Change Concept 1
Routine CQI review of vascular access
- Designate staff member in dialysis facility (RN if feasible) responsible for vascular access CQI.
- Assemble multi-disciplinary vascular access CQI team in facility or hospital.
- Minimally: Medical Director and RN (VA CQI Coordinator).
- Ideally: Representatives of all key disciplines including access surgeons and interventionalists.
- Investigate and track all non-AVF access placements, and AVF failures.
Dialysis facilities should incorporate vascular access into their continuous quality improvement (CQI) processes. Planning and care for vascular access spans many disciplines and settings; breakdowns in communication put patients at risk for sub-optimal treatment. In order to identify patients who will benefit from secondary arteriovenous (AV) fistula placement, facilities need processes that facilitate multidisciplinary communication, assign responsibility for vascular access information coordination, and regularly collect and use data to identify problems and opportunities for improvement.
Changes for Improvement:
Designate a Vascular Access Coordinator
Designate a staff member in the dialysis facility who will be responsible for vascular access. Designate a registered nurse (RN) if possible; if not, choose any renal care professional.
Assemble a Multidisciplinary Vascular Access Team
Assemble a multidisciplinary vascular access CQI team in your facility or hospital. At a minimum, this team should include the medical director and vascular access coordinator. Ideally, representatives from all disciplines, including access surgeons and interventionalists, should be on the team.
Vascular Access CQI Team
- Nephrologist must become informed, take lead role in AVF initiative, encourage patients, and develop relationship with surgeons.
- Access Manager needs to be empowered by Medical Director and team.
Related Tools
From: National Vascular Access Improvement Initiative, National Coordinating Center
Los Angeles, California, USA
Revised 09/09
One of the key change ideas for incorporating vascular access into an organization's ongoing CQI efforts is to designate a Vascular Access Coordinator, a staff member in the dialysis facility who will be responsible for vascular access. This description defines the purpose and essential job functions of the Coordinator.
Excel spreadsheet which can be used to track trends in data on a monthly basis.
Directions
Excel spreadsheet which can be used for monitoring and tracking infections.