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4.5 Patient/Carer Experience 4.5.6 Holiday Dialysis To take a holiday is a reasonable expectation of patients on dialysis. In common with others, renal patients now enjoy a wide choice of destinations and a holiday break is often an important boost to morale offering a welcome change in routine. Holidays can provide a much needed break also for the patients' family or carer. Historically, however, access to holidays, particularly overseas, has been fraught with difficulties and there are many examples of patients being denied the opportunity. To compound the situation patients may be liable for the costs of dialysis itself if venturing outside the EEC. Aided by the international organisation of commercial dialysis providers, patients who are established on peritoneal dialysis benefit from the former's ability to deliver fluids to varied pre-determined destinations throughout the world. This is one of the great advantages of the 'independence' of PD patients. Making arrangements for haemodialysis however is usually more difficult even in the UK. Most HD units are working at or near to capacity which includes those in desirable holiday locations. Often facilities can be overwhelmed by the numbers of requests for holiday dialysis. Hitherto, although money exchanged hands between HA's extra investment to enable NHS units to accommodate holiday patients has not been formally included in planning and commissioning. While a limited number of small private sector initiatives alleviate the situation, holiday dialysis has hitherto failed to attract significant investment from large dialysis companies. Local initiatives within the NHS are long overdue. It should be incumbent upon health commissioners to assess the size of the problem in their locality and to make adequate provision. While central monies should be made available, the staffing of extra dialysis stations will require careful consideration particularly as the demand will have a seasonal component. The increase in requests for holiday dialysis impacts on the time commitments of renal unit staff. The process tends to be time consuming partly because of the lack of agreed methods of data transfer between units. This has been helped recently by the publication of a suggested standardised form (ref. 82). Overseas holidays for HD patients present an extra dimension of difficulty because of the risks of blood borne virus infection. While universal, sterile precautions should be employed in all units to minimise the possibility of virus transmission, guarantees are not possible when patients travel abroad. The problem is particularly difficult in patients travelling to the Asian sub continent. Many renal units have experienced patients returning from these destinations having contracted hepatitis viruses. The alternative to denying patients the freedom to travel, which would be unacceptable, is investment to allow renal centres to 'isolate' patients returning from these destinations for a period of a few months until new infection can be ruled out. In practice this isolation simply requires that patients use dedicated machines in side rooms. Unfortunately this is a luxury that many renal units no longer enjoy, having been drawn into the culture of crisis management which results from inadequate expansion of the haemodialysis base. This will require new units to be designed with enough spacial redundancy to provide temporary isolation facilities for their patients. Haemodialysis expansion should take into account the need to depressurise existing units to permit the development of such facilities. Link to National Service Standard 5  |