Assisting the Dialysis Patient with Diabetes Self-Management

According to the United States Renal Disease (ESRD) Incident and Prevalent Quarterly Update, 37% of patients with ESRD have diabetes. The common measurement to assess prediabetes and type 2 diabetes is the A1C test or the hemoglobin A1C test. The higher the glucose level in the bloodstream, the more glucose will attach to the hemoglobin. The A1C test reflects the average blood glucose levels over the past three months. (1)

Diet plays a very big role in controlling both diabetes and kidney disease; however, it can be a challenge for individuals who have these chronic conditions to follow the recommended diet.

The goal of diabetes self-management is to provide patients with knowledge and strategies to better manage their diets, with a clinical goal of maintaining an A1C of 5.7% or lower. The Dialysis Patient Citizens Education Center is a resource that can provide your patients with suggestions for ways to successfully manage their diets to control their blood sugar and renal disease. This site provides diets and grocery lists to assist patients in controlling intake of restricted foods including those foods high in carbohydrate and sugar content-an essential part of diabetes self-management. (2)

  1. https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis/a1c- test
  2. http://www.dpcedcenter.org/classroom/nutrition-management-kidney-disease- patients/following-diet-diabetes-and-kidney-disease

Getting ready for next year – Is personnel information for your facility up-to-date in CROWNWeb?

CROWNWeb Data Management Guidelines require that key facility personnel are added within five business days of staff changes and that facility staff review personnel information at least quarterly (http://mycrownweb.org/assets/crownweb-dm/dm_guidelines/#p=17).

The Network is starting a new contract year on December 1, 2018. Several new quality improvement activities (QIAs) will be launched at that time. The Network relies on e-mail as an efficient and cost effective way to communicate important information to facility staff. As the source for facility personnel contact information, it is critical that the information in CROWNWeb is current and correct.  Anyone with access to CROWNWeb can update facility personnel information. For more information on how to add, remove and update facility personnel information in CROWNWeb, please see https://iproesrdnetwork.freshdesk.com/a/solutions/.

Data Cleanup for 2744 Facility Survey

The 2744 facility survey form must be submitted to the Network after all the patient information for the year is submitted. This activity starts in the month of January. Please see http://mycrownweb.org/assets/crownweb-dm/dm_guidelines/#p=40. Several data cleanups can be performed in preparation for this activity.

The Network sends a number of data cleanup reports to facilities; these include the “System Discharge Report,” “Gap Patient Report,” “Transient Patient Report,” and “First Admission Not New to ESRD Report.” Taking action on these reports when you receive them will help balance the 2744 form.

Facilities can select “Add New 2744” to create the “2018” form in CROWNWeb. This generates several reports that can be used to balance the surveys. For more information on 2744 data cleanup, please see https://iproesrdnetwork.freshdesk.com/a/solutions/. Starting early on data cleanup will help you complete the form in time and will keep patient information accurate!

Advance Care Planning

As a healthcare practitioner, you play a critical role in helping your patients plan for end of life care. The first step is to have conversations with your patients about their wishes. These conversations about advance directives can be difficult to start, but once you begin you can allow your patients the opportunity to make their own choices about their care before a crisis occurs.

An advance directive is a written statement of a person’s wishes regarding medical treatment, to ensure that their wishes are carried out should the person be unable to communicate them to their doctor

Types of advance directives include:

  • A Healthcare Proxy
  • A Living Will
  • A Living Will with a Health Care Proxy
  • A Do Not Resuscitate Order (DNR)
  • Medical Orders for Life Sustaining Treatment (MOLST) – New York State
  • Patients can obtain advance directive forms from their healthcare provider, attorney, local Agency on Aging or state health department.

More information is available at https://www.medicare.gov/manage-your-health/advance-directives-long-term-care.

When Disaster Strikes: Help for Patients Who Rely on Durable Medical Equipment

When durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) are lost, destroyed, or damaged to the extent that they can’t be used anymore due to an emergency, Medicare

will pay for the replacement DMEPOS that a Medicare beneficiary owns or purchased. Examples of DMEPOS include: home oxygen equipment, diabetes testing supplies, wheelchairs, canes, walkers, artificial limbs, braces, and enteral nutrients and supplies. The link below can help you guide medically vulnerable patients should an emergency cause them to lose use of DMEPOS.

https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Emergency-DME-Beneficiaries-Hurricanes.pdf

What Your Patients Should Know About the Flu Vaccine

Influenza (flu) is a serious disease that can lead to hospitalization and even death. Vaccination is an important preventative tool for people with chronic health conditions such as renal failure. The Centers for Disease Control and Prevention (CDC) recommends a yearly flu vaccine as the most important step of protection against the flu. Flu vaccination can reduce flu related illness. Additionally, flu vaccination decreases patients’ chances of catching the flu and possibly infecting family members, friends, fellow patients and staff at the dialysis clinic. Flu vaccination has also been shown to reduce hospitalizations among people with diabetes (79%) and chronic lung diseases (53%). Flu vaccination may also lessen the intensity of the flu if you do get sick.

Vaccines reduce the risk of infection by working with the body’s natural defenses to help it safely develop immunity to the disease. The body’s immune response declines over time, and each flu season is different. Therefore an annual vaccine is needed to provide ideal protection. Additionally, because the flu virus constantly changes, the vaccine is reformulated each year to keep up with the changing viruses.

The CDC recommends that everyone six months of age and older receive the flu vaccine Additionally, anyone living with and/or caring for dialysis or transplant patients should get the flu vaccine.

Dialysis and transplant patients should not take nasal spray flu vaccines; and patients who have received a transplant within the previous six months should check with their renal care team concerning the flu shot.

Flu season starts in November. It takes about two weeks for the body to develop protection to the flu. Therefore, it’s best to get vaccinated by the end of October, before flu season starts.

 

CDC Preventive Steps: https://www.cdc.gov/flu/consumer/prevention.htm

CDC Key Facts About Seasonal Flu Vaccine: https://www.cdc.gov/flu/protect/keyfacts.htm

The CMS Data Quality Goals

In 2016 CMS introduced the CROWNWeb Data Quality Goals to improve the overall timeliness, accuracy and completeness of patient data entered in CROWNWeb by dialysis facilities and transplant centers.

The CMS Data Quality Goals support the overarching CMS goal of “Putting Patients First” and seek to improve data timeliness on tasks performed in CROWNWeb as shown in the table below.

The Network will continue to encourage and support dialysis providers in attaining higher compliance levels. Please ensure that missing data identified in the CROWNWeb facility dashboard are addressed on weekly basis. For more information, please see http://mycrownweb.org/wp-content/uploads/2017/04/April-Town-Hall-4-26.17-508.pdf.

The Network also sends missing data reports on monthly basis. Please address any data issues raised by the Network immediately.

It is that time of the year! Dialysis Facility Reports and Master Account Holder Information

The Dialysis Data website is used to perform the following activities:

  1. Updating Master Account Holder (MAH) information (use facility CCN as username and MAH password for log in).
  2. Adding/editing users and granting permissions (use facility CCN as username and MAH password for log in).
  3. Accessing Dialysis Facility Report (DFR) and Quarterly Dialysis Facility Compare Report (QDFC) (use individual user email address as username and the password established by the individual user for log in).

To access Dialysis Facility Reports and Quarterly Dialysis Facility Compare Reports, visit www.dialysisdata.org. Click here for help logging in.

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