2011-2012 Vascular Access Improvement Projects
| EARLY ADOPTERS | POSITIVE PERFORMERS | READY FOR CHANGE | CATHETER REDUCTION |
|---|---|---|---|
| March 2011 AVF Rate of 60% - 65% ≥ 30 patients |
March 2011 AVF Rate < 60% At least 4% increase in AVF Rate in prior year ≥ 30 Patients |
March 2011 AVF Rate < 60% Any positive AVF rate change in prior year ≥ 30 Patients |
March 2011 All Catheter Rate ≥ 25% March 2011 AVF Rate < 60% ≥ 30 Patients |
| GOAL: achieve and sustain a 66% or greater AVF Rate by March 2012 | GOAL: 4% increase in AVF Rate by March 2012 | GOAL: 4% increase in AVF Rate by March 2012 | GOAL: 3% reduction in the All Catheter Rate by March 2012 |
| Early Adopters Memorandum (format: PDF, size: 200 kb) distributed June 27, 2011 |
Positive Performers Memorandum (format: PDF, size: 199 kb) distributed June 27, 2011 |
Ready for Change Memorandum (format: PDF, size: 182 kb) distributed June 27, 2011 |
Catheter Reduction Memorandum (format: PDF, size: 199 kb) distributed June 27, 2011 |
| Early Adopters Survey Link | Positive Performers Survey Link | Ready for Change Survey Link | Catheter Reduction Survey Link |
Project Steps
ESRD Network 4 would like to thank you for your past accomplishments. It is through your continued efforts that the Network achieved its CMS required contract prevalent fistula rate by March 2011. We have a lot of work to do in order to meet our March 2012 goal.
If you participated in the 2010-2011 Vascular Access Improvement Projects, please note that this work is complete. You no longer need to submit a "Vascular Access Monthly Incident Patient Tracking Tool" or "Process Implementation Forms" to the Network office.
The steps outlined below are for our 2011-2012 Vascular Access Improvement Projects. We have four initiatives (see table above) and we will be utilizing tools and resources grouped by our 3Ps of Vascular Access Success: Prevent Catheter, Protect and Use Fistula, & Preserve Fistula
[ STEP 1 ]
The Network supplied you with the name of the group your unit was selected to participate in. Complete the online questionnaire (survey) for your group -- links provided to you in your email and also in the table above -- by July 15, 2011.
After your survey is submitted to the Network office, you will recieve a Toolkit based on our 3Ps -- these resources are to help guide your Quality Improvement efforts.
[ STEP 2 ]
Complete a Vascular Access Improvement Plan (format: PDF, size: 64 kb) -- also available in a Microsoft Word format (size: 68 kb).
Submit your Vascular Access Improvement Plan with 30 days after receiving your Toolkit from the Network office.
[ STEP 3 ]
Using your improvement plan, improve your vascular access outcomes in your unit to meet the Network's targets by March 2012.
Toolkits
Three toolkits were adopted from the 3Ps of Vascular Access Success Handbook and were developed to assist in your Vascular Access QAPI efforts. Blank action plans are included in each toolkit for your convenience. (Use of these action plans is optional.) The following additional tools may be used with any of the best practices provided for overall project management.
Vascular Access Data Collection Narrative (format: Word, size: 607 kb) ---- Vascular Access Data Collection Spreadsheet (format: Excel, size: 134 kb) ---- PDSA Worksheet (format: PDF, size: 663 kb) ---- QAPI VA Barriers Questionnaire (format: Excel, size 49 kb)
PREVENT CATHETER TOOLKIT |
PLACE AND USE FISTULA TOOLKIT |
PRESERVE FISTULA TOOLKIT |
The Renal Network is pleased to provide the following articles. These stories were written by patients, for patients. Feel free to print and display them in your patient areas, or pass them around to people you feel would benefit or enjoy reading about "Fistula Journeys".
|
|
For Immediate Release: June 28, 2011 About the movie"We created this short, high-impact message to help dialysis patients understand why replacing a hemodialysis catheter with a fistula is so important," explained MEI Executive Director Dori Schatell. The movie quickly and graphically addresses:
Dialysis professionals can use the movie to start a conversation with patients about converting from a catheter to an arteriovenous fistula (AVF). The movie can be quickly downloaded or sent via email, and is available for mobile devices via YouTube™ (www.youtube.com/watch?v=VmOG2TzO7dk). A DVD will soon be available for a small fee; submit a request via the website (www.lifeoptions.org/letstalk/). Funding for the project was provided by the Fistula First Breakthrough Initiative, Amgen, and Genzyme. Increasing fistula useResearchers estimate that as many as 68,653 lives could be saved in the U.S. solely by reducing dialysis catheter use to less than 7%. The decision to allow creation and use of an AVF is in patients' hands. Gaining patient cooperation to convert from a catheter to a fistula is literally a matter of life and death. About Life OptionsLife Options is a program of the non-profit Medical Education Institute, Inc. Founded in 1993, Life Options is dedicated to helping people with chronic kidney disease (CKD) live long and live well. All Life Options materials are non-commercial and have been reviewed for accuracy by a multidisciplinary panel of experts. For more information about the non-profit Medical Education Institute and its programs, including Life Options, visit www.meiresearch.org. |
How can a dialysis center improve vascular acccess outcomes?
Medical Directors, Nephrologists, physician extenders, acute nurses, nurse educators and dialysis staff are encouraged to help spread the message for catheter prevention. Consider getting started with the following changes and demonstrated best practices:
- Engage in partnerships with referring Primary Care Physicians (PCPs)
- Assure the PCP that the referred patient will return to their care
- Share the CKD treatment algorithms and plans for timely referral to a nephrologist with PCPs
- Encourage meetings with hospital administration to discuss CKD identification and a CKD treatment plan that includes access planning prior to in-patient discharge
- Plan meetings with referring surgical groups to discourage catheter placement
- Provide feedback to surgical groups that includes performance ranking with other local surgeons
- Encourage nephrologists to develop partnerships with surgeons with best outcomes
- Encourage nephrologists upon early referral to adopt an AV fistula plan which includes vein preservation and avoidance of PICC line use
- Designate a Vascular Access Coordinator to monitor catheter reduction
- Ensure assessment of a non-maturing AV fistula (using the Non-Mature AVF tool)
- Re-evaluate patients for AV fistula who were initially overlooked
- Refer to Vascular Access Centers
- Utilize CQI tracking to monitor catheter reduction methods
Fistula First Breakthrough Initiative (FFBI) Change Concepts
The Fistula First Breakthrough Initiative (FFBI) Change Concepts are ideas that have been used by many facilities, providers and organizations. The Change Concepts provide the roadmap to implement the KDOQI vascular access recommendations.
RPA Vascular Access Materials and Tools
The Renal Physicians Association (RPA) and major dialysis organizations nationwide have joined forces to develop and launch the Vascular Access Initiative (VAI), a collaborative project to improve the unacceptable rate of central venous catheter (CVC) use in the nation’s kidney patients receiving life-saving hemodialysis. This series of documents and tools is intended to facilitate that effort.
MAC Catheter Reduction Toolkit
This toolkit was developed by the Medical Advisory Council (MAC) of the Forum of ESRD Networks to assist facilities in meeting the Conditions for Coverage as it relates to catheter reduction. Additional toolkits for medication reconciliation, vaccination, and assurance of diabetes care coordination are available on the Forum website at http://www.esrdnetworks.org/mac-toolkits.
- Catheter Reduction Toolkit 08/01/09 [Format:PDF, 862Kb]
- PDSA Worksheet [Format:Word, 35Kb]
- QAPI - Quality Improvement Project - Worksheet [Format:Word, 34Kb]
- QAPI - Keeping Track of Accountability [Format:Word, 31Kb]
- Catheter Reduction Worksheet [Format:Excel, 184Kb]
- Interactive Tool CVC Reduction [Format:Excel, 638Kb]
- Monthly Catheter Tracking Tool [Format:Excel, 44Kb]
- On Goal Report Catheter Reduction Tool [Format:Excel, 328Kb]
- Referral Letter to a Surgeon [Format:Word, 25Kb]
- Referral Letter - Alternative Access [Format:Word, 29Kb]
- Referral Letter - Non-maturing fistulae [Format:Word, 23Kb]
- Referral Letter - PD Catheter [Format:Word, 23Kb]
- Hemodialysis Access Referral - Existing Access [Format:Word, 779Kb]
- Hemodialysis Access Referral - New Access [Format:Word, 767Kb]
- Refusal Form [Format:Word, 24Kb]
