Transcript Fistula First: AV Fistula Maturation Project Svetlana (Lana) Kacherova, QI Director

Fistula First: AV Fistula
Maturation Project
Svetlana (Lana) Kacherova, QI Director
Lisle Mukai, QI Coordinator
ESRD Network 18
July 22, 2009
1
“Fistula First” GOAL
Goal is to maximize autogenous AVF
construction & success rate…..
To achieve in the shorter term (2006) the
initial K/DOQI minimum benchmark of
AVF use in 40% of prevalent patients….
And in the long-term (2009), a 66% AVF
rate in prevalent patients
Additional Goal: Reduce Catheter Use!
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Fistula First Goals (AVF Rates)
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CMS goal – 66% by June 30, 2009
Yearly Network 18 goal – 57.8 % by
June 30, 2010
Yearly Network Stretch Goal – 58.0%
by June 30, 2010
May 2009 AVF rates: NW 18 – 56.3%
US – 52.6%
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Inclusion Criteria for Participating
Facilities
AVF rate < 50% (April 08 SIMS data)
 Highest percentage and number of AV
Fistulas placed but not used (source: SIMS
vascular access monthly reports)
 Patients census > 50 patients
 Administrative support: All intervention
facilities have a stable leadership
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Exclusion Criteria
Patient census < 50 patients
 Facilities already included in another
QIWP project with the Network
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AVF Maturation Project:
Network Role:
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Project Leader
Supplied the templates for RCA & PDSA
Supplied toolkits to facilities & evaluate their
usefulness
Provided monthly feedback (Vascular Access SIMS
reports)
Collected bi-monthly scans to obtain facilityspecific data
Facility site visits for strugglers
Chased facilities for data & documentation 
Assisted participants to meet QAPI /PDSA
requirements
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Facilities Roles and
Responsibilities:
Returned agreement letter (signed by MD)
 Reviewed toolkit and identified tool(s) to
utilize in your facility
 Followed the project timelines and
completing all steps of the QAPI process
(RCA, PDSA, etc)
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Project Timelines
Oct. 2008 – Environmental scan and
WebEx
 Nov. 208 – RCA and PDSA (steps 1-3)
 Dec. 2008 – 1st follow-up
 Jan-Feb. 2009 – 2nd follow- up
 March-Apr. 2009 – 3rd follow up
 May 2009 – final follow-up
 June 2009 – Project summary and closure
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Project Summary
AVF Maturation Project:
# Of AVFs NOT Used (SIMS)
300
250
240
229
226
Number of AVFs NOT Used
215
218
200
200
196
193
195
Mar 09
Apr 09
May 09
181
150
100
50
0
April 2008
(Baseline)
Sept 08
Oct 08
Nov 08
Dec 08
Jan 09
Feb 09
70
AVF Maturation Project: Group AVF
Trend
65
Percentage of AVFs
60
55
52.8
50
48.6
49.7
49.5
50.8
50.5
49.5
48.5
48.4
45
40
April 2008
(Baseline)
Oct 08
Nov 08
Dec 08
Jan 09
Feb 09
Mar 09
Apr 09
May 09
Ensuring that Fistulas Mature
The key is early recognition of non-maturing
AVFs.
1. Physically assess the access each
treatment (Look, Listen, Feel).
2. Send patient for 4 week follow-up
evaluation of the access
3. Necessary intervention for nonmaturing AVFs
4. Track all new AVFs and their
development
Strategies Implemented by Facilities
Create Vascular Access Team
(Interdisciplinary)
 Designate Vascular Access Manager/
Coordinator
 Educate staff and patients about what to
look for and expect during AVF maturation
process (physical assessment and vascular
access care)
 Refer to surgeon or Vascular Access Center
for vein mapping
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Schedule surgical appointment and 4 week
follow-up
 Obtain results of evaluation findings from
the surgeon and maintain a copy in the
patients charts as well as discuss during
QAPI meetings
 Track all newly placed AVFs and
discuss/review during QAPI meetings
 Physical exam (Look, Listen, & Feel) of
AVFs every treatment by staff
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Schedule follow-up evaluation for AVFs @
4 weeks post placement of AVF
 Track success rates from each vascular
access surgeon – refer to surgeons with best
results
 Conduct stenosis monitoring &
surveillance (See KDOQI Guidelines for
appropriate surveillance methods.)
 Create check-off list for each patient noting
the steps of the plan
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Monthly report of all new AVFs being
cannulated – review during QAPI meetings
 Utilize corporate vascular access tools
(resources and tools)
 Educate patients regarding catheters and
fistulas (pros/cons)
 Have MDs talk to patients about their
vascular access and care for their access.
 Involve SW for insurance issues
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Next Steps
Have a process in place to ensure
maturation of newly placed AVFs
 Learn strategies from other facilities to
implement at your facility if appropriate
 Educate patients and their families, staff
and nephrologists about the maturation
process and vascular access care
 Refer to the Fistula First website for
resources
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Next Steps (Continued)
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Together we can make a difference and find
possible solutions for issues we can impact
Thank you for all your continuous efforts in
improving vascular access care given to our
ESRD population.
Svetlana (Lana) Kacherova, QI Director
[email protected]
Lisle Mukai, QI Coordinator
[email protected]
6255 Sunset Boulevard  Suite 2211  Los Angeles  CA  90028
(323) 962-2020  (323) 962-2891/Fax  www.esrdnetwork18.org