Quality you can count on NephroCare Hungary Quality Report 2014/15

Transcription

1 Quality you can count on NephroCare Hungary Quality Report 2014/15 References Dr. Renáta Gáspár, Nephrologist, Dr. Csaba Rikker, Medical Director, and Anikó Báderné Balla, Nurse (l. to r.), Péterfy Dialysis Centre, Hungary 1 Fresenius Medical Care internal estimate for De Jager D. et al., JAMA (2009); 302: Krick G, Ronco C (eds): On-Line Hemodiafiltration: The Journey and the Vision. Contrib Nephrol. Basel, Karger, 2011, vol 175, pp Maduell F. et al., J Am Soc Nephrol (2013); 24: Panichi P. et al., Nephrol Dial Transplant (2008); 23: Pedrini L. et al., Nephrol Dial Transplant, advanced access published Jan 18, Head office: Fresenius Medical Care Deutschland GmbH Bad Homburg Germany Phone: +49 (0) Fax: +49 (0) Hungary: Fresenius Medical Care Magyarország Egészségügyi Kft Budapest, Szépvölgyi út C. ép. 2. em. Hungary Phone: Fax: fres.group-hu@fmc-ag.com Copyright 2015 Fresenius Medical Care Deutschland GmbH

2 Table of Contents 1.1 Fresenius Medical Care in Hungary our commitment to the highest standard in healthcare Chapter 1: Fresenius Medical Care The partner in renal therapy 1.1 Fresenius Medical Care in Hungary our commitment to the highest standard in healthcare End-Stage Renal Disease Fresenius Medical Care Creating a future worth living Vertical integration Integrated Management System Products and therapies NephroCare Contribution to sustainability in healthcare 11 Chapter 2: Fresenius Medical Care for the patients The highest quality of treatment in Hungary 2.1 Fresenius Medical Care in Hungary comprehensive expertise in dialysis Our role in Hungary Other therapies in Hungary NephroCare the committed partner of the Hungarian healthcare system National overview Professional training for top performance Patient care services The Clinic Management System Implementation of the NephroCare Guidelines Social responsibility Fresenius Medical Care close to the Hungarian patients Management team Country overview 35 The innovative products and services of Fresenius Medical Care have been present in Hungary for more than 20 years. We are committed to the care of patients suffering from chronic and acute organic diseases, especially chronic kidney disease. Our NephroCare network provides dialysis to patients suffering from end-stage renal disease. The high level training of our doctors and specialized medical staff ensures the continuity of our high standards. We are present in all regions of the country; our 23 dialysis centres operate as strategic partners of the healthcare institutions and care for almost 2,400 patients daily. We are proud to report that in 2014 special organ replacement therapies that were recently only dreamt of are now available for Hungarian patients. Here I would like to highlight the special role of our companies FMC Dialysis Centre Ltd. and FMC Hungary Ltd. as service providers and technological suppliers to patients suffering from severe and acute renal failure in intensive care units. Attila Berkes General Manager Fresenius Medical Care Hungary The strategic role we play in Hungarian healthcare demands cooperation within the framework of social responsibility and the support of patient organisations and non-governmental organisations intended to improve patients life conditions. We cooperate with the National Kidney Programme, the Hungarian Kidney Patients Federation, the Transplantation Foundation and the National Association of Transplanted Patients. In order to ensure our long-term reliability as healthcare providers we continuously aim at improving the quality of our service, at confirming the operational transparency of the company, and at increasing our efficiency and sustainability. We do our work with this commitment day by day. Yours sincerely Attila Berkes References 36 2 NephroCare Hungary Quality Report 2014/15 3

3 1.2 End-Stage Renal Disease 1.3 Fresenius Medical Care A growing problem worldwide Creating a future worth living End-stage renal disease (ESRD) is a life-threatening condition in which renal function is essentially lost. Waste products from normal body functions as well as excess fluid (e.g. from drinking) accumulate in the body. As a consequence, ESRD compromises different body and organ functions. ESRD affects around 3.2 million people worldwide, and this number is expected to increase to around 4.7 million by the year Patients suffering from ESRD need appropriate treatment to survive. There are two therapeutic options for these patients: kidney transplantation and dialysis. The number of patients undergoing regular dialysis is predicted to increase from around 2,522,000 in 2013 to around 3,800,000 by Prevalence 1 The prevalence of treated ESRD in the general population shows a strong global variation, with figures ranging from less than 100 to over 2,000 patients per million people (p.m.p.). In the 28 countries of the European Union, the average prevalence is around 1,090 p.m.p. The fact that, at 450 p.m.p., the global average is much lower suggests that access to treatment is still limited in many countries, meaning that many patients with terminal renal failure do not receive treatment at all. However, the steady increase of global prevalence over the years indicates a general rise in the number of people requiring treatment for ESRD as well as a gradual improvement in access to care. Fresenius Medical Care is dedicated to improving patients lives, creating a worthwhile future and providing the highest quality in state-of-the-art dialysis. For over 30 years, Fresenius Medical Care has been setting the standards in dialysis, operating at all levels of care. As a manufacturer of a full range of dialysis products and as a service provider operating over 3,250 centres in more than 40 countries worldwide, Fresenius Medical Care partners with healthcare systems to provide tailor-made therapy options for more than 270,000 dialysis patients around the world. This level of integration provides Fresenius Medical Care with access to an outstanding wealth of experience through direct contact with patients, nephrologists, nurses and technicians. A steep climb the demand for dialysis up to The number of dialysis patients is expected to grow by around 6 % p.a. in the long term. At this rate, the burden on healthcare systems will strongly increase until the year m 3.5 m 3.0 m 2.5 m 2.0 m 1.5 m 1.0 m kidney donations worldwide 0.5 m 0.0 m (potentially) dialysis patients worldwide Countries with Fresenius Medical Care dialysis centres 4 NephroCare Hungary Quality Report 2014/15 5

4 1.3.2 Vertical integration Integrated Management System At Fresenius Medical Care, each product idea undergoes a structured development process with clearly defined project phases, milestones and reporting lines. We develop, manufacture and sell dialysis products at the same time as offering dialysis treatment. The patients are always in the focus of all our efforts. Innovative culture Our research and development teams benefit directly from the experience of patients, nurses and physicians in the Fresenius Medical Care clinics. This ensures that we only pursue ideas that create added value for our patients and customers. As the industry leader with long-standing experience in dialysis, Fresenius Medical Care has access to extensive company resources: production capacities in all regions, know-how on all aspects of highly complex manufacturing technologies and processes, as well as extensive expertise in quality management, procurement and logistics for sophisticated medical products. Our outstanding experience as a provider of dialysis products and services increasingly makes us a valued advisor for healthcare partners. Vertical integration allows us to take advantage of our innovative culture and perform cardioprotective haemodialysis as standard therapy. The 5008 CorDiax and FX CorDiax dialysers enable HighVolumeHDF in daily routine, contributing to a better quality of life and patient survival. All business processes performed in the healthcare environment must comply with regulatory requirements which concern, for example, safety, quality or the environment. In order to comply, the appropriate organisational structures and processes must be established in a systematic way. As a large multinational organization Fresenius Medical Care has decided to consider the applicable regulatory requirements as a basis and to set higher internal standards wherever appropriate. Fresenius Medical Care has therefore established specific management systems that are dedicated to specific areas of activities. In 1999, Fresenius Medical Care started to merge all the different management instruments into one common Integrated Management System (IMS). The two main management systems implemented in our NephroCare clinics are the Healthcare Services Quality Management System (HS-QMS) and the Environmental Management System (EMS). The Quality Objectives of Fresenius Medical Care In order to fulfil this comprehensive responsibility we are committed to four essential objectives. For the patients Our objective is to improve the quality of life and increase the life expectancy of patients with renal disease, liver failure or immune deficiency. For our employees Our objective is to provide safe working conditions, to attract and bind qualified employees to the company and to promote their professional development. For the community Our objective is to fulfil our social responsibilities, protect the environment, comply with safety standards and legal requirements and follow the company compliance codex. Healthcare Services Quality Management System HS-QMS is based on the international quality standard ISO 9001 as well as sector guidelines and internal experts knowledge (e.g. medical care, nursing care, hygiene, dialysis fluids). For our shareholders Our objective is to ensure the continuous development of the company by creating attractive returns for the shareholders and by controlling financial risks. Environmental Management System EMS is based on the international environmental standard ISO and enhanced by clinic-specific tools and workflows to minimize environmental impacts and risks (e.g. electronic eco-controlling workflow, waste management and control of dangerous substances) CorDiax 6 NephroCare Hungary Quality Report 2014/15 7

5 1.3.4 Products and therapies Cardioprotective haemodialysis Comparing dialysis to the natural kidney Schematic graph of weekly clearance Reduced mortality with HighVolumeHDF Optimised use of resources Despite tremendous improvements in the quality and efficacy of haemodialysis (HD) therapy, cardiovascular disease (CVD) remains the leading cause of death for patients with end-stage renal disease (ESRD); almost one in two patients with ESRD still dies as a result of CVD. 2 Weekly clearance Low-Flux Kidney HighVolumeHDF The Catalonian HighVolumeHDF study 4 shows a significant 30 % reduction in all-cause mortality for patients on HighVolumeHDF. Additional results were: 33 % risk reduction in cardiovascular mortality 55 % risk reduction in mortality due to infection 61 % risk reduction in mortality from stroke Fewer hospitalisations with HighVolumeHDF Dialysis patients are often hospitalised due to dialysisrelated complications or existing comorbidities. A high hospitalisation rate not only impacts the patients quality of life but also constitutes a huge burden for the healthcare system. Fresenius Medical Care continues to contribute towards improving the prognosis of ESRD patients. We make every effort to slow down progression of atherosclerosis and protect cardiac function by providing therapies aimed at reducing the complications of CVD. Fresenius Medical Care is focusing on continuous development and advancement to meet the changing requirements of dialysis today. Key therapies The result of these efforts is our new CorDiax product line, which provides products for superior cardioprotective therapies. High-Flux dialysis Performing dialysis using the 5008 CorDiax therapy system together with FX CorDiax High-Flux dialysers enhances the removal of uraemic toxins, particularly middle molecules such as β 2 -microglobulin or myoglobin. This is achieved through advances in membrane structure. HighVolumeHDF During haemodiafiltration, the machine removes more water, which is instantaneously replaced by an electrolyte solution. This additional water transport results in a higher removal of metabolic toxins than in standard High-Flux dialysis. HighVolumeHDF, with its numerous positive effects on dialysis-related cardiovascular risk factors, is currently acknowledged as the most effective dialysis treatment modality 3, coming closest to the elimination profile of the normal kidney. With the 5008 CorDiax, high volumes of sterile and non-pyrogenic substitution fluid can be prepared costeffectively by Online filtration of ready-prepared dialysis fluid. Optimising therapies for improved outcomes Achieving optimal outcomes means addressing cardiovascular risk factors in dialysis patients. Use of advanced therapies such as High-Flux dialysis or HighVolumeHDF, taken together with Fluid Manage ment, improves outcomes, leading to: Reduced mortality risk Fewer cardiovascular complications Optimised use of resources High-Flux ,000 10, ,000 Molecular weight (Dalton ) (Graph adapted from original publication) Results from the Catalonian HighVolumeHDF study 4 Survival probability of patients 1.0 Fewer cardiovascular complications Reduction of inflammation Inflammation is an important cardiovascular risk factor for dialysis patients. Serum levels of inflammatory markers such as cytokines and C-reactive protein (CRP) are higher in these patients than in the general population. CRP has been identified as a predictor of all-cause and cardiovascular mortality in patients on haemodialysis. 5 Patients being treated with HDF benefit from significantly lower levels of CRP than patients on Low-Flux HD. 6 HighVolumeHDF reduces the number of all-cause hospitalisations p = p = Online haemodiafi ltration* High-Flux HD** 250 * median delivered convective volume ranged 0.2 from 23 to 24 L/session 200 ** 92 % on High-Flux HD High-Flux HD HighVolumeHDF Follow-up (months) (Graph adapted from original publication) (Graph adapted from original publication) Number of hospitalisations (n) 450 The hospitalisation rate of patients on HighVolumeHDF is significantly lower (22%) than of patients on High- Flux HD. The Catalonian HighVolumeHDF study therewith confirms the results of several previous studies with varying evidence levels that have been published in the last two decades. 4 8 NephroCare Hungary Quality Report 2014/15 9

6 1.4 NephroCare 1.5 Contribution to sustainability in healthcare As a service of Fresenius Medical Care, NephroCare is dedicated to providing comprehensive renal replacement therapy at the point of care. NephroCare provides dialysis services at more than 830 Fresenius Medical Care centres in more than 30 countries in Europe, Middle East, Africa and Latin America. NephroCare is an explicit commitment to excellence in renal patient care. The service we provide to our partners in healthcare is based on our NephroCare vision of excellence. It mainly consists of our highly committed specialised professionals, our products, therapies and advanced technology, rounded off by our continuous training and education. We have a comprehensive system of management instruments that supports the individual countries in implementing NephroCare s vision in all clinics efficiently and systematically. It ensures that our specialised professionals make the best use of our products, therapies and patient services to deliver excellence in renal patient care. The combination of our vision and our system of management instruments is what we call the NephroCare Excellence System. NephroCare s vision is to be a committed partner for sustaining excellence in renal patient care. We want to delight our patients, everywhere, every day! The number of dialysis patients is growing steadily, challenging the sustainability of the healthcare systems that look after them. The question is how NephroCare can contribute to the sustainability of healthcare? As we have already demonstrated in this Quality Report, we are continuously improving medical outcomes while using resources efficiently. To do this we employ the holistic NephroCare Excellence System. This holistic system supports us in outperforming patient care results and enhancing our capability to replicate this excellence in renal care wherever it is needed. Choosing dialysis with the excellence approach of NephroCare is a way to contribute to sustainability in healthcare, as high-quality and efficient use of re - sources are assured and actively managed through the network. The expertise of NephroCare derives from: More than 30 countries More than 860 clinics More than 87,000 patients... thanks to HighVolumeHDF, the quality of my life has greatly improved! Maria Rosaria Tammaro, NephroCare Patient, Italy The system supports the NephroCare management with implementing improvements, centre by centre, encouraging the assumption of responsibility at all levels. This entails accurately measuring treatment quality using our clinical database, implementing extensive standardisation and efficiency enhancements to the clinic infrastructure as well as the optimisation of dialysis treatment outcomes. 10 NephroCare Hungary Quality Report 2014/15 11

7 Dr. Sándor Keresztesi, Medical Director, and József Valentin, Patient, Kecskemét Dialysis Centre, Hungary Chapter 2: Fresenius Medical Care for the patients The highest quality of treatment in Hungary 12 NephroCare Hungary Quality Report 2014/15 13

8 2.1 Fresenius Medical Care in Hungary comprehensive expertise in dialysis Our role in Hungary Professional clinic management and close contact to public hospital customers participation at our annual peritoneal dialysis and hae- Fresenius Medical Care began its activities in Hungary Fresenius Medical Care patients are covered by the in 1993, when it opened the FMC Sopron Dialysis public health care system our centres are also open Centre the first centre operated by Fresenius Medical for patients with private insurance as well as for holi- Care. In 1994, FMC Esztergom Dialysis Centre became day dialysis patients coming from other countries The Hungarian management of Fresenius Medical the first centre to be built by Fresenius Medical Care inside and outside the European Union. Care has more than 20 years of experience in running In 2012, on top of the annual haemodialysis training dialysis centres. The company is dedicated to invest- for our own employees, Fresenius Medical Care start- another milestone in the service division of the com- modialysis courses for nursing and medical professionals. pany. In 2014 Fresenius Medical Care operated a Fresenius Medical Care dialysis centres in Hungary ing in the future of Hungary s health care system and ed organising haemodialysis training courses for the dialysis network of 23 centres across the country with play an important role in public hospital nephrology has a long-term strategic partnership with the health nursing and medical professionals of our partners at the total number of 2,400 patients. departments, providing cost effective high-quality care administration, its third party customers, the pub- university, public and private dialysis centres using dialysis treatments and nephrology consultation close lic hospitals and private service providers as well as its Fresenius Medical Care therapy systems. to the patients homes. competitors. All of our dialysis centres operate on a contract basis with the Hungarian National Health Insurance Fund Fresenius Medical Care Hungary regularly organises (OEP); the contracts are generally awarded in the pro- Fresenius Medical Care is the market leader in the field training courses on medical devices such as the cess of a public procurement tender. Although most of dialysis service, and has good partnership relations multifiltrate system used at public hospital intensive with its third party customers, most of which are public care units or the Body Composition Monitor (BCM) for hospitals and university hospitals. We offer education, nephrologists and medical professionals working in flexible training solutions, software update training and areas related to the application of BCM. Észak-Magyarország Észak-Közép Magyarország Észak-Alföld Nyugat-KözépMagyarország Dél-Közép-Magyarország Nyugat-Dunántúl Dél-Dunántúl Dél-Alföld Fresenius Medical Care dialysis centres in Hungary 14 NephroCare Hungary Quality Report 2014/15 15

9 2.1.2 Other therapies in Hungary Acute therapies with the multifiltrate system Fresenius Medical Care Hungary has offered mobile treatments in Hungary since the mid-1990s, not only in its dialysis network but also for third parties. We have used the multifiltrate machine since 2001 and have gained much experience in this modality. We offer mobile treatments in 18 intensive care units in our NephroCare network. We not only sell the products but also give full support to our partners. That includes detailed training and follow-up courses for the nurses and doctors, as well as full technical support. multifiltrate system at Semmelweis University In 2013 Fresenius Medical Care Hungary provided the Semmelweis University 1st Department of Paediatrics with a multifiltrate system. It makes the highest possible standard of continuous renal replacement therapies available at the paediatric clinic. The device has a paediatric modality, which makes it possible to treat new-born babies from a weight of 2,000 grams. Fresenius Medical Care Hungary has had a long-term strategic cooperation with Semmelweis University, the largest medical university in Hungary, where we operate a NephroCare dialysis centre. Fresenius Medical Care plays an important role in therapeutic apheresis in Hungary Therapeutic apheresis Fresenius Medical Care played an important role in the introduction of therapeutic apheresis therapies to Hungary and continues to offer treatments as a special service by FMC Hungary Ltd. to its partner hospitals and institutions. We acknowledge the importance of education in dealing with connected systems and therapies, therefore we are dedicated to putting a special focus on the education of our third-party customers in the field of therapeutic apheresis and other therapies. Four therapeutic apheresis modalities are available in Hungary offered by Fresenius Medical Care: Liver support therapy with Prometheus Treatments with the Prometheus therapy system have been carried out since 2005 at Péterfy Hospital, the Transplantation Clinic of Semmelweis University, St. Laszlo Hospital in Budapest and Debrecen University. DALI (treatment of hypercolesterinemia) We cooperate with the University of Debrecen. Together with the medical professionals of the 1st Department of Internal Medicine, our colleagues perform treatments with the DALI system with continuously increasing numbers of patients. MONET (treatment of hypercolesterinemia and/or rheological indications) Treatments with the MONET system started in July 2014 at the 3rd Department of Internal Medicine at the University of Debrecen, in rheological indication, on a patient who suffered from dry macula degeneration. The patient s symptoms decreased significantly after the treatments. Immunoadsorption with Globaffin (autoimmune diseases) Immunoadsorption treatments have also been carried out in Debrecen. In 2014 we had a patient with dilatative cardiomyopathy (DCM) who received five treatments; the medical results are very promising. The new multifiltrate system at the Semmelweis University 1st Department of Paediatrics 16 NephroCare Hungary Quality Report 2014/15 17

10 2.2 NephroCare the committed partner of the Hungarian healthcare system National overview NephroCare dialysis centres are present in all eight healthcare regions. They operate either as a department of a public hospital (e.g. Fresenius Medical Care Semmelweis University and Sopron Dialysis Centres) or as an individual service provider (e.g. Fresenius Medical Care Pécs and Szépvölgyi Satellite Dialysis Centres). Hospitalisation data The complications and comorbidities associated with end-stage renal disease often result in the hospitalisation of dialysis patients. Better patient care means fewer days in hospital, a better quality of life for patients and lower costs for the Hungarian healthcare system. The following data show a steady improvement: Facts and figures Better patient care lowers hospitalisation days dialysis centres offer peritoneal dialysis as a treatment modality and three dialysis centres (Debrecen, Miskolc and Eger) offer therapeutic apheresis treatment. 21 dialysis centres out of the 23 in the network used the 5008 therapy system in 2014 (in 2015 all units will have 5008 machines). All dialysis centres have their own BCM-Body Composition Monitor device to indicate the fluid status of dialysis patients. In 2014 more than 300,000 haemodialysis treatments were performed in the Hungarian NephroCare network % of all treatments were Online HDF. At most dialysis centres, our nephrologists take part in the outpatient care of the Nephrology Departments of nearby hospitals. The Nephrology Centre in Miskolc is the biggest dialysis centre operated by Fresenius Medical Care in Hungary with 225 haemodialysis patients and 57 PD patients in The centre has its own ten-bed nephrology clinic, which is operated by Fresenius Medical Care within the Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital. Hospitalization days Special medical services Our colleagues carry out kidney biopsies in our NephroCare dialysis centres that have a background of imaging diagnostics and histology in a university hospital or public hospitals such as Pécs, Miskolc, Debrecen and the Semmelweis University Dialysis Center in Budapest. Four dialysis centres offer in-house therapeutic apheresis as a treatment modality not only for patients with CKD. The centres are: FMC Miskolc Nephrology Centre, Debrecen University Clinical Centre, FMC Extracorporeal Organ Replacement Centre and FMC Eger Dialysis Centre. Dialysis treatment with the multifiltrate machine in an ICU Mobile treatments In 2014, 18 dialysis centres in the NephroCare network provided mobile haemodialysis treatments for bed-bound patients at the intensive care units (ICUs) of nearby hospitals. The treatments begin with a consultation on the patient s situation. After the NephroCare doctors have decided the treatment method, they go with the nurses to treat the patient at the ICU. At the Szepvölgyi Dialysis Centre, physicians and nurses support the Semmelweis University Heart and Vascular Centre where all Hungarian adult heart transplant activity is recorded. This centre offers a full nephrology service, including consultation, continuous veno-venous haemodiafiltration (CVVHDF) treatments in the ICU and, if necessary, even kidney biopsy. 833 treatments were carried out at this centre, 500 of them were done at the Heart Surgery Clinic (January September 2014). The NephroCare dialysis centres in Debrecen and Pécs also offer mobile treatments for heart surgery clinics. 18 NephroCare Hungary Quality Report 2014/15 19

11 Early diagnosis Medical and nursing professionals at NephroCare dialysis centres cooperate with the outpatient care departments of public hospitals and take part in the early diagnosis of CKD. We provide information material for pre-esrd patients at the outpatient clinics and via the website of the National Kidney Programme ( We also cooperate with patient associations to organize events within the National Kidney Programme to draw attention to CKD. Pre-dialysis patients are in contact with the medical and nursing staff of all 23 dialysis centres in the Hungarian NephroCare network. At some centres we have our own outpatient clinics for pre-dialysis patients. In other cases we cooperate with hospitals operated by the public healthcare system. Cooperation takes various forms; we provide either the building for the outpatient clinic or the doctors and nurses who work there. These early diagnosis efforts are very important because it means that patients in the earlier stages of CKD are properly informed about their condition and can make educated modality choices. Patients who enter the dialysis programme are in a relatively good condition due to the high-quality care in the pre-dialysis stage. Our doctors are in contact with the general practitioners via the outpatient clinics and there are information courses for the general practitioners. Kidney transplantation Although the modality decision is taken before the patient is referred to the dialysis centre, it is part of our philosophy to ensure that all suitable patients are included on the waiting list for kidney transplants. At the end of September 2014, 13.5 % of all the chronic haemodialysis patients treated in the Hungarian NephroCare network were included on the waiting list for transplants. This high percentage is the result of the collective efforts of Fresenius Medical Care, the Hungarian Transplantation Association and the Hungarian Kidney Programme. In 2013 and 2014 the Hungarian Transplantation Association organized several forums about transplantation for patients and their families we supported the participation of our patients. Number of transplantations of Fresenius Medical Care patients in Hungary Number of kidney trnasplantations (Jan Sept) Professional training for top performance Fresenius Medical Care employs over 120 medical and nearly 400 nursing professionals in Hungary, the total number of employees in the country was 736 in the second quarter of Our management is committed to the continuous training of our colleagues; this contributes to the competitiveness of our companies and the worldclass quality of patient care we provide. Special training programme It was a great pleasure for the management of Fresenius Medical Care in 2013 to be informed that FMC Dialysis Centre Ltd. had won a 28.8 million Forint European Union grant. The grant was invested in a special training programme for the nurses, head nurses and economic and technical specialists of the Hungarian NephroCare network. Competence development of health care professionals Within the framework of the grant our employees received professional competence and personal devel - opment courses in three thematic areas: Microsoft Office applications training for economic and technical specialists. Management skills for head nurses. Burnout prevention for dialysis nurses, head nurses and PD nurses. The training programme was created in accordance with the professional needs of the employees in order to promote higher skill levels. Course Employee functions Date Number of participants Microsoft Office training Economic and November technical specialists Management training management skills, confl ict management, stress management and preventing burnout Head nurses October 2013 December Burnout prevention Nurses December 2013 June NephroCare Hungary Quality Report 2014/15 21

12 2.2.3 Patient care services New Performance Management Process In 2013 a new Performance Management Process was introduced at the Hungarian companies of Fresenius Medical Care. The Performance Management Process sets yearly goals for each employee, then follows the work of the employee throughout the year. At the end of the year the supervisor and the employee evaluate the results and set new goals for the next year. The best results are achieved when the supervisor and the employee work together and communicate throughout the evaluation period in order to reach the goals. Our specialised professionals are committed to delivering the highest quality of care. We empower them by enabling their continuous development. The system was developed with the participation of medical and nursing professionals along with the human resources department, so that the result conforms to the special operational situation in the Hungarian network of Fresenius Medical Care. We want to provide each patient with the best pos sible quality of care. Before any kind of treatment starts, we help our patients identify the most suitable renal replacement therapy for their personal health status, needs and preferences. Our specialised professionals use their empathy and experience to make the patients feel comfortable and take them step by step through information materials which can later be used for reference at home or by family members. The NephroCare Patient Introduction Guide contains all the information required for a good start. We also have patient training materials on topics such as fistula care, nutrition and diabetes. Education helps patients understand their clinical situation better, assume responsibility and know how their own behaviour influences their condition. In Hungary, we publish a patient magazine called NephroCare Krónika. It is published twice a year and presents medical, dietary and lifestyle topics as well as interesting news from the world of nephrology. Patient satisfaction survey Our biannual questionnaire asks patients about our facilities, care, confidence in the staff and the treatment received, quality of information provided, etc. The responses are analysed locally and actions to be taken are decided. The results of the latest survey showed a general improvement in all areas. The most significant improvements were in: Knowledge about treatment received Preparation of the patient prior to treatment Staff attention (in all categories: doctors, nurses, etc.) Individual goals are discussed, set and evaluated Patient information materials: Welcome Guide, Fistula Care, Good Food and Diabetes 22 NephroCare Hungary Quality Report 2014/15 23

13 2.2.4 The Clinic Management System Holiday Dialysis We help our patients find holiday destinations where Fresenius Medical Care or other dialysis providers offer high-quality dialysis so they can enjoy their holidays without any problems. A relatively high number of patients choose to travel with the help of NephroCare and Holiday Dialysis International. 90 % of Hungarian patients who travel abroad visit places within the European Union, either on holiday or for business purposes. They use the European Health Insurance Card (EHIC) to pay for their treatment. The most popular destinations are neighbouring countries (Austria, Croatia, Poland, Romania) and popular holiday resorts such as Greece, Spain and Portugal. Patients travelling to Hungary for private or business purposes may contact Fresenius Medical Care, Holiday Dialysis International or other dialysis travel agencies. They will keep in touch with the Holiday Dialysis Coordinator to book the sessions in one of the 23 NephroCare dialysis units in Hungary. The European Health Insurance Card is accepted as a means of payment in every centre. Holidays within the international NephroCare network are now easier for peritoneal dialysis patients thanks to an improved PD product ordering system. within the Fresenius Medical Care companies and the patient does not have to take care of the order and delivery charges within the European Union. Thanks to the new regulations, the number of patients with PD choosing to travel for a holiday or visit relatives in a foreign country increased significantly in 2013 and The implementation of the NephroCare Excellence System is the basis of the high standard of patient care in our 23 dialysis centres. The aim is to harmonise the medical and nursing procedures according to the NephroCare guidelines and to optimize the operation of the Hungarian headquarters and dialysis centres in order to achieve the best possible patient care and the most efficient operation. EuClid, the backbone of the Clinic Management System The implementation of EuClid5 software in the Hungarian NephroCare network enabled the connection of a clinic management system that made possible the registration and visualisation of all patient and treatment data in an internationally unified way. The implementation of EuClid started in 2008 with training courses and a short trial period. The software is now in use in all 23 dialysis centres of the Hungarian NephroCare network. EuClid has gone through continuous changes in order to meet the demands of different countries. In Hungary, we took active part in the development of the software. The main areas of the development were PD regulations and temporary (e.g. acute and intensive care unit) patient movements, treatments and the development of special reports. Holiday dialysis for peritoneal dialysis patients Holidays with peritoneal dialysis (PD) have become easier within the international NephroCare network. Previously, it was often difficult for patients to find a flexible and cost-efficient way of ordering their PD fluids in a foreign country due to the different reimbursement systems. As of 2013, we offer a solution in which the order and shipment of PD products are taken care of by Fresenius Medical Care International. The charges are levied Holiday Dialysis Hungary catalogue EuCliD monitors medical aspects of patient care through anonymous data 24 NephroCare Hungary Quality Report 2014/15 25

14 NephroCare Balanced ScoreCard The NephroCare Balanced ScoreCard is structured on four perspectives and nine strategic objectives which are based on Fresenius Medical Care s Quality Policy and define our responsibilities to patients, employees, shareholders and the community. The system was implemented in the Hungarian NephroCare network in January Since then it has undergone a number of improvements in order to adapt to the network s characteristics. Business Intelligence System In 2012 FMC Hungary Ltd. received a European Union grant for an IT project. The result was the Business Intelligence System, which is now implemented in the Hungarian Network: it uses new technologies for data recording and intersystem communications and provides new perspectives in corporate management. The existing IT system has been replaced and a new dialysis module has been developed Healthcare Information System (HIS) Water treatment systems operating on the principle of reverse osmosis have been mounted with a control device that transmits the quality parameters of the appliances, thus allowing remote intervention. A data warehouse has been developed, which collects treatment data and the technical measurement results of the water treatment systems. Measuring the realisation of performance targets with EuCliD and the NephroCare Balanced ScoreCard enables cost-effective treatments and guides improvement. The main benefits of the Business Intelligence System are the possibility of continuous monitoring, increased efficiency and dynamic and proactive management. Real savings of millions of euros were realized between 2011 and 2014 Benefits Patients: nursing staff has more time to deal with the patients during the treatment. Management: the implemented data warehouse allows quicker and more precise information flow. Staff: fewer data recording tasks reduce the workload of employees. Integrated Quality Management System All NephroCare Excellence initiatives and activities are monitored locally by the quality management system (QMS) of the company. The QMS focuses on the continuous development of the participants, while providing a framework to meet the external and internal expectations. In 2014 all 23 dialysis centres and the headquarters in Budapest had the ISO 9001:2008 quality certificate and the ISO 14001:2004 environmental certificate. Therapy Data Management System The Therapy Data Management System (TDMS) connects therapy systems, equipment (e.g. scales, blood gas analyser) and EuClid so that automated data recording and storing are possible. The efficient processing and monitoring of dialysis treatments and patient data contribute to the significant reduction of administration loads for the nursing staff. The implementation of TDMS in the Hungarian NephroCare network started in 2013, with a pilot project at the FMC Szépvölgyi Dialysis Centre. The pilot project showed that employees could learn to use the system quickly and were happy that the electronic data transfer led to a smaller administration workload. Work stations 4008S classix Our doctors appreciated the flexibility of the system: they could follow every movement of the treatment even from their office and they could send messages through the 5008 therapy system for the nurses to make changes during the treatment. Patients also acknowledged the benefits of TDMS: the nursing staff had more time to spend on them during the treatments, which resulted in an overall positive feedback from the patients side CorDiax/ 5008S CorDiax Local Area Network (LAN) Scales Server TDMS reduces administrative workload by connecting therapy systems, equipment and EuClid 26 NephroCare Hungary Quality Report 2014/15 27

15 2.2.5 Implementation of the NephroCare Guidelines Setting standards for our working procedures has been a priority in Fresenius Medical Care dialysis centres since our beginnings in In 2014 the most important NephroCare guidelines were: Good Dialysis Care Hygiene and Infection Control Water, Concentrate and Dialysis Fluid for Haemodialysis and Related Therapies Dialysis Centres Architectural Guideline A new guideline standardising the processes of peritoneal dialysis the Peritoneal Dialysis Practical Manual for PD Nurses came into effect in on 1st January NephroCare Guideline Good Dialysis Care This guideline helps our employees by standardising work processes and unifying expectations. The clear and detailed descriptions of processes make it very useful for training new employees. NephroCare Guideline Water, Concentrate and Dialysis Fluid for Haemodialysis and Related Therapies The implementation of the guideline in Hungary began in 2008 and was completed in Performing the physical modifications at all the 23 dialysis centres was a huge project. The indicators show that working according to this guideline can prevent system breakdowns, keep high water quality in range and help optimize water consumption. The active application of the guideline has efficiently reduced the volume of water needed for the treatments. Water consumption per treatment L Peritoneal Dialysis Practical Manual for PD Nurses This new guideline was developed and implemented by the Hungarian NephroCare nursing staff. It came about in response to the continuous increase in the number of peritoneal dialysis (PD) patients between 2010 and The NephroCare management in Hungary decided to standardise the PD working procedures in our centres. The main aims were to unify the training of nurses and achieve predictable and cost-effective patient care in PD. The training of PD nursing staff is now based on this manual. We are very proud to have a unique guideline developed by the Hungarian colleagues describing the procedures in peritoneal dialysis. Györgyi Pánczél, PD Nurse, and Tamás Czeroven, Patient, during training in the Peterfy Dialysis Centre, Hungary The processes described include the best practices in the international network of Fresenius Medical Care; it therefore ensures the best possible quality and standardised patient care NephroCare Guideline Hygiene and Infection Control This guideline applies to all hygiene-related procedures including personal hygiene, disinfection, medication preparation and delivery as well as treatment of infected patients The guideline has been in effect since A Hungarian Hygiene Plan is also applied to meet the hygiene regulations. In addition, the national Nursing Management Team organizes a specific hygiene training course every year for the nurses in charge of hygiene in each dialysis centre. 28 NephroCare Hungary Quality Report 2014/15 29

16 2.2.6 Social responsibility Cooperation with Hungarian associations Transplant Foundation for Renewed Lives This non-profit organization focuses on the education of patients, professionals and the public on topics related to transplantation and organ failure. Fresenius Medical Care Hungary has a tradition of strategic cooperation with the Foundation going back many years. Together, we organise presentations and forums all over the country. These include films about organ transplantation for prospective patients and their families. We also organise continuous education sessions for professionals. The education of patients with chronic kidney disease is a very important part of the activity of the Foundation. Since 2009 it has organised forums for patients with organ failure, and for dialysis patients and their families. In this way the Foundation can reach all the patients near the large transplantation centres. Colleagues at NephroCare dialysis centres help inform and motivate patients and families to attend these forums and also support their travel to the venues. Doctors and nurses also help the work of the Foundation by taking part at the events with presentations on chronic kidney disease and the possibilities of transplantation. Hungarian Society for Organ Transplantation The Hungarian Society for Organ Transplantation supports physical and psychological rehabilitation and offers general advocacy for patients with organ failure and post-transplant patients. It organizes events for these patients in order to strengthen their feeling of community. Programme for Healthier Kidneys The Programme for Healthier Kidneys was started at the initiative of Fresenius Medical Care and the National Federation of Hungarian Diabetics. Its aim is to screen patients suffering from chronic kidney disease as soon as possible, thus improving their life quality, efficiently influencing the outcome of the disease and preventing the different medical interventions, such as dialysis or transplantation. In our programme, general practitioners identify diabetes patients who are suspected of having chronic kidney disease. These patients are directed to a nephrologist, where the observed complications receive the appropriate and relevant medical and dietary treatments. We believe that this educational work will help the patients involved in the programme and successfully contribute to the professional work of the treating staff as well. Thanks to our cooperation, our patients can take part in international sports competitions organized for transplant and dialysis patients. For years, Fresenius Medical Care has supported the Hungarian team s participation at the World Transplant Games. In August 2014 FMC Hungary Ltd. supported the full participation of its two former dialysis patients at the 8th European Transplant and Dialysis Sports Championships in Krakow, Poland. Dr. Renáta Gáspár, Nephrologist, and Gáborné Mátyás, Patient, Péterfy Dialysis Centre, Hungary Dr. Erzsébet Ladányi, Country Medical Director at Fresenius Medical Care making a presentation at the Transplantation Forum in Miskolc, NephroCare Hungary Quality Report 2014/15 31

17 National Kidney Programme The National Kidney Programme was launched in 2011 with the financial support of the Association of Nephrology Service Providers and the moral support of the respective ministry, in cooperation with the Hungarian Nephrology Association and the Hungarian Transplantation Association and other civil organizations. Its objective is to provide assistance and guidance regarding any activities connected with the kidney, from prevention to renal replacement treatments and transplantation. The project helps educate citizens and patients about kidney disease. It also promotes professional dialogue and creates guidelines and solutions for the decision makers. The National Kidney Programme aims to reduce the frequency and the seriousness of kidney disease and its complications by emphasizing the importance of a health-conscious lifestyle in society. Under the auspices of the programme, experts and people who have undergone successful transplants also visit the dialysis centres to encourage patients who might be suitable for kidney transplantation to get involved in transplantation programmes. Architecture Refurbishments and repair work are continuous in the 23 dialysis centres of the Hungarian NephroCare network. The focus of the refurbishments is on environmentally friendly investments: new doors and windows with better insulation, environmentally friendly elec trical and mechanical systems (hot water and heating systems). The last dialysis centre expansion project took place in 2014 when a new treatment room was opened at the FMC Péterfy Dialysis Centre with eight new dialysis stations. Eco Controlling The Eco Controlling system collects the consumption and emission data from the environmental reports that are uploaded directly from the dialysis centres to the EuClid system. The monthly reports reflect the consumption and emission data of every dialysis centre: electrical energy, raw water, water treatment systems, concentrates, hazardous waste, including pharmaceuticals, paper and carton packaging, plastic packaging and packaging waste infected with hazardous material. The yearly report includes heating energy consumption data. The system helps us understand and determine extremes in emission and consumption. When high consumption is shown, the exact reason for the difference has to be given and a root cause analysis has to be made. The EuClid E-con5 reports are also integrated into the Business Intelligence System, which helps represent the monthly cumulated consumption and emission data so analyses can be made. Archifm.net integrated facility management software ArchiFM is the most widespread computer aided facility management software system in Hungary; it utilizes the most advanced technologies to help in the tasks of facility management, delivering up-to-date information on the condition of our real estate and non-medical device stocks. Water treatment system At the beginning of 2013 an online control monitor of the water treatment system was launched in six dialysis centres of the Hungarian NephroCare network. The new technology makes it easier to diagnose and monitor the parameters of the water treatment systems. In turn, this helps avoid serious malfunction and failure and makes resource management more effective. Contaminated waste per treatment kg Waiting room of the new Péterfy Dialysis Centre 32 NephroCare Hungary Quality Report 2014/15 33

18 2.3 Fresenius Medical Care close to the Hungarian patients Management team Country overview Fresenius Medical Care in Hungary is made up of two The 23 dialysis centres work as independent regional The healthcare administration in Hungary divides the companies: FMC Hungary Ltd. is responsible for oper- entities, while the strategic and operational administration country into eight healthcare regions. The capital is ational tasks, third-party sales, facility management of the centres is carried out by the Headquarters divided into three regions. Six of the regions have and purchasing, while FMC Dialysis Centre Ltd. carries located in Budapest. The Operational, Quality and medical universities as the highest level healthcare out all tasks related to the operation of the NephroCare Environmental Management Department, the Human providers, while the remaining three regions have network, the 23 dialysis centres in the country. Resources Department, the Financial Department and major and well-equipped county hospitals. Fresenius the Technical Department operate within the Medical Care operates dialysis centres in all regions of Headquarters. Hungary. For details and contact information of the individual dialysis centres, please visit Each NephroCare dialysis centre is headed by a Medical Director (a nephrologist) and a Head Nurse. They are responsible for the operational management of the dialysis centre. Attila Berkes József Geszler Dr. Erzsébet Ladányi General Manager NephroCare Manager Country Medical Director Észak-Magyarország Észak-Közép Magyarország Észak-Alföld Nyugat-KözépMagyarország Dél-Közép-Magyarország Nyugat-Dunántúl István Szabó Emese Dudás Zsolt Sturovics Financial Director Human Resources Director Technical Director Dél-Dunántúl 34 Róza Mogyorósi Krisztina Hohmann Country Head Nurse Country Head Nurse Dél-Alföld Fresenius Medical Care dialysis centres in Hungary NephroCare Hungary Quality Report 2014/15 35