DATE:

January 9, 2020

Welcome to the ESRD Network of the

South Atlantic

LTC QIA Kick-Off

We will be starting the webinar

momentarily

ESRD Network of the

South Atlantic

LTC QIA Kick-Off

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Housekeeping Reminders

• This WebEx will be recorded and slides made available on the

Network Website

• All lines have been muted to eliminate background noise

To ask a private question use the Chat section in the bottom right corner of your screen sending to All Panelists

To ask a question for the answer to be shared with all Attendees or Privately, use the Q&A section in the bottom right corner of your screen

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Objectives

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Network 9IN, KY, OH

Network 6GA, NC, SC

NW2

• Understand the role of the ESRD Network in driving Quality Improvement

Initiatives

• Identify CMS Focus Areas

• Summarize the dialysis facility responsibilities regarding CMS quality

improvement

• List the requirements of the Long-term Catheter Reduction Quality Improvement

Activity (QIA)

• Understand the team approach to quality improvement

• Understand the role and purpose of the Patient Facility Representative (PFR) in

facility quality improvement initiatives

• Understand project interventions and tools with Interdisciplinary Team

• Develop methods for sustainability

• Plan next steps

At the completion of this presentation, the participant will be able to:

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IPRO ESRD

Network

Program Overview

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ESRD Network Structure

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Network 9IN, KY, OH

Network 6GA, NC, SC

NW2

• Centers for Medicare & Medicaid

Services (CMS)

– Contracted ESRD Network Statement of Work

(SOW)

• 18 ESRD Networks

– 50 States and Territories

• ESRD National Coordinating Center

– Bi-Monthly Learning and Action Network (LAN)

Calls

– CROWNWEb Quality Improvement Data

• Quality Improvement Activities

– ALL Medicare Certified Outpatient Dialysis

Centers

Centers for

Medicare and

Medicaid

Services

ESRD National

Coordinating

Center

ESRD

Networks

Medicare

Certified

Dialysis

Facilities

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IPRO ESRD Network 2019 Service Areas(2018 Network Annual Reports

Network 6NC, SC, GA

Patients: 50,539Facilities: 760Transplant: 10

Network 2NY

Patients: 30,337Facilities: 305Transplant: 13

Network 1CT, MA, ME, NH,

RI, VTPatients: 14,856Facilities: 199Transplant: 15

Network 9OH, KT, IN

Patients: 33,890Facilities: 639Transplant: 14

IPRO ESRD Program

129,662ESRD Patients

1,903Dialysis Facilities

52Transplant Centers

NW1

NW2

Network 9IN, KY, OH

Network 6GA, NC, SC

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IPRO ESRD Network 6 Service Area

by Facility Ownership (October 2019)

Ownership Patients Facilities

FKC 21,921 294

DaVita 17,658 286

US Renal Care 2,484 49

DCI 2,324 39

American Renal 2,331 32

Wake Forest 1,908 19

Independents 2,474 47

VA 99 3

Totals 51,199 772

236 Facilities 18,953

Patients

5 Transplant Ctrs

159 Facilities

10,395 Patients

1 Transplant Ctrs

374 Facilities

21,851 Patients

4 Transplant Ctrs

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CMS ESRD Program Focus Areas

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Network 9IN, KY, OH

Network 6GA, NC, SC

NW2

• Patient and Family Engagement

– Incorporate the patient’s voice and perspective in all areas of quality improvement

at the ESRD Network and facility level

– Establishing patient support or new patient adjustment groups and incorporating

patient, family and caregiver participation into the QAPI and governing body of the

facility

– Patient, family member and caregiver involvement in the development of the

individualized plan of care/or plan of care meetings

• Reduce rates of Blood Stream Infections (BSIs)

• Reduce rates of Long-Term Catheters (LTC)

• Increase rates of Patients on a Transplant Waiting List

• Increase rates of Patients Dialyzing at Home

• Improve Quality of Care for ESRD patients

• Promote patient engagement / patient experience of care

• Support ESRD data systems and data collection, analysis

and monitoring for improvement

• Provide technical assistance to ESRD patients and providers

• Evaluate and resolve patient grievances

• Promote best practices

• Support emergency preparedness and disaster response

• Establishing partnerships to improve care

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ESRD Network Role & Responsibilities

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Dialysis Facility Responsibilities

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Network 9IN, KY, OH

Network 6GA, NC, SC

NW2

• Participate in Network Quality Improvement Activities (QIAs)

– Attend webinars (Network & NCC LAN Calls)

– Complete required documentation (surveys, attestations, etc.)

• Inform patients of available Network resources

– Grievance resolution

– Educational materials

– Provide QIA resources to patients and family/caregiver

– Patient Advisory Committee

• Maintain accurate/ timely data (NHSN/ CROWNWeb)

• Notify the Network of major events

• Respond to inquiries and requests for information

– Annual Critical Asset Survey

– Data request

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What’s New this

Year In Quality

Improvement?

Project Branding

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• New QIA Logos

• All QIA emails and

surveys will be color

coded and branded to

distinguish between

projects

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Improving Survey Experience

Introducing REDCap

• “Save & Return Later” feature

• Alerts user if already completed to avoid

duplication of work

• Sends confirmation email of completion

• Allows to save completed PDF for user

• Automatic reminders only if not

completed

• HIPPA compliant!

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Project Overview Guides

• Activities and supporting resources

for the entire project cycle

• Important due dates

• To facilitate better facility planning

• To assist in keeping up with

requirements

• Versions available for project lead,

project navigator and patient facility

representative

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Freshdesk Platform

http://help.esrd.ipro.org/support/home

• Loretta Ezell – BSI &

LTC

• Michelle Lewis – Home

Dialysis

• Alexandra Cruz –

Transplant

Network QIA Leads:

http://help.esrd.ipro.org/support/home

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Long-term Catheter Reduction

2020 LTC Quality Improvement

Activities (QIA) Goals &

Measures

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Medicare/ Medicaid Conditions for Coverage (CfC) for End-Stage Renal Disease Facilities

Conditions for Coverage (CfC) are:

• Medicare regulations for the care of End Stage Renal Disease

patients in dialysis facilities

• Standards for the dialysis facility’s Federal survey and certification

• V-Tags are specific standards, conditions and guidance in the CfC

that dialysis facilities should adhere by

Medicare/ Medicaid Conditions for Coverage (CfC) for End-Stage Renal Disease Facilities

V511

• Evaluation of dialysis access type and maintenance

V550

• The IDT must provide vascular access monitoring & timely referrals to achieve & sustain vascular access

V551

• The patient’s vascular access must be monitored to prevent failure

V562

• The Patient Plan of Care must include: Education on the risks and benefits of vascular access types

V633

• The QAPI program must include efforts to reduce catheter use & infections related to catheter use

19IDT – Interdisciplinary Team

V-Tags addressing Vascular Access

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Making Dialysis Safer by Reducing Harm Caused in the Delivery of Care

Purpose:

• Reduce Rates of Blood Stream Infections and Long Term Catheters. Rates based on individual facility data.

Facility Selection Baseline / Re-measurement Data

Goal

LTC Network Service AreaTiered Approach using ABC

Modeling

Baseline: Jan – July 2019 DataRe-Measure: August 2020

Data

Decrease LTC rates in the NW service

Project

A specific plan or design

A planned undertaking

Intervention

The act of interfering with the

outcome or course especially of a

condition or process (as to prevent

harm or improve functioning)

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Quality Improvement Activities

Definition Source: https://www.merriam-webster.com/

Interventions are created to meet the goals of the CMS Statement of Work, CMS

conditions of Coverage and include Best Practices from NCC LAN calls

https://www.merriam-webster.com/

Tier Levels

Tier 1 Tier 2 Tier 3

LTC Rate

≥ 20%

LTC Rate

15%-19.9%

LTC Rate

10%-14.9%

42 Facilities 82 Facilities 181 Facilities

All Interventions All Interventions NCC LAN Calls

Intervention Facilities Intervention Facilities Facilities of Study

Focused Network

Support

Additional Network

Support

Increase in rate >15% will

need to complete a RCA,

LTC Reduction Plan

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• Assigned based on facility LTC rate

• Interventions based on Tier level

Tier Levels

Tier 4 Tier 5

LTC Rate

8.02% -9.88%

LTC Rate

0% - 8.0%

365 Facilities 56 Facilities

NCC LAN Calls NCC LAN Calls

Facilities of Honor Facilities of Excellence

Lowest LTC rates in the Network

Facilities to share Promising

Practices

Facilities to share Best Practices

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Superhero's

Champions

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LTC (QIA)

Interventions, Tools

and Resources

Timely pre –surgery

requirements i.e. cardiac clearance

Patient refusal for permanent access Delayed & Missed

Appointments

Patient / Staff Education

Availability of Vascular Surgeons

Patients admitted with Catheter

Comorbidities Medically

Unsuitable

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Network Identified Barriers & Factors in LTC Reduction

Understanding and Implementing the Quality Improvement Cycle

Plan-Do-Study-Act (PDSA) Cycle

• Plan - Identify the goal or purpose- Interventions for change- Define success metrics- Put plan into action

• Do- Components of plan are implemented

• Study- Monitor outcomes for signs of progress and

success or problems and areas for improvement

• Act- Close cycle, integrating the learning

generated by the entire process

- Adjust goals, change methods, or reformulate an intervention or improvement initiative altogether

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Executing the Quality Improvement Cycle by Having a Team Approach

Form your QI Team – Get Everyone involved in the

Project!

• Facility Administrator/Clinic or Nurse Manager• PCT/CCHT’s

• Patient’s/Family Members/Caregivers

• Social Worker• Dietitian

• Administrative Assistant

• Medical Director/ Extender

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Vascular Access Navigator Role

Facilities will identify at least one staff member to be a Vascular

Access Navigator during the 2020 LTC Reduction project cycle

• Empower patients with knowledge, skills, and tools

• Encourage patients to take an active role in their healthcare decisions

• Share training(s) with fellow staff members

• Bridge the communication gap between the patient and healthcare

team

• Build trusting relationships with patients and family/ caregivers

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Vascular Access Navigator Role Outline

Vascular Access Navigator

Role & Recruitment Guideline

Vascular Access Navigator

Activity Outline

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Does your Team have a missing link?

Patient Engagement Focus Areas

• Including patients in the QAPI process can

provide the missing link which influences your

daily work that drives quality improvement

measures.

• Establishing a patient support or new patient

adjustment group can provide patients with

ways to cope with their diagnosis,

communicate better with the healthcare team,

and educational opportunities.

• Including patients and families in the plan of

care meetings program can improve

communication & foster personal growth and

provide support.

Patient or Family Member

Medical Director

Nephrologist

NP

Facility Leadership

Infection Prevention Navigator

QIA Project Leads

Dietitian

Social Worker

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Patient Facility Representative Role

Facilities will identify at least one patient per facility to be a Patient

Facility Representative (PFR)

• Partner with Project Lead and Vascular Access Navigator to support the

implementation of targeted interventions for the LTC Reduction QIA.

• Collaborate with the Project Lead and Vascular Access Navigator on the

creation of an Education Station and/or hosting a Lobby Day.

• Discuss QIA activities from the patient perspective during QAPI meetings.

• Foster positive relationships between patients, providers, ESRD

stakeholders and the Network.

• Ideally this role is for a patient who interacts easily with other patients and

staff members, could fill an advocacy role and enjoys educating and sharing

their experience with others.

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Patient Facility Representative Role

https://redcap.ipro.org/surveys/?s=M4N78YXKXT

Recruitment Material

Supporting Material

(You will agree on dates with the

patient to meet your due dates)

https://redcap.ipro.org/surveys/?s=M4N78YXKXT

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Patient Facility Representative Calls

PAC 2020 Schedule – 5pm

• January 29th

• March 25th

• May 27th

• July 22nd

• September 23rd

QIA Initiative Calls Schedule – 5pm

• February

• April

• June

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Supporting Facilities in QAPI and Patient Support Groups

Training Opportunities and Resources:

• Network hosted webinar to assist facilities with incorporating patients, family

members/ caregivers into the monthly QAPI. (webinar on 2/20/20 1-2pm)

– Importance of patient engagement in QAPI

– Tips on how to involve patients

• Network hosted webinar to assist facilities with establishing a patient support

group or new patient adjustment group. (webinar on 4/23/20 1-2pm)

– Supportive formats

– Tips on identifying interest

• Supportive resources for success!

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2020 Interventions

Patient Engagement

– Patient Facility Representative

(PFR)

– Invite patient/ family /caregiver to

QAPI

– Implement Patient Support Group

– Patient Education Station/ Lobby

Day Contest

– Patient education & resources

Knowledge and Practice Assessment

– Root Cause Analysis

Progress Report

– Quantitative Data

– Facility Achievement Levels

Provider Education & Resources

– Network Webinars

– Patient and professional vascular

Access Planning guides

– Huddle Boards

Virtual Collaborative Meetings /Leadership

Performance Calls

– Address barriers and solutions

– Share best practices

NCC LAN Calls

– 1 staff member mandatory participation

– BSI Modality LAN

– 1 CEU provided per call upon

registration

Complete Monthly Access Checklist and Audit Tools

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Hand Hygiene is one of the most effective means of infection prevention

V-633 The QAPI program must include efforts to reduce catheter use & infections related to

catheter use – Discuss audits results/ opportunities at QAPI meetings

Complete Monthly Access Checklist and Audit Tools

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V-633 The QAPI program must include efforts to reduce catheter use & infections related to

catheter use – Discuss audits results/ opportunities at QAPI meetings

NHSN -National Healthcare Safety Network

• Conduct monthly surveillance for BSIs

and other events using CDC National

Healthcare and Safety Network

(NHSN)

• Dialysis Event Surveillance training is

required of all hemodialysis facilities

• Monthly NHSN reporting of data is

needed to meet QIP requirements

• Complete Annual NHSN Training and

Network Attestation Survey (Jan-Aug of

2020)38

Vascular Access Resources

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V562: The facility must provide patients

and their family members/caregivers with

education and training including the risks

and benefits of various vascular access

types … and document in the Patient Plan

of Care

Vascular Access Monitoring Resources

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V551: The facility must have an on-

going program for vascular access

monitoring and surveillance

Incident Vascular Access Summary

by Facility and Physician

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Rapid Cycle Improvement Worksheet

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Monthly Worksheet assist facilities:

• Track LTC status of each patient

• Review and evaluate progress

• Identify barriers and solutions

• Utilize to worksheet to guide huddle

board conversations

• Include Medical Director,

Interdisciplinary Team/ QAPI team

and front line staff members in the

review process

V550 & V633: The facility must have an on-

going program for vascular access

monitoring timely referrals & QAPI efforts to

reduce catheters

Facility Progress Report

• Aligns facility objectives with CMS

goals and priorities

• Keeps your quality improvement

strategies front and center by

reviewing with interdisciplinary

team on a monthly basis (QAPI

meetings)

• Shows how you are progressing

on your Catheter Reduction

interventions

• Can assist QAPI efforts to monitor

and reduce catheters

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Huddle Board / Learning Boards

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Boards support visual management of key elements /

concerns

Boards provide structure to capture critical information/ key

areas of concern that drive discussions intended to improve

quality of patient care and boost staff input

Huddle discussions around the board provides a guide

focused on addressing the issues needed in achieving /

reaching a goal, recognize staff and patients making a

positive impact, and bring awareness to unsafe practices

The huddle also helps make leadership aware of issues

which allows for improved issue resolution and the

removal of barriers to the teams success

Huddle / Learning Board

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Learning Board / Huddle Board

• Learning Boards to capture key areas

of concern, follow up (i.e. RCAs) and

resolution to issues / concerns

• Enhances a guided conversation and

follow up for:

Issues identified by staff

Items in the follow up process

Resolved Items

Sustainability

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Processes to support changes implemented

Modify team training Change becomes part of

culture

Track & measure performance to ensure

improvement

Include Facility / Corporate Leadership for

Support & Approval Sustainability

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Attend NCC Learning and Action Network Calls and get a FREE CEU!

• LANs are mechanisms by which large scale improvement around a goal is

fostered, studied, adapted, rapidly spread and sustained regardless of the change

methodology, tools, or time-bounded initiative that is used to achieve the goal.

• LANs engage communities around an action based agenda that gains

commitment towards the achievement of person-centered outcome-based goals.

• ESRD National Coordinating Center hosts bi-monthly Learning and Action

Network Calls on Transplant, Home Modalities, and Infection Prevention

– 1 CEU provided per call (RN, SW, RD, CCHT)

– Learn from innovators and change makers about successful strategies

– Be a presenter to share your successes!

Facility Performance Review Calls

• Paired conference call within same organization under same leadership

• Open platform to drive meaningful and productive conversations

• Review project goals and objectives

• Share best practices to overcome barriers

• Focus on progress, performance, and expectations

• Facility Leadership included on calls

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Upcoming and Next Steps

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Network Educational Resource Mailing

Sent in December

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Patient Education Contest

• Focus Area Topics:

– Blood Stream Infection (BSI) Reduction

– Vascular Access Planning

– Home Modality Treatment Options

– Transplant as a Treatment Option

• Take a multi-disciplinary approach by

including facility leadership, floor staff, and

patient representatives in your planning.

• Set a Goal and measure your success!

• Dates: January 1st – March 31st Winners will be announced in

May at Network Annual Meeting!

Yadkin Dialysis Center of Wake Forest

University (NC)

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New Communication Methods

• New Network Staff Email Addresses!

– Changed to firstname.lastname@ipro.us Example: Loretta.Ezell@ipro.us

• New Customer Service Platform!

– Submit a ticket using the link http://help.esrd.ipro.org/support/tickets/new or

writing an email to NW6QI@iproesrdnetwork.freshdesk.com

• Surveys will come from no-reply+redcap@ipro.us to Project Lead

– Add this address to your contacts!

mailto:firstname.lastname@ipro.usmailto:Loretta.Ezell@ipro.ushttp://help.esrd.ipro.org/support/tickets/newmailto:NW6QI@iproesrdnetwork.freshdesk.commailto:no-reply+redcap@ipro.us

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Important Dates and Next Steps

• Complete the Key Facility Contact Data Collection: DUE 1/6/2020

• Complete Knowledge & Practice Assessment – DUE 1/24/20

• Identify at least one Patient Facility Representative (Patient Role)

o Patient information will be collected in the HIPAA compliant REDCap Tool – DUE 1/31/20

• Identify at least one Vascular Access Navigator (Staff Role) - DUE 1/31/20

• Listen to recorded ESRD NCC BSI QIA LAN Call (Network will notify facilities when available)

• Start planning your Patient Education Theme! – Picture DUE in March

Be on the lookout for the

QIA Calendar in February!

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Questions or Comments?

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ESRD Network of the South Atlantic (Network 6) Staff

Shannon WrightExecutive Directorswright@nw6.esrd.net

Loretta EzellQuality Improvement DirectorLezell@nw6.esrd.net

Michelle LewisQuality Improvement Data Coordinatormlewis@nw6.esrd.net

Alex CruzQuality Improvement Coordinatoracruz@nw6.esrd.net

Chanell McCainPatient Services Directorcmccain@nw6.esrd.net

Stephanie ClarkeCommunity Outreach Coordinatorsclarke@nw6.esrd.net

Jaya BhargavaOperations Directorjbhargava@nw1.esrd.net

Shasha AylorData Analystsaylor@nw6.esrd.net

Jasmine TabornData Coordinatorjtaborn@nw6.esrd.net

Website http://network6.esrd.ipro.org/

mailto:swright@nw6.esrd.netmailto:wkungu@nw6.esrd.netmailto:tbd@nw6.esrd.netmailto:acruz@nw6.esrd.netmailto:cmccain@nw6.esrd.netmailto:sclarke@nw6.esrd.netmailto:jbhargava@nw1.esrd.netmailto:bwilliams@nw6.esrd.netmailto:jtaborn@nw6.esrd.nethttp://network6.esrd.ipro.org/

Thank You!

IPRO ESRD Network of the South Atlantic909 Aviation Parkway, Suite 300Morrisville, NC 27560

http://esrd.ipro.org/

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