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Dialysis Issues

Dialysis Issues

The Dialysis Working Group's main focus is equity and access to high quality dialysis services for patients diagnosed with end-stage kidney failure. The Group is working to improve the following issues:

Planning and delivery of dialysis services to meet demand in NSW.
Knowledge of anticipated growth in demand for dialysis services - and the capability of the current NSW health system to meet the demand.
Management of water quality, both for dialysis centres and for home treatment systems.
The burden of transport for those patients who are experiencing extreme hardship in regularly attending their haemodialysis centres.
The pre-dialysis pathway and availability of high quality vascular access provided at the right time for commencement of dialysis treatment.
Better use of health budgets through efficient tenders and contracts for purchasing dialysis consumables.
Adequate planning to assist dialysis units to quickly respond in times of disaster.
Increased uptake of home-based dialysis treatments.

NSW Renal Dialysis Plan to 2011

The RSN Dialysis Working Group had considerable input in the development of the NSW Renal Dialysis Plan to 2011. The Plan was endorsed by NSW Health in 2007, and is readily available for use by Area Health Services across NSW to assist planning and to set expectations for renal treatment programs. Please contact the Network Manager for a copy of the Plan.

NSW Dialysis Capacity Audit

In April 2009 an audit was undertaken of dialysis capacity in NSW. The report from the 2009 Dialysis Capacity Audit was prepared and released to all Area Health Services. The results of the first audit were found to very helpful for predicting and planning development of dialysis services.

At the request of clinicians, the audit was repeated in April 2010. As with the first audit, the 2010 results were circulated to all renal units for verification prior to completion of the report. The report from the 2010 Dialysis Capacity Audit has been made available to all renal units and to NSW Health Department.

The NSW Ministry of Health has undertaken the 2011 Dialysis Capacity Audit and the results will be released shortly.

Renal Key Performance Indicators

A set of renal KPIs has been developed for use in NSW, and is included in the NSW Renal Dialysis Plan to 2011. It is intended that the KPIs will reflect progress towards the achievement of the principles outlined in the Plan. Construction of the indicators reflects wording used in the Queensland KPI Project and the proposed Australian Council on Healthcare Standards (ACHS) clinical indicators. NSW Renal Services Network is represented on the national group advising ACHS on the renal clinical indicators.

Renal Minimum Data Set

NSW does not have a system for accurately recording its dialysis services. The Renal Information Management Group developed a minimum data set in 2006, for use by renal services to measure dialysis activity and to assist planning of renal services. At present, not all renal units have a data collection system that can record the items listed in the minimum data set. The renal network is working with NSW Health to build a system that will collect all dialysis episodes statewide.

The Renal Information System Catalogue (RISC) is already in use in many renal units and has been offered across NSW with assistance from GMCT. Those areas which choose to use their own in-house system for renal data collection will need to ensure that their renal data system: (a) includes all components of the minimum data set, and (b) is compatible with the requirements for the eMR.

Once the activity and outcomes data in the minimum data set are recorded, this will also provide reports on the majority of the key performance indicators listed in the NSW Renal Dialysis Plan to 2011.

Water Quality

A multidisciplinary subgroup of the Dialysis Working Group has produced a guide for managing water quality for dialysis in facilities, and a supplement for home and other non-facility-based dialysis water pre-treatment:

Dialysis Water Pre-Treatment for In-Centre and Satellite Haemodialysis Units in NSW: A Set of Guidelines.

Supplement: Water Pre-treatment Standards for Home Haemodialysis.

In response to queries around the use of ‘ultrapure dialysate’, the working group recommends use of the published (2010) Standard ISO 13959:2009: “Water for haemodialysis and related therapies” which identifies standard quality dialysis water to be used in the production of ultra-pure dialysate, with additional reference to ISO 11663:2009 “Quality of dialysis fluid for haemodialysis and related therapies”.

Further information about these standards can be obtained from the Network Manager.

NSW Rural Renal Clinical Advisory Group

This group was coordinated and funded by NSW Health, and had strong links to the Renal Services Network. Following the formation of ACI, it is expected that a rural subgroup will be formed to advise the Renal Network on rural issues.