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The goals and recommendations listed below were adopted by the MARC Board of Directors to focus Network 5 activities during 2009-2010. In addition to the areas addressed below, the Medical Review Board will examine other quality indicators (such as patient grievances, hospitalization, mortality, etc.), and conduct improvement initiatives as indicated.
Click here to download a PDF version of the 2009 - 2010 Goals and Recommendations.
Adequacy
Conflict Resolution
Emergency Preparedness
Facility Quality Assessment and Performanc Improvement (QAPI) Program
Patient Safety
Preventive Care
Transplantation
Vascular Access
End of Life
Goals
1. Adequate Dialysis for Adult Patients ( >18 years)
2. Anemia Management for Adult Patients ( >18 years)
- No more than 10% of all Network 5 patients (hemodialysis and peritoneal dialysis) should have a Hemoglobin < 10 g/dl.
- 55% of all Network 5 patients (hemodialysis and peritoneal dialysis) should have a Hemoglobin between 10-12 g/dl.
- No more than 10% of all Network 5 patients (hemodialysis and peritoneal dialysis) should have a hemoglobin >13 g/dl..
3. Vascular Access for Adult Patients ( >18 years)
Recommendations
1. Adequacy
2. 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.
3. Emergency Preparedness
4. 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.
- Quality improvement 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.
5. Patient Safety
6. Preventive Care
- All facilities are urged to embrace a “culture of safety” and initiate specific measures to enhance safety, and prevent/reduce medical errors, such as:
- Maintain an updated patient medication list
- Use a standardized abbreviation list
- Use stickers to warn of allergies, of like or similar names and anticoagulation therapy
- Post a list of drug dialyzability, or drugs to avoid during dialysis
- Track adverse events/incidents
- All facilities are encouraged to participate in the 5-Diamond Patient Safety Program.
- All facilities should follow the CDC's Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients.
7. Transplantation
- All dialysis patients should be vaccinated against influenza, hepatitis B, and pneumococcal pneumonia, in accordance with the ESRD Conditions for Coverage, and ACIP and CDC recommendations.
- All facilities should offer annual influenza vaccination.
- At least 90% of healthcare workers should receive HBV vaccination, or have HBV antibodies.
- 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.
8. Vascular Access
- 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. End of Life
- 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.
- All facilities should have a written policy addressing advance directives and health care proxy.
Measures Assessment Tool (MAT)
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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