Fistula First

1
Fistula First

• Tift Regional Medical Center
• 5/13/08 Update

2
AIM Statement

• Implement plan of care for 100 of identified
  at risk HTN patients, which includes GFR
  assessment. Nutritional evaluation, ACEI / ARB
  therapy prescribed at discharge, follow-up
  appointment with nephrologists and vascular
  access plan will be included for patients with
  HTN and Stage 4 CKD.

3
Pilot Population

• Patients admitted to the care of hospitalist
  service (no local physician)
• Patients in the age range of 30 50 years
• CVD patients
• Hospitalized (IP or OBS) patients with HTN
  identified as any diagnosis during their
  admission.
• CVD patients with Stage 4 CKD
• Hospitalized (IP or OBS) patients with HTN and
  Stage 4 CKD as any diagnosis during their
  admission
• Excluded patients
• Comfort care only patients
• Hospice Inpatient / Respite patients
• Patients leaving AMA
• Patients who expired during hospital stay

4
Progress to Date

• Established regular meeting schedule.
• Developed work-lists to identify records for
  review monthly.
• Ensured GFR consistently calculated and resulted
  by lab.
• Developed method for clinical dieticians to
  identify patients in pilot population for
  nutritional evaluation.
• Completed assessment of adequacy of documentation
  of Stage 4 CKD based on GFR results.
• Gained agreement between hospitalist physicians
  and outpatient clinic for follow-up in outpatient
  clinic for patients not receiving nephrology
  consult in inpatient setting.
• Began research on stick to the hand.

5
March Senior Leader Report - Results
6
PDSA Cycles

• P2 - Nephrology Follow-up
• Assessment of adequate documentation of Stage 4
  CKD
• P3 Vascular Access Plan
• To begin research of stick to the hand
• Consult outside of team for ideas for system of
  identification of patients
• P6a Nutritional Evaluation
• Piloted report from lab to clinical dieticians
  with GFR in pilot population to assist dieticians
  in identifying patients for nutritional
  evaluation

7
Barriers and Solutions

• Low volume of patients in pilot population
• Determine if there is appropriate documentation
  of Stage 4 CKD based on reported GFR
• Loss of dietician champion
• Identify new champion(s) in department to ensure
  process continues
• Time constraints
• Establish regular schedule for meeting
• Assign tasks to be completed outside of meetings
• Limited resources available on stick to the
  hand
• Networking!
• Internet research
• Prepare to develop our own materials

8
For more information please contact

• Mindy McStott, RN, BSN, CCM, CPAR
• Director Quality/Case Management
• Tift Regional Medical Center
• 229-353-6119