In This Issue

Seven Steps Journey Towards Kidney Transplant ESRD QIP Ultrafilitration National Health and Safety Network Vocational Rehabilitation Resources Professional Boundaries in Healthcare KCER Alerts and Recalls Dialysis Facility Reports and Master Account Holder Information Data Quality Scorecard

Quality Improvement

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 . To Read More

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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: KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update ESRD QIP Summary: Payment Years 2016-2020   [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

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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.

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Patient Services

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

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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.

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KCER Alerts and Recalls Click here for up-to-date KCER Alerts and Recalls. For professional and patient KCER resources, please click here.

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Data Management

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.

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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.

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IPRO ESRD Network of the South Atlantic 909 Aviation Parkway, Suite 300, Morrisville, NC 27560 PH 919-463-4500 · FAX 919-463-4500 [email protected] network6.esrd.ipro.org esrd.ipro.org

IPRO End-Stage Renal Disease Network of the South Atlantic, the ESRD Organization for Georgia, North Carolina, and South Carolina, prepared this material under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. CMS Contract Number: HHSM-500-2016-00006C.