National Vascular Access Improvement Initiative (NVAII) – “FISTULA FIRST”

This 3-year National initiative (2003-2006) is being undertaken to improve vascular access for end-stage renal disease (ESRD) patients, with the specific goal of increasing the placement and utilization of arteriovenous fistulas (AVF) as primary vascular access for hemodialysis.

The mission of “FISTULA FIRST” is to make sure that every eligible ESRD patient will receive the most optimal form of vascular access for that patient (in the majority of cases an AVF), and to avoid vascular access complications through appropriate monitoring and intervention. One of the goals is to make significant progress toward attaining Clinical Performance Measures (CPM) and K/DOQIä standards for AVF placement and use by June 2006.

The initial resources for the “FISTULA FIRST” initiative include:

• INITIATIVE OVERVIEW (pdf) – CMS and the 18 ESRD Networks announcement of the “FISTULA FIRST” Initiative.
• “FISTULA FIRST” CHANGE PACKAGE (pdf) – Eleven key strategies for increasing AVF’s. These concepts are intended to encourage specific changes that make sense within your clinical setting.

‘WHAT TO CONSIDER WHEN REVIEWING A CHANGE PACKAGE?’

1. Which of these strategies are already being done? a) Can any of these strategies be strengthened?
2. Which new change could be made that would cause an improvement?
3. Where will adopting a change require new ways of working (e.g., communication, coordination, clinical skills)?
4. Will any changes require new clinical skills?
5. What kind of knowledge and support may be needed and where can it be found?

A variety of activities have been undertaken by Network 13 to work with the various health care professionals involved in the vascular access care of a hemodialysis patient.

1. A physician conference, “Vascular Access in Hemodialysis” was recently held in
   New Orleans and the conference presentations are being edited for placement on the Web site SOON…
2. A QI tool kit is under development with “tools you can use” to improve the fistula rate in your dialysis facility. It is hoped that distribution can occur before the end of the year.
3. Data collection tools with incorporated vascular access trending reports will be available for facility-specific quality improvement activities.
4. It is hoped that all Network 13 dialysis facilities will be involved in this initiative.

Please check back here often for updates on initiative activities. Please also visit our professional newsletter “News You Can Use” in your unit or on this Web site.