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The presentation will begin at 2pm. Best Practices for Decreasing Catheters. Yolanda Richmond BS, RN, CDN Southeastern Kidney Council, Inc. ESRD Network 6. Objectives. Why Catheter Reduction?. Define Best Practices.

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Best practices for decreasing catheters

Best Practices for Decreasing Catheters

Yolanda Richmond BS, RN, CDN

Southeastern Kidney Council, Inc.

ESRD Network 6




Define best practices
Define Best Practices

Methods and techniques that have consistently shown results superior than those achieved with other means, and which are used as benchmarks to strive for.


Define best practices1
Define Best Practices

No practice is best for everyone or in every situation, and no best practice remains best for very long as people keep on finding better ways of doing things!


Best practices for decreasing catheters1
Best Practices for Decreasing Catheters

Facility #1

33.2%21.5%

  • First Stick Team

  • All staff Vascular Access policy check

  • Early referral for evaluation

  • Weekly review

Timeframe: 7 months


Best practices for decreasing catheters2
Best Practices for Decreasing Catheters

Facility #2

66.0%27.6%

  • Fistula cannulation procedure revised

  • Utilization of Interactive Catheter Reduction Tool NW6 website

  • Patient CVC status review during QAPI meetings

  • Improved Surgeon/ Nephrologists

    • relationship

Timeframe: 19 months


Best practices for decreasing catheters3
Best Practices for Decreasing Catheters

Facility #3

23%10%

  • New patients educated on permanent accesses

  • Vascular Access Manager

  • Weekly focused reviews

Timeframe: 6 months


Best practices for decreasing catheters4
Best Practices for Decreasing Catheters

Facility #4

41%17%

  • Initiated a surgeon comparison outcome data sheet

  • Access Care Maps, CVC logs and computer system update timely

  • Utilization of Vascular Access Center

Timeframe: 14 months


Best practices for decreasing catheters5
Best Practices for Decreasing Catheters

Fistula First Change Concepts

Routine CQI review of Vascular Access

Timely referral to a Nephrologist

Early referral to surgeon for AVF only

Surgeon selection based on outcomes

Full range of surgical approaches to AV fistula evaluation and placement


Best practices for decreasing catheters6
Best Practices for Decreasing Catheters

Fistula First Change Concepts

  • Secondary AVF placement for all AVG patients

  • AVF placement in patients with catheter

  • AVF cannulation training

  • Monitoring and maintenance to ensure access function


Best practices for decreasing catheters7
Best Practices for Decreasing Catheters

Fistula First Change Concepts

  • Education for caregivers and patients

  • Outcomes feedback to guide practice

  • Modify hospital systems to detect CKD

  • and promote planning and placement

  • 13. Support patient efforts to live the best

  • possible quality of life through self-

  • management


Best practices for decreasing catheter
Best Practices for Decreasing Catheter

Implementing Change

  • Recognize it is a TEAM effort

    • a. Nephrologist is the leader of the team

  • Identify root cause

  • Make a plan

  • Implement the plan

  • Check the plan

  • Act accordingly – make changes as needed


Additional tips
Additional Tips

  • Based on 1:1 facility calls-

    • Maintain database of patient accesses’ monthly (prior to end of the month have CCHT take patient schedule and note exactly, looking at patient and asking what they have in place make sure computer system matches)

    • Timely follow-up when accesses are performing poorly (decrease BFR, High AP/VP, decrease access flow monitoring) and are not maturing (6 weeks should be guide)


Additional tips1
Additional Tips

  • Action plan should be team centered

  • Continual patient education

    • Use of “Informed Nonconsent “ form for refusals

    • Incorporate access in educational days

      • Show Access video

      • Brochures

  • Address patients concerns with accesses

    • Fear of needles

    • Perceived convenience of catheter



Patient and provider resources
Patient and Provider Resources

www.esrdnetwork6.org

www.fistulafirst.org

www.aakp.org


Evaluation form
Evaluation Form

  • Will be emailed after presentation

  • Return by January 24, 2011

  • Complete the form inclusive of the “lessons learned” question

  • Thank you!


Questions

[email protected]

(919) 855-0882 Ext. 43


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