511C - Research Paper

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Case Description:
The health service caters to approximately 900,000 individuals, with a rising demand for dialysis care. The introduction of the NP aimed to address gaps in timely and accessible care, particularly in activating transplant waitlist (TWL) candidates. As this was the first time that an NP was introduced to the renal service, the model of care (MOC) was drafted by the medical workforce. However, this draft was ill-informed and has placed some limitations on NP capabilities. Through a review and gap analysis, the NP refined the MOC to better suit patient needs. 

Discussion:
The gap analysis highlighted issues such as irregular patient reviews and delays in transplant assessments. The NP's interventions, including increased dialysis unit rounds, enhanced transplant service models, and heightened presence in renal clinics, significantly improved patient care. In 2023, the NP provided 812 dialysis episodes of care, conducted 108 transplant workups, and contributed to 60 TWL activations and 26 transplants.

Conclusion:
The integration of NP services complements nephrologists' roles, fostering collaboration and significantly improving patient access to timely and convenient care.

401Q - Research Paper

Abstract
Aim:
The aim of this project is to outline how complementary workforces can collaborate to provide holistic patient-centred care in satellite dialysis units.

Method:
The model of care used in our metropolitan satellite dialysis units is unique in Australia as all clinical staff are CRPs with oversight by an RN. The RNs and CRPs have extensive renal specific education and training and defined scope of practice, allowing them to work collaboratively and independently with clearly defined lines of escalation.

Results:
The CRP workforce enables the RN to concentrate on all aspects of clinical care, focusing on holistic patient outcomes and resulting in excellent care for patients. Utilising a complementary workforce reinforces our organisational values and contributes to meeting the demands of an ever-changing dialysis population.

Conclusion:
Working collaboratively with CRPs has been a rewarding experience as an RN and has allowed the opportunity for both workforces to contribute optimally to their scope of practice. Our institution has confidence and fully supports the workforce model and subsequent excellent patient outcomes.

364Q - Research Paper

Abstract
Aim:
To foster community self-determination and align program strategies with community priorities by establishing community reference groups in the EA Region2.

Method:
Renal community reference groups were established in three communities at 6-month intervals. Feedback received from these meetings informed program development and supported advocacy to empower Yolngu workforce and development of community-based workers. 

Results:
Increasing Yolngu health workforce, retention rates and improving development pathways were identified by the renal community reference groups and Yolngu staff as key priorities in strengthening current program delivery. Historically, there has been a high turnover of community support workers (CSW) at Miwatj Health. Numerous enablers for staff retention were identified.

Conclusion:
By imbedding identified enablers into program activities, staff retention improved as CSW felt valued, empowered, and safe. The CSW are passionate about their role in delivering the renal story to community and feel supported to continue to develop their skills.  

166Q - Research Paper

Abstract
Aim:
This multi-phase study sought to: i) develop haemodialysis nurse sensitive indicators (HD-NSIs), ii) create an audit tool to measure these indicators; and iii) test the validity and feasibility of measuring the quality of HD nursing care.

Method:
Study 1 used a Delphi iterative research process to attain consensus from an expert panel.  Study 2 tested the validity of the McIntyre Audit Tool (MAT). A panel of (n=13) nurses participated in two focus groups. Nurses (n=10) then rated each item, and the overall scale level content. Testing feasibility involved nurses (n=30) completing the MAT for each shift they worked over a period of 1 week, followed by a short questionnaire.

Results:
Study one identified 26 HD-NSIs, study 2 reduced these to 20. The MAT demonstrated excellent scale-content validity index average of 0.92. During study 3, 97 audits were completed, and most nurses completed this within 5 minutes (79%). Furthermore, the MAT was easy to complete (91.7%), could be conducted during a normal shift (83.3%), and nurses would complete audits (79.2%).

Conclusion:
It is feasible to evaluate the quality of nursing care using HD-NSIs. Each unit can establish internal benchmarks to improve the quality of care provided to patients by monitoring MAT scores. Furthermore, it assists with demonstrating the staffing levels needs to achieve quality outcomes. Lastly, local, and national benchmarking could be possible to promote improved practice.

471Q - Research Paper

Abstract:
Aim:
To establish a haemodialysis unit equipped to accommodate higher acuity patients otherwise not suitable for satellite dialysis, thereby effectively utilising resources and creating capacity in the acute unit.

Method:
With increasing patient numbers and acuity demands, our service required a new and innovative type of dialysis unit. With the assistance of a generous donation, a unit was purposely designed for the increasing needs. After extensive research, consultation, workforce modelling, and several iterations of business cases: the unit was opened to treat higher acuity and wait listed patients, and those requiring additional precautions. 

Results:
The unit was opened late October 2023 using a mixed-model workforce composed of registered nurses and clinical renal physiologists. To date, the unit has provided 731 dialysis treatments including 48 COVID positive treatments, many of whom would otherwise be dialysing in a COVID positive or acute unit. The unit is not yet at full capacity but is equipped to treat 15 patients per shift with three isolation bays.

Conclusion:
We have found the unit has had a positive impact on our patients, staff, and the wider nephrology department.  It allowed the closure of an inefficient COVID positive area and diverted patients from the acute unit.

451Q - Research Paper

Abstract
Aim:
To establish a Nephrology service at a stand-alone heart hospital, to allow for the provision of a haemodialysis service. 

Method:
Development of the model of care for the service including processes, leadership and governance. The development of the Renal – Cardio Clinical Nurse Consultant (CNC) role to provide a liaison between the service and the offsite main nephrology unit. Education and training of staff from both sites. Set up of haemodialysis compatible bed spaces, implementing storage and supply processes. Clear communication of service capabilities and limitations. Streamlined communication between the main dialysis unit and the renal-cardio CNC. 

Results:
The establishment of 8 haemodialysis rooms and the successful provision of 124 haemodialysis treatments. We have seen no increase in on call demands since commencement. Key success has been linked to the defined role of the Renal-Cardio CNC. The ability of the CNC to provide key relationship building between all stakeholders, to be the visible point of reference for the nephrology service on site. 

Conclusion:
Whilst there has been challenges in setting up and providing haemodialysis services without a dedicated unit, we have been able to successful implement a “fly in fly out” service led by the Renal-Cardio CNC, Nephrology team and the Acute Haemodialysis unit.