Reducing LTC QIA: January Monthly Feedback Report

Form due by February 10, 2020

Please only send one report per facility

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* 1. Facility CCN and Facility Name

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* 2. Project Lead Name Submitting Form

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* 3. Project Lead Email

Data Collection

(Please enter 0 if 0)

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* 4. Central Venous Catheter Tracking

Total # of Hemodialysis Patients (In-Center & Home combined):

100

Clear

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

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* 5. # of in-center Hemodialysis patients using a Central Venous Catheter for more than 90 days on the last treatment day in January:

100

Clear

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

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* 6. # of Home Hemodialysis patients using a Central Venous Catheter for more than 90 days on the last treatment day in January

100

Clear

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

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* 7. # of Hemodialysis patients, who received dialysis using 1 needle in a graft or fistula and 1 CVC Lumen, (i.e. one-and-one or combined access) on the last treatment day in January:

100

Clear

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

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* 8. Referral Tracking

How many LTC-only patients were referred for AV Fistula or Graft placement in January?

100

Clear

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

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* 9. How many LTC patients obtained surgical revision on an AV Fistula or Graft in January?

100

Clear

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

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* 10. How many new AV Fistulae were placed in January?

100

Clear

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

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* 11. How many new Grafts were placed in January?

100

Clear

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

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* 12. How many new PD catheters were placed in January?

100

Clear

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

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* 13. New Start Tracking

How many of your new starts in January came from the hospital?

100

Clear

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

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* 14. Of the new starts from the hospital, indicate the # of patients with a working permanent access?

100

Clear

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

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* 15. Of the new starts from the hospital, indicate the # of patients with a maturing permanent access?

100

Clear

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

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* 16. How many of your new starts in January came from a nephrology office?

100

Clear

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

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* 17. Of the new starts from a nephrology office, how many had a working permanent access?

100

Clear

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

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* 18. Of the new starts from the nephrology office, how many had a maturing permanent access?

100

Clear

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

Access Surveillance Tracking

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* 19. How often does your facility monitor existing permanent accesses for signs of stenosis or any other complication (i.e. Transonic, DVP tracking, access flows)?

Monthly

Quarterly

Annually

N/A

January Highlighted Resource/Activity

In January, you received a Kickoff Package, including QIA calendar, Kickoff webinar, Huddle Helper Checklist, Network Patient Representative application, and My ESRD Network flyer.

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* 20. Regarding the QIA Project Calendar, please rate the usefulness of this resource to assist with tracking of QIA items:

1—Very Beneficial

2—Somewhat Beneficial

3—Undecided

4—Not very beneficial

5—Not beneficial at all

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* 21. Regarding the QIA Kickoff Webinar/PDF Slides, please rate the usefulness of this resource to assist with understanding the QIA requirements:

1—Very Beneficial

2—Somewhat Beneficial

3—Undecided

4—Not very beneficial

5—Not beneficial at all

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* 22. When thinking about the QI processes that were discussed in the Kickoff Webinar (Rapid Cycle Improvement, Root Cause Analysis, SMART Goals, PDSA, Sustainability) please select all that apply:

I learned something new from this webinar

I found the webinar to be useful to better explain quality improvement processes

As a result of this webinar, I will be changing something in my current process regarding how I complete QI projects in my clinic (not just this QIA)

As a result of this webinar, I feel better equipped to complete the QIA

I knew most of what was presented but it was a helpful reminder for me to hear again

I didn’t think the kickoff webinar was worthwhile

I have not yet listened to the webinar

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* 23. With regard to the Huddle Helper Checklist, how did you use the resource? Please check all that apply:

Began using the checklist during staff huddles

Discussed the resource in a staff meeting to begin working on implementation

Asked applicable team members to review the resource but did not share with everyone

Shared the resource in a QAPI meeting or with the Medical Director (or plan to)

Shared the resource with another clinic or with regional leadership

I have not yet implemented the resource but plan to

I did not find the resource to be beneficial and I do not plan to use it

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* 24. CMS expects that dialysis providers share ESRD Network information with patients. You were asked to print and share the My ESRD Network flyer with your patients. Did you share this with your patients?

Yes, we shared in January

We plan to share in February

We do not plan to share

QIA LAN Attendance

The Bloodstream Infections QIA LAN presentation held on January 7th featured Associate Directors of Patient and Family Engagement for the ESRD NCC Jerome A. Bailey, BA and Kim Buettner, BA sharing their respective roles to support the National Patient and Family Engagement (NPFE) LAN; the call also featured a patient Subject Matter Expert (SME) from the NCC’s BSI Affinity Group. The presentation highlighted resources created by the NPFE-LAN BSI Affinity Group and share methods for spreading the resources with patients.

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* 25. Regarding the ESRD NCC Decreasing BSI QIA LAN Call mentioned above please choose the best answer:

Someone from my clinic attended the live QIA LAN presentation and learned at least one promising practice that we plan to implement in our clinic

Someone from my clinic attended the LAN but we are unsure about how to apply the information to our clinic

Someone from my clinic attended the LAN but did not find it relevant to our clinic

We did not participate in the live event but plan to listen to the recording when it is released

Patient Engagement

In January, the Network offered a Patient Engagement Resource to help recruit patients to incorporate into the activities of this QIA.

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* 26. With regard to the above-mentioned resource/activity, how did you use it? Please check all that apply:

Posted an announcement in a common area for reviewing at patient convenience

Discussed the resource in a staff huddle prompting staff to share it with patients

Discussed the resource with staff so they could answer patient questions if needed

Shared the resource in a QAPI meeting or with the Medical Director

Shared the resource with another clinic or with regional leadership

I have not yet shared the resource but plan to

I did not find the resource to be beneficial and I do not plan to use it

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* 27. Have you been able to recruit a patient (or patients) to incorporate into the activities of this QIA?

Yes, we have at least one patient who is able to work with us

We are still working on getting someone

We would like more explanation of the role

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

100

Clear

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

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

Note: Attended the care plan meeting may be defined as: meeting with the patient chairside in the development and assessment for the plan of care, meeting in a conference room or other area to discuss and review the plan of care, meeting virtually using a phone or webcam to discuss the plan of care with the patient/family member(s).

100

Clear

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

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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?

Yes

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

Yes

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* 32. Goal 1: Network Patient Representative in each dialysis facility in the Network region.

This month, my facility: (Mark all that apply)

Had a team discussion to identify a NPR for our facility.

Assisted a patient/caregiver/family member to complete a NPR application

Worked with our active NPR

Encouraged NPR to attend the NPR Connection Call

Reviewed the monthly NPR Connection e-newsletter with the NPR to identify opportunities

Planned a patient engagement activity

Conducted a patient engagement activity (please elaborate on other)

None of the above

Other (please specify)

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* 33. Goal 2: Increased patient/family involvement in the development of their plan of care and/or plan of care meeting.

What actions did your facility take to impact this goal this month?

Reviewed Network resources

Met with NPR to discuss patient perspective on meeting the goal

Discussed during QAPI strategies to improve patient attendance

Implemented a strategy to increase participation

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

100

Clear

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

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

100

Clear

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

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

100

Clear

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

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

100

Clear

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

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

100

Clear

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

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

100

Clear

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

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* 40. Goal 3: Facilities will establish patient support groups; new patient adjustment groups and/or patient councils.

What actions did your facility take to impact this goal this month?

Reviewed Network resources

Met with the NPR to discuss opportunities for engaging patients in groups

Assessed patient interest in groups

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

Yes

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* 42. This month our facility…

Hosted a patient support group

Hosted a new patient adjustment group

Hosted a patient council meeting

Hosted an activity to encourage peer to peer support

Provided information on groups available

None of the above

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* 43. Goal 4: Facilities will include patients and/or family/caregivers in the Quality Assurance Performance Improvement (QAPI) Program and/or governing body.

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

Yes

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* 44. What actions did your facility take to impact this goal this month?

Reviewed Network resources

Identified patient/family member to participate in QAPI

Discussed patient involvement during QAPI team meeting to plan for patient/family member attendance

Provided patient with invitation to participate

Patient/family member attended the QAPI team meeting

None of the above

Reducing LTC QIA: January Monthly Feedback Report

Question Title

* 1. Facility CCN and Facility Name

Question Title

* 2. Project Lead Name Submitting Form

Question Title

* 3. Project Lead Email

Question Title

* 4. Central Venous Catheter TrackingTotal # of Hemodialysis Patients (In-Center & Home combined):

Question Title

* 5. # of in-center Hemodialysis patients using a Central Venous Catheter for more than 90 days on the last treatment day in January:

Question Title

* 6. # of Home Hemodialysis patients using a Central Venous Catheter for more than 90 days on the last treatment day in January

Question Title

* 7. # of Hemodialysis patients, who received dialysis using 1 needle in a graft or fistula and 1 CVC Lumen, (i.e. one-and-one or combined access) on the last treatment day in January:

Question Title

* 8. Referral Tracking How many LTC-only patients were referred for AV Fistula or Graft placement in January?

Question Title

* 9. How many LTC patients obtained surgical revision on an AV Fistula or Graft in January?

Question Title

* 10. How many new AV Fistulae were placed in January?

Question Title

* 11. How many new Grafts were placed in January?

Question Title

* 12. How many new PD catheters were placed in January?

Question Title

* 13. New Start Tracking How many of your new starts in January came from the hospital?

Question Title

* 14. Of the new starts from the hospital, indicate the # of patients with a working permanent access?

Question Title

* 15. Of the new starts from the hospital, indicate the # of patients with a maturing permanent access?

Question Title

* 16. How many of your new starts in January came from a nephrology office?

Question Title

* 17. Of the new starts from a nephrology office, how many had a working permanent access?

Question Title

* 18. Of the new starts from the nephrology office, how many had a maturing permanent access?

Question Title

* 19. How often does your facility monitor existing permanent accesses for signs of stenosis or any other complication (i.e. Transonic, DVP tracking, access flows)?

Question Title

* 20. Regarding the QIA Project Calendar, please rate the usefulness of this resource to assist with tracking of QIA items:

Question Title

* 21. Regarding the QIA Kickoff Webinar/PDF Slides, please rate the usefulness of this resource to assist with understanding the QIA requirements:

Question Title

* 22. When thinking about the QI processes that were discussed in the Kickoff Webinar (Rapid Cycle Improvement, Root Cause Analysis, SMART Goals, PDSA, Sustainability) please select all that apply:

Question Title

* 23. With regard to the Huddle Helper Checklist, how did you use the resource? Please check all that apply:

Question Title

* 24. CMS expects that dialysis providers share ESRD Network information with patients. You were asked to print and share the My ESRD Network flyer with your patients. Did you share this with your patients?

Question Title

* 25. Regarding the ESRD NCC Decreasing BSI QIA LAN Call mentioned above please choose the best answer:

Question Title

* 26. With regard to the above-mentioned resource/activity, how did you use it? Please check all that apply:

Question Title

* 27. Have you been able to recruit a patient (or patients) to incorporate into the activities of this QIA?

Question Title

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

Question Title

Question Title

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

Question Title

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

Question Title

* 32. Goal 1: Network Patient Representative in each dialysis facility in the Network region.This month, my facility: (Mark all that apply)

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* 33. Goal 2: Increased patient/family involvement in the development of their plan of care and/or plan of care meeting.What actions did your facility take to impact this goal this month?

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

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

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

Question Title

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

Question Title

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

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* 40. Goal 3: Facilities will establish patient support groups; new patient adjustment groups and/or patient councils.What actions did your facility take to impact this goal this month?

* 4. Central Venous Catheter Tracking

Total # of Hemodialysis Patients (In-Center & Home combined):

* 8. Referral Tracking

How many LTC-only patients were referred for AV Fistula or Graft placement in January?

* 13. New Start Tracking

How many of your new starts in January came from the hospital?

* 32. Goal 1: Network Patient Representative in each dialysis facility in the Network region.

This month, my facility: (Mark all that apply)

* 33. Goal 2: Increased patient/family involvement in the development of their plan of care and/or plan of care meeting.

What actions did your facility take to impact this goal this month?

* 40. Goal 3: Facilities will establish patient support groups; new patient adjustment groups and/or patient councils.

What actions did your facility take to impact this goal this month?