Tuesday, February 27, 2024
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New system delivers better management of renal patients

James Kon

The Ministry of Health (MoH) through the Department of Renal Services will commence the use of the Therapy Data Management System (TDMS) for the management of renal patients at Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital.

RIPAS Hospital will be the first dialysis facility in Brunei Darussalam to adopt the concept of combining an integrated central monitoring system using TDMS from Fresenius Medical Care with 40 hemodialysis (HD) machines supplied through this project, according to the MoH.

Minister of Health cum guest of honour Dato Seri Setia Dr Haji Mohd Isham bin Haji Jaafar virtually launched the TDMS for the management of renal patients during a ceremony at the Renal Dialysis Unit at RIPAS Hospital yesterday.

With the system, each patient will be provided a personal card containing his medical data which will be connected directly with the TDMS system and Brunei Healthcare Information Management System (Bru-HIMS). This will allow for a more efficient and effective management of patients, while at the same time ensure medical professionals and nurses are able to directly access patients’ dialysis treatment from any branch of the department.

Head of Renal Services Hajah Wan Aslina binti Haji Ibrahim said, “The Renal Dialysis Unit at RIPAS Hospital first opened in 1983. Back then, there were only 15 dialysis points with 15 haemodialysis machines.

“Now we have a total of 40 new haemodialysis machines on lease for seven years, on top of the 10 current HD machines that are still in good condition. We have 108 dialysis treatment points throughout RIPAS Hospital, 24 of which are in the Renal Dialysis Unit for outpatients, and 84 for inpatients.”

“It was planned that the Renal Dialysis Unit RIPAS Hospital would be the first dialysis facility in Brunei Darussalam to adopt the leasing concept of HD machines with integrated central monitoring system using TDMS from Fresenius Medical Care, the world’s leading provider of dialysis products and services,” Hajah Wanaslina said.

Minister of Health Dato Seri Setia Dr Haji Mohd Isham bin Haji Jaafar speaks at the event

The lease started on March 1, 2022, with all 40 machines delivered and installed at designated areas across RIPAS Hospital. Seven years is the usual life expectancy of a HD machine.

Discussing the many benefits of leasing, she said, “It will ease the government’s load, save both time and money, and be managed by the vendor to ensure the efficiency and safety of the services. These include manpower, comprehensive 24/7 maintenance with spare parts for HD machines and TDMS. The seven-year lease will cost the MoH roughly BND2 million.”

Elaborating on the TDMS, Hajah Wan Aslina said, “Every patient will have a Smart card with his details linked to TDMS. From the moment the patient enters the dialysis centre and enters his card into the card reader, TDMS interfaces directly with all patent touch points – from weight taking, BP measurements to the dialysis treatment itself, where all treatment parameters are continuously monitored and recorded.

“Documentation is thus improved, and scribing errors are minimised. Treatment progress and parameters can be monitored in real-time at the TDMS stations in the centre and even remotely by the doctors.

“Treatment summaries will be generated by TDMS after each dialysis session and seamlessly uploaded onto Bru-HIMS. There is increased automation and efficiency, reducing the time nurses’ spend on documentation, allowing them to focus on direct patient care, thereby improving the patient experience and care. There will also be reduced paper use and less physical storage required with digitalisation.”

Meanwhile, Dr Lim Chiao Yuen of the Nephrology Department highlighted that Brunei Darussalam has one of the world’s highest incidence and prevalence of end stage kidney disease. Based on data from 2020, the Sultanate had the second highest incidence of end stage kidney disease in the world, behind Taiwan.

With increasing age risk factors like diabetes, hypertension and obesity, she said, “We will continue to see rising numbers of patients requiring kidney replacement therapy. As much as the department would like to increase the kidney transplant and peritoneal dialysis uptakes, hemodialysis remains the predominant modality, and will remain so for the upcoming years.

“Therefore, there is a need to continue to improve the quality of care that we deliver to hemodialysis patients. Information and data management have to meet growing demands.”

She continued, “One of the department’s initiatives is to implement the TDMS, which is an integrated solution for data acquisition, data management and quality assurance. It integrates in the existing work processes and supports doctors and nurses in daily tasks to improve efficiency.

“TDMS provides intuitive user interfaces for patient specific management of vascular access, hospitalisation, dialysis prescription, medication prescription and clinical documentation. It also supports exchange of patient data, laboratory results and treatment outcomes with BruHIMS.

“TDMS’ full potential can be realised when we dig deeper into the numbers. On average, each patient undergoes hemodialysis three times a week – that is 156 hemodialysis sessions per year. There are roughly 800 hemodialysis patients in the country, making a total of about 120,000 hemodialysis sessions per year. Each hemodialysis session lasts for a standard of four hours, which means we deliver half a million hours of hemodialysis treatments every year. Imagine the amount of time nurses spend on manual monitoring and documentation and the potential for errors there.”

In the current practice, Dr Lim revealed that “the already-overstretched nurses have to manually enter this data either on paper or into BruHIMS.

“Increasingly, more time is now being spent on the documentation of treatments, along with the usual day-to-day nursing activities. It is likely that the extent of documentation will increase even further in the future. This is particularly relevant in the COVID-19 pandemic we are now facing, which has significant repercussion on resources and manpower.

“As Aslina alluded to earlier, there are potential errors when entering and transcribing data. Occasionally, what we observe on the ground is missing hemodialysis records or data loss which becomes a problem when it comes to data accuracy for our Brunei Dialysis and Transplant Registry.

“With TDMS, nurses are relieved of the paperwork and documentation burden, so they can focus more on direct patient care. On top of that, the implementation of TDMS is in alignment with the vision of the National Committee on Quality and Patient Safety. We emphasise on improved patient safety, quality control and accountability.

“When we do root cause analysis of incident reports and sentinel events, a common recurring theme is lack of proper documentation and hand over. So this is one aspect I’m really looking forward to, to see how the system complements our patient safety initiatives.”

The TDMS launch is also in line with various activities organised in conjunction with the World Kidney Day 2022, which is marked every March. The theme this year is ‘Bridge the Knowledge Gap to Better Kidney Care’.

The launch fittingly embraces the theme and brings us closer especially within healthcare by digitalising and making the information available to be integrated with the Bru-HIMS system to enable ‘One Patient, One Record’ to be achieved.

The Renal Dialysis Unit at RIPAS Hospital is one of seven dialysis centres in the country. It caters to the needs of both inpatients and outpatients. At the end of 2020, the Renal Dialysis Unit had 165 HD outpatients.

They consist of patients with a variety of diseases including heart, stroke and frail patients who will benefit from dialysis in a hospital-based environment and patients who have just begun HD treatment.

Inpatients can become unwell with a host of medical issues and will benefit from enhanced dialysis monitoring through TDMS.

The Renal Services Department is committed to quality renal care for patients with kidney disease and will continue to strive to improve services and ensure current and future needs are met.

Permanent Secretary at the MoH Haji Maswadi bin Haji Mohsin, deputy permanent secretaries, Director General of Health Services, department heads and senior MoH officers also attended the event.