| 1. |
Clinical staff education sessions |
Project lead delivery of one-to-one or group sessions (method of delivery adapted to suit the satellite site) Interactive PowerPoint presentation consisting of current guidelines, evidence-base for EOD, improvement strategies identified and developed at satellite site A, objectives of the QI project Opportunity for clinical staff to voice concerns/share perceived barriers and project lead–facilitated collaborative problem solving |
| 2. |
Appointment of permanent clinical staff advocate for EOD (Exercise Link Practitioner) |
Exercise link practitioners at each site appointed prior to intervention commencement (nurse or HCA) Responsibility: facilitating EOD programme in project lead’s absence Training provided: patient and staff motivation, background details on motivation schemes, identification of patient for review, reporting equipment issues and maintaining exercise lists Link practitioners encouraged to contact the physiotherapist for support if necessary at any time Sites D and E each appointed one link practitioner, sites B and C appointed two. The difference reflected staffing levels at different sites |
| 3. |
Motivational schemes and improved access to literature promoting EOD |
Display posters by TIME renal rehabilitation [26] on the dialysis units Introduction of TIME ‘Cycle around Britain’ map [26]. This encourages participants to mark off blocks of time to reflect exercise duration on a graphic map of the UK, receiving postcards along the way and a certificate upon completion Supply leaflets to unit waiting areas, optimizing access to information for all patients attending dialysis |
| 4. |
Patient education sessions |
Provision of one-to-one 10-min education session to patient participants by project lead Interactive PowerPoint presentation (at chairside during dialysis) consisting of benefits and risks of EOD, cycle ergometry rationale Discussion encouraged, with additional content adapted to individual Patients offered opportunity for a personalized EOD review or initial assessment if they have yet to commence EOD Education sessions complemented by a leaflet reiterating content |
| 5. |
Improvement and standardization in documentation of EOD |
Assessment sheet created in line with evidence-based guidelines and completed for each participant Outcome measures and patient-centred goals recorded Quick identification of EOD activity facilitated by the use of a ‘traffic light system’ indicating the level of necessary support from nursing staff |
| 6. |
Provision of appropriate and fully functioning equipment |
Equipment at sites assessed and documented Storage issues identified and solutions identified Faulty equipment identified and repairs facilitated/alternatives supplied Recommendations for purchase of new equipment drafted and supplied to clinical staff |
| 7. |
Provision of training and support for clinical staff |
Provision of education and demonstration Guidelines drafted and made available to all clinical staff Practice sessions organized Provision of training/supporting documents adapted to suit the needs of the unit, responding to variations in equipment, environment and staff |
