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Change Concept #2
Timely Referral to Nephrologist Reach out to the primary care physician (PCP) community to educate clinicians on appropriate referral criteria.
Changes for Improvement
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Changes for Improvement:
Educate Primary Care Physicians to Utilize Pre-End Stage Renal Disease/Chronic Kidney Disease Referral Criteria
The new Kidney Disease Outcomes Quality Initiative (K/DOQI) Chronic Kidney Disease (CKD) Guidelines provide a clear standard for classification and management of patients with kidney disease.
Primary care physicians (PCPs) should use these guidelines to evaluate, manage, and refer their patients with evidence of kidney disease. Referral to a nephrologist should be made for all patients with evidence of CKD,
but certainly before the glomerular filtration rate (GFR) falls below 30 ml/minute (Stage 4 CKD) for nondiabetics or below 60 ml/minute (Stage 3 CKD) for diabetics.
Ideally, the PCP’s regular laboratory will convert serum creatinine measurements to GFR. If not, office staff or the PCP can easily use an online GFR calculator to do the conversion.
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Changes for Improvement:
Document an AVF Plan
Document an AV fistula plan for all patients expected to require renal replacement therapy (RRT), regardless of the type of RRT being considered.
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Changes for Improvement:
Educate Patients and Families on the Benefits of AVFs and on Protecting Vessels.Prepare the patient and the family for an AV fistula before they see a surgeon. Designate a nephrology staff person to educate patients and families on the benefits of AV fistulae and protecting vessels.
Veins should be protected as soon as there is any evidence of possible kidney disease, since ruining them compromises the opportunity and choices for a native AV fistula.
At the first sign of kidney disease, the physician should tell the patient and his/her family that hemodialysis may be required. The physician should examine the patient, select veins to protect, and take steps to protect them. No one should be allowed to use the chosen extremity for needle sticks, catheters, or other procedures that could imperil the veins. In addition, staff should not attempt to use the hands for venipunctures and IVs. Patients should wear a medical alert bracelet on the arm. When the patient is in the hospital, a sign on the bedside should caution staff about not using the chosen extremity to draw blood or for IVs.
Tip: Use reminder bracelets for ensuring vessel protection.
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