Ways to Support Patients on Peritoneal Dialysis
When it comes to the ongoing management of peritoneal dialysis (PD) patients, finding ways to help improve outcomes and reducing patient loss rate should always be the number one focus. In my experience, monthly patient visits are a key touchpoint in the constant quest to achieve better PD results. Monthly visits can be personally and professionally fulfilling because the Interdisciplinary Team (IDT) gets to meet with the patient and the patient’s family, reestablishing personal connections that help ground interactions and strengthen relationships. For planning purposes, it may be helpful to think of the monthly visits in three parts: the pre-visit, the visit, and the post-visit.
For pre-visits, it is important to meet separately with the IDT and review their chief concerns. A litany of topics, including any complications the patient has had and any new consults needing review, are discussed. The IDT also reviews any hospitalizations and, if they occurred, a root cause analysis is performed to understand the reason for admission and what actions to take to prevent a recurrence.
For the actual visit itself, a thorough checklist of what to cover in tandem with electronic health records (EHRs) for documentation may be a good place to start. However, at this point, it is useful to focus first on what is most important to the patient; even though getting through the checklist may be most important to you, it may not be what is most important to the patient. In order to ensure alignment between the two, be sure to cover all key areas, including anemia management, dialysis adequacy (Kt/V), and bone and mineral metabolism. Also spend a lot of time looking at the patient’s prescriptions, reviewing their documents from home, and proactively determining if the membrane is failing. If it is failing, consider other modalities and talk about the possibility of transplantation. Many PD patients are great transplant candidates so be sure they are up to date in their evaluation of that option.
Taking a holistic approach to care is vital to ensuring that the patient is safe and healthy, not just on the day of the patient visit, but on the other 29 days of the month as well. In the same vein, adopting the following three strategies can encourage patients to remain active in their own healthcare while supporting improved clinical outcomes.
- Have the patient train on and demonstrate the PD techniques. Properly adhering to preferred procedures and techniques can help prevent infections and avoid cross contamination.
- Observe the patients at home. The ability for the IDT to visit patients at home not only helps support the patient’s health, it goes a long way in building trusted relationships. After completing the initial home visit for each patient, the number, timing, and frequency of additional home visits will be based on individual patient needs as indicated in the patient’s plan of care.
- Consider how to collaborate with the rest of the health system, including the hospital and other consultants. When patients are hospitalized, smooth transitions of care, whether going into or coming out of the hospital, are desired. Furthermore, the IDT can discuss with the hospital team how to best care for PD patients.
In summary, the best way to achieve improved clinical outcomes for PD patients is being diligent in the pre-visit, visit, and post-visit stages while proactively anticipating problems that might occur. Problems discovered in the pre-visit can be addressed when the IDT voices concerns they have. Any potential problems during the visit can also be addressed by listening to what’s important to the patient, and making sure a transition plan is in place if they need to transition to a different modality. Finally, we proactively address problems by training and retraining patients when they are in the dialysis center and also in their homes. When considered as a whole, all of these approaches can help keep PD patients safer and healthier.