2012-2013 Facility Resource Material

The Facility Resource Materials (FRM) provides updated materials set forth by the Network 13 Medical Review Board (MRB) and helpful information regarding the care of ESRD patients. The information is printer friendly so please feel free to copy materials as needed.

The current Network standards and recommendations are provided for reference, as well as information on disaster preparedness, infection control, patient services and other information including the updated Reference Library resource list. Use the Table of Contents to direct focus to the information needed. Place your pointer over the sections in the bar on the left for a quick view of the Table of Contents for each section, or print a copy of the expanded Table of Contents.

All applicable Quality Improvement (QI) correspondence will continue to be forwarded to the dialysis and transplant facilities. The Network QI responsibilities will continue to include:

Submittal of any required QI items to the Network;
Maintenance and knowledgeable about what QI materials are mailed to nurse managers;
The responsibility for dissemination of this information to the appropriate people in your facility.

With 280+ facilities in the Network, it is known that everyone approaches Network QI responsibilities in a variety of ways. It is our hope that the information on this site can be utilized by the facilities in improvement of ESRD patient care outcomes.

Revisions and modifications occur annually. We distribute replacement copies for inclusion in the manual each Spring/Summer. Requests for information can be done at any time by contacting the Network.

1. Network 13 Information

  1. ESRD Network 13 Board of Directors (BOD), Medical Review Board (MRB) and Network Committees (Quality Improvement, Patient Services/Grievance, Patient Advocacy)
  2. ESRD Network 13 Office Staff
  3. ESRD Network 13 Website
  4. Notification of Facility Status Changes - Guidance
  5. Network 13 Glossary of Acronyms

2. Network 13 Directives

  1. NETWORK GRIEVANCE POLICY: All ESRD facilities are required to inform their patients of the Network’s grievance policy and their right to complain and/or file a grievance.
  1. Grievance Policy
  2. Grievance Poster Arkansas, Louisiana, and Oklahoma (11” X 17” available upon request)
  1. CMS SANCTION RECOMMENDATION PROCEDURE: All ESRD facilities are directed to participate toward the achievement of Network 13 goals and objectives (e.g. Quality Improvement, Data Registry, Complaints/Grievances, etc.) Sanction or alternate sanction recommendations are directed and/or implemented at the direction of the CMS Region VI Office in Dallas, TX.
  2. CONCEALED WEAPONS: Sample Policy: The Network provides a sample concealed weapons policy for use in the renal communities as necessitated by state law or corporate directive.
  3. F. SERVICE ANIMALS IN HEALTHCARE FACILITIES – Reference / Guidance resources

3. ESRD-Related Resources for Professionals and Patients

  1. UNIFORM ESRD TRANSIENT FORMS
  1. ESRD MEDICAL RECORDS – A NATIONAL MODEL
  2. Clinical Laboratory Improvement Amendments (CLIA) / Regulations
  1. General Resources (Associations/Organizations)
  2. Acute Myocardial Infarction Websites
  3. Diabetes Websites
  4. Heart Failure Web sites
  5. Reduce Disparities Websites—also see SDPS Intranet links
  6. Quality Improvement with Medicare+Choice Plans Websites
  7. End Stage Renal Disease (ESRD) Websites
  1. MEDICAL EDUCATION INSTITUTE A non-profit educational institute specific to chronic kidney disease, offers many educational resources for patients and professionals. www.meiresearch.org
  1. DIALYSIS FACILITY COMPARE (DFC) This CMS-managed Web site provides important information and resources for patients and family members who want to learn more about chronic kidney disease and dialysis.

4. Continuous Quality Improvement (CQI) Resources

  1. Network 13 Performance Guidance: This resource is to provide guidance in ascertaining appropriate delivery of dialysis care to patients on chronic dialysis therapy in the areas of…

Performance Guidance Document
    • Adequacy of Dialysis
    • Anemia Management
    • Nutrition Management
    • Mineral Metabolism
    • Vascular Access Management
    • Immunizations
    • Infection Control
    • Patient Safety
  1. ACCELERATING QUALITY IMPROVEMENT
  1. QI TOOLS - These tools are intended to provide QI tracking and monitoring resources for use in any Facility-Specific QI application. Tools can be modified upon request to assist your Interdisciplinary Dialysis Team (IDT) in the provision of quality care.
  1. Quality Assessment and Performace Improvement Tools
    1. Quality Improvement Project
    2. QI Sample – sample “Action Plans”
    3. CQI Trend Tool – (Aggregate collection tool with review and prioritization)
    4. Facility Quality Indicators
    5. Sample Fishbone Templates (Word™ and Excel™)
    6. Cause and Effect Diagram
    7. Run Chart
    8. Interdisciplinary Team Agenda Template
    9. Interdisciplinary Team Meeting Minutes Template
    10. QAPI Facility Checklist
  2. Adequacy of Dialysis
    1. Hemodialysis
      1. Self-Study: Adequacy of Hemodialysis (Prescription & Delivery)
      2. Prescription and Delivery Audit Tool and Instructions
      3. Adequacy of Hemodialysis Tools – (Prescription delivery tool quantifies root cause)
      4. Pre- and Post-Dialysis Blood Sampling Validation Forms
      5. Frequent Hemodialysis Adequacy of Hemodialysis – (conversion formula)
      6. Illustrative Conversions: G-Codes/URR to stdKt/V
      7. Hemodialysis Adequacy and Kinetic Modeling Channel: Hypertension, Dialysis and Clinical Nephrology (HDCN)
      8. The Nephron Information Center
    2. Peritoneal Dialysis (PD)
      1. Self-Study: Adequacy of Hemodialysis (Prescription & Delivery)
      2. PD Adequacy Flow Sheet
      3. Adequacy Barrier Worksheet
      4. Educational Web sites of Interest for PD
  3. Anemia Management
    1. Anemia Management Worksheet (with medication adjustment)
    2. Anemia Management Barrier Worksheet – (Root Cause Analysis Assistance)
  4. Dialysis-Specific Infection Control Issues (See FRM section 8)
  5. Nutrition Management
    1. Malnutrition in ESRD Patients – (Algorithm)
    2. Management of Hypoalbuminemia In Adult Dialysis Patients Algorithm
    3. Patient Facility Percent Albumin – (Trending tool creates graphs)
    4. Subjective Global Assessment Rating Form – (Patient assessment form)
    5. Chronic Kidney Disease Nutrition Management, RD Training Modules / Education Resources.
  6. Vascular Access Tools (See FRM Section 5 for AVF Functionality Tool and Catheter Reduction Worksheet)
    1. Fistula First Bruit Audio Clips Available for Patient and Staff Education Located at the bottom of the "What's New" Column "Listen to the Bruit"
  7. Self-/Home- Care Training Materials
    1. Hemodialysis Home Training Checklist
  8. Water Treatment
    1. Water Quality Chart
    2. Water and Dialysate for Hemodialysis - Preventing Waterborne Bacteremia
  9. Hemolysis
  10. Patient Assessment and Plan of Care / Initial Patient Assessment Webex Recording
  11. Diabetic Foot Screening
    1. Diabetic Foot Examination Risk Categories
    2. Basic Foot Assessment Check List – (With foot diagram & Referral Action Plan)
    3. Prevention of Serious Complications from Diabetes (NIH) – (Patient education sheet)
    4. Preventing Foot Ulcers and Amputation – (Professional education sheet)
  12. Automated External Defibrillator (AED)
    1. SAMPLE Procedure: AED
    2. SAMPLE Policy (supplied from Medtronic)
    3. Emergency Cardiovascular Care (ECC) Class Connector
  13. Patient Safety
    1. Medication Error/Reconciliation
    2. Institute for Safe Medication Practices
  14. Fluid Management (Dry Weight Algorithm / Tool)
  1. ESRD Program Interpretive Guidelines
  2. ESRD Freqently Asked Questions (FAQs) - Version 1.3
  3. Tools and Resources (e.g, Measures Assessment Tool, etc.)
  4. Optional Surveyor Worksheets and Tools
  5. Survey and Certification Letters

5. FF Tools and Resources by Change Concept

  1. AVF Plan and Referral Resources: Timely Referral to Nephrologist
  1. DRAFT LETTER: “To PCP from Nephrologist” Pre-ESRD Vascular Access/AVF Plan
  2. SAMPLE POLICY AND PROCEDURE: Fistula Preservation, Development and Maintenance
  3. POWERPOINT: Fistulas for Dialysis Access: The Challenge of Preservation, Creation, Maturation, and Cannulation (Lesley C. Dinwiddie MSN, RN, FNP, CNN and William Marston MD)
  4. ALGORITHM: Pre-ESRD Vascular Access/AVF Plan
  5. SAMPLE GUIDELINES: Venous Access in Patients with Chronic Kidney Disease
  1. Surgeon Referral Resources: Early Referral to Surgeon
  1. ALGORITHM: Pathway to Autologous AVF
  2. TOOL: Hemodialysis Access Referral Form for New Access
  3. TOOL: Request form for Surgical Evaluation/Consultation
  4. TOOL: AV Access Checklist/Form
  5. TOOL: Vascular Access Diagram (Sample FAX Form to Dialysis Facility and/or Nephrologist)
  6. BEST PRACTICE RESOURCE: “A Practitioner’s Resource Guide to Hemodialysis Arteriovenous Fistulas” (Gerald A. Beathard, MD, PhD, FACP, FCAP)
  7. BEST PRACTICE RESOURCE : “A Practitioner’s Resource Guide to Physical Examination of Dialysis Vascular Access” (Gerald A. Beathard, MD, PhD, FACP, FCAP)
  8. REFERENCE ARTICLE: Surgical Anatomy of Upper Arm: What is Needed for AVF Planning (Surendra Shenoy M.D., Ph.D.)
  9. REFERENCE ARTICLE: Ultrasound in Vascular Access (Jason Wellen, and Surendra Shenoy M.D., Ph.D.)
  10. SAMPLE GUIDELINES: Upper Extremity Vein Mapping for Placement of a Dialysis Access
  1. Surgeon Questionnaire: Surgeon Selection
  1. Surgical Creation of AVF: Surgical Approaches
  1. POLICY: Duplex of Upper Extremity Vessels prior to AVF Surgery
  2. POWERPOINT: AVF in Most (All?) Patients (William Jennings, MD, FACS)
  3. POWERPOINT: Wrist (Cimino) and Brachial AVF’s (William Jennings, MD, FACS)
  4. POWERPOINT: Exploiting the Proximal Radial Artery (William Jennings, MD, FACS)
  5. POWERPOINT: Vein Transpositions (Lawrence M. Spergel, MD, FACS)
  6. POWERPOINT: The Difficult Access Patient (William Jennings, MD, FACS)
  7. SURGICAL CD/DVD SERIES: “Creating AV Fistulae in All Eligible Hemodialysis Patients” (Drs. Spergel, Jennings, and Arnold) (Available Upon Request at Network Office – Limited Supply)
  1. AVG Resources: Secondary AVF Placement
  1. SLEEVES UP: “Checking Upper Arm for Developing Veins in Patients With a Forearm AV Graft”
  2. TOOL: Referral Form for Existing Access
  3. POWERPOINT: A-V Fistula construction: Secondary AVF’s (Lawrence M. Spergel, MD, FACS)
  4. TOOL: AVG to AVF Conversion Checklist
  5. PROTOCOL: Conversion to Secondary AVF
  6. TOOL: AVG Intervention Rate Worksheet (Provided by NW14)
  7. TOOL: AVG Thrombosis Rate Worksheet (Provided by NW14)
  8. FACT SHEET: NKF Update on HeRO®
  9. ALGORITHM: AVG Assessment and Intervention
  1. Cannulation Techniques: Training
  1. REFERENCE ARTICLE: Cannulation Camp: Basic Needle Cannulation Training for Dialysis Staff (Deborah J. Brouwer, RN, CNN)
  2. REFERENCE ARTICLE: Improving AVF Cannulation Skills (Lynda K. Ball, BS, BSN, RN, CNN)
  3. POLICY AND PROCEDURE: Cannulation of New AVF
  4. REFERENCE ARTICLE: Determining Maturity of New AVF (Lynda K. Ball, BS, BSN, RN, CNN)
  5. REFERENCE ARTICLE: Determining AVF Blood Flow (Linda Duval, William Jennings, and Lynda Ball)
  6. TOOL: Arm Diagram to Document Flow Direction
  7. POLICY AND PROCEDURE: Clamp Usage
  8. SAMPLE GUIDELINES: Rating & Improving Dialysis Staff Cannulation Competency
  9. POWERPOINT: Network 13 Vascular Access Evaluation and Cannulation Training Session (Cheryl George, RN)
  10. BUTTONHOLE TECHNIQUE:
    1. SAMPLE CRITERIA: Buttonhole Creation
    2. REFERENCE ARTICLE: “The Buttonhole Technique for AVF Cannulation” (Lynda K. Ball, BS, BSN, RN, CNN)
    3. SAMPLE PROCEDURE: Buttonhole Technique
    4. TOOL: Buttonhole Cannulation Log
    5. FACT SHEET: Buttonhole Technique
    6. REFERENCE ARTICLE: Buttonhole Technique for AVF needle insertion (Dr. Zbylut J. Twardowski and Mr. George Harper)
    7. REFERENCE ARTICLE: Buttonhole Chair side Perspective (Cate Lewis, RN, BSN, CNN)
    8. REFERENCE ARTICLE: A Multi-Center Perspective of the Buttonhole Technique (Lynda K. Ball, Lynne Treat, Virginia Riffle, Dennis Scherting, and Liz Swift)
    9. POWERPOINT: Buttonhole Damage Education Slides (Deb Brouwer, Kay Bregel, Janet Holland and Patt Ryder)
    10. TOOL: Buttonhole Cannulation Skills Checklist
    11. POWERPOINT: Network 13 Buttonhole Technique Training (Cheryl George, RN)
    12. REFERENCE ARTICLE: Buttonhole Cannulation – An Unexpected Outcome (Ball, Doss, Schiller, and Moran)
    13. BROCHURE: Network 16 Patient Education on Buttonhole Technique
  11. SELF CANNULATION TRAINING RESOURCES:
    1. PROCEDURE: Self-Cannulation of Vascular Access Procedure
    2. POWERPOINT: Self Cannulation of Hemodialysis Vascular Access (Lynda K. Ball, BS, BSN, RN, CNN)
    3. REFERENCE ARTICLE: Using ‘Tandem Hand’ Technique to Facilitate Self-Cannulation in Hemodialysis (Stuart Mott, BS, BA. LPN and Harold Moore, MA, Ed, BS, Ed, BS)
    4. REFERENCE ARTICLE: The Art of Teaching Buttonhole Self-Cannulation (Stuart Mott, Vascular Access Nurse)
  1. Education for Staff and Patients
  1. STAFF
    1. FACT SHEET: Frequently Asked Questions for Professionals about AVF’s
    2. POWERPOINT: Best Access Procedures Dialysis Unit Viewpoint (Lesley C. Dinwiddie MSN, RN, FNP, CNN)
    3. REFERENCE LIST: Articles by Fistula First Change Concepts
    4. CONTACT INFORMATION: Provider Resources
  2. PATIENTS
    1. CONTACT INFORMATION : Patient Resources
    2. FACT SHEET: Frequently Asked Questions for Patients about AVF’s
    3. BROCHURE: Doppler & Vessel Mapping
    4. BROCHURE: Network 16 Patient Education on Buttonhole Technique (English / Spanish)
    5. BROCHURE: Hemodialysis Vascular Access Options (English / Spanish)
    6. FACT SHEET: Caring for your Fistula after surgery (English/Spanish)
    7. POSTER: Network 2 Poster - Vascular Access for Hemodialysis (English/Spanish)
    8. ARTICLE: The Importance of Washing your Access (Lynda K. Ball, BS, BSN, RN, CNN)
    9. FACT SHEET: AV Fistula After-Care and Monitoring
  1. Patient Quality of Life Through Self-Management
  1. Available Network 13 Education Outreach Posters (For Posting in Your Patient Waiting Areas)

6. QI Activities

  1. NETWORK 13 ANNUAL REPORT
  2. NATIONAL CMS CLINICAL PERFORMANCE MEASURES (CPM) ACTIVITIES OVERVIEW
  3. NATIONAL ESRD CLINICAL PERFORMANCE MEASURES PROJECT

7. Data Abstraction Activities

  1. NETWORK 13 DATA DEPARTMENT OVERVIEW AND INFORMATION
  1. CROWNWEB (Consolidated Renal Operations in a Web-Enabled Environment)
  1. QUALITYNET IDENTITY MANAGEMENT SYSTEM (QIMS)

8. Infection Control

  1. RECOMMENDATIONS FOR PREVENTING TRANSMISSION OF INFECTIONS AMONG CHRONIC HEMODIALYSIS PATIENTS
  1. HEPATITIS CONTROL MEASURES FOR DIALYSIS CENTERS
  1. CDC's Division of Viral Hepatitis
    • Guidelines for Viral Hepatitis Surveillance and Case Management
    • Hepatitis A, B, and C: Learn the Differences
    • Hepatitis B / C Frequently Asked Questions
    • Hepatitis B / C Patient Education materials
    • Testing and Public Health Management of Persons with Chronic Hepatitis B Virus Infection
  2. CDC Study: Failures to Follow Infection Practices Have Placed More than 60,000 Patients at Risk for Hepatitis B and C
  3. NIH Consensus Development Conference: Management of Hepatitis B
  4. Immunization Action Coalition, Specific to Hepatitis
    • Hepatitis B "What You Need to Know" (English/Spanish)
    • Hepatitis C "What Vaccinations are Needed?"
  5. Hepatitis/HIV Resources Newsletter
  1. TUBERCULOSIS
  1. Tuberculosis CDC Homepage
    • Tuberculosis Q and A
    • Tuberculosis Fact Sheets
    • Tuberculosis Surveillance Information/Management
  2. Tuberculosis Glossary of Terms
  3. OSHA Enforcement Policy for Occupational Exposure to Tuberculosis
  1. IMMUNIZATIONS
  1. Immunizations CDC Home Page
    • Adult Immunization Recommendations (Schedule USA 2010 version)
    • 2010 Childhood & Adolescent Immunization Schedules
    • Summary of Recommendations Immunizations
    • Infection Control Measures for Prevention and Control of Influenza in Long-Term care Facilities
  2. Adult Vaccination Screening Forms (English and Spanish)
  3. Influenza CDC Home
    • Updated Influenza Information
  4. Immunization Action Coalition Home Page
    • Adult Shingles Immunization Information
    • Vaccine Information Statements English/Spanish
    • Immunization Action Coalition: State Info
    • Immunization Action Coalition: Coodinator Info
    • Immunization Action Coalition: Laws Info
    • Immunization Action Coalition: Indian Health Services (IHS) Info
    • How to Administer Intramuscular (IM) Injections
    • Administering Vaccines to Adults: Dose, Route, Site, Needle Size, and Preparation
  5. Prevent Influenza Now Web site
  6. Influenza Vaccine Availability Tracking System (IVATS)
  7. Prevention of Herpes Zoster
  8. eDispense™ Information
  9. CDC Statement on Oseltamivir (Tamiflu®) Resistance and Antiviral Recommendations
  10. Dosing Recommendations for Anti-Virals
  11. New Emergency Storage Issues
  12. Pneumococcal Vaccination Recommended to Help Prevent Secondary Infections
  13. H1N1 Flu and Season Flu: Caring for Someone Sick at Home
  14. Tips for Locating Old Immunizations Records
  1. COMMUNICABLE DISEASE AND INJURY REPORTING as known by state (Available via Internet)

9. Patient Services

  1. PATIENT CENTEREDNESS
  1. REHABILITATION
  1. Rehabilitation Web Links
  2. Vocational Rehabilitation Services (Arkansas, Louisiana, Oklahoma): Includes Eligibility for Services Criteria
  1. SOCIAL WORKER RESOURCES
  1. Social Worker Resources Web Links
  2. Arkansas
    1. State Medical Assistance Program
    2. DMERC-Durable Medical Equipment Regional Carrier
    3. Fiscal Intermediary-Medicare Part A and Medicare Part B
  3. Louisiana
    1. State Medical Assistance Program
    2. DMERC-Durable Medical Equipment Regional Carrier
    3. Fiscal Intermediary-Medicare Part A and Medicare Part B
  4. Oklahoma
    1. Oklahoma State Medical Assistance Program
    2. DMERC-Durable Medical Equipment Regional Carrier
    3. Fiscal Intermediary-Medicare Part A and Medicare Part B
  5. Multi-Language Medicare Publications
  6. New Help with Employment Services - Assessment Tool
  7. New Help with Services/Resources - Assessment Tool
  8. State NKF - Contact Information
  1. LINKS TO MENTAL HEALTH SERVICES (state specific)
  1. Missed and Shortened Treatments

10. Disaster Planning

  1. DISASTER PREPAREDNESS TOOLS (Arkansas, Lousiana, Oklahoma)
    THESE MATERIALS WERE DISTRIBUTED IN ARKANSAS, LOUISIANA AND OKLAHOMA FOR DISASTER PREPAREDNESS; HOWEVER THE MATERIALS REMAIN AVAILABLE AND CAN BE UTILIZED/MODIFIED FOR ANY DISASTER PREPAREDNESS ACTIVITY. MATERIALS CAN BE REQUESTED THROUGH THE NETWORK OFFICE OR DOWNLOADED FROM THE NETWORK 13 WEBSITE
  1. Disaster Information
    1. Kidney Community Emergency Response (KCER) Coalition
    2. Patient ID Card: Dialysis and Transplant
    3. Patient and Staff Placards for Vehicles/Checkpoints
    4. Needs Assessment
    5. Mutual Aid Agreement (Sample)
    6. Communication Templates: Emergency Operations Center, Electric Co., Water Co.
    7. Earthquake Safety for Dialysis Providers
    8. Radiation Medical Issues Fact Sheet
    9. Disaster Poster for Patient Waiting Areas (Posters available upon request)
    10. Earthquake Poster for Patient Waiting Areas (Posters available upon request)
  2. Evacuation Resources (During Disaster) (Located in State Specific Tools Listed Above)
    1. Region
    2. Dialysis Facility and Patient Counts by Parish/County
    3. Emergency Contact Information by City
    4. Evacuation Routes and Potential Dialysis Units
  3. Post Disaster
    1. Triage Information for Shelters as Needed
    2. ESRD Fact Sheet for General Public
    3. Public Service Announcement (Sample)
    4. Disaster Distress Helpline (DDH)
    5. American Red Cross Safe and Well List Website
  1. DISASTER SUPPLIES KIT (Please NOTE that supply kits are generic, not renal-specific)

11. Medicare Part D

  1. MEDICARE PART D WEB LINKS
  2. CMS FORMULARY GUIDANCE (Copy of printable brochure - Revised February 2011)
  3. YOUR GUIDE TO MEDICARE PRESCIPTION DRUG COVERAGE (Copy of printable brochure)

12. Kidney Transplants

  1. TRANSPLANT WEB LINKS
  1. What every Patient Needs Know
  2. Transplant Living
  3. Living Donation Guidelines
  4. Q & A’s about Multiple Listing & Waiting Time Transfer
    1. English – (Large File)
    2. Spanish – (Large File)

13. Patient and Community Outreach

  1. NETWORK PATIENT REPRESENTATIVE PROGRAM (NPR PROGRAM)
    An NPR is a dynamic patient in the facility who actively promotes patient education an well-being by maintaining a patient bulletin board that promotes patient and staff educational materials and activities. Below is a list of the items contained in an NPR Orientation Packet or “starter kit.” The Network 13 NPR Coordinator reviews these materials with a new NPR and facility representative one-on-one during an orientation conference call.
  1. KIDNEY COMMUNITY GATHERING PLANNING MANUAL FOR FACILITIES
  2. ESRD RESOURCE LIBRARY FOR PROFESSIONALS AND PATIENTS
  3. SUPPORT GROUPS

14. Educational Posters

  1. COMPLAINTS AND GRIEVANCES, English (AR, LA, OK) and Spanish Versions (AR, LA, OK)
  2. DIASTER PREPAREDNESS – Dialysis Facility Version and Transplant Facility Version
  3. EARTHQUAKE PREPAREDNESS
  4. FISTULA/AV ACCESS (AVF, Buzz, Catheter)
  5. PATIENTS’ RIGHTS
  6. PATIENTS’ RESPONSIBILITIES