Read the following instructions carefully

WARNING: DO NOT USE ANY PATIENT-SPECIFIC INFORMATION IN THIS SURVEY (NAME, DATE OF BIRTH, SOCIAL SECURITY NUMBER, ETC.). THIS WOULD BE CONSIDERED A SECURITY INCIDENT DUE TO PATIENT CONFIDENTIALITY AND AS SUCH WOULD BE REPORTED TO CMS.
A root cause analysis (RCA) is a quality improvement tool used to identify any causes or reasons behind a specific issue. Completion of a thorough and credible RCA will assist you in the development or updating of an existing facility improvement action plan. The Network recommends you complete this RCA with the input of your facility's NHSN team (e.g. staff responsible for gathering information about dialysis events (DE) specifically the positive blood cultures (PBCs) at the facility and from other health care setting outside the facility and staff that reports all the data gathered to NHSN).

Dialysis events (DE) and Positive Blood Culture (PBC) reporting specifics

Facilities follow the rules outlined in DE protocol to report DE data (IV antimicrobial starts, PBC and Pus, redness and swelling are the three types of Dialysis events) to NHSN

PBC Reporting: Per the DE protocol, all positive blood cultures from specimens collected as an outpatient or collected on the first or second day of hospital admission are to be reported to NHSN, regardless of whether or not true infection is suspected or infection is thought to be related to hemodialysis. 
 
Please read the description of the RCA categories below before starting the survey:
Facility Specific Factors: Factors that are under the control of the dialysis facility staff, examples include staffing issues, lack of follow-up, staff do not know the protocol or do not follow the protocol

Patient-Related Factors: Factors that are under the control of the dialysis patients, examples include patient does not understand or does not communicate due to language barrier or unaware of the importance of communicating information

Organizational Factors: Facility policy and procedure factors, example include,  a protocol in place for retrieving information from hospital, tracking the PBCs, validating data reported to NHSN

NHSN Factors: Examples include barriers related to the NHSN system itself 

Hospital Factors: Factors that are under the control of hospital, examples include no access to hospital EMR, no or lack of knowledge of hospital EMR
 
1. Complete the questions below by selecting the root cause or root causes which you think are barriers to reporting positive blood cultures (PBCs) from the first or second day of hospital admission or emergency department visit (ED)(multiple selections allowable)
2. Describe any root causes NOT listed under each category in the Other (comment) field.
 

* 1. Provide 6-digit CMS provider number (CCN#, begins with a 45 or 67).

* 2. What are Facility Specific Factors that you think are attributable to no or low Positive Blood Culture (PBC) reporting in NHSN of PBCs that occur on first or second day hospital admission/ ED visit?

* 3. What are Patient-Related Factors that you think are attributable to low or no Positive Blood Culture (PBC) reporting in NHSN of PBCs that occur on first or second day hospital admission/ ED visit?

* 4. What are Organizational Factors (operational, policies, systemic) that you think are attributable to low or no Positive Blood Culture (PBC) reporting in NHSN of PBCs that occur on first or second day hospital admission/ ED visit?

* 5. What are NHSN Factors that you think are attributable to low or no Positive Blood Culture (PBC) reporting in NHSN of PBCs that occur on first or second day hospital admission/ ED visit?

* 6. What are Hospital Factors that you think are attributable to low or no Positive Blood Culture (PBC) reporting in NHSN of PBCs that occur on first or second day hospital admission/ ED visit?

* 7. Completion of this root cause analysis was easy to do on-line.

* 9. Provide first and last name of person completing this survey

* 10. Any additional thoughts or comments you would like to provide about this process?

* 11. Provide name of facility

* 12. I have printed a completed copy of this RCA survey with all the answers for my records (right-click over the survey and select "Print")

* 13. Enter a date and time that you will be available to discuss this Root Cause Analysis and develop a PDSA with the Network, it will take approximately 30 minutes to an hour. At least one selection must be made. Choose a date and time between Monday-Friday (7am-3pm), excluding holidays. Example: 01/04/2017 @ 2:35 pm

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