MAGIC is a quality improvement project designed by the British Renal Society’s Vascular Access special interest group (BRS VA) and the Vascular Access Society of Britain and Ireland (VASBI), supported by the Kidney Quality Improvement Partnership (KQuIP). It aims to improve cannulation / needling of arteriovenous fistulae (AVF) and grafts (AVG). It uses the ‘BRS Clinical Practice Recommendations for Needling of AVF and AVG’ as a basis to define best practice.
The aim of MAGIC is to:
• Improve rates of AVF and AVG use through preserving the lifespan of existing AVF and AVG
• Improving patient experience of needling, to encourage patients to choose AVF or AVF as their preferred type of vascular access
• Promoting service structures to support AVF/G formation and care
• Promoting future quality improvement into vascular access.
MAGIC’s driver diagram shows key elements that will drive this change in units.
MAGIC has been designed to work at a regional level and regions will be offered the opportunity to become involved in MAGIC through the KQuIP regional days.
The process of MAGIC within the KQuIP regional structure is shown in the process diagram. This structure provides a core element to MAGIC, with space for regional specific QI to be incorporated into the structure.
MAGIC has created a set of objectives to shape the project. Again, these objectives provide a core structure to MAGIC but allow addition of regional designed objectives.

MAGIC takes a collaborative approach, as the leadership of MAGIC within renal units will make it a success locally, regionally and nationally. Individuals will drive MAGIC within their own local area, with support and advice from experts involved in MAGIC and KQuIP. We have created a MAGIC pledge to outline the commitment individual units initiate when agreeing to participate in MAGIC. In particular, we are asking participating units to nominate a needling champion and vascular access service appraisal lead to drive MAGIC locally. The pledge specifies who these people should be and what their role will be. Support for these leads will be available through 3-monthly calls / webinars and KQuIP regional events.

The MAGIC group have developed a number of materials, endorsed by BRS and VASBI, to help units implement best needling practice. These include:
Educational materials including;
o Slide sets with lesson plans
o ELearning package
o Competency document
Awareness materials including
o Posters
o Cards
Further information on these elements will be available soon.

Vascular Access Service Appraisal
MAGIC will use the Scorecard generated by the Scottish Vascular Access Appraisal to enable units to evaluate their vascular access service. This will highlight strengths and weaknesses in individual services. Units will access support through KQuIP, VASBI and BRS VA to develop Plan-Do-Study-Act cycles to improve their vascular access service.

MAGIC has developed a measurement strategy to evaluate whether MAGIC changes practice. We have used Kirkpatrick’s educational evaluation model to structure this with 4 levels of measures:
• Level 1 – was use of the materials enjoyable
• Level 2 – did use of the materials lead to learning
• Level 3 – did use of the materials lead to changes in clinical practice
• Level 4 – did use of the materials lead to changes in clinical outcomes
The clinical outcomes linked with MAGIC will be measured monthly from a sample of haemodialysis patients and recorded using run charts, which will be visible to individual renal unit teams.
These outcomes have been developed in-line with MAGIC’s core objectives. There is space to include regional specific measures within the measurement strategy.
Further information on these elements will be available soon.

MAGIC is governed by a steering group which consists of representatives’ from BRS VA, VASBI, KQuIP and patient representation. If you would like further information on MAGIC, please contact any member of the steering group. The steering group structure with contact detail is outline in the structure document.