91-603 / Advanced practice nurse attending patients with Advanced Chronic Kidney Disease (ACKD)

GOP Information
Organisation sharing the GOP
Related practices from PaSQ database
Andalusian Public Health System


Quality improvement project
Professional learning program on quality and safety
Education in Patient Safety
GOP Description
Implementation level
Clinical settings
Primary and hospital care
Enhancing patients’ empowerment to allow them to make decisions about different types of renal replacement or conservative therapy; Enhancing self-care and patients’ autonomy; improving quality of life of patients with Advanced Chronic Kidney Disease (ACKD).
Patients with Advanced Chronic Kidney Disease (ACKD) (IV-V) with renal replacement or conservative therapy and their cares.
Definition of target population, objectives, and service portfolio of ACKD nurses.
Definition of competencies profile.
Design and development of training plans.
Dissemination and strategy of establishment plan.
Definition of results and quality criterias.
Timeframe implementation
1 year
Implementation tools available
Protocol of advanced practice nurse attending patients with ACKD edited by Department of Care Strategies – Andalusian Regional Ministry of Health and Social Welfare.
Training plan.
Dissemination and establishment strategy.
Competencies accreditacion manual (in process)
Implementation cost
Design and digital publication of protocols: 1500 euros.
Accreditated training activities for 20 nurses: 3000 euros.
Accreditation process of advanced competency: 0 euros for Andalusian Public Health System workers.
Adaptation of Digital clinical history and information systems for recording and monitoring: between 8000 and 10000 euros
Method used to measure the results
Training monitoring data (Training and Professional Developement Service of Andalusian Health Service)
Andalusian Agency for Health Care Quality information system for accreditation of advanced competency
A total of 11 nurses of 6 hospitals of the Andalusian Health Service were trained. During 2011 a total of 283 patients were attended. At 31st December, 224 of them are still active (31 with conservative therapy). 33 started dialysis during 2011 and y 27 died. 65.2% of patients who decided on technique chose hemodialysis (HD) and 34 % Peritoneal dialysis (PD)
Analysis of the results
Analysis after the first year of implementation 2010 – 2011:
Peritoneal dialysis grew up compared to hemodialysis in our region in 2011, in 166 new patients. This increase verified fundamentally in centers related with the strategy development (from 8.3% in 2010 to 12.7% in 2011 for hemodialysis). It allowed a saving 420000 euros for the Andalusian Health Service (~14500€ for patient/year). The development of protocol of advanced practice nurse attending patients with ACKD, permitted an increase of house peritoneal dialysis, the transplant from living donor previous to dialysis and conservative therapy.
Implementation barriers
Did you find implementation barriers?
Please describe implementation barriers
Now we are extending the practice to other hospitals of the Andalusian Health Service
Describe the strategies used to overcome the barriers (If needed)
Review and monitoring of implementation and reorientation indicators with managers of hospital centers to provide continuity to advanced practice development.
Other information
Other information about the GOP that you would like to add (Link or attached document)
Advanced practice attending Advanced Chronic Kidney Disease is provided by a nurse who have received formal training and developed specific competencies to give cares to patients with Advanced Chronic Kidney Disease in 4 y 5 level.
The nurse provides comprehensive cares, personalized and with an optimum quality level to pepole with Advanced Chronic Kidney Disease and their cares, guarantying to cover every need and expectative of patients and their cares.
The nurse informs adequately patients and their cares about the replacement therapy, encouraging patients’ decision making choosing freely between the different types of therapies, promoting patients’ participation managing them, inciting continuity between different care levels and performing a rational use of the resources.615_834_GOP_INFORME EJECUTIVO FEBRERO 2012a.pdf