Change Concept 13

Support patient efforts to live the best possible quality of life through self-management

  • Patient achieves optimum treatment outcomes and health status through collaborative knowledge-building related to CKD progression and treatment and through effective application of self-management interventions, such as self-monitoring and decision-making.
  • Health care clinicians utilize techniques and strategies for the education of those who participate in vascular access education and management that are designed to encourage, enhance, and support patient self-management. This includes motivational interviewing, health coaching, and other patient empowerment strategies and techniques.

Patient self-management support will increase patients’ skills and confidence in managing their health problems, including goal setting, regular assessment of progress and problems, and problem-solving support.

Changes for Improvement:

Empower patients with earlier stages of CKD to:

  • Know their GFR and Kidney Disease Stage
  • Understand the dangers of PICC lines and blood draws and utilize tools and strategies to preserve arteries and veins once diagnosed with CKD
  • Actively participate in developing their plan of care
  • Understand all treatment modalities available for treatment of ESRD

Empower CKD Stage 4 patients preparing for hemodialysis to:

  • Understand what criteria should be used to select the appropriate vascular access (vessel mapping, physical exam, co-morbid conditions)
  • Compare the risks and benefits of all vascular access (AV fistulas, AV grafts, catheters)
  • Identify and overcome barriers to timely placement of an AV fistula and have an AV fistula placed and matured before initiating hemodialysis
  • Participate in developing their vascular access plan
  • Know the benefits of self-cannulation and prepare for self-cannulation, i.e. pre-cannulation training

Empower ESRD patients on hemodialysis to preserve their AV fistula by:

  • Understanding the need to examine their access several times daily by feeling for a thrill. If a stethoscope is available listen for a bruit and changes in sounds heard .
  • Understanding access monitoring and interventional procedures to ensure vascular access patency
  • Learning and performing self-cannulation and understanding access depth (deep access = 1¼” needle; very superficial=3/5” needles)
  • Learning and performing buttonhole cannulation

Health care facilities, physicians and staff provide support for patient self-management by:

  • Understanding and implementing the core concepts of patient self-management, dignity and respect, information sharing, participation, collaboration, and empowerment
  • Developing guidelines and protocols to implement patient self-management concepts in all treatment areas including in-center dialysis, should be sensitive to cultural and linguistic competency of patients.
  • Assess patient’s health literacy level, use visual aids, easy readability brochures and video tapes to assist patients to understand all aspects of their treatment, to include vascular access planning and care, fluid balance, nutrition, co-morbidities, and treatment modalities.
  • Promoting self-management among patients to achieve better outcomes and quality of care

Related Tools

How to Have a Good Future with Kidney Disease

The non-profit Medical Education Institute, Inc., developed the How to Have a Good Future with Kidney Diseasetoolkit so any practitioner or presenter can educate his or her patients.  This slide series can help you educate people from stage 3 CKD through end-stage renal disease, one-on-one or in groups.

A How-To Manual: The Art of Teaching Buttonhole Self-Cannulation

An article written by Stuart Mott that is an excellent resource for patients to learn step-by-step how to self-cannulate using the Buttonhole Technique.

5 Diamond Patient Safety Program, Patient Self-Management – New

From: The Mid-Atlantic Renal Coalition in collaboration with the ESRD Network of New England
Midlothian, Virginia, USA
Developed 4/10

Core Concepts of Patient Self-Management – New

From: The FFBI Coalition, Patient Self-Management Change Concept Workgroup
Midlothian, Virginia, USA
Developed 2/10

Self-Management Guidelines & Self-Management Protocol – New

From: The FFBI Coalition, Patient Self-Management Change Concept Workgroup
Midlothian, Virginia, USA
Developed 2/10

10 Rules to Live By

From: The FFBI Coalition, Patient Self-Management Change Concept Workgroup
Midlothian, Virginia, USA
Developed 2/10

Self-Cannulation of Vascular Access Procedures

An example procedure statement on successful self-cannulation of vascular access.

Training Checklist for Self-Cannulation

A checklist for patients who will be self-cannulating
Revised 06/11