The purpose of this scan is to identify improvement opportunities to decrease the number of long term catheters 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 for Decreasing Long-Term Catheters

Long Term Catheter (or LTC): A Long-Term Catheter is defined as a catheter that is in place for GREATER THAN 90 days.

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* 4. In your opinion, what is the main cause(s) for why LTCs are in use at or above 15% of your unit's patient population?

Strategies to Aid Early Referral for Permanent Access Placement

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* 5. Do your patients have permanent access planning (vascular and/or peritoneal) prior to starting hemodialysis?

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* 6. Upon admission, do all of your patients receive education regarding all treatment options; Home Dialysis, NxStage, transplant, and/or palliative care?

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* 7. Does your facility have policies and procedures in place that support LTC reduction?

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* 8. Does your facility have a Vascular Access Manager (VAM), Access Coordinator, or a similar position on staff?

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* 9. Does your facility routinely post the current LTC rate for all staff to see?

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* 10. Does your facility routinely post the current LTC rate for *patients* to see?

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* 11. Does your facility document patient reasons for refusing to obtain a permanent access?

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* 12. Does your facility staff (clinical and non-clinical) take part in training or observation at a vascular access center or hospital?

Strategies to Decrease Missed Opportunities for Long Term Dialysis Catheter Removal

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* 13. Does your staff educate and later re-educate patients about the risks of LTC usage?

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* 14. Does your facility have a process to acknowledge the anticipated removal date of a patient’s catheter, appointment dates, or permanent access plan?

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* 15. Does your facility have a process in place to remind patients dialyzing with a catheter of the anticipated removal date and/or time?

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* 16. Does your facility have access to LTC educational resources to help answer questions from patients and caregivers?

Strategies to Improve Data Accuracy within CROWNWeb

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* 17. Do your staff input LTC removal information into the EMR system during the first dialysis treatment without a catheter present?

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* 18. Does your facility have a process in place to check the accuracy of the vascular access data in CROWNWeb?

(especially if your corporation provides data uploads (i.e. Batch) from your electronic medical record)

Patient Partnership and Engagement

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* 19. 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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* 20. 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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* 21. Does your facility have a patient(s)/family member(s) acting as a Network Patient Representative (NPR)?

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

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

0 100
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i We adjusted the number you entered based on the slider’s scale.

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

0 100
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i We adjusted the number you entered based on the slider’s scale.

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

0 100
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i We adjusted the number you entered based on the slider’s scale.

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

0 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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

0 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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

0 100
Clear
i We adjusted the number you entered based on the slider’s scale.

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

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

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

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

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