Please complete the following dialysis facility information. (One Survey Per Facility CCN)

*Inclusion Criteria:
  1. Network facilities that had a long-term catheter (LTC) (catheter in use > 90 days) in use rate greater than 15% along with a high BSI rate .
  2. Network facilities that had the highest BSI rates Healthcare-Associated Infections (HAIs) Bloodstream infections (BSIs) in the first and second quarters of 2017.
* Please note that not all facilities were selected for the BSI component if your rates were not in the highest 20% of Network facilities. The same applies to LTC rates where facilities with LTC less than 15% were excluded from the LTC component.
 
Goal:
  1. Reduce BSI rates in outpatient dialysis facilities and encourage accurate reporting of data in selected facilities.
  2. Reduce LTC rates by at least 2 percentage points at re-measurement in selected facilities. 

Project Objective:
  1. Promote the implementation of CDC recommended audit tools.
  2. Promote best practices in the reduction of high LTC rates.
  3. Assist at least 20% of selected facilities to join a Health Information Exchange(HIE) to receive information relevant to positive blood cultures during transition of care. 
Initial Activities:
  1. Provide the name, phone number, and email address of the project lead, back-up project lead, and any other supporting contacts in your organization via the survey below. The survey due date is January 4, 2018.
  2. Attend kickoff webinar, the Network will disseminate a meeting invitation, date/time to be determined. During this webinar, the requirements of the entire project will be reviewed.
Survey Instructions:
  • Populate all fields in the survey.
  • If the contact requested in a specific job title question is the same as the project lead or back-up project lead, enter "Same as project lead" or "Same as back-up project lead" in the name, phone number, and email address fields.
  • If your facility does not have corresponding personnel in a specific job title, enter "N/A" in the name, phone number, and email address fields.
  • Survey completion is dependent on all fields being completed.

Question Title

* 1. Please select your facility from the dropdown list below; facility name and CMS Certification Number (CCN) have been included.

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* 2. Project Lead: 

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* 3. Project Lead Role:

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* 4. Project Lead Phone Number:
e.g. 123-456-7890

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* 5. Project Lead E-mail Address:

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* 6. Back-up Project Lead:

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* 7. Back-up Project Lead Role:

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* 8. Back-up Project Lead Phone Number:
e.g. 123-456-7890

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* 9. Back-up Project Lead E-mail Address:

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* 10. Medical Director:

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* 11. Medical Director Phone Number:
e.g. 123-456-7890

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* 12. Medical Director E-mail Address:

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