Thrill Seekers II -- A Vascular Access Program PLUS Cannulation Camp

June 29, 1010
Christiana Hospital / Room 1100 / 4755 Stanton-Odletown Road / Newark, DE 19718

Do you have an interest in ... Helping your patients receive the hightest quality of care? ... Promoting quality improvement within your clinic?

Materials for the Thrill Seeker Program ARE NOW AVAILABLE (format: PDF, size: 6.7 Mb, 124 pages). This information should be printed and reviewed prior to the program.

Fee (per person): Pre-Register = $25.00, At-The-Door = $35.00. Pre-registration must be postmarked by June 19, 2010

Thrill Seekers Program Registration Form (format: PDF, size: 177 kb) -- please follow the instructions on this flyer to registration for this program.

A Multi-Disciplinary Approach: Chronic Kidney Disease (CKD) Management for Primary Care Providers

Chronic kidney disease is the ninth leading cause of death in the U.S.

The two main causes of chronic kidney disease are diabetes and hypertension, which are responsible for up to two-thirds of the cases. It affects 11% of the U.S. population over the age of 65, and those affected are at increased risk of cardiovascular disease and kidney failure.

Educate Primary Care Physicians to Utilize Pre-End Stage Renal Disease/Chronic Kidney Disease Referral Criteria

The new Kidney Disease Outcomes Quality Initiative (K/DOQI) Chronic Kidney Disease (CKD) Guidelines provide a clear standard for classification and management of patients with kidney disease. Primary care physicians (PCPs) should use these guidelines to evaluate, manage, and refer their patients with evidence of kidney disease. Referral to a nephrologist should be made for all patients with evidence of CKD, but certainly before the glomerular filtration rate (GFR) falls below 30 ml/minute (Stage 4 CKD) for nondiabetics or below 60 ml/minute (Stage 3 CKD) for diabetics. Ideally, the PCP’s regular laboratory will convert serum creatinine measurements to GFR. If not, office staff or the PCP can easily use an online GFR calculator to do the conversion.

CKD Tool Kit

The following tools are designed for primary care physicians with managements of CKD stages 1 to 5.

CKD Treatment Algorithm (format: Microsoft Excel, size: 24 kb) -- created by the PennDel CKD Partnership
Stages of Chronic Kidney Disease: A Clinical Action Plan (format: Microsoft Word, size: 109 kb) -- a pocket guide, side 1
Additional Clinical Interventions for Adults (format: Microsoft Word, size: 113 kb) -- a pocket guide, side 2
Chronic Kidney Disease: Improving Outcomes and Planning for Dialysis (format: Microsoft PowerPoint, size: 5.8 mb) -- slide deck prepared by the PennDel CKD Partnership
Link to Online Calculators for GFR -- The Renal Network provides a series of calculators to determine GFR

PICC Avoidance Tool Kit

The Use of Peripherally Inserted Central Catheters in the patient with chronic kidney disease jeopardizes the patient's ability to obtain a permanent vascular access should the need for dialysis arise in his or her future. Vein preservation in chronic kidney disease is crucial to the continued well-being of these patients.

The Vascular Access Advisory Panel (VAAP) for the Medical Review Board of The Renal Network, Inc., has assembled a tool kit of resources to assist the clinician in the hospital with developing alternate policies to PICC placement in patients with CKD Stage 3 or greater.

Within this tool kit you will find:

Cover letter from VAAP Chair
Algorithm - Reducing the Use of PICC Lines in CKD Patients
Examples of catheters suitable for tunneled small bore catheter in jugular vein location
Guidelines for PICC Avoidance in CKD, ESRD & Renal Transplant Patients
Fistula First Breakthrough Initiative Position Paer: Recommendations for the Use of PICC Lines
warning Signs to use at the Hospital Bedside
Literature Search (index)

To download the materials from the PICC Line Avoidance Toolkit, submit your contact information.

The PennDel CKD Partnership: Scope and Mission

The Centers for Medicare & Medicaid Services (CMS) has charged the Forum of ESRD Networks with the responsibility of the establishment of a renal coalition within their individual Networks. The PennDel CKD Partnership was established in October 2005 as the result of this endeavor. The two-fold mission of the PennDel CKD Partnership is to aid in early identification of those at risk for Chronic Kidney Disease and to increase the incident/prevalent fistula rate within ESRD Network 4 to meet the CMS goal of 66% by 2009.

Mission: To enhance the ability of the renal community to improve the quality of healthcare services of quality of life for the CKD/ESRD Medicare beneficiaries in ESRD Network 4, Inc.

Vision: The PennDel CKD Partnership will reduce fragmentation and duplication of services so that resources and educational efforts can be efficiently directed towards services or projects.

Goal: To strengthen and build new partnerships in the renal community. To educate the target populations about CKD issues.

The partnership is comprised of members from many different organizations and professional backgrounds within the renal field. Our partners include members of the renal community:

National Kidney Foundation (NKF)
American Nephrology Nurses Association (ANNA)
State Surveyors (Pennsylvania & Delaware)
Quality Improvement Organization (QIOs)
Independent Dialysis Organizations (DCI, DaVita, FMC)
Vascular Access Centers
Nephrologists
Surgeons
Nurse Practitioners and Physicians Assistances
Nurses
Social Workers
Dietitians
Administrators
Patient Care Technicians
Pharmacists
Renal Educators and Clinical Specialists

Becoming a member is simple-just contact the PennDel CKD Partnership at penndel@nw4.esrd.net with your contact information. you will receive an email notification with the information to participate in monthly telecomferences (usually the second or third Tuesday at 8:00 AM). It's that easy!

Your contribution supports the partnership to acheive its mission of promoting and improving patient outcomes. Additionally, it provides an ongoing opportunity to communicate and network with other renal professionals.

Partnership and Subcommittee Endeavors

The CKD subcommittee's focus includes early referral of CKD patients to a nephrologist and surgeon. The secondary goal would then be early AV fistula placement prior to the initiation of renal replacement therapy.

The Fistula First subcommittee is committed to finding ways to assist clinics with achieving the CMS goal of a 66% prevalent AV fistula rate. Each subcommittee has provided learning resources, hosted symposiums and created educational tools for both patients and renal providers. Examples of these projects include:

The development of a Primary Care Physician Toolkit (includes an education slide presentation, a CKD Stage 1-5 Algorithm of Care, a Pocket Guide and a list of educational resources)
Hosted a Primary Care Physician Dinner Symposium in Hershey, Pennsylvania
Collaborated with the National Kidney Foundation, the University of Pittsburgh and the University of Pittsburgh Medical Center (UPMC) to host a full-day CKD symposium, "A Multi-Disciplinary Approach: CKD Management for Primary Care Providers"
Compiled a packet of educational resources to promote Fistula First Best Practices for Network 4 dialysis centers
Developed patient educational brochures with accompanying posters to encourage AV fistula placement for the Network 4 dialysis patients and facilities
Surveyed dialysis facilities to obtain information of "best practices" from those providers achieving optimal AV fistula rates
Conducted a "Thrill-Seekers" project to encourage dialysis facilities to identify a "point-of-contact" to disseminate vascular access education
Hosted a full-day Vascular Access Program in Pittsburgh for dialysis facility caregivers
Grand Rounds at local hospitals
Patient Education Sessions
Public Service Announcements to be broadcast on "Newsmakers", a Comcast® Cable
Public Education Session at a Pittsburgh Penguins game with autographed t-shirt giveaway
KEEP (Kidney Early Evaluation Program) Screenings and public awareness campaigns on KEEP
T-shirt & Key Chain Campaign to raise awareness of World Kidney Day

Additional Resources Available

Eleven (11) Change Concepts (format: PDF, size: 1.2 Mb) which outline clinical and organizational changes that can be adapted and applied locally to improve AVF prevalence and success.
Algorithm/Protocol (format: PDF, size: 58 kb) for the Referral and Placement of Permanent Vascular Access in New Dialysis Patients.
Sample Policy and Procedure: Cannulation of New Fistula (format: PDF, size: 94 kb).
Article: A Multidisciplinary Team Approach to Increasing AV Fistula Creation (format: PDF, size: 49 kb): a community based nephrology practice experience, found in Nephrology News and Issues, June 2003, written by Vo D. Nguyen, MD; Chris Griffith, MD; and Lynn Treat, BSN, RN, BA, CNN.
Video Series: "Creating AV Fistulae in ALL Eligible Hemodialysis Patients"

Additionally the Fistula Subcommittee has recently developed two brochures with accompaning posters. The brochures/posters entitled "The ABCs of Fistula Placement" and "How Do I Look?" have been designed and sized to be displayed together on a single bulletin board.

ABCs of Fistula Placement Brochure, Side 1 (format: PDF, size: 8.7 Mb)
ABCs of Fistula Placement Brochure, Side 2 (format: PDF, size: 444 kb)
ABCs of Fistula Placement POSTER! (format: PDF, size: 8.5 mb)
How Do I Look Brochure, Side 1 (format: PDF, size: 2.9 Mb)
How Do I Look Brochure, Side 2 (format: PDF, size: 262 kb)
How Do I Look POSTER! (format: PDF, size: 2.8 Mb)

To further our endeavor, the Fistula Subcommittee surveyed medical directors and head nurses from 152 clinics on the ESRD Network 4 Chairman Preferred and Gold Preferred List. The survey tool sought information regarding factors though to be associated with high AF Fisulta rates and how those factors impact these clinics. The survey had a 36% response rate and a great deal of information was gathered.