In January 2005 Victoria released the final report from its review of
renal services in Victoria. The review aimed to:
| |
Recommendations |
Status |
| 1 |
The department will recognise overnight
haemodialysis as a separate modality for funding purposes. It will
also regularly assess the scope for adopting new technologies and
developments in other modalities which should be considered for support
in a Victorian context. |
Nocturnal home haemodialysis (NHD) mainstreamed
as of 1 July 2005. Reporting requirements updated to include
NHD. |
| 2 |
The department will seek to collect
supplementary data via hospital returns that are incorporated into
ANZDATA to assess compliance with Principle 5, that patients and
their carers should be able to access the haemodialysis satellite
that is most convenient to their place of residence. It will also
monitor use of non-emergency transport to ensure haemodialysis services
accessed by patients are cost-effective. |
Victorian Dialysis Registry upgraded
to collect additional information as of 1 July 2005 and on a monthly
basis.
Three Maintenance Dialysis Facility Audits have been conducted (September 2005,
June 2006 and June 2007). |
| 3 |
Future development of Victorian
public maintenance dialysis services should be more centrally coordinated
via a maintenance dialysis advisory committee. This committee will
include representatives from hubs, satellites and consumer groups.
The department will chair the committee, which will meet at least
six monthly. Representation on the committee will be rotated. |
Maintenance Dialysis Advisory Committee (MDAC)
was established and has now been replaced with the Renal Health Clinical
Network. |
| 4 |
The roles and responsibilities of
maintenance dialysis service providers will be defined according
to a service level framework which describes service provision responsibilities
at different levels within the maintenance dialysis system, minimum
staffing qualifications at each level, and provider responsibilities
at each level relating to renal nurse training, quality assurance,
allied health provision, technical support, and business support. |
Service level framework was used
as a reference in the development of Western Health and Eastern Health
as hub level providers. In 2008-09, both Eastern Health and Western
Health will attain hub level status. |
| 5 |
A new category of service provider
should be introduced and termed a ‘node’. Node providers
will assume a greater level of responsibility for patient management
than the majority of satellites currently assume (for example, routine
care of peritoneal dialysis patients). There should be a medium term
target over the next five to ten years to create a node in each departmental
non-metropolitan region. The Maintenance Dialysis Advisory Committee
will assess the capability of a service provider to assume node responsibilities
(see Recommendation #3). |
Currently working with Bendigo Health
Care Group to establish the first regional node service. |
| 6 |
Funding and service agreements between
hubs and satellites must be updated on an annual basis as a condition
of department funding and contain a minimum level of detail on the
following areas: types of services to be provided by the hub and
satellite (consistent with the service level framework), activity
performance targets, level of funding for undertaking these services,
minimum staff and facility standards, and other services to be provided
by the hub and satellite. |
Funding and Service Agreement developed
for use by services from 2007-08. |
| 7 |
Over time there should be a move
to greater regionally defined hub responsibilities for infrastructure
and clinical support, commencing with regionalised education services. |
Further work on this recommendation
will occur under the direction of the Renal Network. |
| 8 |
Satellites will only be required
to conform with one set of clinical protocols unless there is demonstrated
clinical evidence to the satisfaction of the Maintenance Dialysis
Advisory Committee that more than one set of protocols would not
be detrimental to patient care. The protocols of the primary hub
to which a satellite relates will take precedence over the protocols
of other hubs. Statewide protocols for the application of infectious
diseases (such as Hepatitis C and vancomycin resistant enterococci
) will be developed. |
Services advised of the policy of only having
to comply with one set of clinical protocols in August 2005.
Infection control guidelines for renal units were approved for
release in August 2006. |
| 9 |
The department in conjunction with
the Maintenance Dialysis Advisory Committee will explore the further
extension of renal nurse practitioner models. |
Further work on this recommendation will occur
under the direction of the Renal Network. |
