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Overview

  • The purpose of this guideline is to maximise the safety of patients on dialysis, while protecting staff from infection. It will also enable dialysis services to make the best use of NHS resources and match the capacity of dialysis services to patient needs if these become limited because of the COVID-19 pandemic
  • This Guidelines summary only covers key recommendations for primary care. For a complete set of recommendations, see the full guideline

Communicating with patients

  • Communicate with patients and support their mental wellbeing to help alleviate any anxiety and fear they may have about COVID-19. Point them to resources such as Kidney Care UK
  • Some patients will have received a letter telling them they are at high risk of severe illness from COVID-19. Tell them:
  • Tell patients to alert their dialysis unit if they are unwell. Ask them and their carers to report COVID-19 relevant symptoms before leaving home to attend the dialysis unit
  • Minimise face-to-face contact by:
    • offering telephone or video consultations
    • cutting non-essential face-to-face follow up
    • using home-delivery services for medicines
    • using local services for blood tests
  • Tell patients who still need to attend services to follow relevant parts of government advice on social distancing (this differs across the UK)

Patients not known to have COVID-19

  • Encourage patients, and their carers if needed, to use their own transport, and to travel alone to the dialysis unit when possible
  • Minimise time in the waiting area by:
    • careful scheduling
    • encouraging patients not to arrive early
    • texting patients when you are ready to see them, so that they can wait outside, for example, in their car

Patients known or suspected to have COVID-19

Patients with symptoms of COVID-19 at presentation

Leadership and network-level planning

  • Develop plans to reduce demand on dialysis facilities during the COVID‑19 pandemic by considering the feasibility of either delaying starting dialysis or reducing dialysis prescriptions or frequency

    • individualise these plans for patients after assessing current residual renal function, volume control and biochemistry

    • develop local policies on advising patients about diet and fluid intake, and reviewing current and additional medication, for example, loop diuretics and bicarbonate

    • think about using potassium binders in line with the recommendations in NICE technology appraisal guidance on patiromer and sodium zirconium cyclosilicate to support delaying starting dialysis or to treat hyperkalaemia

  • Regional or national networks with commissioning support should prioritise:
    • overseeing appropriate provision across the network, including assessing capacity, the supply chain and transport issues
    • establishing a pathway to ensure patients on dialysis do not get admitted into a hospital without dialysis facilities and to enable rapid transfer if they do

Staffing when workforce capacity is reduced

  • If healthcare professionals need to self-isolate but are well, ensure that they can continue to help by:
    • enabling telephone or video consultations and attendance at multidisciplinary team meetings
    • identifying patients who are suitable for remote monitoring and follow up and those who are vulnerable and need support
    • entering data
  • Support staff to keep in touch as much as possible, to support their mental wellbeing
  • Prioritise safe staffing of dialysis services. Cross-cover from other staffing groups is difficult because of the specific skills and training needed. Regional networks should enable rapid transfer of staff from one organisation to another to maintain safe levels of care
  • Identify all staff in the regional network who have experience in dialysis but are not currently working in the area. Provide them with training and support to allow them to be incorporated into the dialysis workforce if necessary
  • Have written protocols in place for all processes critical to the provision of dialysis and ensure that cross-cover arrangements for staff are defined
  • Regularly review staffing levels and have plans to flexibly adjust nurse-to-patient ratios if needed
  • Do a risk review of the frequency of all routine assessments and only do those that are deemed necessary
  • Take account of the information on the NHS Employers website about good partnership working and issues to consider when developing local plans to combat COVID-19

Home dialysis provision

  • Continue and maintain current home dialysis provision (home haemodialysis and peritoneal dialysis), and maintain adequate supplies and staffing support. Assess the resilience of care reliant on paid or unpaid carers, family and friends
  • Think about whether it is possible to increase home dialysis provision for new incident patients
  • Test for COVID-19 in patients, carers and assistants (paid and unpaid) in the community using any form of home dialysis if they develop symptoms. Test paid assistants carrying out assisted automated peritoneal dialysis

© NICE 2020. COVID-19 rapid guideline: dialysis service delivery. Available from: www.nice.org.uk/guidance/ng160. All rights reserved. Subject to Notice of rights.

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

Published date: March 2020.

Last updated: 21 May 2020.