Improving specialist care for patients with Nephrostomies

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Background

Nephrostomies are vital for patients with obstructed kidneys and are relied upon to preserve renal function, often to allow further treatment adjuncts such as chemotherapy in cancer patients. When they fall out, they put patients at risk of renal failure, pain and sepsis.

Problem

• Nephrostomies frequently falling out, or blocking.
• Dressings noted to be in poor state, connections not being changed
• Resultant increase in morbidity and number of emergency admissions and nephrostomy exchanges

Aim:

Quantify percentage of nephrostomies being replaced due to premature falling out, and identify reasons for this recurrent problem

• Enable all patients with nephrostomies access to regular, specialist dressing and connector changes

Methods

• Retrospective 1 year audit of all nephrostomy changes and insertions
• Discussion with district nurses to identify barriers to community care – inadequate funding identified.
• Cost analysis performed for all required dressings
• Approached the CCG to negotiate further funding

Results

• On average a nephrostomy falls out every 18 days, comprising 11% of the workload for new insertions
• Demonstrated that there is poor access to the specialist required dressings due to financial restraint, which directly caused unnecessary emergency admission, patient distress and burden on the Urology and Radiology services

Conclusion

• Our bid to increase dedicated funding to enable patients and nurses to access specialist dressings was successful
• As a result the CCG contract was amended and £20,000 was made available
• Each patient can now be given enough supplies to last until next scheduled nephrostomy change
• Plan to re-audit after 12 months