1. Adequate Dialysis for Adult Patients (>18 years) At least 90% of hemodialysis patients should have a delivered Kt/V > 1.2, determined by the single pool method. At least 96% of hemodialysis patients should have a URR level > 65%. At least 90% of peritoneal dialysis patients should have a weekly Kt/Vurea > 1.7 CAPD and Cycler. 2. Anemia Management for Adult Patients (>18 years and excluding patients not receiving ESAs and on dialysis for < 90 days) 26% or less of all patients (hemodialysis and peritoneal dialysis) should have a pre-dialysis hemoglobin > 12 g/dL. 3. Vascular Access for Adult Patients (>18 years) By March 2012, at least 57.3% of all prevalent hemodialysis patients (adult > 18) should receive care with an AV Fistula. No more than 10% of all prevalent hemodialysis patients (adult > 18) should be maintained on catheters > 90 days with no internal access in place.
1. Adequate Dialysis for Adult Patients (>18 years)
2. Anemia Management for Adult Patients (>18 years and excluding patients not receiving ESAs and on dialysis for < 90 days)
3. Vascular Access for Adult Patients (>18 years)
Adequacy and Anemia goals have been established based on 42 CFR Part 413 Medicare Program; End-Stage Renal Disease Quality Incentive Program; Final Rule (Federal Register, January 5, 2011, Vol 76, No 3)
1. Adequacy Residual renal function should be incorporated into adequacy measures when appropriate (250cc/day). 2. Anemia Management for Adult Patients (>18 years and excluding patients not receiving ESAs and on dialysis for < 90 days) 10% or less of all patients (hemodialysis and peritoneal dialysis) should have a pre-dialysis hemoglobin < 9 g/dL.
1. Adequacy
3. Conflict Resolution
All facilities should provide staff training on professionalism by utilizing resources found on the MARC website. All facilities should provide staff training on dealing with difficult patient situations by utilizing resources found on the MARC website. Facilities should actively consult with the Network regarding difficult patient situations prior to any situation escalating to the consideration of an involuntary discharge. 4. Emergency Preparedness All facilities will have a policy and plan for emergency preparedness and response. All facilities will send the Network two (2) disaster contacts and their contact information which must include two (2) non-facility phone numbers. 5. Facility Quality Assessment and Performance Improvement (QAPI) Program All facilities must develop, implement, maintain and evaluate an effective, data-driven QAPI program with participation by the professional members of the interdisciplinary team. QAPI activities at the facility level should enhance the facility’s ability to provide high quality care, and, to meet and/or exceed Network 5 goals.
4. Emergency Preparedness
5. Facility Quality Assessment and Performance Improvement (QAPI) Program
6. Patient Safety All facilities are urged to embrace a “culture of safety” and initiate specific measures to enhance safety, and prevent/reduce medical errors, such as Use a standardized abbreviation list Use stickers to warn of allergies, of like or similar names, and anticoagulation therapy Post a list of drug dialyze-ability and/or drugs to avoid during dialysis Track adverse events/incidents Identify and track healthcare-associated infections (HAIs) that develop during the course of care in the facility Identify, track, and use preventative measure against central line-associated blood stream infections (CLABSIs) that include Routine review of central venous line care procedures with healthcare workers and patients Removal of non-essential central venous lines All facilities are encouraged to participate in the 5-Diamond Patient Safety Program. All facilities should follow the Centers for Disease Control and Prevention's (CDC's) Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients. 7. Preventative Care A. Immunization All adult hemodialysis and peritoneal dialysis patients (> 18 years) should be vaccinated against influenza, hepatitis B, and pneumococcal pneumonia, in accordance with the ESRD Conditions for Coverage and Advisory Committee on Immunization Practices (ACIP) and CDC recommendations. Influenza vaccination: Offered yearly to adult and pediatric patients Offered yearly to all healthcare workers Hepatitis B vaccine: Offer a 3-dose series to patients not vaccinated or not completely vaccinated as recommended by the CDC dosing schedule and appropriate timeframe. Vaccine response, annual testing and revaccination for anti-HBs should be documented and tracked. All healthcare workers should be screened and offered the Hepatitis B vaccine with anti-HB compliance noted and record keeping as mandated by OSHA requirements. Policies should be in place for healthcare workers who do not respond to the vaccine or who are unable to receive it Tuberculin (TB) Skin Test (TST): All dialysis patients should be tested for baseline TST and re-screened if TB exposure is detected. Chest x-rays may be used if TST is not an option. All newly hired healthcare workers should be screened for potential active TB infection with test results and follow-up recorded. Pneumococcal polysaccharide vaccine (PPSV): is recommended for patients with ESRD over age two. Confirm all patients' vaccination status including a recommended one-time revaccination after 5 years for persons aged 19 through 64 years of age. Pneumococcal conjugate vaccine (PCV) series for children with underlying medical conditions as recommended by CDC Immunization schedule. B. Other Adult and adolescent patients should be evaluated for dyslipidemias at least annually in accordance with K-DOQI Practice Guidelines. All facilities should offer smoking cessation materials to patients who use tobacco.
6. Patient Safety
7. Preventative Care
A. Immunization
B. Other
8. Transplantation
All facilities should establish the transplant status of patients. All facilities should have a written policy defining delivery of transplant information to all patients, including when transplant information will be presented to new patients, what tools (brochures, video) are used, and who conducts annual follow-up education/contact with patient. All facilities should designate one staff member to facilitate transplant education, evaluation referrals, submission of laboratory samples, and patient status changes. All Network 5 transplant centers will provide written kidney transplant inclusion and exclusion criteria to the Network. The Network will post a link to this information on the MARC website.
9. Vascular Access
All facilities should employ a prospective monitoring (assessment) program for vascular accesses where staff trend results. All facilities should employ a surveillance program which utilizes one of the K-DOQI preferred and CROWNWeb collected methods: Intra-access flow measures, direct or derived static venous pressure, or duplex ultrasound. All facilities should have a written policy addressing referral to a surgeon for vascular access.
10. End of Life
All facilities should have a written policy addressing advance directives and health care proxy. 11. Medication Reconciliation All facilities should have a written protocol/policy defining medication reconciliation and the processes required for a systematic and comprehensive review of all medications to determine current medication accuracy. Medication Reconciliation should be performed during Care transitions such as hospital events A medication reconciliation process should involve a 3-way comparison; home medications compared to facility medication listing and the hospital discharge medication listing Patient assessments in the plan of care Monthly for unstable patients Quarterly for stable patients Board of Directors Approved May 2011 Board of Directors Revised October 2011
11. Medication Reconciliation
The Measures Assessment Tool (MAT) was developed by CMS and released with the Interpretive Guidance in October 2008. It references current professionally accepted clinic practice standards. Facilities should use the MAT to establish clinical goals for each patient's clinical outcomes. The standards listed in the MAT are targets; each patient should be individually evaluated for his/her outcomes.
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