Dec 18th

2:00-3:00 PM

Welcome to the ESRD Network of the

South BSI QIA Kick-Off

We will be starting the webinar

momentarily

ESRD Network of the

South Atlantic

BSI QIA Kick-Off

Date 18, 2019

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Housekeeping Reminders

• This WebEx will be recorded and slides made available on the

Network Website

• All lines have been muted to eliminate background noise

To ask a private question use the Chat section in the bottom right corner of your screen sending to All Panelists

To ask a question for the answer to be shared with all Attendees or Privately, use the Q&A section in the bottom right corner of your screen

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Meeting Objectives

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Network 9IN, KY, OH

Network 6GA, NC, SC

NW2

• Understand the role of the ESRD Network in driving Quality Improvement

Initiatives

• Identify CMS Focus Areas

• Summarize the dialysis facility responsibilities regarding CMS quality improvement

• List the requirements of the Bloodstream Infection Reduction Quality Improvement

Activity (QIA)

• Identify a Infection Prevention Navigator at the facility

• Understand the role and purpose of the Patient Facility Representative (PFR) in

facility quality improvement initiatives

• Discuss project interventions and tools with Interdisciplinary Team

• Plan next steps

At the completion of this presentation, the participant will be able to:

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IPRO ESRD

Network

Program Overview

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ESRD Network Structure

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Network 9IN, KY, OH

Network 6GA, NC, SC

NW2

• Centers for Medicare & Medicaid

Services (CMS)

– Contracted ESRD Network Statement of Work

(SOW)

• 18 ESRD Networks

– 50 States and Territories

• ESRD National Coordinating Center

– Bi-Monthly Learning and Action Network (LAN)

Calls

– Large Dialysis Organizations (LDO) Data

Submission

• Quality Improvement Activities

– ALL Medicare Certified Outpatient Dialysis

Centers

Centers for

Medicare and

Medicaid

Services

ESRD National

Coordinating

Center

ESRD

Networks

Medicare

Certified

Dialysis

Facilities

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IPRO ESRD Network 2019 Service Areas(2018 Network Annual Reports

Network 6NC, SC, GA

Patients: 50,539Facilities: 760Transplant: 10

Network 2NY

Patients: 30,337Facilities: 305Transplant: 13

Network 1CT, MA, ME, NH,

RI, VTPatients: 14,856Facilities: 199Transplant: 15

Network 9OH, KT, IN

Patients: 33,890Facilities: 639Transplant: 14

IPRO ESRD Program

129,662ESRD Patients

1,903Dialysis Facilities

52Transplant Centers

NW1

NW2

Network 9IN, KY, OH

Network 6GA, NC, SC

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IPRO ESRD Network 6 Service Area

by Facility Ownership (October 2019)

Ownership Patients Facilities

FKC 21,921 294

DaVita 17,658 286

US Renal Care 2,484 49

DCI 2,324 39

American Renal 2,331 32

Wake Forest 1,908 19

Independents 2,474 47

VA 99 3

Totals 51,199 772

236 Facilities 18,953

Patients

5 Transplant Ctrs

159 Facilities

10,395 Patients

1 Transplant Ctrs

374 Facilities

21,851 Patients

4 Transplant Ctrs

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CMS ESRD Program Focus Areas

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Network 9IN, KY, OH

Network 6GA, NC, SC

NW2

• Patient and Family Engagement

– Incorporate the patient’s voice and perspective in all areas of quality improvement at the

ESRD Network and facility level

– Establishing patient support or new patient adjustment groups and incorporating patient, family

and caregiver participation into the QAPI and governing body of the facility

– Patient, family member and caregiver involvement in the development of the individualized

plan of care/or plan of care meetings

• Reduce rates of Blood Stream Infections (BSIs)

• Reduce rates of Long-Term Catheters (LTC)

• Increase rates of Patients on a Transplant Waiting List

• Increase rates of Patients Dialyzing at Home

• Promote NCC LANs to all facilities in the Network service area

• Improve Quality of Care for ESRD patients

• Promote patient engagement / patient experience of

care

• Support ESRD data systems and data collection,

analysis and monitoring for improvement

• Provide technical assistance to ESRD patients and

providers

• Evaluate and resolve patient grievances

• Support emergency preparedness and disaster

response

• Establishing partnerships to improve care

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ESRD Network Role & Responsibilities

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Dialysis Facility Responsibilities

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Network 9IN, KY, OH

Network 6GA, NC, SC

NW2

• Participate in Network Quality Improvement Activities (QIAs)

– Attend webinars (Network & NCC LAN Calls)

– Complete required documentation (surveys, attestations, etc.)

– Maintain accurate/ timely data (NHSN/ CROWNWeb)

• Inform patients of available Network resources

– Grievance resolution

– Educational materials

– Provide QIA resources to patients and family/caregiver

– Patient Advisory Committee

• Notify the Network of major events

– Dialysis facility emergencies

– Facility closures, relocation, renovations or changes in ownership

• Respond to inquiries and requests for information

– Annual Critical Asset Survey

– Data request

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What’s New This

Year in Quality

Improvement?

Project Branding

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• New BSI QIA Logo

• All BSI emails and surveys

will be color coded and

branded to distinguish

between projects

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Improving Survey Experience

Introducing :

• HIPPA compliant

• “Save & Return Later” feature

• Alerts user of survey completion to avoid

duplication of work

• Sends confirmation email of completion

• Allows user to save and print completed

survey in PDF

• Automatic reminders only if not completed

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Project Overview Guides

• Activities and supporting

resources for the entire project

cycle

• Important due dates

• To facilitate better facility

planning

• To assist in keeping up with

requirements

• Available for project lead,

project navigator and patient

facility representative

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Freshdesk Platform

http://help.esrd.ipro.org/support/home

http://help.esrd.ipro.org/support/home

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2020 BSI QIA Goals,

Measures &

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Making Dialysis Safer by Reducing Harm Caused in the Delivery of Care

Purpose:

• 5-Year Target: By 2023, reduce the national rate of blood stream infections in dialysis

patients by 50% of the blood stream infections that occurred in 2016.

• Reduce Rates of Blood Stream Infections and Long Term Catheters (LTCs)

Facility Selection Baseline / Re-measurement Data

Goal

BSI 20% of Facilities, with highest BSI rates from NHSN Excess Infection

Report

Baseline: Jan-June 2019 Data Re-measure: Jan-June 2020

Data

20% relative reduction in the semi-annual pooled

mean at re-measurement

LTC Network Service AreaTiered Approach using ABC

Modeling

Baseline: August 2020 DataRe-Measure: August 2021

Data

Decrease LTC rates in the NW service area by at

least 0.25%

Frequent Access to bloodstream

through catheters and needles

Ineffective communication between

dialysis, hospitals, nursing homes, etc.

Cross - contamination risk from improper

disinfection of equipment & Improper

Hand Hygiene

Patient Education

Staff educationPatients Admitted with BSI

Weakened Immune system

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Barriers & Factors in ESRD BSIs

Frequent

Hospitalizations

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Cross- Contamination Examples

Provider donned gloves & answers

machine alarm

Provider touches machine & patient

Provider touches next patient with the same

gloves

Patient held access with gloved hand

Patient touches scale with

gloved hand

Staff does not disinfect scale

Another patient touches scale

Staff

Patient

Plan-Do-Study-Act (PDSA) Cycle

• Plan

- Identify the goal or purpose

- Interventions for change

- Define success metrics

- Put plan into action

• Do

- Components of plan are implemented

• Study

- Monitor outcomes for signs of progress and success or problems and areas for improvement

• Act

- Close cycle, integrating the learning generated by the entire process

- Adjust goals, change methods, or reformulate an intervention or improvement initiative altogether

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Understanding and Implementing the Quality Improvement Cycle

Form your QI Team – Get Everyone involved in the Project

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BSI Quality Improvement

Activities (QIA),

Interventions, Tools and

Resources

Project (noun)

A specific plan or design

A planned undertaking

Intervention (noun)

The act of interfering with the

outcome or course especially of a

condition or process (as to prevent

harm or improve functioning)

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Quality Improvement Activities

Definition Source: https://www.merriam-webster.com/

Interventions are created to meet the goals of the CMS Statement of

Work, CMS conditions of Coverage and include Best Practices from NCC

LAN calls

The components of an infection

control program is to include:

• Infection control practices for

hemodialysis units

• Infection control precautions

specifically designed to

prevent transmission of blood

borne viruses and pathogenic

bacteria among patients.

• Routine serologic testing for

hepatitis B virus infections.

• Vaccination of susceptible

patients against hepatitis B.

• Isolation of patients who test

positive for hepatitis B surface

antigen.

• Surveillance for infections and

other adverse events.

• Infection control training and

education…education includes

staff and patients

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Conditions Of Coverage (CfC)

V110: Infection Control: Infection control requirements apply to

both the chronic dialysis in-center facility and any home dialysis

programs

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Develop a Team Approach to Quality Improvement

Form your QI Team – Get Everyone involved in the Project!

• Facility Administrator/Clinic or Nurse

Manager

• PCT/CCHT’s

• Patient’s/Family Members/Caregivers

• Social Worker

• Dietitian

• Administrative Assistant

• Medical Director/ NP

Infection Prevention Navigator

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Identify

• Team Oriented and enthusiastic about the role

• Has an interest in preventing infection and is open to new ideas

• Effective communicator with both patients and staff

Train

• CDC / SPICE videos

• Understand Facility and Evidence Based Guidelines for infection prevention

• Patient Navigator Project Outline Guide

Empower

• Lead CDC Audits, Huddle Board, QAPI Infection Reporting

• Support the Patient Facility Representative role

• Address RCA challenges identified when an infection occurs

Sustain

• Share best practices identified across the multi-disciplinary team

• Reinforce training and best practices with new employees

• Celebrate your success across your organization!

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Does your Team have a missing link?

Patient Engagement Focus Areas

• Including patients in the QAPI process can

provide the missing link which influences

your daily work that drives quality

improvement measures.

• Establishing a patient support or new

patient adjustment group can provide

patients with ways to cope with their

diagnosis, communicate better with the

healthcare team, and educational

opportunities.

• Implementing a peer mentorship training

program can improve communication, foster

personal growth and provide support.

Patient or Family Member

Medical Director

Nephrologist

NP

Facility Leadership

Infection Prevention Navigator

QIA Project Leads

Dietitian

Social Worker

PAC Facility Representatives Support QIA Projects

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• Partner with Project Lead and Infection Prevention Navigator

to support the implementation of targeted interventions for

the BSI Reduction QIA.

• Assist Infection Prevention Navigator with distributing

educational resources.

• Collaborate with the Infection Prevention Navigator on the

creation or refresh of the Education Station and hosting a

Lobby Day.

• Foster positive relationships between patients, providers,

ESRD stakeholders and the Network.

Facilities will identify at least one patient to be a PAC Facility Representative for 2019 BSI QIA

Patient Education/ Engagement

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Staff Education and Competency

Evidenced Based Research

demonstrates:

• BSIs in dialysis patients are preventable

• CDC audits are highly effective

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CfC V132: Infection Control Training and Education

Infection control practices for hemodialysis units:

intensive efforts must be made to educate new staff

members and reeducate existing staff members

regarding these practices. OSHA mandates dialysis

staff receive blood borne pathogen training annually

and CDC recommends infection control training

initially on employment and annually.

Staff Education and Competency

Statewide Program for Infection

Control & Epidemiology (SPICE)

Injection Safety Video

Educates and demonstrates critical

elements of safe injection practices,

and details infection risks when safe

practices are not adhered to.

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CDC (Centers for Disease Control)

5 Part Video segments with how to

prevent infection in patients with

catheters, fistulas, or grafts. It

includes hand hygiene, glove us, and

dialysis station disinfection

information for front line staff

Infection Prevention Pledge

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Complete Monthly Observation and Audit Tools - Infection Prevention Navigator

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Assessing and observing

practice helps to improve

practice

Complete Monthly Observation and Audit Tools – Patient Facility Representative (PFR)

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PFR partnering with the Infection

Prevention Navigator to support the

implementation of targeted interventions

for the BSI Reduction QIAs

Catheter Care & AVF/AVG Access

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Catheter Care & AVF/AVG Access

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CDC Staff Education Information

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Environmental Disinfection & Injection Safety

CfC V122: Cleaning and disinfection of

contaminated surfaces, medical devices and

equipment.

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Complete Monthly Observation and Audit Tools - Patient Facility Representative

Catheter Reduction

Pursue initiatives through:

• Patient Education

• Vascular Access Coordinator

• Identifying and addressing barriers to

permanent vascular access

placement and catheter removal

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Antimicrobial Ointment

Share research related to antimicrobial use with your QAPI

team:

Bloodstream Infection Rates in Outpatient Hemodialysis Facilities Participating

in a Collaborative Prevention Effort: A Quality Improvement Report

Patel. P et al

AJKD August 2013 Vol 63, Issue 2, pages 322 – 330

Bloodstream Infection Prevention in ESRD: Forging a Pathway for Success

Patel, P. & Kallen, a

Centers for Disease Control and Prevention, Atlanta, Georgia

AJKD February 2014 Vol 63, Issue 2, pages 180-182

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NHSN -National Healthcare Safety Network

• Conduct monthly surveillance for BSIs

and other events using CDC National

Healthcare and Safety Network

(NHSN)

• Dialysis Event Surveillance training is

required of all hemodialysis facilities

• Monthly NHSN reporting of data is

needed to meet QIP requirements

• Complete NHSN Training and Network

Attestation Survey (Jan-Aug of 2019)42

Huddle Board / Learning Boards

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Boards support visual management of key elements /

concerns

Boards provide structure to capture critical information/ key

areas of concern that drive discussions intended to improve

quality of patient care and boost staff input

Huddle discussions around the board provides a guide

focused on addressing the issues needed in achieving /

reaching a goal, recognize staff and patients making a

positive impact, and bring awareness to unsafe practices

The huddle also helps make leadership aware of issues

which allows for improved issue resolution and the

removal of barriers to the teams success

Huddle / Learning Board

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Learning Board / Huddle Board

Learning Boards to capture key areas of

concern, follow up (i.e. RCAs) and

resolution to issues / concerns

Enhances a guided conversation and

follow up for:

Issues identified by staff

Items in the follow up process

Resolved Items

Rapid Cycle Improvement Worksheet

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Worksheet assist facilities:

• Track BSI frequency, occurrences,

audits and observations of practice

• Review each BSI:

• evaluate the root cause

• Identify factors involved in BSIs

and add corrective actions timely

• Utilize to help guide huddle board

conversations

• Involve the Interdisciplinary Team

and front line staff members in the

review process

CfC V112: Surveillance for infections and other

adverse events is required to monitor the effectiveness

of infection control practices...

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Attend NCC Learning and Action Network Calls and get a FREE CEU!

• LANs are mechanisms by which large scale improvement around a goal is

fostered, studied, adapted, rapidly spread and sustained regardless of the change

methodology, tools, or time-bounded initiative that is used to achieve the goal.

• LANs engage communities around an action based agenda that gains

commitment towards the achievement of person-centered outcome-based goals.

• ESRD National Coordinating Center hosts bi-monthly Learning and Action

Network Calls on Transplant, Home Modalities, and Infection Prevention

– 1 CEU provided per call (RN, SW, RD, CCHT)

– Learn from innovators and change makers about successful strategies

– Be a presenter to share your successes!

Facility Performance Review Calls

• Paired conference call within same organization under same leadership

• Open platform to drive meaningful and productive conversations

• Review project goals and objectives

• Share best practices to overcome barriers

• Focus on progress, performance, and expectations

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Facility Progress Report

• Aligns facility objectives with CMS

goals and priorities

• Keeps your quality improvement

strategies front and center by

reviewing with interdisciplinary

team on a monthly basis (QAPI

meetings)

• Shows how you are progressing

on your Infection Prevention

interventions

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Health

Information

Exchange

Health Information Exchange

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• Is the mobilization of healthcare information electronically across organizations within a region, community or hospital system

• Directed exchange is also being used for sending immunization data to public health organizations or to report quality measures to The Centers for Medicare & Medicaid Services (CMS).

Health Information

Exchange

• Is a secure electronic way for medical professionals to share and view patient information that is needed at the point of care

• This could be a system you already have in place

Effective Information Exchange System

Note: Facility should have policy in place to govern the process used

Health Information Exchange

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• NC HealthConnex

• SCHIEX

• GaHC (Statewide)

Three Regional HIEs

Health eCOnnection

HealthHIEGeorigia

GRAChIE

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Upcoming and Next Steps

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Network Educational Resource Mailing

Arriving at your facility the last week in December

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Patient Education Contest

• Focus Area Topics:

– Blood Stream Infection (BSI) Reduction

– Vascular Access Planning

– Home Modality Treatment Options

– Transplant as a Treatment Option

• Take a multi-disciplinary approach by

including facility leadership, floor staff, and

patient representatives in your planning.

• Set a Goal and measure your success!

• Dates: January 1st – March 31st Winners will be announced in

May at Network Annual Meeting!

342665 Yadkin Dialysis Center of

Wake Forest University

On the Horizon:

• New Network Staff Email Addresses!

– Changing to firstname.lastname@ipro.us Example: Loretta.Ezell@ipro.us

• Network Annual Meeting

– Wednesday May 20th and Thursday May 21st , Cary NC

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On the Horizon

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• Complete the Key Facility Contact Data Collection: Due December 11, 2019

• Attend the ESRD NCC LAN call- January 7, 2019 3pm – 4pm ET

• Complete the Knowledge & Practice Assessment: DUE 1/13/20

• Identify at least one Infection Prevention Navigator (Staff Role)

• Identify at least one Patient Facility Representative (Patient Role)

– Will be collected in REDCap – DUE 1/15/20

• Update CROWNWeb staff and emergency contact information

• Attend the upcoming Network call on incorporating patients into QAPI – 2/20/20

1PM – 2PM

• Attend the upcoming Network call on establishing a Patient Support Group –

4/23/20 1PM – 2PM

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Questions or Comments?

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• Freshdesk

– http://help.esrd.ipro.org/support/home

• Website

– http://network6.esrd.ipro.org/

• Facebook

– https://www.facebook.com/IPROESRDProgram

Stay in Touch!

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ESRD Network of the South Atlantic (Network 6) Staff

Shannon WrightExecutive Directorswright@nw6.esrd.net

Loretta EzellQuality Improvement DirectorLezell@nw6.esrd.net

Michelle LewisQuality Improvement Data Coordinatormlewis@nw6.esrd.net

Alex CruzQuality Improvement Coordinatoracruz@nw6.esrd.net

Chanell McCainPatient Services Directorcmccain@nw6.esrd.net

Stephanie ClarkeCommunity Outreach Coordinatorsclarke@nw6.esrd.net

Jaya BhargavaOperations Directorjbhargava@nw1.esrd.net

Shasha AylorData Analystsaylor@nw6.esrd.net

Jasmine TabornData Coordinatorjtaborn@nw6.esrd.net

Website http://network6.esrd.ipro.org/

Thank You!

IPRO ESRD Network of the South Atlantic909 Aviation Parkway, Suite 300Morrisville, NC 27560

http://esrd.ipro.org/

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