Category: All Networks

Ethics: Professional Boundaries in Healthcare

A code of ethics is the blueprint for professional behavior, and it provides employees with principles of conduct. Those principles guide professionals through their daily interactions within the workplace and help set clear expectations for the organization. One of the key components of a code of ethics is the need for professional boundaries, especially in a healthcare setting. ESRD healthcare professionals work closely with patients on a daily basis, and often face ethical dilemmas in which they may experience a conflict between their professional responsibility and personal feelings. The National Council of State Boards of Nursing (NCSBN) and the National Association of Social Workers (NASW) provide guides to help healthcare professionals practice ethically to prevent boundary lines from becoming blurred.

Vocational Rehabilitation Resources: The Ticket to Work Program

One of the Network’s quality improvement activities (QIA) in 2018 focuses on efforts to support the gainful employment of ESRD patients ages 18-54 who are not currently enrolled in vocational rehabilitation or accessing services.

Each facility participating in the QIA has been asked to conduct a vocational rehabilitation (VR) audit for all patients in CROWNWeb to identify eligibility, interest in VR, documentation of referral, and utilization of services.

To help accomplish goals of the QIA, the Social Security Administration’s Ticket to Work program can provide information for patients about returning to work without losing their disability benefits. The website includes valuable resources:

  • Employment Network’s search tool
  • Success Stories to support patient referral efforts
  • Past and upcoming webinars
  • Blog that provides daily updates on the program

 

Using the National Health and Safety Network (NHSN) as a Resource in your Infection Control Efforts.

Bloodstream infections (BSIs) are the second leading cause of death in dialysis patients according to the Centers for Disease Control and Prevention (CDC). Healthcare practitioners can prevent many of these infections by following basic infection guidelines (CDC Core Interventions) and tracking the results. The CDC’s National Healthcare Safety Network (NHSN), the nation’s most widely used healthcare-associated infection tracking system, provides facilities, states, regions, and the nation with data needed to identify problem areas, measure progress of prevention efforts, and ultimately eliminate healthcare-associated infections. Visit the NHSN website for information on training, protocols, forms, support materials, resources and FAQs related to surveillance of BSI events, prevention measures, and vaccination information for facility staff members and patients.

ESRD QIP Ultrafiltration: Longer Dialysis Treatments

Assuring that ESRD patients receive the appropriate amount of renal replacement therapy at a rate that allows them to feel well and prevent adverse reactions is the ultimate goal for nephrologists. As defined by the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI), Clinical Practice Guideline for Hemodialysis Adequacy, the upper limit a patient should dialyze is 13 millimeters per hour per kilogram of body weight. Patients who dialyze at increased ultrafiltration rates are at greater risk for a cardiovascular event [1]. There are documented clinical benefits for patients who have longer and slower dialysis treatment [2]. Many clinics now offer nocturnal hemodialysis options to their patients so they can dialyze longer and slower while sleeping [3]. Facilities that do not offer a nocturnal program may want to consider increasing scheduled treatment times to ensure that patients are meeting their 1.2 Kt/V clearance goals and  maintaining an ultrafiltration rate of 13ml/hr/kg or slower.

REMINDER: Ultrafiltration rate reporting is a new requirement for the 2018 CMS Quality Incentive Program.

To read more, please click on the links below:

[1] https://www.ajkd.org/article/S0272-6386(15)01019-7/fulltext
[2] Chazot, C. MD, Guillaume, J. MD (2009). “The Advantages and Challenges of Increasing the Duration and Frequency of Maintenance Dialysis Sessions.” Nature Clinical Practice Nephrology
[3] Glickman, J. (2012, April 27). Stunning Consequences of Thrice-Weekly In-center Dialysis

 

 

 

The Seven Step Journey Towards Kidney Transplant

The Centers for Medicare & Medicaid Services (CMS) has incorporated in the 2018 transplant quality improvement activity (QIA) a series of standardized steps toward transplant. According to the 2012 Clinical Journal of American Society of Nephrology article, “Impact of Navigators on Completion of Steps in the Kidney Transplant Process: A Randomized, Controlled Trial,” these steps were first defined and performed in 23 hemodialysis facilities in Ohio. The steps are: (1) Suitability for Referral to Transplant Center; (2) Interest in Transplant; (3) Referral Call to Transplant Center; (4) First Visit to Transplant Center; (5) Transplant Center Workup; (6) Successful Transplant Candidate; (7) On Waiting List or Evaluating Potential Living Donor.

Research has identified that the guidance offered by a transplant navigator –or mentor- helps patients move further and faster through the seven steps than they would without a navigator. If you are interested in starting a Peer Mentorship Program at your facility, contact the Network.

Update Admit/Discharge Records in CROWNWeb!

Patients should be admitted / discharged in CROWNWeb within 5 business days of their first treatment and within 5 business days of their last treatment at a Medicare-certified dialysis facility.

 

See Page 31 of the CROWNWeb Data Management Guidelines for details.

To send a help desk ticket to the Network: support@iproesrdnetwork.freshdesk.com

Looking for resources on depression and mental health?

The National Forum of ESRD Networks’ Kidney Patient Advisory Council (KPAC) has developed the Dialysis Patient Depression Toolkit. Created by patients for patients, with important contributions by professionals, this toolkit was is designed to help patients who feel that they may be experiencing depression. It also offers facility staff guidance in providing hope and assistance to patients with mental health concerns. The toolkit also addresses anxiety, sleepiness, substance abuse and more. It provides coping skills for patients, whether or not they are currently working with a professional in these areas of mental health, as well as resources and contact information for those individuals interested in more information about how to find help.

Cultural Competency in the ESRD Community

Cultural competence in healthcare describes the ability to provide care to patients with diverse values, beliefs and behaviors, including tailoring healthcare delivery to meet patients’ social, cultural and linguistic needs[1]

Dialysis facilities can improve their cultural competence by providing education about diverse populations to staff members.  This can assist to eliminate racial and ethnic disparities in care.

Some of the benefits of cultural competence include:
  • An increase mutual respect and understanding between patient and the organization
  • Increases participation and involvement in health issues
  • Reduces care disparities in the patient population
  • Reduces the number of missed treatments

[1] American Hospital Association and Institute for Diversity in Health Management. (2012, June). Diversity and Disparities: A Benchmark Study of U.S. Hospitals. Chicago: IL. Accessed at www.hpoe.org

 

Learn More About Network Publications

The IPRO ESRD Network Program offers educational content for patients through our Kidney Chronicles and PAC Speaks newsletters. Primarily distributed electronically, these newsletters focus on topics that involve patient engagement and education about ESRD, as well as updates on quality improvement activities and emergency response resources.

Here’s a quick look at what each newsletter has to offer!

Kidney Chronicles features educational information for patients, their care partners and family members. It is emailed to facility staff members with a request that they print and distribute copies to patients served by the facility. Network Patient Advisory Committee (PAC) members and Patient Subject Matter Experts (SME) also receive the newsletter via email.

The PAC Speaks newsletter is written by patients for patients about important issues for people living with end stage renal disease. This newsletter is also distributed to participants of the PAC and to patient SMEs, as well as dialysis facility staff.

Check out each Network website to read the latest editions of Kidney Chronicles and PAC Speaks!

ESRD QIP Corner

Don’t miss these important updates:

Facility DFC Data Updated:  The Centers for Medicare & Medicaid Services (CMS) has completed its April refresh of the facility data in Dialysis Facility Compare (DFC). Details about this update can be found at https://data.medicare.gov/data/dialysis-facility-compare.

The newly updated DFC database and current five-star facility ratings can be found at https://www.medicare.gov/dialysisfacilitycompare/.

ESRD QIP Measures Technical Specifications Updated: CMS also recently updated its web page on technical specifications for ESRD QIP Measures to include the CY2018 ESRD PPS Final Rule, and links to Technical Measure Specifications through PY2021.

Find this page at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/061_TechnicalSpecifications.html.

ESRD QIP Rule and NHSN Core Interventions:  The Centers for Disease Control and Prevention (CDC) recently updated its NHSN and CMS ESRD QIP Rule web page and its nine recommend Core Interventions for reducing BSI.

Find these updates at https://www.cdc.gov/nhsn/faqs/dialysis/faq-esrd-qip.html and https://www.cdc.gov/dialysis/prevention-tools/core-interventions.html.

What’s the current status of the ESRD QIP?

The ESRD QIP Current Status webpage can be found here: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/02_CurrentStatus.html

The ESRD QIP establishes incentives for dialysis facilities serving the ESRD population to meet performance standards established by CMS. The quality measures are improved every year via rulemaking. Facility evaluation and payment reductions in a given payment year (PY) are based on performance during a prior year.

Improved Patient Health Outcomes through Peer Mentors

Did you know that peer mentoring has been proven to be a successful strategy to educate patients about their options for treatment, including transplant? The Network has resources and tools available to help train patients who are interested in becoming peer mentors. Contact the Network today to sign up your facility for the Network’s new peer mentorship training program.

According to the National Kidney Foundation, peer support is reported to be effective in helping kidney patients adjust to kidney disease, long-term dialysis therapy and kidney transplantation. Peer support programs utilize someone who is living with the same disease to assist patients in managing their own health. This can be particularly effective when the patient is newly diagnosed or is having trouble coming to terms with the disease. In addition, peer support has become strongly linked with attempts to increase patients’ ability to self-manage their condition, and the drive to improve healthcare outcomes. Peer support works because patients are able to give each other something the clinician does not have, shared life experience.

A peer mentor empowers fellow patients to move forward with their lives after being diagnosed with ESRD. Peer mentoring provides support and increases the confidence that many new patients need, and offers patients access to someone who has been through the similar experiences and can understand their concerns. Peer mentors can come from all backgrounds. Mentors should be individuals with positive outlooks on managing kidney disease. Individuals who are succeeding at achieving their treatment goals can provide insight to help others successfully manage kidney disease.

 

For more information about peer mentorship visit, https://www.kidney.org/professionals/Peers

New Resources About Home Dialysis

Dispelling myths and providing concrete information regarding home modalities is often a challenge for in-center chairside dialysis practitioners. Another ESRD Network organization (HealthInsight ESRD Alliance Network 16 and 18) has created materials that help patients distinguish between myth and fact in an easy FAQ format. We hope these materials, which can be found at the links below, provide resources for you to offer your patients when they are considering whether home therapy is right for them.
My Choice, Home Dialysis – MYTH VS. REALITY