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Systematic and Routine Symptom Assessment and Management to Relieve Distress in Patients with End-Stage Renal Disease
Quality Forum 2015February 20, 2015
Helen Chiu, MSc, MHABC Renal Agency
John Duncan, MD, FRCPC
Kaillie Kangro, MSW, RSWVancouver General Hospital
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Disclosure
• Helen Chiu: Administrative Fellowship, BC Renal Agency • John Duncan and Kaillie Kangro: Nothing to disclose
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Storyline
• Background and goal• What have we done?• How did we measure?• Challenges & lessons learned• Take home message
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The Setting
• Operates 7 a.m.-11 p.m. daily• >50 renal care professionals• ~200 patients
– Mostly elderly– Multiple co-morbidities– Heavy symptom burden– On life-sustaining machine for 4 hours x 3 days/week
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What is this about?
• High symptom burden
• Historically under recognized
• Symptom management is essential
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Our Goal
To improve symptom care by reducing overall distress due to symptom burden in all
patients at the haemodialysis unit of the Vancouver General Hospital
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Our Team• John Duncan, EOL Co-lead; Nephrologist• Kaillie Kangro, EOL Co-lead; Social Worker• Michael Copland, Medical Director, Kidney Services VCH/PHC• Jazek Jastrzebski, Director, Renal Program; Head, HD program• Kerri Berryman, Operations Manager, Renal Program• Karen Shalansky, Pharmacist• Mary Vander Hoek, Clinical Nurse Leader• Toni Trewern, Clinical Educator• Jane Chu, Dietitian• Florence Ng, Data Management Coordinator• Helen Chiu, Project Coordinator
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Changes Tested in PDSA Cycles
• Presentation and administration
• Layout of form
• Preparing staff
• Data collection
• Screening and documentation
• Follow up
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What we are measuring: Process
• All patients were approached• >70% of patients with assessment
Nov-2013
Nov-2013
Dec-2013
Jan-2014
Mar-2014
Jun-2014
Sep-2014
Jan-2015
Mar-2015
Jun-2015
0%
20%
40%
60%
80%
100%
# of assessment collected/ # of pts approached
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What we are measuring: Outcome
Nov-2013
Nov-2013
Dec-2013
Jan-2014
Mar-2014
Jun-2014
Sep-2014
Jan-2015
Mar-2015
Jun-2015
-
20.0
40.0
60.0
80.0
100.0
Average Distress Level
Aver
age
over
all a
sses
smen
t sco
re
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From our patients…• More open about symptom burden with
self-reported assessment• Proof is in the pudding
– “What are you going to about it?”• Barriers
– Language– Visual and cognitive impairment
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Lessons Learned
• Keep eyes on the prize • Inter-disciplinary team work • Ongoing review of process (PDSA)
• Challenges – Build trust and impart value – Maintain momentum– Ensure expected positive impact is realized
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As good as it gets? Or, birth of a notion?
• Engagement best tailored for various frontline team members
• Iterative process
• Possible to change culture of care for and with the patients
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Thank you!
• Questions?• For more information, please contact
– Kaillie [email protected]
– John [email protected]
– Helen [email protected]
