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Community Based Peritoneal Dialysis
(PD) Clinic: Nurses and Patients’
Experience
Charelle S. Serrano
Peritoneal Dialysis - Sister
Barts and The London NHS Trust
London, England
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Background
Definition of Nurse Led Clinic
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A clinic or drop in service that is run at set times by a
registered nurse.
The nurse has his or her own patient case load.
The service involves an increase in the autonomy of the
nursing role.
The clinic requires the patient to fit into set time slot often
through an appointment system.
(Hatchett, 2003)
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National Drivers
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Making a difference (DOH 1999)
National Service Framework ( 2000)
Reduction in junior doctors hours (DOH 2002)
Modernisation agency ( 2004)
National Institute of Clinical Excellence (NICE
2005)
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Objectives
To identify and evaluate nurses’ and patients’
experiences in attending a community based
nurse-led clinic.
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Method
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2 Community based nurse-led clinics were
established
* Renal Satellite Unit
* GP Surgery clinic
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8-10 patients attended the nurse-led clinic
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Questionnaires were provided to 30 patients
attending outreach clinics and 7 senior nurses
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Why develop a Community
Based PD Nurse Led clinic?
Patients:
Organisation:
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Improve quality of life
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Meet objectives,
guidelines/standards
Provide invaluable patient
centred approach
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Expand community program
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Cost effective service
provision
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Recruitment and retention
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Freedom from hospital
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Expectations and Demands
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Criteria for Community Based PD
Nurse-led Clinic:
Patients:
Nurses:
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Appointment
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Specialist Nurse
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Suitability
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Autonomy
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Accessibility
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Skills
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Role and Limitations of
Outreach clinics
Role
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Limitations
Blood tests
Urea Kinetic Modelling
(UKM)
Peritoneal Equilibrium tests
(PET)
Standard Permeability Test
(SPA)
Line changes
Nurse clinics for fluid
assessment
Review of problems and
medications
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Does not replace Home
Visits
Cannot assess Home
circumstances
Cannot assess PD
exchange technique
Nurse prescribing
Results
Patients:
Nurses:
90% (n-27) were satisfied
with the services rendered
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Less hospital visit
Reduced travelling time to
and from the clinic
Less time spent in clinic
Nurses have more time for
patients
Meeting other patients
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Job satisfaction
Gained more confidence
Autonomy in clinical
decision
Professional growth and
development
Developed management
skills
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Outcome for the Organization
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Opening of another outreach clinic
Increased hospital capacity for
doctor’s clinic
Recruitment and retention of nurses
Reduce cost for hospital transport
Improvement in meeting clinical
standards, objectives and guidelines
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Conclusion
Community based nurse-led clinics made
significant contribution towards satisfying
patient’s demands and nurses experience for
these services provided by the unit, thus
improving their quality of life.
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Recommendations
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Establish more outreach clinic
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Information dissemination
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Encourage more nurses to lead/manage
outreach clinics
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Acknowledgements
Renal Abstract Peer Group
PD Team
Dr Stanley Fan
Sally Punzalan
Jao Ortial
Contact:
Charelle.Serrano@bartsandthelond
on.nhs.uk
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References
Department of Health “ Making a Difference”
1999
Department of Health “National Service Framework” 2000
Department of Health “Reduction in Junior Doctors” 2002
Hatchett R “Nurse-led Clinics” 2003
Department of Health “Modernisation Agency” 2004
National Institute for Health and Clinical Excellence 2005
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