Case study:

11 May 2010

Hospice Staff Exchange Programme involving Renal and Palliative Care Services in Central Manchester Foundation Trust

Key points

An exchange scheme between hospice and renal staff at Central Manchester Foundation Trust is helping to improve the palliative care of renal patients with end stage renal disease who have decided against dialysis

The scheme was introduced after it became clear neither hospice nor renal staff had the knowledge and skills needed to care for this group of patients. It also builds on an in-service training programme on kidney disease at four local hospices.

The programme involves staff from the renal unit working at either St Anne’s Hospice in Cheshire or St. Anne’s Hospice in Salford for a week and staff from the hospices working in the renal unit for a week. Aims and objectives of the placements are linked to individuals’ Knowledge and Skills Framework.

Since the programme started two years ago eight patients have withdrawn from dialysis to spend their last days in local hospices. In addition four patients who had opted for conservative management of their renal disease have accessed hospice day care and in-patient care for symptom control. Meanwhile 75 hospice staff have attended the renal element of the hospice in-service training programme.

Three multidisciplinary team meetings have taken place between renal and hospice staff which led to amended documentation and altered placement schedules following feedback from staff who undertook the programme.

This collaboration is one part of a wider initiative across the palliative care and renal networks to improve access to services for patients with chronic kidney disease. Plans for the future include extending the programme to other local hospices and strengthening links with specialist primary care teams and other community services.

Renal services have seen a growth in the number of elderly patients and patients with multiple co-morbidities in recent years as well as an increase those opting for conservative management. The training programme was set up because it was recognised that renal services needed to develop their skills and work more closely with their local hospice providers in order to support this group effectively.

Although the training sessions were evaluated positively there was still a problem in transferring this knowledge into the clinical environment. As a result the staff exchange programme was developed between the renal centres and local hospice services.

Senior staff were encouraged to undertake the exchange first, allowing them to cascade the benefits of the programme to other renal staff, which increased support for the initiative. The general response to the programme has been overwhelmingly positive but staff shortages have meant that occasionally some exchanges have had to be postponed.

All staff involved in the care of renal patients, including allied health professionals, will be included in the exchange programme in the future. It will also be included in staff induction programmes.