National NICE Quality Standard for Chronic Kidney Disease in Adults
This conference focuses on improving care and outcomes for people with Chronic Kidney Disease and implementing the Updated NICE Quality Standard released in July 2017. Chaired by Jonathon Hope Patient Leader, the conference will demonstrate how to improve practice against the new quality statements.
Jonathon Hope opened the conference with a presentation on The Patient Perspective and how can we help people with CKD live their best life?
He talked about Chronic Kidney Disease from a patients point of view, having been a patient himself. He stated the best outcomes come from "sharing power with patients is key" and how we approach patients..
He spoke about service improvement being about integrity and by staff, patients and public coming together on roles, responsibility and position.
Whilst at school Jonathon was diagnosed with kidney failure. Since then he has experienced 15 years of dialysis, around 3 years in hospital and 3 unsuccessful transplants. In 2005 he received a fourth transplant which is working well.
Over the last 14 years, he has chaired or co-chaired a wide range of local and national healthcare modernisation projects, including those on Kidney Care, Palliative Care, Shared Decision Making and Self-Care.
Until recently, Jonathon co-chairing ‘Transforming Participation in Chronic Kidney Disease (TP-CKD) programme’ with Richard Fluck, funded by the NHS. The TP-CKD programme was using PAM, CS-PAM and a range of other PROM and PREM measures to develop a person-centred approach to kidney care: https://www.thinkkidneys.nhs.uk/ckd/
Jonathon has spoken at over 50 conferences on a wide range of subjects, including service improvement, the patient and carer role in service improvement, the importance of co-design and co-production and the emerging role of patient leaders in transforming the NHS.
Jonathon has also chaired a number of conferences, most recently on Patient Leadership and Co-Production.
In 2012 Jonathon was awarded an MBE for Services to Kidney Patients; was named among the inaugural HSJ Top 50 Patient Leaders survey in 2015; and chaired the first national Patient Leadership Conference mid-2017. Jonathon has a 20 year background in financial services.
Dr Robert Lewis Specialist Committee Member Quality Standard for Chronic Kidney Disease NICE & Consultant Nephrologist Portsmouth Hospitals NHS Trust continues the morning sessions with an update on 'The National Quality Standard for Chronic Kidney Disease' and will cover;
- an introduction to the New NICE Quality Standard for CKD
- what can you address in CKD that will make a difference to outcomes
- arriving at the quality indicators and what has changed
- Quality Statement 1: why is this important to outcomes?
Dr Lewis talked about what good primary care for patients with CKD looks like. This includes early diagnosis, early intervention to reduce risk, intelligent monitoring and appropriate referral to specialist services. He discussed pitfalls in diagnosis and how patient education was key to early intervention.
He summarised that CKD is associated with increased mortality and morbidity and that early intervention and management improve outcomes. CKD can be detected early and economically in at-risk populations (eGFR and ACR) and that management of CKD is no longer a QOF priority. Measurement of the quality of early management of CKD (in primary care) remains desirable.
He concluded that CKD quality statements aim for simplicity in practice, measurability and impact but that the main aim is to drive quality.
Pre conference abstract
Chronic Kidney Disease (CKD) affects about 6% of the adult population. It is associated with an increased risk of cardiovascular disease, in addition to progression towards end-stage kidney failure. Guidelines for the management of CKD were updated and published by NICE in 2014. In 2016 NICE went on to develop a series of quality measures arising from these guidelines which are designed to improve detection rates, slow progression and reduce risk.
In this presentation, the rationale for having quality indicators will be explained. An account will be given of how the new indicators were selected and what has changed since their last iteration in 2011. I will describe how these indicators might be used in practice to improve outcomes. Of the three quality indicators chosen in 2017, the first, which addresses detection of CKD in primary care, will be described in detail (the remaining two quality indicators are addressed later in the day).
Dr Lewis' Biography
Robert is Chief of Service for Renal Medicine and Transplantation at the Wessex Kidney Centre which, provides specialist renal services to an extensive area of the central south coast of England. The Service is based in Portsmouth, but his own clinical practice is in West Sussex.
He graduated from the Westminster Medical School, (now Imperial College London) in 1984 and undertook his renal training at St Bartholomew’s Hospital, Kings College Hospital and Guy’s Hospital. He completed his thesis at Guy’s Hospital in 1996 and was appointed as a consultant in Wessex in the same year.
He was a founder member of the CKD Strategy Committee for the British Renal Society and was a member of the development group for the 2014 NICE guidelines for management of CKD in adults. He authored and edited an online teaching resource (CKD online) in 2010 and published a textbook on CKD in 2012. He was a member of the NICE quality standards advisory committee for CKD in 2016-17 and is currently part of the NICE guideline surveillance group.
The afternoon speakers began with an extended session from Dr Richard Fluck Clinician Co-Chair Think Kidneys & Rachel Gair Person Centred Care Facilitator Transforming Participation in Chronic Kidney Disease programme on 'Improving Quality in Chronic Kidney Disease' and discussed;
- embedding quality improvement into daily practice
- improving outcomes and delivering quality improvement
- leading quality improvement and getting it right first time
- sharing good practice and reducing unwarranted variation
- monitoring improvement against the New NICE Quality Standard
Richard discussed how we can involve people in their own care and how we can raise awareness on kidney disease. He stated there is no magic bullet and its about creating relationships with patients and working together.
Dr Fluck's Biography
Richard trained at Trinity Hall, Cambridge and the London Hospital Medical College. After training posts, he undertook research at Bart, examining the impact of chronic kidney disease on calcium signalling. He was appointed Consultant Renal Physician at Derby City Hospital in 1996, initially as a single handed nephrologists.
Over the last 20 years, he has continued an interest in the cardiovascular consequences of kidney disease but has a broad range of research and improvement interests. At Derby, he is a member of the Renal Risk in Derby project and the Acute Renal Risk in Derby study (RRID and ARRID). He has led local work to improve vascular access outcomes, infection risk in dialysis and the uptake of home therapies.
Nationally, he continues to publish chapters of the national UK Renal Registry annual report, led the national Renal Audits and, as National Clinical Director (Renal), established the Think Kidneys programme to improve outcomes related to Acute Kidney Injury and Patient Participation in CKD. He is chair of the Leadership Development programme for the Kidney Quality Improvement Partnership.
Other roles include chairing the steering committees of several NIHR and Health Foundation projects, is a Q member and is country co investigator for the Dialysis Outcomes and Practice Patterns Study (DOPPS). He has been President of the British Renal Society and is now Clinical Co-chair for Specialised Commissioning (Internal Medicine NHS England.
Rachel is the Person Centred Care Facilitator for the Transforming Participation in Chronic Kidney Disease programme and in this role she works closely with the clinicians and patients involved in the programme. She is the Expert nurse Specialist on the Programme Board and is also on all three of the workstream groups. Rachel is a Registered General Nurse and trained at Hammersmith Hospital in London.
Rachel has worked at several large renal units and was the matron for renal services in Plymouth for 10 years. Following this she was the nurse director for the Peninsula renal network where she developed a special interest in improving services for young people with kidney problems, linking it to the concept of person centred care. She helped establish and currently coordinates the Renal Shared Decision Making and Transition Network for professionals interested in young people’s services and how these can be underpinned by person centred care.
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