P136
QUALITY IMPROVEMENT IN DIALYSIS NURSE VASCULAR ACCESS
EDUCATION DELIVERS RAPID IMPROVEMENT IN FISTULA CARE AND
FACILITATES SHARED DECISION MAKING
Baker, M, Sinha, S, Donne, R, Chapman, J, Bridgford, S, Pondor, Z, Fletchman, L,
Hyde, A
Department of Renal Medicine, Salford Royal NHS Foundation Trust, Manchester
PURPOSE: To improve the care of patients with AV fistulas and grafts by providing a
vascular access education and assessment programme for dialysis nurses.
INTRODUCTION: Maintaining a healthy AV fistula/graft forms a crucial part of dialysis
nursing care to optimise dialysis, prevent catheter usage and minimise the risk of
complications from vascular access. Good cannulation skills also help to reduce cannulation
pain and improve the patient experience. Initial studies at our centre revealed gaps in
vascular access knowledge and skills of our dialysis nurses. We sought to improve this by
providing an education and assessment programme. We hoped that this would in turn lead to
improved patient education and engagement in fistula care.
METHODS: “Quality improvement” methodologies were used to develop a teaching
package and an electronic skills self-assessment tool which asked questions on knowledge,
skills and attitudes in vascular access. Achievements in the tool were categorised from levels
1 (novice) to 5 (expert). Band 3-8 dialysis nurses attended vascular access teaching sessions
and used the assessment tool to measure their progression over time. A 4-point cannulation
bundle assessment tool was then developed to provide objective assessment of the quality of
each cannulation.
The 4 bundle elements were:
(1) appropriate needle placement including use of full stretch of fistula
(2) needles and lines secured safely
(3) avoidance of aneurysms
(4) absence of scab >3mm in size.
This tool was used to assess the same 15 patients twice weekly. Compliance with individual
bundle elements and the whole bundle was measured to show improvements.
RESULTS: The teaching and assessment tools were welcomed by staff and patients.
Achievement of “level 3 competency” improved from 58% to 80% over a 4 month period.
The cannulation bundle tool facilitated patient education and shared care regarding needle
placement, leading to a rapid improvement in full bundle compliance from 0% to 80% in 2
months.
CONCLUSION: Rapid improvements were achieved in vascular access competencies by
providing a programme of education, self assessment and an objective cannulation bundle
assessment tool. Patient engagement, education and shared decision making were crucial in
effecting real change in cannulation practices. We hope that this combined approach will lead
to improved fistula prevalence and patient experience. These simple tools could easily be
utilised by other dialysis units.