Authors (including presenting author) :
Leung JTW(1), Kwok MK(1), Ho TL(1), Yeung S(1),Tsang SWC(1)
Affiliation :
(1)Haemodialysis Centre, Department of Medicine, Tseung Kwan O Hospital
Introduction :
Telenursing is increasingly used around the world because the benefit of information technology is extended to ongoing care beyond the hospital walls. At TKOH, patients on home-based automated peritoneal dialysis (APD) are required to attend nephrology nurse clinic (RENN) in person at different time intervals for assessment. Through integration of advance technology, a web-based platform (Sharesource) facilitates telenursing service which is initially used as a pilot project to streamline the care pathway for APD patients.
Objectives :
1.To enhance patient safety and patient access to healthcare 2.To improve nursing efficiency by restructuring patient care pathway 3.To optimize patient outcomes and life quality
Methodology :
Stable patients using APD with modem device were recruited for Sharesource connection. Telenursing consultation (RENP) was arranged as alternate of RENN at week 2-3, 6-month post training or when needed. Nephrology nurse examined the triggered flag rules from the remote monitoring system and conducted detail review on patients’ dialysis pattern, treatment adherence prior RENP. Preset template was employed to record specific issues that occurred during dialysis treatment. Patient safety was enhanced by providing proactive nursing education and recommendations via phone in a timely manner, with no limitation on RENN dates and quotas. More flexible RENP would be offered to reduce potential complications. Patients were invited to complete a satisfaction survey at next in-person visit.
Result & Outcome :
From 15 August 2020 to 31 December 2020, 5 APD patients (4 men and 1 woman, mean age of 51.5 years, range 31 to 73) were recruited to pilot RENP program. Majority (80%, n=4) performed self APD whilst one (20%) was done by helper. All APD operators worked full-time. Results showed that total 8 RENPs were provided, thus lessened relative RENN quotas. Prior data review and retrieval from Sharesource platform also diminished total consultation time. Average RENP duration was 19.16 ± 3.13 minutes, range 18 to 26, with about 10.84 minutes reduced if attended RENN. 100% participants completed the Week 2-3 RENP, two (50%) required ≥2 additional RENPs for further education and monitoring before schedule doctor follow-up in Week 6-7. No unplanned admission but one patient had urgent consultation for dialysis complication. Patient satisfaction survey indicated a high score on the restructured service. Over 90% patients agreed that RENP could identify early problems, time-saving and convenience to daily work. All patients were satisfied and preferred telenursing consultation mode. To conclude, patient achieves better life quality by reduction of long waiting time for follow-up, number of hospital visit and frequent absence from work. Early complications detection diminishes unplanned hospital admission and ultimately, reduces hospital cost. Moreover, in the era of COVID-19, telemonitoring option might be a best way to protect home dialysis patient.
