Fluid Restrictions During the Holidays

Dialysis patients deal with several issues that make compliance with fluid restriction difficult all year round; however, during holiday seasons these issues are often compounded, making it particularly difficult to follow guidelines related to fluid restrictions. In addition, there are other dietary considerations that need to be taken in consideration, like sodium restriction. Registered dietitians can help patients personalize fluid restriction goals and manage thirst; they can also offer patients tips to plan their holiday meals. Educating patients about appropriate serving sizes, seasonings and hidden fluid can also prepare them for their festivities. Talk to your patients to help them enjoy their holiday season while avoiding unwanted hospitalizations or other health complications. For more information, please visit https://www.kidney.org/atoz/content/fluid-overload-dialysis-patient.

Great American Smokeout® – November 15, 2018

“About 36.5 million Americans still smoke cigarettes, and tobacco use remains the single largest preventable cause of disease and premature death in the world,” as reported by the Centers for Disease Control and Prevention. Every year on the third Thursday of November, smokers across the nation take part in the American Cancer Society Great American Smokeout.

The Great American Smokeout is an opportunity for smokers to commit to healthy, smoke-free lives; not just for a day, but year round. Individuals, community groups, businesses, healthcare providers, and others can use this event to encourage people to make a plan to quit, or initiate a smoking cessation plan on the day of the event. The event also promotes the many tools and resources available through the American Cancer Society that people can use to help them quit and “stay quit.”

To learn about the available tools, click on the links below or call 1-800-227-2345.

Monitor Missing Data in CROWNWeb for your Facility

The Centers for Medicare & Medicaid Services has published “Data Management Guidelines” for data submission in CROWNWeb. They have also set up data quality goals for 2017-2018. Please click here to see the goals set by the CMS.

The CROWNWeb facility dashboard provides easy identification of missing data.

Once a user logs in to CROWNWeb, the facility dashboard can be seen by entering facility CCN in the search box.  The facility dashboard provides direct access to a comprehensive list of items requiring submission in CROWNWeb. It is important that facility administrators, medical directors and nurse managers look at the dashboard on monthly basis to ensure data are submitted according to CMS requirements. This is an easy way to monitor data submission.

The CMS ESRD QIP NHSN Reporting Measure Deadline and Data Quality Checks

Reporting to NHSN for the CMS ESRD QIP rule:

Facilities must follow NHSN Dialysis Event Surveillance Protocol and Reporting for calendar year 2018 (payment year 2020) for compliance with the ESRD QIP. The quarterly reporting deadline for April – June 2018 data is on or before September 30, 2018.

Data Quality Checks: 

NHSN data should be completely and accurately reported according to the Dialysis Event Protocol. Determining whether or not the data are correct is your facility’s responsibility. Data quality checks should be performed before the data submission deadline for the quarter. For example, for April to June data, quality checks should be performed by September 30. For more information on how to perform data quality checks, please go to https://iproesrdnetwork.freshdesk.com/solution/articles/9000153404-how-to-perform-data-quality-checks- or https://iproesrdnetwork.freshdesk.com/support/solutions/folders/9000169529

“Welcome to Medicare” a Chance to Coordinate Care

If you have patients who are new to Medicare, encourage them to schedule their “Welcome to Medicare” physical exam. This is a FREE comprehensive screening that will ensure

  • A record and evaluation of their medical and family history, current health conditions, and prescriptions.
  • Baseline measures of blood pressure, vision, weight, and height.
  • Review of preventive screenings and services, like cancer screenings and immunizations.
  • Ordering of additional tests, if needed, depending on their general health and medical history.

After the visit, the doctor will give them a plan or checklist outlining free screenings and preventive services that they need. By collaborating with the physician/practice that performs the comprehensive review of the patient’s health status, the medical team at the dialysis clinic can be assured that the patient has an established resource for healthcare issues that are not specifically related to ESRD. This is a great opportunity to coordinate care for essential services like immunizations, diabetes management and cardiac related issues, just to name a few.

For more information, see: https://www.medicare.gov/people-like-me/new-to-medicare/welcome-to-medicare-visit.html

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=40Several 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.