Authors (including presenting author) :
Lam MK (1), Li KN (1), Chan PW (1), Mak CL (1), Hau CS (1), Wong SW (1), Chu SW (1), Kwan MS (1), Kung Y (1), Choy BY (1), Chan TM (1).
Affiliation :
(1) Nephrology, Department of Medicine, Queen Mary Hospital
Introduction :
Home visit service (HVS) to dialysis patients has established in the Renal unit of Queen Mary hospital for long times. It provides an opportunity to assess patients’ home environment for the continuity of care between patients and home visitors. However, such service was suspended due to COVID-19 pandemic since February 2020, quite a numerous post training home visits were deferred.
Objectives :
In view of the accumulated numbers of deferred home visit cases. We started to continue home visit by zoom to the targeted groups of patients. Those peritoneal dialysis (PD) patients who had completed training since February 2020 but did not receive home visit service due to COVID -19 pandemic and those home Haemodialysis (HHD) patients required pre home environment assessment and post training assessment was included.
Methodology :
“Zoom” was chosen as the media to perform home visit because it is free of charge. The screen display is stable and the picture quality is good. The picture is synchronized with the sound as well when comparing to “Whatsapp” and “Wechat”. Numerous preparation works have to be done before conducting zoom home visit. A pilot run of one-month zoom home visit starting in December 2020 were planned initially depends on current COVID-19 situation. For pre Zoom phase: A work group has been formed by the Ward Manager (WM), Nurse Consultant (NC), Advanced Practice Nurses (APNs) and five dialysis nurses. Checklists for both PD and home HD patients were modified from the existing one. Targeted patient / helper participants were figured out to join the study. Around thirty PD cases and one HHD cases were included to start the zoom home visit within the set period with temporary arrangement of extra nursing manpower to fulfill the task. Consent form to join the HV were revised and was endorsed in the Renal Management meeting. Zoom apps were allowed to use after discussion with the internet technology (IT) department. Two instruction guides for downloading zoom apps and how to join zoom meeting were prepared to nurses and patients / helpers. Special stabilizing devices were also provided to patients for stabilization of their cell phone / i-pad / tablet according to their needs. One trail run was conducted with nursing staff at home and two trail runs were conducted with two PD patient volunteers with comments and feedback. Modifications were done accordingly due to time limitation in using zoom. Zoom home visit were conducted according to the recommendations and time scheduled planned before. Patient’s home environments, bag exchange techniques, PD related knowledge were evaluated during the HV for PD patients. For HHD patients, post assessment to home HD patients were carried out according to post training home visit checklist as well. Performance improvement advice were given to patients and caregivers before end of the HV. Comments also gathered from patients / caregivers for the effectiveness and any drawbacks of the zoom HV.
Result & Outcome :
Total 26 PD patients and 1 HHD patients with zoom home visit done in December 2020. During zoom home visit, environmental advice was given, those patients with modified steps, omit hand washing and those forgot to wear masks were reminded. One patient was found contamination of transfer set and need to return to hospital for treatment. Evaluation forms were prepared to patients and nurses post HV to obtain feedbacks. 24 patients were satisfied with the zoom home visit arrangement and agreed that zoom was easy to manage but 2 of them disagreed. 6 patients mentioned that their performance would be affected by external factors and causing some distractions but 17 of them disagreed. All 6 nurses who had conducted zoom HV before agreed that zoom HV were easy to manage and they were satisfied with the arrangement. 2 of them were distracted by external factors and 4 of them were neutral on this point.
