FFBI Change Concepts FFBI Change Concept #12 Presented by: Ellen DePrat, MSN, RN, NE, CPHQ Project Coordinator - HealthInsight (QIO for Nevada/Utah) October 2010
FFBI Mission Statement • The Fistula First Breakthrough Coalition (FFBI), consisting of the Centers for Medicare & Medicaid Services (CMS), ESRD Networks, and the entire renal community, works together to ensure that every suitable patient will receive the most optimal form of vascular access - which, in most cases, will be a native Arteriovenous fistula, or AV fistula. The focus of the FFBI is also on reducing catheter use and vascular access complications.
Change Concept • A change concept is a general notion or approach to change that has been found to be useful in developing specific ideas for changes that lead to improvement.
Hospital Workgroup - Processes • Develop the Change Concept • Identify and develop tools to support the change concept – those currently attached to other change concepts – those not currently existing • Brainstorming • Sharing • Tool development
Why Is Optimizing Care of CKD Patients Important? Early treatment makes a difference Brenner BM, et al. N Engl J Med. 2001;345:861-869.
Change Concept – Acute Care Modify hospital systems to detect CKD and promote AV fistula (AVF)planning and placement • Immense opportunity to affect the incident and prevalence AVF rates for newly diagnosed CKD patients, the CKD Stage 5 patient who presents for emergent dialysis treatment and patients who progress rapidly to CKD Stage 4 or 5 while being treated for another condition.
Stages of Chronic Kidney Disease*GFR is glomerular filtration rate, a measurement of the kidney's function.
Hospital - Impact areas • Patient education • Pharmacy – medication review/alerts • Radiology/Pharmacy Alerts • Dietary consultation • Nephrology consultation and/or referral • PICC line reduction strategies • Vessel preservation/vein mapping/vascular consult • Coordination/communication with care managers, discharge planners, social services, primary care physicians
Adopting a Change PackageConsiderations • Which of these am I already doing? • Could I strengthen how I perform these? • Which new changes could I make that would cause an improvement? • Where will adopting a change require new ways of working (e.g. communication, coordination, clinical skills?) • What kind of knowledge and support might I need and where could I find it?
Available Resources • Hospital Care Plan • What Hospital Professionals Can Do • CKD Treatment Algorithms • Discharge planning • Discharge checklist • Vessel preservation tools • www.fistulafirst.org