Doctor of Nursing Practice
Date of Defense
Dr. Vanessa Loyd
Dr. Vanessa Loyd
Dr. Tonya Haynes
Jennifer Monk-Beckley, MSN, APRN
Problem: The central venous catheter (CVC) usage rate in a large urban dialysis clinic was 34.5% and the Centers for Medicaid and Medicare Services (CMS) goal is 10.7%. CVC usage is a quality metric monitored by CMS to assess whether dialysis facilities are providing quality services which can impact reimbursement for the clinic. Failure to meet this metric can result in a penalty of up to 2% in reimbursement. The purpose of this quality improvement project was to determine if an interdisciplinary team (IDT) approach to vascular access planning and care influenced the CVC usage rate by 10% in three months.
Methods: An observational descriptive design with a retrospective medical record review was used to evaluate the effectiveness of interventions aimed to decrease CVC utilization rates in a large urban dialysis clinic. This pilot study evaluated an IDT approach to permanent vascular access coordination and was completed between June through August 2021.
Results: Pre implementation of the IDT approach there were (N=57) patients dialyzed through a CVC and post implementation there were (N=59). The monthly CVC usage was compared to CMS performance goal of 10.7%. A Pearson chi-square test was performed ((1)> = 1.775, p = 0.183), and resulted in no statistical significance, but was clinically significant with lowering the CVC usage rates to 29.31% from 34.5%.
Implications for practice: An IDT approach may be adopted over a longer time to assess CVC usage rates before starting hemodialysis by addressing patient barriers (i.e., no insurance, referrals to vascular surgeons).
Jordan, Antionette, "Decreasing Central Venous Catheter Usage for the Hemodialysis Patient" (2022). Dissertations. 1154.