Change Concept 1: Routine CQI Review of Vascular Access

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.

• 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.

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

1. Nephrologist must become informed, take lead role in AVF initiative, encourage patients, and develop relationship with surgeons.
2. Access Manager needs to be empowered by Medical Director and team.

Resources

AVG Assessment and Intervention Algorithm

This tool will assist facilities to improve consistency of AVG assessment and intervention, as well as communication efforts with surgeons, nephrologists, and interventionists.  

Vascular Access Management: A Toolkit for Medical Directors 

This tool defines the role of the Medical Directors with vascular access and is designed as a requested, filed document for any provider of nephrology care with patient privileges at the dialysis center.