Health Authority – Abu Dhabi

أبوظبي - الصحة هــيئـــــة

Title: HAAD Standard for renal dialysis clinical service Reference: PHP/POS/RD1

Issue Date: 16/06/09 Next Review Date: 16/06/10

Purpose This standard provides an interim advisory guide to health care professionals to support the delivery of quality and safe clinical services to patients receiving haemodialysis or continuous ambulatory peritoneal dialysis.

Policy Statement The Health Authority Abu Dhabi is the authority responsible for regulating all aspects of health care service, including quality of care and patient safety. HAAD fulfils its mandate through regulations, standards and guidance material, including integrated care management standards for specific diseases and clinical services to ensure that patients move progressively through a clinical experience to positive outcomes.

An integrated care standard provides professionals and patients a framework of multidisciplinary approach to the treatment required and supportive care expected within a clinical setting and timeframe.

Specific integrated care standards are evidence‐based, take into account variances in care and patient outcomes, and are designed with a view to patient‐centred care. They aim to reduce unnecessary variations in patient care and outcomes.

Clinical services and patient care should be delivered in accordance with the laws and regulations of the Emirate of Abu Dhabi and consistent with HAAD policies, standards and guidelines.

Scope This standard establishes guidelines that set out the processes of care and service specifications for patients receiving haemodialysis or continuous ambulatory peritoneal dialysis (“CAPD”).

Applicability This standard is intended for use by all healthcare facilities providing haemodialysis or continuous ambulatory peritoneal dialysis services to patients.

Roles and Responsibilities The interim advisory status applies for a period of 12 months from the date of publication or release by HAAD. The standard becomes mandatory after 12 months from publication by HAAD, at which point all health care facilities delivering haemodialysis or continuous ambulatory peritoneal dialysis must comply with this standard. During the interim arrangement (advisory status), all healthcare providers engaged in delivering haemodialysis or continuous ambulatory peritoneal dialysis services endeavour to:

• follow this care standard as guidance for delivering clinical services and care for patients receiving haemodialysis or continuous ambulatory peritoneal dialysis;

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• record variations or deviation from this standard where this is determined as necessary by the specialist treating doctor.

Standards A full‐range of clinical services should be provided for patients receiving haemodialysis or continuous ambulatory peritoneal dialysis (”CAPD“). The care should include the following:

Standard 1: Clinical definition o Case mix, to include:

1. Chronic renal failure and acute renal failure (including inpatient dialysis and dialysis provided for patients cared for within the Intensive Care Unit);

2. Patients with co‐morbidities, including blood borne virus infection (as per HAAD regulations and existing arrangements with haemodialysis and peritoneal dialysis services).

o Care pathway, to include: 1. A range of types of ongoing dialysis, i.e., for patients who have completed induction into a

stable treatment regime including both haemodialysis and CAPD; 2. Dietary advice and support for the patient and carers; 3. New patient induction, including A‐V fistula formation, management of venous access, and

regular monitoring to titrate dialysis treatment regime, including frequency; and 4. Pre‐transplantation work‐up, including ongoing dialysis, service coordination for the

multidisciplinary team, and provision of certain clinical investigations. o Service specification; the Provider will be required to:

1. Support haemodialysis either three times or twice per week (as required on an individual patient basis), or support CAPD as required by individual patients;

2. Comply with HAAD requirements for information technology (“IT”) and data management, including sharing of pathology results, electronic patient records and disease management systems;

3. Provide erythropoietin injections as clinically required by patients; 4. Provide general medical treatments for patients as required clinically.

Standard 2: Service specification o Opening hours – the Provider will be expected to provide haemodialysis services from 7am to 10pm

seven days a week; it is expected that the Facility will need to be open from 6am to 11pm to underpin the provision of services between these times.

o Geographical access – clinics and treatment centres providing haemodialysis services will be expected to take into account patients’ needs for access and transport requirements.

o Health workforce – the provider will be expected to ensure clinical staff and treatment facilitators work as part of a collaborative multi‐disciplinary team.

o Facilities – all healthcare facilities providing haemodialysis or continuous ambulatory peritoneal dialysis services must be licensed by HAAD. The Provider will be expected to have available the equipment and supplies necessary for treatment and patient care, maintained according to HAAD requirements and standards.

o Patient education‐ the provider will be expected to deliver a culturally and socially relevant patient education and information regarding the treatment and care, consistent with the HAAD patient Charter and relevant HAAD policies.

Service model o Clinical care model:

1. It is expected that day‐to‐day care will be delivered by consultants and specialist doctors and appropriately trained nursing staff, supported by allied health professionals. All health professional must be licensed by HAAD;

2. Consultant and Specialist Doctors will provide the following clinical services:

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a. Regular supervision of patients (e.g., it is expected that patients will be seen by their supervising doctor at least once per week, and as required clinically);

b. Maintenance of “clinical lists”, i.e., which patients are receiving care in the Facility, and what the nature of their care is.

o Clinical management ‐ Providers will be required to ensure their services and management systems: 1. Comply with current HAAD Standards, e.g., for clinical supervision, including the requirement

for regular peer review, e.g., comprehensive case reviews by Consultant and Specialist Doctors;

2. Underpin a drive for continuous improvement in clinical quality, and are capable of tracking performance, including trends in clinical quality/outcomes;

3. Provide seamless care in partnership with other providers, including primary care and hospitals, as required for holistic patient care.

Key Performance Indicators (KPIs) The Provider will be performance managed according to key performance indicators; these will include: o Clinical KPIs

1. Clinical outcomes, e.g., based on KDOQI (Kidney Disease Outcomes Quality Initiative); 2. Patient quality of life, e.g., SF36 questionnaire; 3. Patient satisfaction surveys.

o Management KPIs 1. Meeting local and/or regional community dialysis service needs (efficient and cost‐effective

service); 2. Timely, high‐quality reporting, including adverse incidents and Health Informatics system

(HIS); 3. Meeting other required regulations, e.g., health and safety, insurance.