New Priorities and Goals Planned for ESRD Stakeholders

The Department of Health and Human Services (HHS) National Quality Strategy (NQS) is a national effort to align public- and private-sector stakeholders to achieve better health and healthcare for all Americans. It was developed “through a transparent and collaborative process with input from a range of stakeholders. More than 300 groups, organizations, and individuals, representing all sectors of the health care industry and the general public, provided comments.”

The Centers for Medicare & Medicaid Services (CMS) contracts with End Stage Renal Disease (ESRD) Networks to implement the NQS principles and HHS Secretary’s priorities in the ESRD community. Starting in December 2017, Networks will launch a set of new quality improvement activities, data reporting requirements, and educational programs that reflect updated priorities and goals.

HHS Secretary’s Priorities

  1. Reform, Strengthen, and Modernize the Nation’s Health Care System
  2. Protect the Health of Americans Where They Live, Learn, Work, and Play
  3. Strengthen the Economic and Social Well-Being of Americans Across the Lifespan
  4. Foster Sound, Sustained Advances in the Sciences
  5. Promote Effective and Efficient Management and Stewardship

CMS Goals

  1. Empower patients to make decisions about their health care
  2. Usher in a new era of state flexibility and local leadership
  3. Support innovative approaches to improve quality, accessibility, and affordability
  4. Improve the CMS customer experience

November is American Diabetes Month

According to the Centers for Disease Control and Prevention (CDC), more than 30 million children and adults in the United States are living with diabetes. At least 1 out of 3 people will develop diabetes in their lifetime. The American Diabetes Association has selected the month of November to raise awareness of the disease and its serious complications. The following resources can be helpful for dialysis staff and patients to discuss the importance of diabetes prevention and control:

How to Prevent, Diagnose, and Treat Hemodialysis Catheter-Related Infections

The best way to prevent infectious complications in dialysis patients is to avoid the use of central-venous catheters (CVC), when possible. However, this is not possible for some patients, and in those cases the adoption of prophylaxis protocols, early diagnosis and effective treatment of infectious complications are essential to improve outcomes. These are some of the conclusions reported in an article in the Journal of Vascular Access, which provides a comprehensive review of literature related to hemodialysis catheter – related infections as well as a discussion of prevention, diagnosis criteria and management of CVC-related infections in hemodialysis patients.

Emergency Planning: Can you answer these questions?

Are you confident that all members of your staff and your patients are aware of what to do in an emergency? Are you prepared to review your facility’s emergency planning with a state surveyor? Can you, your staff, and your patients:

Describe the facility’s emergency preparedness program?

  • Staff and patients should be able to explain what they would do in an emergency, based upon what they have learned in training and drills.

Know where to find the facility’s emergency plan and documentation?

  • Staff should know where the plan is, and who the leads are in an emergency.
  • Patients should have, at least, an emergency contact sheet and a copy of their dialysis orders.

If you answered NO to either of these questions, find out who the emergency lead is at your facility, and work with them to ensure that you, your staff, and your patients are prepared.

For more information visit the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (HHS ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE)’s Tools and Templates webpage at https://asprtracie.hhs.gov/technical-resources/50/dialysis-centers/47#plans-tools-and-templates.

2017 Fall ICH CAHPS Data Collection is Starting Up in October

Starting this month dialysis patients will be mailed pre-notification letters in preparation for the distribution of the upcoming ICH CAHPS fall 2017 survey. The surveys will be sent to patients in two mailings; one on November 3 and the second on December 1. Data collection will continue until January 12, 2018. The survey administration specifications can be reviewed at Survey and Protocol.

For more information or additional questions, please contact the Coordination Team via email at ichcahps@rti.org or call 1-866-245-8083.

Encourage Your Patients to Review Their Options: Medicare Open Enrollment is October 15 – December 7

Helpful resources for your patients:

Personnel Update – Action Required!

As a Medicare-certified dialysis unit, CMS expects your facility to keep Personnel Details in CROWNWeb up-to-date, within five business days of staff changes, and to review Facility Personnel information at least quarterly. CROWNWeb is the Network’s authoritative source for facility contact information. Accurate personnel information is needed to facilitate proper communication among facilities, the Networks, and CMS. Instructions on how to update the information in the CROWNWeb system can be found in the Facility Personnel Update Guide.

Please review personnel information for your facility in CROWNWeb and make any necessary changes.

The Art of Needle Cannulation – A 10-Step Guide

If you’re looking for a primer on needle cannulation, an article in Dialysis & Transplantation, Vol. 24 No. 11, 1995, outlines the basic skills needed by all dialysis staff to successfully cannulate an AV fistula or graft.  The article provides detailed explanations and illustrations for a 10-step guide to cannulation.  Topics covered include determination and direction of flow; assessment, site selection and preparation; and needle selection, placement,  and direction. Various cannulation techniques and guidance on preventing, identifying and resolving cannulation complications are also covered in the article.

The Network recommends annual review of this information along with competency testing to ensure staff competencies are maintained.  Please review your facility’s policy and procedure manuals to determine annual education and competency testing requirements.

Click here to read the full article, “Cannulation Camp: Basic Needle Cannulation Training for Dialysis Staff.”

 

Influenza Vaccinations for Patient and Staff

It is that time of year again! Flu season is right around the corner.  According to the Centers for Disease Control and Prevention (CDC), the influenza virus can be active year round, but it is most active in the late fall and winter months. Every flu season is different, but in the United States it can begin as early as October and last as late as May.  It is recommended that individuals receive their flu vaccination before the end of September. Reminder: Staff members, as well as patients, should be vaccinated against the flu.

There are many myths that surround the flu vaccine. Please review the CDC links below for resources regarding the influenza.

 

Network Boards and Committees: Call for Nominations

Network staff members rely on the end stage renal disease community for guidance on initiatives and goals.  To ensure adequate representation of community members in Network activities, the Network is seeking individuals to serve on boards and committees.

For more information on the roles, responsibilities, and time commitments involved, or for candidate nomination forms, please contact your local Network.

Network Boards/Committees:

  • The ESRD Divisional Board (DB) and Medical Review Board (MRB) are staffed by renal professionals and patients qualified to evaluate the quality and appropriateness of care delivered to ESRD patients. The DB is responsible for the oversight and management of the Network and serves as an expert panel that analyzes and advises the IPRO Board of Directors on quality improvement activities (QIAs) and policies and procedures for the ESRD Network Program. The MRB advises the DB on QIAs and guides the development, implementation, and evaluation of Network projects.
  • The Patient Advisory Committee (PAC) assists in identifying and addressing barriers to obtaining quality healthcare from the perspective of ESRD patients. The PAC supports Network activities by assisting with the development of educational materials for patients and providing feedback on the effectiveness of beneficiary-related activities.
  • The Network Grievance Committee is an advisory panel to the DB, composed of nephrology physicians, nurses, social workers and patient representatives. The committee investigates and resolves patient grievances in accordance with CMS procedures and Network policies.

Teleconferencing Can Help You Involve Your Patients in their Plans of Care

Part of the responsibility of the interdisciplinary team (IDT) is to include patients, and if requested, their care partners and family members in both developing/setting goals and reviewing the patient plan of care.

Is it acceptable to hold a plan of care meeting with the IDT and the patient, their care partner or family members (if requested) via telephone conference? As stated in the CMS Interpretive Guidance for the Conditions for Coverage for End-Stage Renal Disease Facilities, the answer is “yes.”

“A substitute mechanism for a team conference needs to facilitate discussion among team members about the information gathered from the comprehensive patient assessment and provide the opportunity for team coordination and development of an effective, individualized plan of care for the patient to ensure the desired outcomes are achieved. To facilitate full team participation in conferences, any member, including the patient, may participate through telecommunication.”

CMS Interpretive Guidelines (see page 205): https://esrd.ipro.org/wpcontent/uploads/2017/08/InterpretiveGuidelines.pdfÂ

For more information on the regulations on plans of care, see the CMS Conditions for Coverage for end-stage renal disease facilities. Subpart C – Patient Care: https://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol5/xml/CFR-2011-title42-vol5-sec494-90.xml