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Report from the Executive Director. Glenda Harbert, RN, CNN, CPHQ. MISSION Statement. The ESRD Network of Texas, Inc. supports quality dialysis & kidney transplant healthcare through patient services, education, quality improvement & data exchange. 2003. ESRD Network #14. - PowerPoint PPT Presentation
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Report from the Executive Director
Glenda Harbert, RN, CNN, CPHQ
MISSION Statement
The ESRD Network of Texas, Inc. supports quality dialysis & kidney transplant healthcare through patient services, education, quality improvement & data exchange.
2003
ESRD Network #14
•The 2nd largest Network in number of dialysis patients (35,415) behind Network 6 (37,143)
•The 2nd largest Network in number of dialysis patients (35,415) behind Network 6 (37,143)
The 3rd largest Network in number of dialysis Providers (456)
behind Network 6 (561) & Network 9 (490).
The 3rd largest Network in number of dialysis Providers (456)
behind Network 6 (561) & Network 9 (490).
Topics
• Network activities• TEEC• DSHS Referrals• The Future
Activities of the Network
• Quality Improvement • Community Information & Outreach
– TEEC & Disaster preparedness– Patient & Provider Technical Assistance &
Education – Complaints & Grievances– Averting Involuntary Discharge
• Information Management
Quality Improvement
• Quality Improvement Projects– Improving Phosphorus– Quality of Care Concerns, Elab Data Collection &
CPM’s• Vascular Access Improvement Projects• 2 year outliers for clinical labs• Adequacy of HD
Community Information & Outreach
What is TEEC?
The mission of TEEC is to ensure a coordinated preparedness, plan, response and recovery to emergency events affecting the Texas ESRD community.
TEEC Steering Committee Brian Sanders, RN. MBA (Network 14
liaison) John Dahlin Eugenia De Los Reves, RN Balbi Godwin, RN (Chair-Elect) Vanessa Guillory, RN (Chair) Glenda Harbert, RN (ED for Network
14) Courtney Harman Kelley Harris Doug Havron, RN Debbie Heinrich, RN Becky Heinsohm, RN (consultant)
Derek Jakovich, JD (consultant) Robert Leggington, MD Minnie Malone, RN (consultant) Connie Oden, RN Glenda Payne, RN (consultant) Alex Rosenblum, RN Narendra Singh Steven Tays Jeff Thompson, MD Karen Walton, RN Mikki Ward, RN
Coastal CountiesJune 6, 2010184 Facilities
14, 715 Patients
Pre-Hurricane Preparations• Independent facilities must pre-plan for backup
dialysis with another provider
• Patients should be STRONGLY encouraged to evacuate
• Any patient with limited mobility, support systems and or transportation MUST be registered for evacuation with 211
• Telling patients to go the hospital for dialysis is NOT a disaster plan!
Annual Preparations
• Mail-out from NW– Template Disaster Plan
• Forms • Letters• Checklists for pre & post disaster
• Drills with EMSystem & DSHS • Webinar & mentoring for independent
facilities
The packet informed me of the:
The contraflow
routes relative to my facility
Hub Cities close to my
facility
Disaster preparation
activities expected
of my facility
Usage & requirement
of EMSystems
Educate our patient
population
Educate our staff
70% 74% 73% 78% 99% 99%
Resources provided will be used to:
Resources provided will be used to:
#responses: 260
My facility will make the expected disaster preparations
% of Compliant FacilitiesEMSystems – 07/2009 to 03/2010
% of Compliant FacilitiesEMSystems - 07/2009 to 03/2010
Complaints, Grievances & Involuntary Discharge (IVD)
NW 14 Trends in “negative contacts”Percent of total
“Drill down” of Quality of care beneficiary complaints and inquiries 09-10
New focus on caring
Communications
Trending Number of Complaints by FacilityTrending Number of Complaints by Facility
14% decrease 08-09 in facilities with 1 complaint
Trends in complaints
Cause of Formal Grievance
3 FG 2007, 8 FG 2008, 5 FG 2009
Trending Involuntary Trending Involuntary DischargeDischarge
Rate remains < 0.1% of total patients
•3 year trend in increase reversed•22% decrease in # pts •15% decrease in # facilities with IVD
Averted IVD’s
7/09- 6/10 • 12
Information Management
What happened to Crown Web?
•Phase II- Pilot Project with all Networks & 10 Facilities each •Full Implementation ??•For more information
•Visit CW booth •Attend last session Saturday
•Phase II- Pilot Project with all Networks & 10 Facilities each •Full Implementation ??•For more information
•Visit CW booth •Attend last session Saturday
DSHS Referral Update
Number of Cases & Levels
Common ThemesUnsafe Infection Control Practices
Simultaneous care of Hepatitis B negative and Hepatitis B positive patients
Failure to follow vaccination programPoor hand washing practicesInappropriate use of Personal Protective Equipment (PPE)Not disinfecting surfaces
Failure to implement Quality Assessment and Performance Improvement (QAPI)Lack of tracking, trending and analyzingInconsistent participation of Interdisciplinary team
membersFailure to recognize, report and track Adverse Events
Common ThemesPatient Safety Concerns
Lack of patient assessments (pre, during & post)Lack of staff knowledge regarding emergency equipment
Vascular Access OutliersHigh Catheter Rate/ Low AVF Rate
Unsafe Physical Environment Dirty floors, broken tilesInsectsUnlabeled hazardous chemicals
Water Treatment PracticesNot testing properlyLack of staff knowledgeUnsafe Reuse practices
Communication Issues
Nurses not following Physician’s ordersPCT’s not reporting critical treatment data/events to nurses:
Failure to report Hyper & Hypo tension pre, during, and post dialysis treatments
Initiating Sodium Profiling with BPFailure to:
obtain accurate weightsidentify wet transducerscommunicate “Reportable Parameters” to physician or nurse
Percent of DSHS Referral Facilities that Met MRB Cut Points at Year End
100
100
96.2
96.2
94 96 98 100 102
Catheter >= 90 days
AVF Rate
Anemia
Adequacy
Percent
Percent of DSHS Referral Facilities With Improved Outcomes Using Most Current Data
57.7
76.9
65.4
69.2
0 20 40 60 80 100
Catheter >= 90 days
AVF Rate
Anemia
Adequacy
Percent
Percent of DSHS Referral Facilities With Improved Outcomes
Improved all 4 indicators at
time of release from CAP
26.9%
Improved upon 3 of the 4
indicators at time of release
from CAP30.8%
Improved upon 2 of the 4
indicators at time of release
from CAP26.9%
Improved upon 1 of the 4
indicators at time of release
from CAP15.4%
14/19 (73.7%) with improvement in fewer than 4/4 indicators met or exceeded MRB QOC cut point at time of referral
Patients directly impacted with improved outcomes DSHS referrals
• 494 patients with improved outcomes– Removal of Catheter > 90 days– AVF placed– Anemia improved– HD Adequacy improved
• 2,513 patients potentially impacted
Future
• Healthcare Acquired Infections (HAI)
• Catheter Reduction
• Disparities
• Vulnerable populations
Coming soon
DVD for patients• Short• Diverse patient presenters• Highlights benefits of
exercise
Giving thanksThere is always something to be thankful for
What didn’t happen
H1N1 & the dialysis setting
“swine flu”
No Devastating Hurricane
Galveston Island Post Ike
