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Welcome to the August 30 issue of the Quality Insights Renal Network 4 e-newsletter. In this issue, we bring you information about updated vaccination recommendations for the upcoming flu season, patient education features, our quality improvement activities, upcoming events, National Healthcare Safety Network (NHSN) updates, CROWNWeb updates, continuing education opportunities,  resources and much more. We encourage you to  contact us with any questions, concerns or suggestions.  
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FeaturedEducation2FACILITY-LED PATIENT EDUCATION TOPIC OF THE MONTH: 
Vaccinations
We provide a Network 4 Patient Education Sheet each month in 2018. These documents are also located on our website. Please provide all of your patients with this education sheet this month.   Also, we ask that you please encourage your facility's Patient  Representatives to pass out this educational information as well. 
Thinkstock vaccine vials ACIP2ACIP provides updated recommendations for the 2018-2019 seasonal influenza vaccines
Below are excerpts from the summary of the recommendations by Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines in the United States. The full article, Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices-United States, 2018-19 Influenza Season, published in Morbidity and Mortality Weekly Report/ August 24, 2018 can found on the CDC website.
  • Vaccine viruses included in the 2018-19 U.S. trivalent influenza vaccines will be an A/Michigan/45/2015 (H1N1)pdm09-like virus, an A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus, and a B/Colorado/06/2017-like virus (Victoria lineage). Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013-like virus (Yamagata lineage). 
  • Recommendations for the use of LAIV4 (FluMist Quadrivalent) have been updated. Following two seasons (2016-17 and 2017-18) during which ACIP recommended that LAIV4 not be used, for the 2018-19 season, vaccination providers may choose to administer any licensed, age-appropriate influenza vaccine (IIV, RIV4, or LAIV4). LAIV4 is an option for those for whom it is appropriate. 
  • Persons with a history of egg allergy of any severity may receive any licensed, recommended, and age-appropriate influenza vaccine (IIV, RIV4, or LAIV4). Additional recommendations concerning vaccination of egg-allergic persons are discussed. 
  • Information on recent licensures and labeling changes is discussed, including expansion of the age indication for Afluria Quadrivalent (IIV4) from ≥18 years to ≥5 years and expansion of the age indication for Fluarix Quadrivalent (IIV4), previously licensed for ≥3 years, to ≥6 months.
QIAsQuality Improvement Activities (QIAs)

Increasing patient participation in Network 4's quality improvement activities through subject matter experts 
Many patients with kidney disease face barriers in completing the necessary steps required to be on the transplant waitlist. Studies show that peer support is effective. As a result, Network 4 - in consultation with its patient subject matter experts (SMEs) - is in the process of developing guidelines for a Patient Advocacy Initiative focused on improving the patient transplant waitlist status and home dialysis training initiations. Our goal is to build a pipeline of patients helping patients. Patient Advocates will be available for patient-to-patient sharing of experiences. The goal is to encourage/guide patients as they move through the processes of transplant evaluation and home therapy initiation. We currently have three SMEs partnering with four facilities. 

"stitches of hope" campaign encourages getting on transplant waitlist 
One of Network 4's four Quality Improvement Activities (QIA) is focused on increasing the number of patients on the Transplant Waitlist and there are currently 100 Network 4 facilities participating. As a creative way to keep track of patients who are waitlisted during the project period, Network 4, in consultation with our patient/caregiver subject matter experts, is creating a "Stitches of Hope" quilt. Imagine if 100 facilities are able to assist at least 10 patients each to get on the transplant waitlist. We could exceed CMS' goal! One of our caregivers has drafted a design and will make the quilt. 

Featured Patient Testimonial: 
Houa's Story

Check out an inspirational story from Houa Yang, a caregiver for several family members who suffered from kidney disease. Houa knows the benefit of kidney transplant first hand through experience with her mother and siblings. Read Houa's story

Learn more about the "Stitches of Hope" quilt campaign.

UPDATE: We recently received 10 quilt patches from a facility! This means facility staff have assisted 10 patients in getting on the transplant waitlist. We look forward to continued responses from project facilities. Please remember to mail all quilt patches along with signed patient consent forms and any unused patches to Network 4 in the included self-addressed envelope by September 28, 2018 (or as soon as you have recorded information on all 10 patches).  

New resource addresses challenges associated with kidney transplant 
Quality Insights Renal Network 4 recently completed a brochure titled "Understanding Challenges: A Guide to Understanding the Challenges of a Kidney Transplant Evaluation and Workup." Download the brochure  
UpcomingEventsUpcoming Events
aakp webinar on emergency preparedness scheduled for september 5
The American Association of Kidney Patients (AAKP) will present a HealthLine webinar titled Prepping and Staying Safe During Emergencies on September 5, 2018 Register today
11th Annual Kidney Classic Golf Tournament
Get in the games for the Kidney Foundation of Central PA's 11th Annual Kidney Classic Golf Tournament on Monday, October 8 at the Country Club of Harrisburg.  This event includes a grab bag lunch, silent auction and a fun round of golf with an after tournament buffet and awards.  This event is open to male and female golfers of all skill levels.  Proceeds benefit Camp Kydnie, a week-long summer camp for children with chronic kidney disease who would not be able to attend camp without financial aid.  Download the brochure or call the KFCP office at (800) 762-6202 or email info@kfcp.org.
2018 NRAA Annual Conference set for October 17 - 19
The 2018 National Renal Administrators Association (NRAA) Annual Conference is set for October 17 -19, 2018 in Boston, MA. View a conference schedule and register by visiting the NRAA website
2018 Kidney Transplant symposium
On Tuesday, October 23, 2018, the Penn Transplant Institute will offer the 2018 Kidney Transplant Symposium. This year the program will address the impact of the opioid crisis on kidney transplantation and organ donation. Topics include: 
  • Overview of Kidney Transplantation
  • Substance Use and the Kidney Transplant Evaluation
  • Organ Donation and the Opioid Crisis  
  • Infectious Disease and Kidney Transplantation

The session offers 6 continuing education credits for nurses and PA social workers. The symposium is open to all dialysis unit staff as well as nephrology and transplant nurses. For additional information, please download a copy of the symposium flyer or contact Margaret Leid at margaret.leid@uphs.upenn.edu or (215) 298-3929.

NHSNUpdatesNHSN Updates
Required Dialysis Event Surveillance Training
CMS requires that at least one person from each outpatient dialysis facility that is eligible to report positive blood cultures (PBC), IV antibiotic starts, and pus, redness and swelling (PRS) to the National Healthcare Safety Network (NHSN) in 2018, complete the Annual NHSN Dialysis Event Surveillance Training. Eligible facilities include:
  • Facilities that provide in-center hemodialysis to at least 11 in-center hemodialysis patients
  • Facilities that have a CMS Certification date prior to January 1, 2018 

Learn more about eligibility.

Starting in 2018, Network 4 must verify, track, and report to CMS on a monthly basis the number of facilities completing this training for 2018. Please complete the following steps as soon as possible. 

  1. Complete the training and attestation no later than September 28.
  2. Print the certificate of completion. 
  3. Attest to completion of the training.

Dialysis Event Training/Re-training is available:  

CMSUpdatesCMS Updates
update: Py2019 QIP preview period timeline changes
CMS has announced that the PY2019 Preview Period for the ESRD QIP will now begin August 6, 2018, and end September 19, 2018 at 11:59 pm PDT.

The deadline extension is a result of the discovery of an inaccuracy with the data file used to calculate performance scores. The original score calculation did not include data on Peritoneal Dialysis patients, which resulted in inaccurate Mineral Metabolism and Hypercalcemia measure score results and Total Performance Scores. The error impacted approximately one-third of eligible facilities. A complete list of facilities impacted can be found on QualityNet.

CMS has resolved the issue by recalculating the PY 2019 ESRD QIP performance score results. The corrected Performance Score Reports and Patient List Reports have been released. While only impacted facilities will see a change in their reports, all facilities will receive new reports

Facilities are encouraged to review their preliminary PSR and to submit clarification questions or a formal inquiry. CMS encourages all facilities to review their PSRs and to submit clarification questions and formal inquiries in a timely manner. Their current notice does not mention this, but in their earlier notice they urged facilities to submit their clarification questions during the first two weeks of the Preview Period, in order to be assured that their questions will be answered in time for use in formulating their formal inquiry if that is necessary.

For further assistance regarding the information contained in this message, please contact the ESRD QIP Support Team using the ESRD QIP Q&A Tool. If you have questions or concerns regarding use of the ESRD QIP system, please contact the QualityNet Help Desk at qnetsupport-esrd@hcqis.org or 866-288-8912 Monday through Friday between 5:00 a.m. and 5:00 p.m. PDT.
CY2019 esrd pps proposed rule webinar slides and recording now available
In case you missed the August 14 CMS conference call on the CY2019 ESRD PPS Proposed Rule, impacting PY2021-24 you can still review the presentation slides and listen to the speakers. The audio will appear on the CMS website by the end of August. The slides from the call are available now.

The Proposed Rule includes language for new facilities to begin QIP reporting in their fourth month of operation rather than their first month (slide 31). The slides also include timelines and resources. The call did not include questions, as listeners were directed to use the Federal Register comment process, which is detailed on the slides.  Learn more
Updates to QIP Py2021-24 announced
CMS has announced a correction to their bulletin about proposed PY2021-24 QIP performance measure changes.

Depression Screening is NOT proposed to be eliminated in PY2021, and Pain Assessment IS proposed to be eliminated in PY2021. 
 
CMS has released the proposed ESRD QIP Technical Specifications for PY2021, 2022, and 2024. Proposed changes include:
  • Elimination of Pain Assessment (NOT Depression Screening as indicated earlier), NHSN Healthcare Personnel Vaccination, Anemia Management, and Serum Phosphorous in PY2021.
  • New measures for Medication Reconciliation Reporting and Existing-Patient Transplant Waitlist for PY2022.
  • A new measure for Incident-Patient Transplant Waitlist in PY2024.
Learn more about the proposed Technical Specifications. Comments on the proposals are due by September 10, 2018.
Updated dialysis facility compare data now available
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that new data on the quality of dialysis facilities will soon be available on Dialysis Facility Compare (DFC), the website that allows patients and health centers to view and compare quality data about dialysis facilities. CMS uses this data, organized into a series of measures, to create a rating system that can help patients make educated decisions about where to get their dialysis treatments, as well as to assist them in speaking with their healthcare team regarding their care.

What's in the July 2018 Refresh?
With the July 2018 refresh, the following measures on Dialysis Facility Compare will be updated with new data:
  • Adult and child patients who had enough waste removed from their blood during hemodialysis or peritoneal dialysis
  • Adult patients who had too much calcium in their blood
  • Hemoglobin management (Downloadable Data Only)
  • Phosphorus concentrations in the blood (Downloadable Data Only)
  • Proportion of adult hemodialysis patients who received treatment through an arteriovenous fistula
  • Proportion of adult hemodialysis patients who had a catheter (tube) left in a vein longer than 90 days, for regular hemodialysis treatments

The following measure and Star Ratings will continue to display the April 2018 release data until the next update: 

  • Survey of patients' experiences
  • Quality of patient care Star Ratings

The following measures will continue to display the January 2018 refresh data until the next update: 

  • Frequency of patient death, hospital admission, or readmission
  • Frequency of transfusions
  • Prevention of bloodstream infections

For more information about the July 2018 measures refresh, visit the DFC website. Please submit questions to dialysisdata@umich.edu.

CEUOppsEducation and CEU Opportunities
Advanced Renal Education
This educational site provides CEU credits for anyone who completes a course. Register to gain access and complete a course.
American Kidney Fund
The American Kidney Fund offers several online courses that provide free CEs for health care professionals. Learn more
Armstrong Institute for Patient Safety and Quality
The Armstrong Institute for Patient Safety and Quality is now offering short, interactive samples of courses to get a feel for how it creates engaging learning experiences that are relevant and applicable to your work improving patient safety. Samples are now available for the following cours es:
  • Patient Safety Certificate Program
  • Human Factors for Patient Safety
  • Becoming a Patient Safety Hero
  • Foundations of CUSP
These samples will work on mobile devices; however, for the best experience use on a laptop or desktop computer. Browse the course catalog for details on all courses, including continuing education credits, learning objectives and costs.
Centers for Disease Control and Prevention (CDC)

Tune In for Safe Healthcare Webinar Series
The CDC has new free continuing education opportunities available through its Tune In for Safe Healthcare webinar series. Webinars include: 
  • Empowering Nurses to Protect Themselves and Their Patients: The Importance of Collaboration between Nurses and Environmental Services
  • Infections in Dialysis Centers: Understanding what Matters to Patients
  • Empowering Nurses for Early Sepsis Recognition
Morbidity and Mortality Weekly Report (MMWR) and Medscape
CDC's Morbidity and Mortality Weekly Report (MMWR) presents a FREE continuing education activity on the following topic:
  • Containing Unusual Antibiotic Resistance
This activity is intended for infectious disease practitioners, critical care practitioners, hematologists/oncologists, internists, laboratory practitioners, pathologists, public health officials, urologists, nurses, pharmacists, and other clinicians who treat and manage patients with multidrug-resistant organism infection. 

Upon completion of this activity, participants will be able to
  1. Describe changes from 2006 to 2015 in the annual proportion of selected pathogens that were nonsusceptible to extended-spectrum cephalosporins (ESBL phenotype) or resistant to carbapenems (carbapenem-resistant Enterobacteriaceae [CRE]), based on infection data from the National Healthcare Safety Network
  2. Describe findings from January to September 2017 of carbapenemase testing and screening tests, based on a Centers for Disease Control and Prevention (CDC) study
  3. Describe clinical implications of changes in spread of two multidrug-resistant (MDR) pathogens over time, based on a CDC study
Access other free MMWR/Medscape CE activities. If you are not a registered user on Medscape, please  register for free or login without a password and get unlimited access to all continuing education activities and other Medscape features.
renal physicians association e-Learning portal offers new course
The Renal Physicians Association (RPA) has an eLearning portal that offers a wide variety of courses. The newest course, 2018 Fundamentals of Nephrology Coding and Billing, is now available online. This course will provide a better understanding of the federal and regulatory requirements for proper nephrology coding, billing and documentation. 
ESRDResourcesESRD Resources
Latest edition of KCER Watch is Now Available  
The  August 2018 issue of KCER Watch , the monthly environmental scan that provides timely and pertinent information related to emergency preparedness, is now available. Kidney Community Emergency Response (KCER) reviews available literature from peer-reviewed journals and emergency and disaster related trade publications; social media postings; and stakeholder websites to identify news and events in the emergency management field that are beneficial to the ESRD community.  The goal of KCER Watch is to facilitate the exchange of information, sharing of resources, and advancement of knowledge and expertise among ESRD and emergency management stakeholders. The Network encourage you to share KCER Watch with your colleagues and patients. 
cdc resources available on demand in multiple languages  
The Network would like to remind facilities that the CDC provides patient resources on a variety of health topics in many languages. These resources can be accessed and downloaded on the CDC website. Below are just some of the resources which may be useful for non-English speaking patients/family members.
  • Dialysis Safety - Available in Spanish
  • Flu Education for Refugees - Available in Arabic, Burmeses, Farsi and Spanish
  • Hepatitis - Available in Arabic, Chinese, French, Korean, and Vietnamese
  • Tuberculosis (TB) - Available in Vietnamese
AHRQ releases new opioid management toolkit for primary care providers  
The Agency for Healthcare Research and Quality (AHRQ) has released a new toolkit to support a structured, team-based approach to improving the management of patients who take opioids to ease chronic pain. The majority of patients taking opioids for chronic pain are managed by primary care providers and their staff. The Six Building Blocks toolkit supports improvement in six areas: leadership and consensus; policies, patient agreements and workflows; tracking and monitoring patient care; planned, patient-centered visits; caring for complex patients; and measuring success. The website was developed as part of a collaboration among AHRQ, the Washington State Department of Health and the Centers for Disease Control and Prevention.  Download this new tool
Check out the ESRD NCC Information Exchange
The ESRD Network Coordinating Center (NCC) provides centralized coordination and support for the Medicare ESRD Network program. Each month, the ESRD NCC distributes an e-newsletter, known as the Information Exchange, that compiles the most important information from numerous ListServs and publications related to renal health. To sign up to receive this informative newsletter, please contact the ESRD NCC at ncc@ncc.esrd.net or visit the ESRD NCC website

 
Executive Director
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IMPORTANT NOTE:
This bi-weekly e-newsletter will serve as our primary method of communicating important news and updates. We encourage you to visit our Web site for the most up-to-date information or to contact us with questions, comments or suggestions.
 
This material was prepared by Quality Insights Renal Network 4 under contract with the Centers for Medicare & Medicaid Services (CMS). The contents do not necessarily reflect CMS policy.

Publication No. ESRD4-082818