NW2 Home Dialysis QIA Kick-off
Webinar Post Assessment

Please complete the following information.

This for is being used to assess understanding of purpose, facility role, and Network role in the 2018 Home Therapies Quality Improvement Activity. Please review the Webinar Recording and/or webinar slides prior to competing this form.

Please complete by February 9, 2018.

Question Title

* 1. Please select your facility from the dropdown list below (CMS Certification Number (CCN) and Facility name listed)

Question Title

* 2. Contact:

Name

Email Address

Phone Number

Question Title

* 3. This webinar was over 1 hour long

Yes

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* 4. There are __ steps to Home Therapy Training being tracked in this project:

Four

Twelve

Seven

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* 5. The Network is requiring a 14 Question Root Cause Analysis to be completed for this project

Yes

Question Title

* 6. The goal(s) of this QIA is/are:

At least a 10 percentage point increase in patients training for home therapies

All Staff being educated on Home Therapies

All Patients understating their treatment options

Standardizing the process of patient education on home therapies

NW2 Home Dialysis QIA Kick-off
Webinar Post Assessment

Please complete the following information.

Question Title

* 1. Please select your facility from the dropdown list below (CMS Certification Number (CCN) and Facility name listed)

Question Title

* 2. Contact:

Question Title

* 3. This webinar was over 1 hour long

Question Title

* 4. There are __ steps to Home Therapy Training being tracked in this project:

Question Title

* 5. The Network is requiring a 14 Question Root Cause Analysis to be completed for this project

Question Title

* 6. The goal(s) of this QIA is/are:

Question Title

* 7. What is the name of the Network staff member who is leading this QIA?

Question Title

* 8. Do you have any other comments, questions, or concerns?