This ESRD facility monthly newsletter highlights the latest ESRD insights and resources. Our goal is to provide you with a resource that makes it easy for you to stay on top of trends and support you in providing the best possible care for those you work with and serve.
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In This Issue:
- News You Can Use
- Patient Services
- Home Dialysis
- Hospital Admissions, Readmissions and Emergency Visits
- Transplant
- Vaccinations
- Patient and Family Engagement
- Professional Spotlight
- EQRS
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“Oh, Christmas isn't just a day, it's a frame of mind. ” ― Kris Kringle, Miracle on 34th Street
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News You Can Use
- In November, we changed our approach to quality improvement outreach to reduce the burden on facility staff. Some of you may have already received a call from one of our staff and are aware that we are trying to avoid QI projects. Instead, we are opting for one-on-one phone calls to review the facility report card and discuss barriers and best practices for multiple measures. This approach will decrease the number of emails and activities as previously structured. Every month, we will contact selected facility managers via email and provide an appointment scheduling link for you to meet with a Network staff member. Please schedule appointments as requested. The earlier you schedule your appointment, the greater the likelihood that Network staff will be available at your preferred time. Those unable to speak with us will need to complete alternate improvement plan activities so that we meet the contractual technical assistance required by CMS.
- Due to our high volume of calls, we may not always be able to answer right away. If you require assistance with patient, clinical, or EQRS-related issues, please leave a message in the appropriate mailbox. If you do not select the correct mailbox, there may be a delay in our response time. Facility staff should select “3” from the main menu (numbers 1 and 2 are reserved for patient/ family callers). From there, follow the prompts for the mailboxes:
- Press 1 for staff concerns about patient behavior in Network 8 (MS, AL, TN) facility.
- Press 2 for staff concerns about patient behavior in Network 14 (Texas) facility.
- Press 3 for all quality improvement or clinical questions.
- Press 4 for all EQRS questions, including questions about admissions, discharges and forms, if you need additional assistance following the submission of the EQRS ticket. Please submit a ticket first, as this will allow us to resolve your issue more quickly. Complete a ticket here.
- Free CEs available. Infection Prevention in Outpatient Hemodialysis Settings
- Also of interest, the following is a summary of “A cluster of gram-negative bloodstream infections in Connecticut hemodialysis patients associated with contaminated wall boxes and prime buckets,” published in the June 2023 issue of the American Journal of Infection Control by Backman et al.
The investigation examined patient records, facility policies, practice observations, and environmental cultures. The cluster included two confirmed cases of D acidovorans BSI. Both patients were recently dialyzed at Station #2, where a wall box culture revealed the presence of D acidovorans. One patient also had a bloodstream infection (BSI) caused by Enterobacter asburiae, isolated from multiple other wall boxes and prime saline barrels (SPB).
Observations revealed that wastewater leaked from wall receptacles onto the floor and that SPBs were only sometimes properly disinfected and dried before reuse. Several deficiencies in hand hygiene and station sanitation were observed. No defects in water purification practices were identified, and no pathogens were detected in water cultures. Due to inadequate hand hygiene and station disinfection, the cluster of D acidovorans infections was most likely caused by indirect exposures to contaminated wall boxes and possibly SPBs.
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Patient Services
Network 8 and Network 14 take your clinic safety seriously. Health care violence has increased at the same rate as violence in society. With ongoing high staff turnover, many facilities are focused on retaining and hiring new staff. These new staff members should be trained to handle difficult patient situations professionally and confidently.
Consider holding multiple conflict resolution training courses with your staff. Repeated exposure to the training and self-awareness increases the likelihood that your staff will handle challenging situations effectively. The DPC Addendum can be downloaded and used for huddles and homeroom meetings. To review the material with Network staff, contact the contacts listed below.
Consider holding multiple conflict resolution training courses with your staff. Repeated exposure to the training and self-awareness increases the likelihood that your staff will handle challenging situations effectively. The DPC Addendum can be downloaded and used for huddles and homeroom meetings. To review the material with Network staff, contact the contacts listed below.
Patients skip treatments for a variety of reasons, such as:
- Dialysis adjustment issues
- Avoidance of pain
- Discomfort or embarrassing situation
- Life tasks or family obligations
- Transportation problems
- Conflict with staff
- Substance abuse and mental health issues
Interventions:
- Send a letter to the patient that focuses on your concerns about their safety and a desire to meet with the patient.
- Consider waiting until the patient arrives to set up the machine if the patient chronically does not call/or show up.
- Move patients to the last shift of the day to minimize disruption to facility operations.
- Involve the patient’s nephrologist in an attempt to re-engage.
- Conduct welfare checks as needed.
- Document all interventions thoroughly.
Contacts:
Network 8: ericka.webb@allianthealth.org
Network 14: cassandra.hanna@allianthealth.org
Network 8: ericka.webb@allianthealth.org
Network 14: cassandra.hanna@allianthealth.org
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Home Dialysis
Many clinics have struggled to identify suitable candidates for home dialysis during our outreach. If you also face this issue, try asking, "Why shouldn't this person be on home dialysis?" rather than "Is this patient a home candidate?" It is recommended to use open-ended questions as it can help dialysis staff better understand and support patients. For more helpful information on the assessment, recruitment, and retention of home dialysis candidates, please refer to Chapter 6 in the recently updated Home Dialysis Tool Kit developed by the National Forum of ESRD Networks Medical Advisory Board.
Home Dialysis Contact: grace.robbins@allianthealth.org
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Hospital Admissions, Readmissions and ER Visits
As the weather turns colder, many facilities struggle with increased hospitalizations, re-admissions and unnecessary emergency room visits. Regular dialysis attendance and fluid control could prevent many of these visits. By shifting the focus from "nonadherence" to "healthy living," we can encourage more positive conversations and open lines of communication. People are generally more responsive to information that is delivered in a caring and concerned manner rather than through scolding. The Network provides various resources to help educate and promote a healthy lifestyle.
Hospitalization Contacts:
Network 8: kristi.durham@allianthealth.org
Network 14: koby.guthrie@allianthealth.org
Network 8: kristi.durham@allianthealth.org
Network 14: koby.guthrie@allianthealth.org
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Transplant
The kidney transplant process can be overwhelming for many patients. There are multiple steps involved that patients must complete before becoming actively listed on the kidney transplant waitlist. The Kidney Transplant Road Map is a general overview that helps patients get through the process successfully. Patients can follow along each checkpoint from the start of the referral to evaluation testing, waitlisting decision, learning about living donation as you wait, life after transplant, and ways to give back.
Each of the 10 checkpoints provides information and describes how patients can successfully move to the next checkpoint. Utilize the Transplant Road Map as a bulletin board display, hang the checkpoint handouts near your board, and create patient markers so the patient can move their marker along as they move through each checkpoint and take the next checkpoint handout. Check out the English and Spanish versions of the Transplant Road Map and Checkpoints on our website.
Transplant Contact: arlandra.taylor@allianthealth.org
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Vaccinations
During discussions about pneumococcal vaccinations, one common concern is the documentation of vaccine type in the facility's electronic medical record (EMR). It's important to note that the data from the facility's medical records populates EQRS fields through the batch data upload. If the information in the facility EMR is incorrect, it will also be wrong in EQRS.
Selecting a generic pneumococcal vaccine instead of the specific type provided (PCV 13, PCV 20, PPSV 23) prevents accurate calculation of specific vaccination rates. This may result in failure to meet CMS goals on the monthly facility report card. To quickly improve an inaccurate rate, conducting a vaccination audit for each patient is recommended to ensure that the facility EMR contains the correct vaccine type.
Determining which pneumococcal vaccine a patient needs can be difficult since multiple options are available. However, the PneumoRecs VaxAdvisor mobile app can help vaccination providers quickly and easily determine the right pneumococcal vaccine for each patient and when it's needed. To use the app, enter the patient's age, note if the patient has specific underlying medical conditions, and answer questions about the patient's pneumococcal vaccination history. The app then provides patient-specific guidance consistent with the immunization schedule recommended by the U.S. Advisory Committee on Immunization Practices (ACIP). Download the mobile app from the App Store or Google Play, or use the web version.
Determining which pneumococcal vaccine a patient needs can be difficult since multiple options are available. However, the PneumoRecs VaxAdvisor mobile app can help vaccination providers quickly and easily determine the right pneumococcal vaccine for each patient and when it's needed. To use the app, enter the patient's age, note if the patient has specific underlying medical conditions, and answer questions about the patient's pneumococcal vaccination history. The app then provides patient-specific guidance consistent with the immunization schedule recommended by the U.S. Advisory Committee on Immunization Practices (ACIP). Download the mobile app from the App Store or Google Play, or use the web version.
Vaccination Contacts:
Network 8:kristi.durham@allianthealth.org
Network 14: koby.guthrie@allianthealth.org
Network 8:kristi.durham@allianthealth.org
Network 14: koby.guthrie@allianthealth.org
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Patient and Family Engagement (PFE)
The Network Patient Advisory Committee (PAC) is comprised of patients and caregivers, also known as subject matter experts (SMEs), from Networks 8 and 14. During our monthly meetings, we work to promote patient empowerment, engagement, and involvement in care at the facility level. The primary goal of the PAC is to help ESRD Networks respond to patients' needs and improve patient and staff relationships. The PAC's responsibilities include:
- Understand the needs of renal patients
- Provide feedback to the ESRD Network and CMS
- Treat each other respectfully
Patient and Family Engagement Contacts:
Network 8: casey.rich@allianthealth.org
Network 14: debbie.odaniel@allianthealth.org
Network 8: casey.rich@allianthealth.org
Network 14: debbie.odaniel@allianthealth.org
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Professional Spotlight
We want to acknowledge the contributions of two professionals who participated in the monthly PAC meetings in November and December. In November, Gloria Brien, MS, RDN, LDN, CDCES, was invited to present to the group. Gloria is a registered dietitian from Jackson, Tennessee and has been practicing in the Jackson area for 27 years. She has worked in local hospitals, the VA outpatient clinic, and the DCI dialysis clinic. Gloria is passionate about helping individuals lead healthier lives and values the opportunity to serve others. We are grateful to Gloria for volunteering her time and expertise to present on holiday eating tips.
Our second guest speaker was DaVita Survey Outcome Manager/Manager of Clinical Services Javier Rodriguez, RN. Javier also provides emergency/disaster training to DaVita staff and is a member of the Network 14 Medical Review Board. He has been a member of the DaVita team for over 10 years. On December 6, Javier provided PAC attendees with information about Respiratory Syncytial Virus (RSV), the RSV vaccine, and how this disease can impact the health of the ESRD patient. A huge thank you to Javi from the Network and Network PAC members!
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EQRS
The CMS Annual Survey (CMS 2744) is coming soon. The CMS 2744 provides a brief overview of the activities at your facility for the previous year. For dialysis facilities, it recaps patients at the beginning of the year, patients added and lost during the year, patients at the end of the year, the number of treatments provided during the entire year, and staffing levels at the end of the year. For transplant facilities, the report captures the transplants done during the year, the number of patients on the waitlist, and the Medicare status of the 2023 CY transplanted patients.
All Medicare-certified dialysis and transplant facilities are required to complete the CMS Annual Survey if they were certified at any point in the previous year.
Since this report encompasses the 2023 calendar year – unless your facility closed during 2023 – the form should not be submitted before January 15, 2024. This gives time for data entry and batching cycles to run so that all the 2023 activities are captured. The deadline for submitting an error-free 2744 with all warnings commented on is March 31, 2024.
There are several resources available to assist you. If you are part of a large dialysis organization, your company may complete the 2744 for you or assist you in completing it through a national team. Check with your company to see what support they offer and if they want to complete the 2744 directly through a national team.
In addition, the CMS Center for Clinical Standards and Quality (CCSQ) can assist you with 2744 issues. CCSQ Support Central is the primary contact for help with EQRS. Create a ticket here or call them at 866-288-8912.
The CMS 2744 is submitted through the EQRS application. If you are responsible for the CMS 2744, ensure you have an active EQRS account. Additional information on the CMS 2744 will be emailed to your facility around the first of January.
All Medicare-certified dialysis and transplant facilities are required to complete the CMS Annual Survey if they were certified at any point in the previous year.
Since this report encompasses the 2023 calendar year – unless your facility closed during 2023 – the form should not be submitted before January 15, 2024. This gives time for data entry and batching cycles to run so that all the 2023 activities are captured. The deadline for submitting an error-free 2744 with all warnings commented on is March 31, 2024.
There are several resources available to assist you. If you are part of a large dialysis organization, your company may complete the 2744 for you or assist you in completing it through a national team. Check with your company to see what support they offer and if they want to complete the 2744 directly through a national team.
In addition, the CMS Center for Clinical Standards and Quality (CCSQ) can assist you with 2744 issues. CCSQ Support Central is the primary contact for help with EQRS. Create a ticket here or call them at 866-288-8912.
The CMS 2744 is submitted through the EQRS application. If you are responsible for the CMS 2744, ensure you have an active EQRS account. Additional information on the CMS 2744 will be emailed to your facility around the first of January.
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Our mailing address is:
ESRD Network 8
775 Woodlands Parkway, Suite 300
Ridgeland, MS 39157
ESRD Network 14
4099 McEwen Rd., Suite 820
Dallas, TX 75244
Our mailing address is:
ESRD Network 8
775 Woodlands Parkway, Suite 300
Ridgeland, MS 39157
ESRD Network 14
4099 McEwen Rd., Suite 820
Dallas, TX 75244