Lesley C. Dinwiddie, MSN, RN, FNP,CNN

(1)

The Vascular Access Coordinator: The Vascular Access Coordinator:

A Patient and Treatment Team’s A Patient and Treatment Team’s

Best Friend Best Friend

Lesley C. Dinwiddie,

The Vascular Access Coordinator: The Vascular Access Coordinator:

A Patient and Treatment Team’s A Patient and Treatment Team’s

Best Friend Best Friend

(2)

Greetings Greetings and and Thanks to Thanks to Network 14 Network 14 Network 14 Network 14 for this for this exciting exciting opportunity! opportunity!

(3)

Purpose Purpose

The purpose of this webinar is to promote the use, and expand the practice, of Vascular

Access Coordinators to improve AVF rates and patient outcomes by identifying suitable roles and providing tools and resources.

Topics include qualifications, training, role of the coordinator and team in the dialysis

center, access center, and hospital setting as well as trending and tracking results.

Purpose Purpose

The purpose of this webinar is to promote the use, and expand the practice, of Vascular

Access Coordinators to improve AVF rates and patient outcomes by identifying suitable roles and providing tools and resources.

Topics include qualifications, training, role of the coordinator and team in the dialysis

center, access center, and hospital setting as well as trending and tracking results.

(4)

The Genesis &Impetus The Genesis &Impetus

is from FFBI is from FFBI

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

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 and AVF failures.

The Genesis &Impetus The Genesis &Impetus

Routine CQI review of vascular access

Designate staff member in dialysis facility (RN if feasible) responsible for vascular access CQI.

disciplinary vascular access CQI team in disciplinary vascular access CQI team in

Minimally: Medical Director and RN (VA CQI

Ideally: Representatives of all key disciplines including access surgeons and interventionalists.

(5)

My Story (circa early 1995) My Story (circa early 1995)

Wanted: one nurse practitioner with extensive

nephrology, especially HD, experience to help out in the nephrology division and acute unit with

continuity of care especially vascular access

“whatever is best for the patient

• “just call Lesley”

• “and just who are you”?

My Story (circa early 1995) My Story (circa early 1995)

Wanted: one nurse practitioner with extensive

nephrology, especially HD, experience to help out in the nephrology division and acute unit with

continuity of care especially vascular access “whatever is best for the patient”

(6)

The Rest of My Story The Rest of My Story

The evolution of my workweek calendar and

the concomitant responsibilities

The culmination of an extraordinary

experience experience

Writing and presentations

Invitations to committees and workgroups A career in consulting

An enduring philosophy of access advocacy

through patient centered care

The Rest of My Story The Rest of My Story

The evolution of my workweek calendar and the concomitant responsibilities

The culmination of an extraordinary

Writing and presentations

Invitations to committees and workgroups An enduring philosophy of access advocacy through patient centered care

(7)

Access Advocacy Access Advocacy

The overriding principle of:

“what is best for the patient”

promotes assertive communication with

colleagues colleagues

dictates persistent patient and staff education

(not nagging)

drives the relentless search for innovative

solutions

reinforces the use of process (CQI) and the

interdisciplinary team approach

Access Advocacy Access Advocacy

The overriding principle of:

“what is best for the patient”

promotes assertive communication with

dictates persistent patient and staff education drives the relentless search for innovative

reinforces the use of process (CQI) and the interdisciplinary team approach

(8)

It’s always It’s always about the about the Patient! Patient! Patient! Patient!

(9)

Model Vascular Access Algorithm Model Vascular Access Algorithm

Early referral from nephrologist

Assessment including vessel mapping

Referral to surgeons for assessment/plan

Access creation

Post op followup

Ongoing monitoring

Troubleshooting/referral for appropriate care

Model Vascular Access Algorithm Model Vascular Access Algorithm

Early referral from nephrologist

Assessment including vessel mapping

Referral to surgeons for assessment/plan Referral to surgeons for assessment/plan

(10)

VAC Model Responsibilities VAC Model Responsibilities

Assess new and established patients VA status and needs and organize appropriate interventions as per nephrologists orders

Patient and staff teaching/support

Interact with dialysis staff (especially the designated

Interact with dialysis staff (especially the designated vascular access manager) to assure ongoing access monitoring

Oversee data collection and management

Organize and maintain CQI process that involves all members of the VA collaborative interdisciplinary team

VAC Model Responsibilities VAC Model Responsibilities

Assess new and established patients VA status and needs and organize appropriate interventions as per Patient and staff teaching/support

Interact with dialysis staff (especially the designated Interact with dialysis staff (especially the designated vascular access manager) to assure ongoing access Oversee data collection and management

Organize and maintain CQI process that involves all members of the VA collaborative interdisciplinary

(11)

VAC Role Attributes VAC Role Attributes

patient advocate

teacher (patients and colleagues)

liaison (communicator extroadinaire)

flexible and mobile

assertive and accountable

manager (CQI)

researcher

collaborator

VAC Role Attributes VAC Role Attributes

teacher (patients and colleagues)

liaison (communicator extroadinaire) flexible and mobile

(12)

Different Programs/Different Needs Different Programs/Different Needs

Some vascular access programs are directed by

the surgeons who do all access placement

In some academic programs the access care is

dictated by the hospital CQI or the nephrology dictated by the hospital CQI or the nephrology division

Some large dialysis organizations have

coordinators covering several dialysis units

but all have the same goal

Different Programs/Different Needs Different Programs/Different Needs

Some vascular access programs are directed by the surgeons who do all access placement

In some academic programs the access care is dictated by the hospital CQI or the nephrology dictated by the hospital CQI or the nephrology Some large dialysis organizations have

coordinators covering several dialysis units

(13)

Vascular Access Coordinator Role CC1 Vascular Access Coordinator Role CC1

Reports to: Facility Administrator, Medical Director, VA Team Purpose of Vascular Access Coordinator Role:

• Primary source of vascular access information and care coordination for designated facility (provider)

• Focus on vascular access care and management to increase access longevity

• Maintain vascular access data to assure tracking and trending of dialysis therapy and outcomes

• Provide leadership and communication among caregivers

• Oversee and direct vascular access planning for current and future accesses

SUMMARY OF BASIC Role: SUMMARY OF BASIC Role:

• Collection of accurate and complete vascular access data.

• Coordination of the care and management of patients’ vascular accesses.

• Communication and collaboration with the Multidisciplinary Access Care Team

Role Qualifications:

• Experienced hemodialysis professional

• Certification in nephrology or hemodialysis preferred

• Demonstrated proficiency in vascular access care and management

• Demonstrated commitment to continuous quality improvement (CQI)

• Excellent communication, writing, and organization skills

• Empowered by the facility administrator, medical director and Multidisciplinary Access Care Team

: Facility Administrator, Medical Director, VA Team

Primary source of vascular access information and care coordination for designated facility (provider) Focus on vascular access care and management to increase access longevity

Maintain vascular access data to assure tracking and trending of dialysis therapy and outcomes Provide leadership and communication among caregivers

Oversee and direct vascular access planning for current and future accesses Collection of accurate and complete vascular access data.

Coordination of the care and management of patients’ vascular accesses. Communication and collaboration with the Multidisciplinary Access Care Team

Certification in nephrology or hemodialysis preferred

Demonstrated proficiency in vascular access care and management Demonstrated commitment to continuous quality improvement (CQI) Excellent communication, writing, and organization skills

(14)

ESSENTIAL JOB FUNCTIONS:

1. Collaborate with medical director, facility administrator et al to identify and continuously re members of the Multidisciplinary Access Care Team.

2. Proactively collect and report accurate and complete

teammates, patients and other care providers (the Multidisciplinary Access Care Team) for baseline and ongoing outcomes.

3. Educateteammates, provider partners, and hemodialysis patients in the care and management of vascular accesses, with particular attention to opportunities for improvement.

4. Monitorvascular access and hemodialysis care

and opportunities to increase arteriovenous fistulas (AVFs) and reduce catheters.

5. Facilitate process of referral for diagnosisfor accesses with dysfunction or other pathology.

6. Support referral for Interventional or surgical treatment

dysfunction.

7. Ensure documentation of care and outcome,

status.

8. Participate in Continuous Quality Improvement

and facility outcomes.

9. Facilitate routine Multidisciplinary Access Care Team related improvements.

10 Complete other vascular access-related tasks as directed.

Collaborate with medical director, facility administrator et al to identify and continuously re-evaluate the members of the Multidisciplinary Access Care Team.

Proactively collect and report accurate and complete data and assessmentsof the accesses to facility, teammates, patients and other care providers (the Multidisciplinary Access Care Team) for baseline and

teammates, provider partners, and hemodialysis patients in the care and management of vascular accesses, with particular attention to opportunities for improvement.

are delivery with particular focus on identifying access dysfunction and opportunities to increase arteriovenous fistulas (AVFs) and reduce catheters.

for accesses with dysfunction or other pathology.

Interventional or surgical treatment appropriate for diagnosed vascular access

documentation of care and outcome, and communicate vascular access-related outcomes and

Continuous Quality Improvement of Vascular Access care and management to improve patient Facilitate routine Multidisciplinary Access Care Team meetings to identify opportunities for vascular

(15)

Why does Vascular Access Care need Why does Vascular Access Care need to be Coordinated in the Dialysis Unit? to be Coordinated in the Dialysis Unit?

Because infection of vascular access is the leading

cause of hospitalization in our patients. Coordination of care increases awareness and infection prevention? of care increases awareness and infection prevention?

Because prevention is far superior to treatment the best method of prevention is the creation and maintenance of fistulas!

of vascular access is the leading

cause of hospitalization in our patients. Coordination of care increases awareness and infection prevention? of care increases awareness and infection prevention?

Because prevention is far superior to treatment – and the best method of prevention is the creation and

(16)

(17)

(18)

The fistula first experience of Networks 5 & 11

“Implementation of a

multifaceted intervention multifaceted intervention

including a vascular access nurse and an algorithm to prioritize

surgery significantly increased the proportion of patients starting

dialysis therapy with an AVF by

improving the overall coordination of the surgical waiting list.”

Polkinghorne et al. AJKD 2009

(19)

Change in all-cause & cause

hospitalization rates, by modality

Figure 16 p.218

cause & cause-specific hospitalization rates, by modality

Period prevalent ESRD patients; adjusted for age, gender, race, & primary diagnosis. ESRD patients, diagnosis. ESRD patients, 2005, used as reference cohort. Vascular access hospitalizations are “pure” inpatient vascular access events, as described in Appendix A. New vascular access codes for peritoneal dialysis patients appeared in late 1998; therefore, peritoneal dialysis vascular access values are shown as changing since 1999 rather than 1993.

(20)

Why does Vascular A Why does Vascular A

be Coordinated in the Dialysis Unit? be Coordinated in the Dialysis Unit?

Care Coordination can promote:

early referral for access

creation/preservation; creation/preservation;

access monitoring and surveillance

timely referrals for access dysfunction increased patient self

r Access Care need to r Access Care need to be Coordinated in the Dialysis Unit?

be Coordinated in the Dialysis Unit?

Care Coordination can promote:

early referral for access creation/preservation; creation/preservation;

access monitoring and surveillance

timely referrals for access dysfunction increased patient self-management*.

(21)

Why does Vascular Access Care need Why does Vascular Access Care need to be Coordinated i

to be Coordinated i

VA Care Coordination can reduce:

care errors; care errors;

delayed or missed appointments; failed accesses;

catheter dysfunction.

Why does Vascular Access Care need Why does Vascular Access Care need d in the Dialysis Unit? d in the Dialysis Unit?

VA Care Coordination can reduce:

delayed or missed appointments;

(22)

The Duties of the In The Duties of the In

Care Coordinator Care Coordinator

The in-center coordinator* is responsible for:

interfacing with the external vascular access

coordinator (VAC) and the vascular access team coordinator (VAC) and the vascular access team (VAT) to assure continuity & consistency of VA care;

organization of staff and patient teaching re VA; oversight of vascular access data collection;

participating on the VAT and in

The Duties of the In

The Duties of the In--Center VA Center VA

center coordinator* is responsible for:

interfacing with the external vascular access

coordinator (VAC) and the vascular access team coordinator (VAC) and the vascular access team (VAT) to assure continuity & consistency of VA

organization of staff and patient teaching re VA; oversight of vascular access data collection;

(23)

The in-center coordinator is responsible for

interfacing with the external vascular access coordinator (VAC) and the vascular access

coordinator (VAC) and the vascular access team (VAT) to assure continuity and

consistency of care through:

Prompt patient referrals for access creation and preservation*

Being the onsite clinician overseeing monitoring and surveillance and reporting events

The Duties of the In--Center VA Center VA

center coordinator is responsible for

interfacing with the external vascular access coordinator (VAC) and the vascular access

coordinator (VAC) and the vascular access team (VAT) to assure continuity and

consistency of care through:

Prompt patient referrals for access creation and preservation* Being the onsite clinician overseeing monitoring and

(24)

VA Care Coordinator VA Care Coordinator

The in-center coordinator is responsible for

organization of staff and patient teaching re VA including:

VA including:

Updates from the literature

Reports from presentations from professional meetings

New product information

CQI event-related goals

The Duties of the In--Center Center

center coordinator is responsible for

organization of staff and patient teaching re Updates from the literature

Reports from presentations from professional New product information

(25)

The in-center coordinator is responsible for oversight of vascular access data

collection/management including: collection/management including:

Average flow rates per treatment/BVP. Average arterial and venous pressures. Adequacy labs.

Monitoring and surveillance data. Number and type* of events.

Number and type of interventions to correct events

The Duties of the In--CenterCenter

center coordinator is responsible for oversight of vascular access data

collection/management including: collection/management including:

Average flow rates per treatment/BVP. Average arterial and venous pressures. Monitoring and surveillance data.

Number and type* of events.

(26)

The Attributes of the In The Attributes of the In

The in-center coordinator is responsible for participating on the VAT and in

CQI.Therefore he/she must possess the CQI.Therefore he/she must possess the following attributes:

- knowledgeable and experienced in HD - possess excellent management and

communication skills

- be a team player/mentor/mentee - be an ASSERTIVE patient advocate!

The Attributes of the In

The Attributes of the In--Center Center

center coordinator is responsible

for participating on the VAT and in-center CQI.Therefore he/she must possess the

CQI.Therefore he/she must possess the

knowledgeable and experienced in HD possess excellent management and

communication skills

be a team player/mentor/mentee be an ASSERTIVE patient advocate!

(27)

Being ASSERTIVE! Being ASSERTIVE! Being ASSERTIVE! Being ASSERTIVE!

(28)

It Takes a Team It Takes a Team

coordinated by a Nephrology Nurse! coordinated by a Nephrology Nurse!

and and

A Continuous Quality Improvement A Continuous Quality Improvement A Continuous Quality Improvement A Continuous Quality Improvement (CQI) Process for Be

(CQI) Process for Be

Patients Patients

and their Vascular Access! and their Vascular Access!

It Takes a Team It Takes a Team

coordinated by a Nephrology Nurse! coordinated by a Nephrology Nurse!

and and

A Continuous Quality Improvement A Continuous Quality Improvement A Continuous Quality Improvement A Continuous Quality Improvement

Better Outcomes for Better Outcomes for Patients

Patients

and their Vascular Access! and their Vascular Access!

(29)

Collaborative Care Collaborative Care

Nurses have a pivotal role as vascular access

advocates through:

assertive preservation of existing access

• patient & staff education • patient & staff education

• interaction with radiologists and surgeons • promoting expert cannulation & self

persistent preservation of remaining access sites

• minimizing central catheter access

• minimizing venous cannulation in “virgin” limbs

re of Vascular Access re of Vascular Access

Nurses have a pivotal role as vascular access

assertive preservation of existing access

patient & staff education patient & staff education

interaction with radiologists and surgeons

promoting expert cannulation & self-cannulation

persistent preservation of remaining access sites

minimizing central catheter access

(30)

Collaborative Care of Vascular Access Collaborative Care of Vascular Access

Nephrologists have a leading

creation and continuity of care through:

early vein preservation (as soon as CRF dxd) early vein preservation (as soon as CRF dxd) early referrals to nurse educators & surgeons

strong recommendations for appropriate access

selection to the patient & team

post procedure

follow-of access adequacy and care

leading role in access creation and continuity of care through:

early vein preservation (as soon as CRF dxd) early vein preservation (as soon as CRF dxd) early referrals to nurse educators & surgeons

strong recommendations for appropriate access selection to the patient & team

-up and ongoing oversight of access adequacy and care

(31)

Surgeons have a role as vascular access advocates through:

Creating/placing access in an

diagramming new accesses & labelling arterial anastomosis

diagramming new accesses & labelling arterial anastomosis communicating specific access orders directly to the nurses visiting the dialysis units to

to familiarize staff c surgeon’s point of view

be readily accessible for consultation

Surgeons have a role as vascular access advocates

Creating/placing access in an accessible location

diagramming new accesses & labelling arterial anastomosis diagramming new accesses & labelling arterial anastomosis communicating specific access orders directly to the nurses

to do patient & staff education and to familiarize staff c surgeon’s point of view

(32)

Interventional Nephrologists/Radiologists have a role as vascular access advocates through:

restoring access patency promptly to prevent CVC placement sending report of procedure with findings, recommendations, sending report of procedure with findings, recommendations,

& catheter lumen volumes

communicating specific access orders directly to the nurses visiting the dialysis units to do patient & staff education and

to familiarize staff c IVR’s point of view

be readily accessible for consultation

Interventional Nephrologists/Radiologists have a role as vascular access advocates through:

restoring access patency promptly to prevent CVC placement sending report of procedure with findings, recommendations, sending report of procedure with findings, recommendations, communicating specific access orders directly to the nurses

visiting the dialysis units to do patient & staff education and to familiarize staff c IVR’s point of view

(33)

Patients and their families must be heard as

their own vascular access advocates through:

including them in the discussions for decision making

at their level of comprehension at their level of comprehension

making written materials and videos easily accessible educating them about new products and techniques

such as self-cannulation

respecting the fact that it is their lives, their bodies,

their time ---their choice!

Patients and their families must be heard as their own vascular access advocates through:

including them in the discussions for decision making at their level of comprehension

at their level of comprehension

making written materials and videos easily accessible educating them about new products and techniques respecting the fact that it is their lives, their bodies,

(34)

Their Lives Their Lives …… …… Their Their Choice Choice

(35)

What is the Goal of a Team? What is the Goal of a Team? What is the Goal of a Team? What is the Goal of a Team?

(36)

It Takes a Team! It Takes a Team!

The Chairside Nurse has the primary responsibility for

treatment-to-treatment assessment, vascular access care, and documentation. However, she should be able to consult with the:

vascular access manager/coordinator.

nephrologist and/or APN (a nurse with higher education and expanded

duties)

interventionalists and surgeons.

interventionalists and surgeons. clinic manager/administrator.

social worker (transportation etc).

dietitian (adequacy, infection/nutrition) And collaborate with dialysis technicians

That’s what CQI is all about! The collaborative care and responsibility for vascular access to improve outcomes.

It Takes a Team! It Takes a Team!

has the primary responsibility for

treatment assessment, vascular access care, and documentation. However, she should be able to consult with the:

vascular access manager/coordinator.

nephrologist and/or APN (a nurse with higher education and expanded

dietitian (adequacy, infection/nutrition) And collaborate with dialysis technicians

That’s what CQI is all about! The collaborative care and responsibility for vascular access to improve outcomes.

(37)

Nurses try to do it All! Nurses try to do it All! Nurses try to do it All! Nurses try to do it All!

(38)

CQI Process for Better CQI Process for Better Outcomes for Patients Outcomes for Patients

Creation or adaptation of an algorithm to set dialysis unit policy for management of vascular access

dysfunction that includes:

Identification of vascular access team.

Identification of vascular access team. Definitions of dysfunction.*

Assessment and diagnosis. Appropriate interventions. Documentation

CQI data collection and meeting schedule.

CQI Process for Better CQI Process for Better Outcomes for Patients Outcomes for Patients

Creation or adaptation of an algorithm to set dialysis unit policy for management of vascular access

dysfunction that includes:

Identification of vascular access team. Identification of vascular access team. Definitions of dysfunction.*

Assessment and diagnosis. Appropriate interventions.

(39)

Sources and Resources Sources and Resources

IHI.org

(40)

Monthly review of individual data to track trends of labs and events.

Monthly review of aggregate facility data and

CQI Process for Better CQI Process for Better

Outcomes for Patients Outcomes for Patients

Monthly review of aggregate facility data and

comparison with previous trends.

Identification of root causes for events in both the

individual and facility.

Evaluation of interventions and outcomes.

Literature review for research on improved vascular

access outcomes.

Monthly review of individual data to track trends of Monthly review of aggregate facility data and

Monthly review of aggregate facility data and comparison with previous trends.

Identification of root causes for events in both the Evaluation of interventions and outcomes.

(41)

Data collection, including:

Average flow rates per treatment/BVP.

Average arterial and venous pressures.

Adequacy labs.

Outcomes for Vascular Access Outcomes for Vascular Access

Monitoring and surveillance data

Number and type of dysfunction events.

Number and type of interventions to catheter correct

dysfunction, including:

• Lytic administration.

• Referrals to interventionalist or surgeon. • Bacteremias with positive cultures.

• Antibiotic therapy.

Data collection, including:

Average flow rates per treatment/BVP. Average arterial and venous pressures.

Outcomes for Vascular Access Outcomes for Vascular Access

Monitoring and surveillance data

Number and type of dysfunction events.

Number and type of interventions to catheter correct

Referrals to interventionalist or surgeon. Bacteremias with positive cultures.

(42)

The 2006 KDOQI Updates The 2006 KDOQI Updates The 2006 KDOQI Updates The 2006 KDOQI Updates

(43)

CPG 4. Detection of CPG 4. Detection of

Monitoring & Surveillance Monitoring & Surveillance

Monitoring: The evaluation of the vascular access by means of physical examination to access by means of physical examination to

detect physical signs that suggest the presence of dysfunction. (KDOQI glossary)

of Access Dysfunction: of Access Dysfunction: Monitoring & Surveillance

Monitoring & Surveillance

The evaluation of the vascular access by means of physical examination to access by means of physical examination to

detect physical signs that suggest the presence of dysfunction. (KDOQI glossary)

(44)

CPG 4. Detection of CPG 4. Detection of

Monitoring & Surveillance Monitoring & Surveillance

Surveillance: The periodic evaluation of the vascular access by means of tests which may

involve special instrumentation, and for which an abnormal test result suggests the presence of

dysfunction. (KDOQI glossary)

of Access Dysfunction: of Access Dysfunction: Monitoring & Surveillance

Monitoring & Surveillance

The periodic evaluation of the vascular access by means of tests which may

involve special instrumentation, and for which an abnormal test result suggests the presence of

(45)

Goal setting to improve outcomes!

Education of staff:

CQI Process for Better CQI Process for Better Outcomes for Patients! Outcomes for Patients!

Dissemination of CQI process findings and goals.

Retraining on areas of care where events are

occurring.

Sharing literature demonstrating evidence

practice.

Goal setting to improve outcomes!

Dissemination of CQI process findings and goals. Retraining on areas of care where events are

(46)

Education of patient and family:

Discussion of patient’s current access status

(perhaps through a “report card”

similar to what dietitians use for monthly lab

similar to what dietitians use for monthly lab dissemination).

Discussion of the dat

that the patient can monitor as well, such as:

• Actual blood flow = prescribed.

• Arterial and venous pressure monitors on and limits set.

• Adequacy data.

Discussion of patient’s current access status (perhaps through a “report card”-type medium similar to what dietitians use for monthly lab

similar to what dietitians use for monthly lab

ata points and their importance that the patient can monitor as well, such as:

Actual blood flow = prescribed.

(47)

Effective Teaching! Effective Teaching!

(48)

Discussion of patient’s access options

(if appropriate).

If the events include infection/s:

• handwashing

• review catheter dressing care as per unit protocol.

• review importance of patient and staff adhering to Dialysis Center Precautions when handling or accessing catheter or cannulating fistula/AVG.

Encourage patient to keep a personal access record

(similar to medication record) to track access events.

Discussion of patient’s access options

If the events include infection/s:

review catheter dressing care as per unit protocol.

review importance of patient and staff adhering to Dialysis Center Precautions when handling or accessing catheter or

Encourage patient to keep a personal access record (similar to medication record) to track access events.

(49)

Recommended Infection Control Recommended Infection Control Practices for Hemodialysis Units Practices for Hemodialysis Units

http://www.cdc.gov/ncidod/diseases/hepatitis/resource/PDFs/hemo_poster.pdf

Recommended Infection Control Recommended Infection Control Practices for Hemodialysis Units Practices for Hemodialysis Units

(50)

Issues for the VAC Issues for the VAC

creating/adapting the role

networking with other vascular access coordinators printed resources

printed resources

needs assessment - different places/different

resources

set realistic goals

collaborative relationships vs turf wars

Issues for the VAC Issues for the VAC

creating/adapting the role

networking with other vascular access coordinators different places/different

(51)

Facilitators & Barriers to Practice Facilitators & Barriers to Practice

Never losing sight of the fact that the goal of

everything you do is “doing what is best for the patient”

the patient”

Having realistic expectations of/for yourself

and communicating that to colleagues and your patients

Facilitators & Barriers to Practice Facilitators & Barriers to Practice

Never losing sight of the fact that the goal of everything you do is “doing what is best for Having realistic expectations of/for yourself and communicating that to colleagues and

(52)

Conclusions Conclusions

More than 80% of patients starting dialysis do so with a

catheter so it is up to the HD

for the best access for every patient

Vascular Access infection is the leading cause of

hospitalization in hemodialysis patients.

The associated morbidity and mortality (and cost) can be

reduced with vascular access management by both an The associated morbidity and mortality (and cost) can be reduced with vascular access management by both an internal and external coordinator.

A nephrology nurse, knowledgeable and experienced in

HD, is ideal to fill the role of the in

liaison to the vascular access team (VAT)

It takes a team and a CQI p

access and assure better outcomes for the patient!

Conclusions Conclusions

More than 80% of patients starting dialysis do so with a

D team to determine & arrange for the best access for every patient

Vascular Access infection is the leading cause of hospitalization in hemodialysis patients.

The associated morbidity and mortality (and cost) can be reduced with vascular access management by both an The associated morbidity and mortality (and cost) can be reduced with vascular access management by both an internal and external coordinator.

A nephrology nurse, knowledgeable and experienced in HD, is ideal to fill the role of the in-center coordinator and liaison to the vascular access team (VAT)

I process to manage vascular access and assure better outcomes for the patient!

(53)

(54)

This is the This is the GOAL GOAL --always doing always doing always doing always doing what’s

what’s bestbest _for_for

the patient! the patient!

(55)

Dinwiddie LC (2007) Overview of the role of a vascular access nurse coordinator in the optimisation of access care for

patients requiring haemodialysis.

Nephrology, 9 (2) pgs 99-103.

Dinwiddie LC Investing in the lifeline: The value of a vascular access coordinator, Nephrology News and Issues

access coordinator, Nephrology News and Issues Burrows Hudson S. & Prowant B. (2005)

Standards of Practice and Guidelines for Care

Pitman, NJ.

NKF manual “Elements of Excellence: A Team Approach to

CKD Care” June, 2008.

Dinwiddie LC (2007) Overview of the role of a vascular access nurse coordinator in the optimisation of access care for

patients requiring haemodialysis. Hong Kong Journal of

103.

Dinwiddie LC Investing in the lifeline: The value of a vascular

Nephrology News and Issues, May, 2003

Burrows Hudson S. & Prowant B. (2005) Nephrology Nursing

Standards of Practice and Guidelines for Care –ANNA,

(56)

Kalman PG, Pope M, Bhola C, Richardson R, Sniderman KW. A practical approach to vascular access for hemodialysis and predictors of success. J Vasc Surg 30:4:727

King B. The vascular access coordinator role: an interview

•http://fistula.memberpath.com/HealthcareProfessionals

•/FFBIChangeConcepts/ChangeConcept1.aspx

King B. The vascular access coordinator role: an interview with Donna Carlton. NNJ, 2005 (6)

Polkinghorne KR et al. Effect of a vascular access nurse

coordinator to reduce central venous catheter use in incident hemodialysis patients: a quality improvement report. AJKD 2009 Jan;53(1):99-106.

Kalman PG, Pope M, Bhola C, Richardson R, Sniderman KW. A practical approach to vascular access for hemodialysis and

of success. J Vasc Surg 30:4:727–733, 1999

King B. The vascular access coordinator role: an interview

http://fistula.memberpath.com/HealthcareProfessionals /FFBIChangeConcepts/ChangeConcept1.aspx

King B. The vascular access coordinator role: an interview with Donna Carlton. NNJ, 2005 (6)

Polkinghorne KR et al. Effect of a vascular access nurse

coordinator to reduce central venous catheter use in incident hemodialysis patients: a quality improvement report. AJKD

(57)

Too Much Too Much Too Much Too Much Information! Information!