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* 2. Complete the below information.

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* 3. Please list the Primary and Secondary Contacts for this project. (If UNKNOWN, list the Facility Administrator for the Project Lead and Regional Corporate Representative as the Backup)

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* 4. Is corporate management involved in your facility's efforts to decrease long-term catheters?

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* 5. Does your facility actively use the CDC's Core Interventions related to catheter care and reducing long-term catheters? https://www.cdc.gov/dialysis/PDFs/Dialysis-Core-Interventions-5_10_13.pdf

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* 6. Do you know what a Healthcare-Associated Infections Learning and Action Network (HAI LAN) is?

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* 7. Do you have a Facility Patient Representative (FPR), Patient Subject Matter Expert (SME) or an ACTIVELY engaged patient in your facility?

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* 8. Does your facility hold MONTHLY patient engagement or educational activities related to long-term catheters for all patients?

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* 9. What do you believe is the main reason for high long-term catheter rates?

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* 10. What do you hope to gain from this LTC Quality Improvement Activity?

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* 11. Do you have a designated vascular access coordinator?

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* 12. How many vascular surgeons are available to work with your patients in your area?

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