Home hemodialysis bringing life-saving care into patients’ homes

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It’s 4 a.m. on a Tuesday morning. While most of Durham Region is sound asleep, Peter Robinson and his wife Mary awaken to give Peter his regular dialysis.

Instead of heading to a Lakeridge Health site, training from the hospital’s RNs allows Peter to complete the dialysis process from the comfort of his home and with the assistance of his wife. By 8 a.m., Peter and Mary have finished his home hemodialysis and are both free to spend their time as they please – go shopping, visit their children, or even go for a swim.

“Before I had home hemodialysis I was a very, very sick person both physically and mentally,” says Peter.  “Now, I feel as normal as I can be. I am alive because of [Lakeridge Health] and Mary’s help.”

The Lakeridge Health Home Hemodialysis Clinic is part of the hospital’s Regional Nephrology System, one of the top three nephrology programs in the province. It has grown from three patients to 50 in just six years and uses education and training to take a patient’s care into their own hands and homes. The clinic is the only one of its kind in Durham Region and has been recognized as being leading practice by Accreditation Canada.

To Peter, home hemodialysis is a “win-win” situation for patients and for hospitals like Lakeridge Health. It is a life-saving and life-preserving treatment offered to patients with kidney failure that allows them to receive dialysis more often than they would in the hospital and on their own schedule. Through receiving dialysis more frequently, patients are healthier and require fewer hospital visits.

Putting care into the hands of patients

Peter was going to a kidney specialist for several years before he was diagnosed with kidney disease. Just one month after this diagnosis, Peter needed to go on dialysis and worked with a nephrologist to choose between peritoneal, nocturnal, inpatient and home hemodialysis services offered at Lakeridge Health.

Peter and his wife then agreed to go into an intense six to eight week training program at Lakeridge Health that would allow him to receive treatment through home hemodialysis. While there, the couple met Tina Regular, an RN at Lakeridge Health who trained Peter and his wife to look after his health independently.

“Our patients come to us when it’s chronic, last stage and not reversible,” says Regular. “They do better because they are looking after themselves through self-management and self-care. When you give them that knowledge and you guide them, they are going to take it and use it so that they don’t get sick and they don’t end up in the hospital.”

With a nurse-to-patient ratio of one nurse for every 15 to 20, patients of the home hemodialysis program receive one-on-one training and guidance from a Lakeridge Health nurse, who then assists them with the transition into their home. Patients in any home hemodialysis program also undergo extensive modifications to the electrical and plumbing infrastructure of their homes. “If a patient’s residence is not up to code, a social worker will assist them with finding new housing,” says Colleen Holstein, an RN in the Home Hemodialysis Clinic at Lakeridge Health. “If they need technical support, our biomedicine technologists are there for them. Our RNs are available to them 24/7 for additional support as well. On top of that, the patient will visit the hospital once every two months for a check-up with a physician, dietician and pharmacist. The support is endless.”

Tailor-made care for unique patients

Before joining the program, each and every patient in the home hemodialysis program at Lakeridge Health receives tailor-made treatment and proper, thoughtful consideration. “We tailor specific care to each individual patient,” saysHolstein. “It’s all about who you are training. What worked for the last patient might not work for this patient and it might not be what they need.”

Patients in the program vary in age and location, with an age range of 18 to 93 and patients living up to 2.5 hours away from Lakeridge Health Whitby.Holsteinand Regular, as well as other nurses, work to ensure treatment is given to the patient who needs it the most.

“Whatever the barrier to care is, we will work with them to get over it,” says Regular. “Some patients may be living alone, speak a language other than English, or have other concerns that need to be addressed in order to be successful with this treatment. Our team will work with the patient to overcome the barrier or issue.