1. The presentation will begin at 2pm

2. Best Practices for Decreasing Catheters Yolanda Richmond BS, RN, CDN Southeastern Kidney Council, Inc. ESRD Network 6

3. Objectives Discuss Catheter Use Why Focused Review Define Best Practices Review Facility Processes Conclusion Questions

5. Why Catheter Reduction?

6. Define Best Practices MethodsMethods and techniques that have consistently shown results superior than those achieved with other means, and which are used as benchmarks to strive for.techniquesresults benchmarks

7. 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!practice

8. 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

9. 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

11. Best Practices for Decreasing Catheters Facility #3 23% 10% New patients educated on permanent accesses Vascular Access Manager Weekly focused reviews Timeframe: 6 months

13. 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

14. Best Practices for Decreasing Catheters 1.Routine CQI review of Vascular Access 2.Timely referral to a Nephrologist 3.Early referral to surgeon for AVF only 4.Surgeon selection based on outcomes 5.Full range of surgical approaches to AV fistula evaluation and placement Fistula First Change Concepts

15. Best Practices for Decreasing Catheters 6.Secondary AVF placement for all AVG patients 7.AVF placement in patients with catheter 8.AVF cannulation training 9.Monitoring and maintenance to ensure access function Fistula First Change Concepts

16. Best Practices for Decreasing Catheters 10. Education for caregivers and patients 11. Outcomes feedback to guide practice 12. 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 Fistula First Change Concepts

17. Best Practices for Decreasing Catheter 1.Recognize it is a TEAM effort a. Nephrologist is the leader of the team 2.Identify root cause 3.Make a plan 4.Implement the plan 5.Check the plan 6.Act accordingly – make changes as needed Implementing Change

18. 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)

19. 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

20. Best Practices for Decreasing Catheters Decreasing Catheters PlanDoCheckAct

21. Patient and Provider Resources www.esrdnetwork6.org www.fistulafirst.org www.aakp.org

22. Evaluation Form 1.Will be emailed after presentation 2.Return by January 24, 2011 3.Complete the form inclusive of the “lessons learned” question 4.Thank you!

23. Questions yrichmond@nw6.esrd.net (919) 855-0882 Ext. 43