WHO WHAT WHY HOW Jen Adam Consultant Nephrologist

WHO? WHAT? WHY? HOW? Jen Adam, Consultant Nephrologist North Cumbria Integrated Care Trust

What does a good vascular access service look like? Shared vision: Haemodialysis Nurses • Timely access creation • Best cannulation Nephrologist Patient Vascular Surgeons • Robust monitoring processes • Early Identification of problems • Prompt access to intervention Interventional Radiology • Optimal patient experience

Cannulation PLANNING What is good cannulation? NEEDLING TECHNIQUE PATIENT INVOLVEMENT

What tools exist?

Consequences of Poor Cannulation Causes: Education Monitoring Documentation Ownership Primary Consequences: Pain Bleeding Haematoma Stenoses Aneurisms Secondary Consequences: Poor patient experience Premature Access Failure

What is KQu. IP? • Kidney Quality Improvement Partnership • Formalised QI Structure • Embed Best Practice • Reduce Variability Transplan t First MAGIC Dialysis at Yours

What is Magic? Managing Access by PRESERVE Vascular Access Generating Improvements in Cannulation IMPROVE Patient Experience EMBED Quality Improvement

HOW PLAN INTERVENE Phase 1 Phase 2 MEASURE EVALUATE MAINTAIN

PLAN • Timeline Baseline Measures Phase 1 Phase 2 Phase 3 Staff Education Patient Awareness Region Designed • Teams • Medical and Nursing Lead from each unit • Establish definitions and baseline measurement • Cannulation • Type missed • Unit • Native access rates • Infection rates • Access failure rates

TIMELINE KQu. IP Regional day Identify QI leads MDT/ Medical Measurement Platform April ‘ 19 Leadership Training Day Shortsmoor & Leadership Into Action Oct ‘ 19 Leadership/ Measurement Launch Event patients, peers & stakeholders 28 Jan 2020 Measurement Training Day 1 Introduction to QI 12 Mar 2020 Staff education MAGIC Training Day 2 Sharing & learning 10 Jun 2020 Patient awareness Training Day 3 Maintaining Momentum 22 Sep 2020 Regional designed Celebration event 10 Dec 2020 What’s next for QI vascular access

MEASUREMENT: Metrics Unit Measures New Access Native Access Rates Bacteraemia Rates Access Failure Patient Measures Cannulation Type Missed Cannulation PREM Needling Scores

Measurement: MAGIC Data Platform

Measurement: MAGIC Data Platform

INTERVENTION • Promotion • Raise profile of AVF/G cannulation • Raise expectations and awareness • PHASE 1: Staff education Site preparation Rope Ladder Buttonholing Monitoring Area puncture Missed cannulation Pain and anxiety for patients REDUCE IMPROVE • e. Learning module based on BRS/VASBI Best Practice Guideline on cannulation

INTERVENTION • PHASE 2: Patient Education and empowerment • Encourage dialogue between patient and cannulating staff • Improve knowledge and understanding through visual cues

EVALUATION • Phase 1 + 2 • Implementation of Intervention • e. Learning • Patient Education • Impact of intervention on: • Cannulation type • Missed cannulation • Access rates • Infection rates • Access failure

MAINTENANCE…… TBC! • Embed good practice • Maintain awareness, knowledge, technique • Educate and assess new staff • Ongoing engagement of patients with cannulation • Future planning….

Making Best Practice Usual Practice

QUESTIONS?