The purpose of this scan is to identify improvement opportunities to decrease the rate of bloodstream infections in your patients. This assessment should be completed by your project primary or secondary lead, or another team member. 

Please return this scan no later than close of business on January 24th, 2020.

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* 1. Facility CCN and Facility Name

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* 2. Project Lead Name

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* 3. Project Lead Email

Strategies to Decrease Bloodstream Infections

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* 4. In your opinion, what is the main cause for bloodstream infections in your clinic?

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* 5. How often does your facility currently perform infection control audits?

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* 6. How often does your facility educate staff regarding infection control policies?*

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* 7. Do you currently have patients participating in infection control audits?

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* 8. Do you have a policy for educating patients about infection control?

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* 9. Do your patients pass by a clean sink on the way to their treatment chair?

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* 10. Would you say that your patients are overall willing to wash their access upon arrival if asked?

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* 11. Do you feel that your physicians follow infection control practices when rounding?

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* 12. Do you feel that your nurses follow infection control practices when assessing patients?

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* 13. In your opinion, does your clinic have all of the supplies needed to carry out universal infection control precautions?

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* 14. Are there any other barriers to proper infection control/hand hygiene that you would like to share?

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* 15. In your opinion, does the pace of the dialysis shift impact the ability to perform appropriate infection control measures?

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* 16. In your opinion, are there infection control slips or near misses that appear to be “overlooked” out of fear of confrontation?

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* 17. Do you think that your answers to any of the above questions have an impact on your BSI rates?

Communication Systems


There is a CMS initiative connected to the Decreasing BSI QIA to improve communication between the dialysis Center and Hospitals. We need to know more about your communication pathway with the hospitals.

Please answer the following questions to gauge what the communication process includes in your clinic. Please note: You may want to ask/include the Charge RN, Administrative Assistant, or Clinic Manager to accurately depict the current process.

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* 18. Are you using a Health Information Exchange (HIE) or another evidence-based highly effective information transfer system to receive information relevant to positive blood cultures during the transition of care?

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* 19. If you answered yes to the previous question, what aspects are included?

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* 20. How are you notified that one of your patients was admitted into the hospital?

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* 21. Do you have a system in place to receive regular updates while your patient is still admitted at the Hospital?

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* 22. What is included in your process or system to obtain regular updates while your patient is still admitted at the Hospital?

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* 23. Do you have a standard Communication Form that you use to request details (via fax or other) about a patient’s Hospital stay?

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* 24. Which of the following details are included in your communication form?

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* 25. Overall, how would you rate the systems and processes your work area/ unit has in place to prevent, catch, and correct problems that have the potential to affect patients?

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* 26. Over the past 12 months, how often has your dialysis unit had problems exchanging accurate, complete, and timely information with Vascular Access Centers/Interventional Radiology?

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* 27. Over the past 12 months, how often has your dialysis unit had problems exchanging accurate, complete, and timely information with other medical offices/ outside physicians?

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* 28. Over the past 12 months, how often has your dialysis unit had problems exchanging accurate, complete, and timely information with Pharmacies?

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* 29. Over the past 12 months, how often has your dialysis unit had problems exchanging accurate, complete, and timely information with Hospitals?

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* 30. Over the past 12 months, how often has your dialysis unit had problems exchanging accurate, complete, and timely information with Emergency departments?

Patient Partnership and Engagement

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* 31. Does your facility involve patients in the day-to-day culture & education of the facility including to assist in patient education, helping new patients adjust and enjoys being a part of facility activities?

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* 32. Does your facility have a patient or family member/caregiver that likes to help improve the patient experience of care, through patient education, and/or by welcoming new patients and/or by helping with facility activities?

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* 33. Does your facility have a patient(s)/family member(s) acting as a Network Patient Representative (NPR)?

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* 34. Which of the following patient engagement activities do your patients (NPR or other patient/family member representative) participate in currently?

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* 35. How many care plan meetings did you complete this month?

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* 36. How many patients/family members attended these care plan meetings?

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* 37. How many attended their meeting (with all team members) with the patient chairside in the development and assessment for the plan of care?

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* 38. How many patients/family members attended a meeting in a conference room or other area to discuss and review the plan of care?

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* 39. How many patient/family member(s) attended a meeting virtually using a phone or webcam to discuss the plan of care?

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* 40. How many patients had their POC reviewed with them following the POC meeting?

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* 41. What strategies do you currently use to involve patients in the development of their plan of care and/or plan of care meetings?

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* 42. Does your facility coordinate (or provide information on) established patient support groups OR new patient adjustment groups OR patient councils?

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* 43. If yes, please mark all that apply:

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* 44. If yes, how often do you hosts your groups?

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* 45. Does your facility include patients and/or family/caregivers in the Quality Assurance Performance Improvement (QAPI) Program and/or governing body of the facility?

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* 46. What are the barriers to increase patient engagement at your facility?

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