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Decreasing BSI QIA January Monthly Feedback Report

Form due by February 10, 2020

Please only send one report per facility
1.Facility CCN and Facility Name(Required.)
2.Project Lead Submitting Form:(Required.)
3.Project Lead Email(Required.)
Infection Data Tracking
4.How many bloodstream infections did your facility have in January?

(Enter 0 if 0)(Required.)
0
100
5.Please briefly describe the source(s) of each infection; If there were no infections, type N/A: (Please do not include any direct patient health information)(Required.)
Prevention Tracking: Infection Control Audits Completed in January

Please indicate the number of audits completed for each category.

Note: Based on the requirements of this project we ask that each clinic complete at least 20 audit types among any of the given categories and 5 additional infection prevention audits that are completed by patients. Clinics may choose which types of audits to complete based on individual needs. Reporting example: if a completed audit includes assessment of Hand Hygiene, Dialysis Station Disinfection, and Cannulation Prep, that is reported as 3 infection prevention audits. A “perfect” outcome is a deficiency-free audit.
6.Total Number of audit categories completed:(Required.)
0
100
7.Number of patient-performed Audits:(Required.)
0
100
8.Number of Hand Hygiene Audits:(Required.)
0
100
9.Number of Perfect Hand Hygiene Outcomes:(Required.)
0
100
10.Number of AV Fistula/Graft Cannulation prep Audits:(Required.)
0
100
11.Number of Perfect cannulation prep Outcomes:(Required.)
0
100
12.Number of Catheter Care Audits:(Required.)
0
100
13.Number of Perfect Catheter Care Outcomes:(Required.)
0
100
14.Number of Dialysis Station Disinfection Audits:(Required.)
0
100
15.Number of Perfect Dialysis Station Disinfection Outcomes:(Required.)
0
100
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.
16.Regarding the QIA Project Calendar, please rate the usefulness of this resource to assist with tracking of QIA items:(Required.)
17.Regarding the QIA Kickoff Webinar/PDF Slides, please rate the usefulness of this resource to assist with understanding the QIA requirements:(Required.)
18.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:(Required.)
19.With regard to the Huddle Helper Checklist, how did you use the resource? Please check all that apply:(Required.)
20.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?(Required.)
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.
21.Regarding the ESRD NCC Decreasing BSI QIA LAN Call mentioned above please choose the best answer:(Required.)
Patient Engagement

In January, the Network offered a Patient Engagement Resource to help recruit patients to incorporate into the activities of this QIA.
22.With regard to the above-mentioned resource/activity, how did you use it? Please check all that apply:(Required.)
23.Have you been able to recruit a patient (or patients) to incorporate into the activities of this QIA?(Required.)
24.How many care plan meetings did you complete this month?(Required.)
0
100
25.How many care plan meetings did you complete this month?

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).(Required.)
0
100
26.Does your facility coordinate (or provide information on) established patient support groups OR new patient adjustment groups OR patient councils?(Required.)
27.Does your facility include patients and/or family/caregivers in the Quality Assurance Performance Improvement (QAPI) Program and/or governing body of the facility?(Required.)
28.Goal 1: Network Patient Representative in each dialysis facility in the Network region.

This month, my facility: (Mark all that apply)(Required.)
29.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?(Required.)
30.How many care plan meetings did you complete this month?(Required.)
0
100
31.How many patients/family members attended these care plan meetings?(Required.)
0
100
32.How many attended their meeting (with all team members) with the patient chairside in the development and assessment for the plan of care?(Required.)
0
100
33.How many patients/family members attended a meeting in a conference room or other area to discuss and review the plan of care?(Required.)
0
100
34.How many patient/family member(s) attended a meeting virtually using a phone or webcam to discuss the plan of care?(Required.)
0
100
35.How many patients had their POC reviewed with them following the POC meeting?(Required.)
0
100
36.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?(Required.)
37.Does your facility coordinate (or provide information on) established patient support groups OR new patient adjustment groups OR patient councils?(Required.)
38.This month our facility…(Required.)
39.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?(Required.)
40.What actions did your facility take to impact this goal this month?(Required.)
41.What other resources would be helpful for you to meet the PFE Goals?