1. FFBI Change Concepts FFBI Change Concept #12 Presented by: Ellen DePrat, MSN, RN, NE, CPHQ Project Coordinator - HealthInsight (QIO for Nevada/Utah) October 2010 1

2. 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. 2

3. 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. 3

4. 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 4

5. 5

6. Why Is Optimizing Care of CKD Patients Important? Brenner BM, et al. N Engl J Med. 2001;345:861-869. Early treatment makes a difference 6

7. 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. 7

8. Stages of Chronic Kidney Disease *GFR is glomerular filtration rate, a measurement of the kidney's function. StageDescription/Action PlanGFR* mL/min/1.73m2 1Slight kidney damage with normal or increased filtration Diagnosis and treatment to slow progression More than 90 2Mild decrease in kidney function Estimating progression 60-89 3Moderate decrease in kidney function Evaluation and treatment of complications 30-59 4Severe decrease in kidney function Preparation for replacement therapy 15-29 5Kidney failure requiring dialysis or transplantation Replacement (if uremia present) Less than 15 8

9. 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 9

10. Adopting a Change Package Considerations 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? 10

11. Available Resources Hospital Care Plan What Hospital Professionals Can Do CKD Treatment Algorithms Discharge planning Discharge checklist Vessel preservation tools www.fistulafirst.org 11

12. 12