What's In This Issue.

The Centers for Medicare & Medicaid Services (CMS) has released the End-Stage Renal Disease (ESRD) Conditions for Coverage (CfCs) that will modernize the Medicare conditions for coverage for the nation’s dialysis centers and promote higher quality of care for patients receiving dialysis.

The final regulation will enhance the quality of care available to more than 336,000 Medicare beneficiaries with ESRD who receive dialysis treatment from more than 4,700 Medicare-approved renal dialysis facilities across the U.S.  The regulation reflects important clinical and scientific advances in dialysis technology and standards of care practices.  The regulation also updates the current requirements that were first published in 1976. 

The final rule is displayed at:
http://www.cms.hhs.gov/CFCsAndCoPs/
downloads/ESRDfinalrule0415.pdf

Network 13 is required to distribute information regarding Federal Drug Administration (FDA) alerts, dialysis recalls, etc., that potentially affect dialysis facilities and/or patients.  This information is distributed utilizing a variety of methods [e.g., blast fax, email, or Network 13 Web site (www.network13.org)]

So what is MedWatch?  The FDA has the responsibility for assuring the safety and efficacy of all regulated marketed medical products.  MedWatch, the FDA Safety Information and Adverse Event Reporting Program, serves both healthcare professionals and the medical product-using public. They provide important and timely clinical information about safety issues involving medical products, including prescription and over-the-counter drugs, biologics, medical and radiation-emitting devices, and special nutritional products (e.g., medical foods, dietary supplements and infant formulas).

Medical product safety alerts, recalls, withdrawals, and important labeling changes that may affect the health of all Americans are quickly disseminated to the medical community via the MedWatch E-list. and the general public via the FDA Web site (http://www.fda.gov/).  You can select Safety Information to see reports, safety notifications, and labeling changes posted to the Web site since 1996.

MedWatch allows healthcare professionals and consumers to report serious problems that they suspect are associated with the drugs and medical devices they prescribe, dispense, or use. Reporting can be done on line, by phone, or by submitting the MedWatch 3500 form by mail or fax. Select How to Report for more details.

While rounding at an FMC dialysis unit in Baton Rouge, Louisiana on an early January afternoon, Fay, one of the Registered Nurses, asked if I planned to stay and see the third shift patients. She went on to share her concern for one of her evening patients, Jane. Jane had been sick with nausea, vomiting, and diarrhea for several days. She had been so sick that she came to the unit the day before for an injection of Phenergan and a refill for her PRN medication. Fay went on to say Jane just looked very sick and wanted her to be assessed for possible admission to the hospital. Jane is in her late 30s, lives alone, has no family living in Louisiana, and has a long history of brittle diabetes and gastroparesis. I assured Fay I would stay and see all the patients even though I had a scheduled meeting at 4:30 P.M.    

Around 4:30 P.M. the phone rang in the dialysis unit and one of the Patient Care Technicians (PCT's) answered. After she hung up the phone, she recounted a strange phone call from Jane. She went on to say that Jane had just called from her cell phone and was lost driving to dialysis. After asking Jane where she was or what she could see, she learned that Jane was approximately 1.5 miles from the unit in one of our city’s parks. The PCT thought this was strange and she sounded confused since Jane had been coming to this dialysis unit for over a year now. Jane also told the PCT she did not have the right pair of glasses. I thought this interesting since I had never seen Jane wear glasses. After hearing this we became more concerned for Jane but expected her to arrive in 10 minutes. Approximately 20 minutes passed when the dialysis unit telephone rang again.  

Another PCT answered the phone to discover it was Jane again. This time she said Jane was again lost and could read a bank sign. Jane was told she was very close to the unit, to turn at the bank, and she was now within a few blocks of the unit. After this call, I was told Jane did not sound ‘right.’ Fay was pacing and again voiced her concerns as we walked to the front door of the waiting room. As we stood in the doorway, I asked what kind of car Jane drives. Fay told me what car to look for. In the near distance Fay and I could hear sirens. I now knew I had to go find Jane since she’s been driving over 45 minutes and it was getting dark. So as we walked back into the unit, I asked one of the PCT to call Jane on her cell phone and instruct her to STOP THE CAR and I would come and get her. This time the PCT placed the call on the speaker phone. I was shocked when I heard Jane’s voice. Her speech was slow and slurred. Again Jane was told to stop driving and that I was on my way. As I was racing to my car I was thinking, “this will be easy. I’ll go and when I see her car, I’ll dial 911 and ask for help after all she’s sick and lost within blocks of the dialysis unit.” As I arrived at the boulevard intersection where the bank is located, all my preconceived plans vanished. You see Jane was not driving toward the dialysis unit but away from it. To make matters worse she had not stopped. She was slowly driving out of a turn lane in the opposite direction directly into the evening rush hour traffic! So what did I do? I drove into the turn lane heading in the wrong direction behind her. I jumped out of my car, and ran as fast as I could down the median strip until I arrived next to her passenger’s door. Now to truly appreciate this story you need to get a mental picture of this. I’m 50'ish and less than five feet tall chasing a car driving into oncoming rush hour traffic at dusk. Don’t get me wrong, by this time Jane is too sick to drive fast, she’s coasting alone, neither pushing on the accelerator nor the brake.           

As I arrive at her passenger’s door, I’m banging on the window to get her attention. Seeing her car within a couple of feet from approaching headlights was a frightening experience. I pulled on the passenger’s door handle and found it unlocked, so I hopped in the passenger side, and leaned over to turn the ignition key off. Now that I had Jane stopped, I called 911. To my surprise, with all of this going on, I heard no one honking their horns. The cars were slowing approaching and changing lanes to go around us. Jane was becoming more lethargic and asking with her slow, slurring speech, if I could drive her to dialysis while I was talking to the 911 operator on my cell phone and Fay, the unit nurse, on Jane’s cell phone.

Within minutes a fire truck was the first to arrive with a Baton Rouge city police car arriving a minute or two later. Finally I’m feeling safer from oncoming traffic with the fire truck parked beside the car and now the city police car in front. As one arriving policeman walked around Jane’s car, he shook his head and asked, “how in the world did she not get hit?” “Only by the grace of God”, I responded. After several more minutes the EMS ambulance arrived and lifted her out of her driver’s seat. Jane was admitted to ICU with diabetic ketoacidosis, encephalopathy, and glucose level greater than 1000. Thanks to the FMC staff members at her dialysis unit Jane was located and transported to the hospital before any injury occurred to her or others.

Fistula First Recognition!

PICTURES / NAMES AS RECEIVED

FMC - FRANKLINTON # 19-2660 Names from left to right:  - Eileen Breslin, RD, LDN - Kayla Allen, RN - Rhoda Graves, PCT - Diana Denenea, PCT - Amy Seal, RN, Clinic Manager - Nicole Roux, RN - Rachel McCarroll, GSW Front - Tiphanie Foy, LPN

DIALYSIS SPECIALISTS OF SEMINOLE # 37-2563 Names from left to right (Standing): - Deanna Brison, RN - Missy Brinker, PCT - Debbie Hollingsworth, Chief Tech - Jack Kieffer, PCT - Sherri Porter, PCT - Paula Slover, RN (Sitting): - Vicki Arocha, Clinical Manager - Mauda Stephens, Unit Secretary

DAVITA - SLIDELL KIDNEY CARE # 19-2556 Names from left to right: - Dean Hegwood, FA - Emily Amedeo, RN - David Kaplan, MD - Crispin Bolisay, MD - Mallie Monroe, RN

FMC - WESTBANK # 19-2670 Names from left to right: (Standing): - Elliott "Chip" Roy, Facility Administrator - Jonathan Garfield, PCT - Matthew Sanger, MD Medical Director - Charlene Avery, PCT - Madrid Pierre, RN Charge Nurse - Monique Ward, PCT - Judy Savioe, RD (Kneeling): - Kim Williams, SW - Patrick Miller, BSN, RN, Clinic Manager - Aurelia Sentmore, PCT - Demetria McCall, PCT

These eight (8) facilities have shown great dedication, teamwork and leadership in optimizing the quality of care for hemodialysis patients by supporting the concept that an AVF should be the first consideration for hemodialysis vascular access.  Their ongoing focus and practice towards putting this concept into action appears to have led to the CONSISTENT ACHIEVEMENT OF THE NATIONAL GOAL OF 66% AV fISTULA USE RATE.  IT CAN BE DONE! 

DAVITA - TRI-STATE DIALYSIS # 37-2547 Names from left ro right: (Back row): - Terry Monasco, PCT - J.Williams, RN - Emmajo Henderson, LPN (Front row): - Denise Parkison, RD - Katherine Wooley, PCT - Beverley Walker, LPN - Kim Buffalo, RN

DAVITA - DURANT DIALYSIS # 37-2565 Names from left to right: - Tamara Buck, PCT - Sheri Swanson, RN - Kandie Groce, PCT - Dr. Glen Willie, Medical Director - Sue Brumley, Facility Administrator - Tracy Madden, Dietician

www.FistulaFirst.org

Over the past few months, ESRD Network 13 has been providing a series of educational WebEx sessions for social workers in an effort to provide continuing education on important topics related to the performance of your role in the dialysis facility. The use of this medium has allowed for participation without the need to travel, and minimizes the time required to attend these educational offering.  Visit the Network 13 Web site www.network 13.org for a list of upcoming WebEx sessions.

Quick Steps to the Webex presentation information:

• Go to  www.network13.org
• Click on the RESOURCES tab at the top
• Click on SOCIAL WORKERS

The Network encourages your participation in these educational offerings. Attendance is limited to 30 attendees per session so sign up early. 

Educational offerings for May and June 2008 are:

May 2008

Date:   Monday, May 5, 2008
Time:   10:00-11:00 a.m. CDT
or
Date:   Thursday, May 8, 2008
Time:   3:00-4:00 p.m. CDT

June 2008

Date:   Monday, June 2, 2008
Time:   10:00-11:00 a.m. CDT
or
Date:   Thursday, June 5, 2008
Time:   3:00-4:00 p.m. CDT

Date:    Wednesday, June 11, 2008
Time:    3:00-4:00 p.m. CDT

Instructions for accessing the WebEx sessions

Event Password: socialworker

Teleconference: 1-877-802-4003
Teleconference Access Code: 934031

Please follow these instructions to join the event:

All ESRD facilities are required to develop policies and procedures for emergency/disaster preparedness.  To meet the unique needs of ESRD patients and providers and to minimize the effects of an emergency, one must plan ahead to be prepared BEFORE an emergency strikes.

The Network is currently reviewing and updating all 2008 disaster preparedness materials for distribution in early to mid-May 2008.  The revisions are based in part, on the newly released CMS Conditions for Coverage. 

The Network will be pre-populating patient ID cards for all patients (dialysis & transplant) currently known to the Network.  The disaster preparedness individual patient needs assessments can be pre-populated upon request to Jason Clem at jclem@nw13.esrd.net. 

The materials distribution will consist of hard copy materials being mailed to each dialysis unit nurse manager / transplant coordinator and CD’s sent to each facility administrator.   As the materials are mailed out, the information will also be updated on the Network’s Web site. 

The Network recently provided Disaster Preparedness information at the Spring 2008 workshops and via three WebEx sessions.  The PowerPoint with associated reference is available upon request to Linda Duval at lduval@nw13.esrd.net.

In our efforts to assist facilities to provide the best care possible to ESRD patients, Network 13 is going green!  What does that mean to you?  It means that Network 13 will be sending information and resources via email when possible. You can help by making sure Network 13 has updated emails for those in facilities that would like to receive information via email.  Send your email address to nycu_editor.com today!

2007 Annual Compliance Reports

The 2007 Annual Compliance Reports are calculated and will be out soon.  As mandated by the Centers for Medicare & Medicaid (CMS), the Networks must track all mandatory forms (2728 & 2746) received by each provider for timeliness and accuracy and report this information back to you for comparison to statewide rates and CMS expectations.  CMS expects a 90% compliance rate annually for timeliness and accuracy.”  The Network Compliance rate is above this 90% compliance rate, but we are still struggling to maintain this percentage.  This means that the facilities in our “Club 100” and “Gold Club” are particularly exceptional this year.

Each year, we recognize our “Club 100” facilities.  These facilities have maintained a 100% compliance rate for timeliness and accuracy.   In this newsletter you will find a list of the 45 facilities that met this goal for 2007. 

In addition, there are 10 facilities that qualified for our prestigious “Gold Club”.  These are facilities that have maintained 100% compliance rate for 3 consecutive years starting in 2005.  We are extremely proud of these facilities.  They will be receiving a special award in recognition of their efforts. 

We’re always looking for new members for both of these clubs!  A special “Thanks” to all who have maintained a 90% or higher annual rate…. we appreciate your efforts.

David Gallgeos was misidentified as the Director of the LWIPA in Issue 27 of News You Can Use. Below is the correct contact information for Loyd DeMers, Director of that organization.

LSUHSC Human Development Center
Lloyd DeMers, Director
Louisiana Work Incentive Planning and Assistance (LAWIPA) Project
LSUHSC Human Development Center