforce (retirements, new hires) , transitions to and from PD programs etc.

• Developing best practices

guidelines for PD programs- a structured approach to PD care will contribute to quality outcomes in BC

• Transition to and from PD

support tools for patients and programs

• BCPRA sponsoring tuition for

new or current PD nurses to complete BCIT NSNN advanced PD online course

Areas of Focus for 2017-2018

Best practices guidelines for PD programs in BC

Transition to PD- support tools for staff and patients

Remote and rural community PD support tool

ISPD 2018

Thank you to all BC PD colleagues for their hard work

and efforts this year!