At least 90% of Network 5 hemodialysis patients should have a delivered Kt/V >= 1.2, determined by a single pool method.

At least 90% of Network 5 peritoneal patients should have a weekly Kt/Vurea >=1.7 CAPD and Cycler.

2. Anemia Management for Adult Patients

At least 80% of Network 5 adult patients (hemodialysis and peritoneal) should have a hemoglobin >= 11.0.

No more than 15% of Network 5 adult patients (hemodialysis and peritoneal) should have a hemoglobin >= 13.0.

3. Vascular Access for Adult Patients

By March 2009, at least 48.1% of all prevalent hemodialysis patients (adults >= 18) should use an A-V fistula with a long-term goal of 66%.

Less than 10% of all prevalent hemodialysis patients (adults >= 18) should be maintained on catheters >= 90 days with no internal access.

Recommendations

1. Adequacy

Residual renal function should be incorporated into adequacy measures when appropriate (250cc/day).

2. Conflict Resolution

All facilities should have a policy on Conflict Resolution.

3. Disaster Preparedness

All facilities should have a policy and plan for Disaster Preparedness.

4. Facility Quality Program

Quality improvement activities at the facility level enhance the facility's ability to provide high quality care, and, to meet and/or exceed Network 5 goals. All Network 5 providers are urged to:

• Have an operational quality improvement program with active physician involvement; and,
• Engage in unit-specific, internally drive, quality improvement projects.

5. Patient Safety

Dialysis facilities are urged to embrace a "culture of safety" and initiate specific measures to enhance safety such as: maintain an updated patient medication list, use a standardized abbreviation list, use stickers to warn of allergies and/or anticoagulation therapy (in addition to treatment-related heparin), post a list of "drugs to avoid in ESRD patients" in the dialysis unit, and track adverse effects/incidents.

6. Preventive Care

All ESRD patients shoud be vaccinated against influenza, hepatitis B, and pneumococcal pneumonia, in accordance with ACIP and CDC recomendations.

All ESRD providers should offer annual influenza vaccination.

At least 90% of medical caregivers 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.

Smoking cessation materials should be offered to all ESRD patients who use tobacco.

7. Transplantation

All facilities should monitor the transplant status of patients to ensure that <5% have no transplant status established.

100% of dialysis 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.

100% of dialysis facilities should designate one staff member to serve as the transplant liaison to oversee transplant education, evaluation referrals, submission of laboratory samples, and patient status changes.

100% of Network 5 transplant centers will provide written kidney transplant inclusion and exclusion criteria to dialysis facilities referring patients for transplant evaluation or transplant centers will post a link to this information on the MARC web site.

8. Vascular Access

Facilities should employ a prospective monitoring program for A-V accesses (grafts and fistula), which utilizes intra-access flow, and/or static venous pressures, and/or dynamic venous pressures.

All facilities should have a written policy addressing referral to a surgeon for vascular access.

9. End of Life

100% of facilities should have a written policy addressing advance directives and health care proxy.

Board of Directors Approval January 2008