End Stage Renal Disease (ESRD) Network 13 - Serving Arkansas, Louisiana and Oklahoma Renal Communities

ESRD Network 13


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Facility Resource Materials

Printer Friendly - Text Version

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 Clearinghouse 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.

Click Here to Get a Copy of the Table of Contents

All Sections

1. Network 13 Information
(July 2010)

2. Network 13 Directives

4. CQI Resources

5. FF Tools and Resources

6. QI Activities

7. Data Abstraction Activities

8. Infection Control

9. Patient Services

10. Disaster Planning

11. Medicare Part D

12. Kidney Transplant

13. Network Patient Representative (NPR) Program

14. Clearinghouse Library for Professionals and Patients: 2010

Copy of Table of Content (pdf)

1. Network 13 Information (July 2010)

A. Network 13 Glossary of ACRONYMS

B. Listing of Board of Directors (BOD), Medical Review Board (MRB) and Network Committees (Quality Improvement, Grievance, Patient Advocacy)

C. ESRD Network 13 Office Staff

D. ESRD Network 13 Web site http://www.network13.org/

E. Network Notice of Facility Status – Guidance

Back to Table of Contents

2. Network 13 Directives

A. NETWORK STANDARDS: These standards are established by the Network with the expectation that all ESRD facilities will comply accordingly towards the provision of quality care within the renal health care community.
1. Placement of Patients in Self-/Home- Care Setting

2. Transplantation

3. Vocational Rehabilitation

4. Adequacy of Hemodialysis

5. Adequacy of Hemodialysis: Performance of Delivery of Care Audits - Revised 2010

6. Anemia Management in Chronic Renal Failure

7. Vascular Access

a. Catheters

b. Arteriovenous Fistula (AVF’s)

c. Monitoring for Access Dysfunction

8. Mineral Metabolism in Chronic Renal Failure

9. Peritoneal Dialysis (PD) Adequacy

10. Disaster Preparedness

11. Nephrologist as Dialysis Facility Medical Director

12. Facility Status Notification

13. Involuntary Discharge

B. NETWORK RECOMMENDATIONS: While not at a ‘standards’ level, the following recommendations are to be strongly considered for implementation as applicable within your renal organization.

1. Continuing Education Credits in Renal Health Care

2. Management of Hyperkalemia

3. Advance Directives

4. CMS Criteria to Determine Eligibility For the ESRD Program

5. 2008 CAHPS Survey

6. Patient Education Awareness

7. Assessment of Health-Related Quality of Life

8. Nutrition in Chronic Renal Failure

C. 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 Poster Arkansas, Louisiana, and Oklahoma (11” X 17” Poster available per request)

D. NETWORK 13 HIV POLICIES: All ESRD patients have the right to privacy, as well as equal treatment as directed by the Office of Civil Rights.

1. Human Immunodeficiency Virus (HIV – AIDS)

2. Understanding the Rights of HIV+ / AIDS Patients

3. HIV Resources

E. NETWORK 13 PROCEDURE: ALTERNATE SANCTION RECOMMENDATION: All ESRD facilities are directed to participate towards the achievement of Network 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, Dallas, TX

F. 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.

Back to Table of Contents

3. ESRD-Related Resources for Professionals and Patients

A.   UNIFORM ESRD TRANSIENT FORMS

1.    Hemodialysis

2.    Peritoneal Dialysis

B.   ESRD MEDICAL RECORDS – A NATIONAL MODEL

C. Clinical Laboratory Improvement Amendments (CLIA) / Regulations http://www.cms.gov/clia/

D. KNOW YOUR OPTIONS – Medical Device and Laboratory Product Problem Reporting Program

1. Guidance for Industry - Medical Device Tracking; Guidance for Industry and FDA Staff

http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/default.htm

2.    Guidance for Reporting Dialysis Reactions: FDA Adverse Event Reporting

a.    To Report Online https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm

b.   Voluntary Reporting Form

http://www.fda.gov/downloads/Safety/MedWatch/HowToReport/DownloadForms/ucm082725.pdf

c.    Mandatory Reporting Form

http://www.fda.gov/downloads/Safety/MedWatch/HowToReport/DownloadForms/ucm082728.pdf

E.   WEB SITES OF INTEREST

a.    General Resources (Associations/Organizations)

b.    Acute Myocardial Infarction Web sites

c.    Diabetes Web sites

d.    Heart Failure Web sites

e.    Reduce Disparities Web sites—also see SDPS Intranet links

f.     Quality Improvement with Medicare+Choice Plans Web sites

g.    End Stage Renal Disease (ESRD) Web sites

F.   MEDICAL EDUCATION INSTITUTE (http://www.meiresearch.org/): A non-profit educational institute

specific to chronic kidney disease, offers many educational resources for patients and professionals.

1.    Kidney School (www.kidneyschool.org)

2.    Life Options (www.lifeoptions.org)

3.    Home Dialysis Central (www.homedialysis.org)

G. 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

(http://www.cms.gov/DialysisFacilityCompare/)

H. COMMUNITY OUTREACH / WEBEX SESSIONS: These Web links provide listings of current and/or ongoing community outreach opportunities.

1.   Network 13 Workshops & Events Web Page http://www.network13.org/workshop.asp

2.   IFMC Direct WebEx Hosting Web site https://ifmcevents.webex.com

Back to Table of Contents

4. Continuous Quality Improvement (CQI) Resources

A. 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…

· Adequacy of Dialysis

· Anemia Management

· Nutrition Management

· Mineral Metabolism

· Vascular Access Management

· Immunizations

· Infection Control

· Patient Safety

B. CQI

1. Measures of Morbidity and Mortality

C. Accelerating Quality Improvement

D. 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

a. Quality Improvement Project

b. QI Sample – sample “Action Plans”

c. CQI Trend Tool – (Aggregate collection tool with review and prioritization)

d. Facility Quality Indicators

e. Sample Fishbone Templates (Word™ and Excel™)

f. Cause and Effect Diagram

g. Run Chart

h. IDT Agenda Template

i. IDT Meeting Minutes Template

j. QAPI Facility Checklist

2. Adequacy of Dialysis

a. Hemodialysis

1. Prescription and Delivery Audit Tool and Instructions

2. Adequacy of Hemodialysis Tools – (Prescription delivery tool quantifies root cause)

3. Dry Weight Algorithm

4. Dry Weight Monitoring Tool

5. Pre- and Post-Dialysis Blood Sampling Validation Forms

6. Frequent Hemodialysis Adequacy of Hemodialysis – (conversion formula)

7. Illustrative Conversions: G-Codes/URR to stdKt/V

8. Hemodialysis Adequacy and Kinetic Modeling Channel: Hypertension, Dialysis and Clinical Nephrology (HDCN) http://hdcn.com/ch/adeq/

9. The Nephron Information Center http://nephron.com/

b. Peritoneal Dialysis

1. PD Adequacy Flow Sheet

2. Infection Control for Peritoneal Dialysis (PD) Patients: CDC Fact Sheet

3. Anemia Management

a. Anemia Management Worksheet (with medication adjustment)

b. Anemia Management Barrier Worksheet – (Root Cause Analysis Assistance)

4. Dialysis-Specific Infection Control Issues

a. Hemodialysis Infection Control Log – (Provides Tracking, Trending, and Reporting)

b. Peritoneal Infection Control Log – (Provides Tracking, Trending, and Reporting)

c. Peritonitis – Exit Site Infections – (sample guidelines)

d. CDC Hand Hygiene Fact Sheet

e. CDC Hand Hygiene Poster

f. Immunization Data Collection Tool

g. Immunization Reminder Poster

5. Nutrition Management

a. Malnutrition in ESRD Patients – (Algorithm)

b. Management of Hypoalbuminemia In Adult Dialysis Patients Algorithm

c. Patient Facility Percent Albumin – (Trending tool creates graphs)

d. Subjective Global Assessment Rating Form – (Patient assessment form)

6. Vascular Access Tools (See Section 5 for AVF Functionality Tool and Catheter Reduction Worksheet)

a. Fistula First Bruit Audio Clips Available for Patient and Staff Education (http://www.fistulafirst.org/) Located at the bottom of the "What's New" Column "Listen to the Bruit"

7. Self-/Home- Care Training Materials

a. Hemodialysis Home Training Checklist – (Patient competency checklist)

8. Water Treatment

a. Water Quality Chart

9. Hemolysis

10. Annual Modality and Resource Evaluation (e.g. Vocational Rehabilitation, Grievance)

11. Diabetic Foot Screening

a. Diabetic Foot Examination Risk Categories

b. Basic Foot Assessment Check List – (With foot diagram & Referral Action Plan)

c. Prevention of Serious Complications from Diabetes (NIH) – (Patient education sheet)

d. Preventing Foot Ulcers and Amputation – (Professional education sheet)

12. Automated External Defibrillator (AED)

a. SAMPLE Procedure: AED

b. SAMPLE Policy (supplied from Medtronic)

c. Emergency Cardiovascular Care (ECC) Class Connector

http://www.americanheart.org/presenter.jhtml?identifier=3012360

13. Patient Safety http://www.kidneypatientsafety.org/

E. Institute for Healthcare Improvement (IHI)

1. An Introduction to the Model for Improvement

http://www.ihi.org/IHI/Programs/AudioAndWebPrograms/OnDemandPresentationMFI.htm

2. Building Skills in Data Collection and Understanding Variation

http://www.ihi.org/IHI/Programs/AudioAndWebPrograms/OnDemandPresentationVariation.htm

3. Using Run and Control Charts to Understand Variation

http://www.ihi.org/IHI/Programs/AudioAndWebPrograms/OnDemandPresentationMeasurement.htm

F. ESRD SURVEY AND CERTIFICATION MATERIALS

1. Measures Assessment Tool (1.6)

2. Outline of the Basic ESRD Survey Process (1.4)

3. End Stage Renal Disease Facilities V-Tags & Identifiers (1.4)

4. Personnel Requirements (1.2)

5. Correlation Grid for Patient Assessment & Plan of Care (1.3)

6. Principles of Documentation Overview (1.0)

7. Infection Control (1.3)

8. Dialysis Lab Tests at a Glance (1.1)

9. Chemical Contaminant Levels in Water Used to Prepare Dialysate (1.0)

10. Surveyor Worksheet (Optional): Verification of Dialysis Patient Care Technician Certification

11. Phasing Implementation of Life Safety Code

12. Helpful websites for Surveyors (1.1)

13. AAMI rd52 Water chart decision tree

14. ESRD FAQs Memo (1.1)

a. ESRD FAQs Data

b. Acronyms

c. PCT Certification FAQs

Back to Table of Contents

5. FF Tools and Resources by Change Concept

2010 Fistula First Tools and Resources Table of Contents

A. Routine CQI Review of Vascular Access

B. Timely Referral to Nephrologist

C. Early Referral to Surgeon for "AVF Only" Evaluation and Timely Placement

D. Surgeon Selection Based on Best Outcomes, Willingness, and Ability to Provide Access Services

E. Full Range of Appropriate Surgical Approaches to AVF Evaluation and Placement

F. Secondary AVF Placement In Patients with AV Grafts

G. AVF Placement In Patients with Catheters Where Indicated

H. Cannulation Training for AV Fistulas

I. Monitoring and Maintenance to Ensure Adequate Access Function

J. Education for Caregivers and Patients

K. Outcomes Feedback to Guide Practice

L. Modify Hospital Systems to Detect CKD and Promote AV Fistula Planning and Placement

M. Support Patient Efforts to Live the Best Possible Quality of Life Through Self-Management

N. Payer Issues

O. Available Network 13 Education Outreach Posters (For posting in your Patient waiting areas)

P. Other Vascular Access Education / Resource Web Links

Back to Table of Contents

6. QI Activities

A. Network 13 Annual Report 2008 (pdf format) http://www.network13.org/data_report.asp#ar

B. National CMS Clinical Performance Measures (CPM) Activities overview
CMS CPM OVERVIEW Link: http://www.cms.gov/CPMProject/

C. National ESRD Clinical Performance Measures Project

D. NETWORK 13 QUality improvement activities

1. Preliminary 2010 CPM QI Work Plan (QIWP)

Back to Table of Contents

7. Data Abstraction Activities

A. CROWNWeb – (Consolidated Renal Operations in a Web-Enabled Environment)

1. Overview

2. Article – CROWNWEB – A Phased in Approach – description of the program

3. Training Modules (Power Point Presentations) LINK TO INTERACTIVE ONLINE TRAINING

a. Facility Module - Facility Personnel

b. Facility Module - Intro and Facility Info

c. Facility Module - Managing Role and Scope

d. Patient Admit Module - Admit and Discharge

e. Patient Admit Module - Completing a CMS-2728 Form

f. Patient Admit Module - Viewing and Editing Patient Attributes

g. Patient Treatment Module - Entering Clinical Values

h. Patient Treatment Module - Viewing and Verifying PART

i. Patient Treatment Module - Completing a CMS-2746 Form

B. QUALITYNET IDENTITY PROVISIONING SYSTEM (QIPS)

1. Copy of QIPS Registration Form https://www.qualitynet.org/crown/registration_form.pdf

2. Role Selection for CROWNWeb Users

3. Hard Copy Instructions:

a. Instruction for completing QIPS registration form for Facility Security Administrator (FSA)
(must be mailed to Network office for entry into QIPS system)

b. Instructions for completing QIPS registration form for User-Editor and User-Viewer
(must be entered into QIPS system by FSA and mailed directly to CMS designee)

4. Instructions for QIPS Editor/Viewer registration forms entry into QIPS system by FSA

C. QUALITYNET and SECURITY

1. QualityNet Registration Form – Secure method for electronic transfer of PHI (not CROWNWeb)

2. HIPAA Acknowledgement Form

D. PATIENT FORMS

1. CMS-2728 (Medical Evidence Report) Overview

a. Form with Instructions http://www.cms.gov/cmsforms/downloads/CMS2728.pdf

b. CMS–2728 Form Mandatory Fields

c. Most Common Errors

d. CMS-2728 Forms Completion Training Tool

2. CMS-2746 (Death Notification) Overview

a. Form with Instructions http://www.cms.gov/cmsforms/downloads/CMS2746.pdf

b. Most Common Errors found on CMS-2746 form

c. CMS-2746 Forms Completion Training Tool

E. NON-ELECTRONIC FACILITY REPORTING

1. Monthly Activity Reports

a. Network Patient Activity Report (NPAR) and Instructions

http://www.network13.org/Forms_Instructions/PAR.xls and

http://www.network13.org/Forms_Instructions/PAR_Instructions1.pdf

b. Patient Event Definitions and Business Rules for Facilities

http://www.network13.org/Forms_Instructions/EventDefinitionsandBusinessforFacilities.pdf

c. Helpful Hints for Completing NPAR

d. Transplant Activity Report and Instructions

http://www.network13.org/Forms_Instructions/TARFORM.pdf

e. Disaster Patient Activity Report

Back to Table of Contents

8. Infection Control

A. Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients

B. Preventative Measures for Health-Care Settings

1. Universal Precautions

2. Hand Hygiene Fact Sheet http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm

3. CDC Web site in Spanish http://www.cdc.gov/spanish/

4. Dialysis Surveillance Report: National Healthcare Safety Network (NHSN)�Data Summary for 2006

5. Pandemic Planning Update VI http://www.flu.gov/professional/pdf/panflureport6.pdf

6. Complying with OSHA�s Bloodborne Pathogens Standard

http://www.osha.gov/SLTC/bloodbornepathogens/index.html

7. Measuring Hand Hygiene Adherence

C. Hepatitis Control Measures for Dialysis Centers

1. CDC's Division of Viral Hepatitis http://www.cdc.gov/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 http://www.cdc.gov/media/pressrel/2009/r09106.htm

3. NIH Consensus Development Conference: Management of Hepatitis B http://consensus.nih.gov/2008/hepb.htm

4. Immunization Action Coalition, Specific to Hepatitis http://immunize.org

� Hepatitis B "What You Need to Know" (English/Spanish)

� Hepatitis C "What Vaccinations are Needed?"

5. Hepatitis / HIV Resources Newsletter http://www.hivandhepatitis.com/

D. Human Immunodeficiency Virus (HIV-AIDS)

1. Recommendations for Prevention of HIV Transmission in Health-Care Settings

http://wonder.cdc.gov/wonder/prevguid/p0000318/P0000318.asp

2. Sterilization or Disinfection of Patient Equipment HIV Related

http://www.cdc.gov/ncidod/dhqp/bp_sterilization_patient_care.html

3. Advancing HIV Prevention: Fact Sheet

http://www.cdc.gov/hiv/topics/prev_prog/AHP/resources/factsheets/pdf/Progress_2005.pdf

4. HIV Fact Sheets http://www.cdc.gov/hiv/resources/factsheets/index.htm

E. Prevention of Intravascular Catheter-Related Infections

1. Guidelines for the Prevention of Intravascular Catheter-Related Infections

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm

2. Examples of Clinical Definitions for Catheter-Related Infections

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a2.htm

F. Antimicrobial Resistance in the Healthcare Settings / Drug-Resistant Pathogens

1. Prevent Antimicrobial Resistance in Healthcare Setting Fact Sheet

http://www.cdc.gov/drugresistance/healthcare/dialysis/12steps_dialysis.pdf

2. Multi-Resistant Organisms in Non-Hospital Healthcare-Settings FAQ: MRSA-VRE-ESBLS-PRSP�

http://www.cdc.gov/ncidod/dhqp/ar_multidrugFAQ.html

3. Amino glycoside Resistance in Enterobacteriaceae and Pseudomonas aeruginosa

http://www.cdc.gov/ncidod/dhqp/ar_lab_amino.html

4. Vancomycin-resistant Enterococci (VRE) and the Clinical Laboratory

http://www.cdc.gov/ncidod/dhqp/ar_lab_vre.html

5. Recommendations for Preventing the Spread of Vancomycin Resistance - US Department of Health &

Human Services - September 1995 http://www.cdc.gov/mmwr/PDF/RR/RR4412.pdf

6. Methicillin-resistant Staphylococcus aureus � MRSA http://www.cdc.gov/ncidod/dhqp/ar_mrsa.html

G. Tuberculosis

1. Tuberculosis CDC Homepage http://www.cdc.gov/tb/default.htm

� 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

http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=21919

H. Immunizations

1. Immunizations CDC Home Page http://www.cdc.gov/vaccines/�

� 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 Page http://cdc.gov/flu/

� Interim Antiviral Guidance for 2008-09

� Updated Influenza Information

4. Immunization Action Coalition Home Page http://immunize.org

� 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 http://www.preventinfluenza.org/

6. Influenza Vaccine Availability Tracking System (IVATS)

http://www.ama-assn.org/ama/pub/physician-resources/public-health/vaccination-resources/adult-vaccination/national-influenza-vaccine/influenza-vaccine-availability.shtml

7. Prevention of Herpes Zoster http://www.cdc.gov/mmwr/PDF/rr/rr57e0515.pdf

8. eDispense� Information http://www.dispensequick.com/edispense.html

9. CDC Statement on Oseltamivir (Tamiflu�) Resistance and Antiviral Recommendations

http://www.cdc.gov/media/pressrel/2009/s090109.htm

10. Dosing Recommendations for Anti-Virals

11. New Emergency Storage Issues

12. Pneumococcal Vaccination Recommended to Help Prevent Secondary Infections

http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00301

13. H1N1 Flu and Season Flu: Caring for Someone Sick at Home http://www.cdc.gov/h1n1flu/homecare

I. Other Infectious Diseases

1. INFLUENZA http://www.cdc.gov/flu/

i. H5N1 [Avian (Bird) Influenza and Avian Influenza A Virus Information]: http://www.cdc.gov/flu/avian/

ii. H1N1 [Swine Influenza Information]: http://www.cdc.gov/h1n1flu/

� Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Novel

Influenza A (H1N1) Virus Infection in a Healthcare Setting

http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm

iii. Software to Aid State and Local Planners with Estimating the State Level Impact of 2009 H1N1

Influenza

iv. Software for Flu Work Loss for Small Buisinesses - Beta

v. Software Impact 2009 - Estimating Cases of Novel H1N1

2. Anthrax: What you Need to Know http://www.bt.cdc.gov/agent/anthrax/pdf/needtoknow.pdf

3. Severe Acute Respiratory Syndrome (SARS):� Preparedness and Response in Healthcare Facilities

http://www.cdc.gov/ncidod/sars/guidance/C/pdf/c.pdf

4. Responding to Detection of Aerosolized Bacillus anthracis by Autonomous Detection Systems in the Workplace

http://www.cdc.gov/mmwr/pdf/rr/rr53e430-2.pdf

J. Communicable Disease and Injury Reporting as known by state (Available via Internet)

ARKANSAS: � Arkansas Disease Information

http://www.healthyarkansas.com/data/pdf/reportable_disease2004.pdf

LOUISIANA:� Louisiana Disease Information

http://www.dhh.louisiana.gov/offices/miscdocs/docs-249/annual/LaIDAnnual__Diseaselist2006.pdf

OKLAHOMA:� Oklahoma Disease Information

http://www.ok.gov/health/documents/Blue%20Card.pdf

Back to Table of Contents

9. Patient Services

A. Patient Education
1. Patient Education Web Links
2. Dialysis Facility Compare - http://www.medicare.gov/Dialysis/Home.asp
3. Network 13 Patient Rights & Patient Responsibilities Poster (11” x 17” Posters available upon request)

B. Patient Centeredness

1. Patient Centered Web Links

2. Patient Centeredness In the Dialysis Unit (Power Point)

C. Difficult Situations Behavioral Management

1. Decreasing Dialysis Patient/Provider Conflict (DPC) Toolkit

2. Difficult Situations Behavioral Management Web Links

3. Behavioral Agreement (SAMPLE)

4. Guidelines for Behavioral Agreements

5. Violence Policy (SAMPLE)

6. Involuntary Discharge (Recommendation)

7. CMS CDC Requirements for IVD

8. Interpretive Guidelines for IVD

9. Network 13 Documentation Requirement for IVD

10. Unstable Patients: Conditions for Coverage Interpretive Guidelines

D. Quality of Life

1. QOL Web Links

2. Measurement of Physical Functioning In Older Adult Populations (Requires Log-in)

http://www.nia.nih.gov/NR/rdonlyres/AF0997F6-0C16-4A76-96C0-

D3780F00E6D4/2300/phys_perform_meet_agend_particip_12_12_03.pdf

E. End Of Life

1. End of Life Web Links

2. Kidney End of Life Coalition - http://www.kidneyeol.org

3. Advance Care Planning in Dialysis Facilities

4. USDHHS: Advanced Literature Review on Advance Directives

5. FAQ About End of Life Care for Renal Patients

6. End of Life Issues and Care http://www.apa.org/topics/death/end-of-life.aspx

7. Guidelines for Terminating Treatment (University of Michigan)

http://www.med.umich.edu/adultethics/Witholding_Life_Sustaining_Tx.pdf

8. Hospice Payment System: Fact Sheet Series

F. Rehabilitation

1. Rehabilitation Web Links

2. Vocational Rehabilitation Services (Arkansas, Louisiana, Oklahoma): Includes Eligibility for Services Criteria

G. Social Worker Resources

1. Social Worker Resources Web Links

2. Arkansas

a. State Medical Assistance Program

b. DMERC-Durable Medical Equipment Regional Carrier

c. Fiscal Intermediary-Medicare Part A and Medicare Part B

3. Louisiana

a. State Medical Assistance Program

b. DMERC-Durable Medical Equipment Regional Carrier

c. Fiscal Intermediary-Medicare Part A and Medicare Part B

4. Oklahoma

a. Oklahoma State Medical Assistance Program

b. DMERC-Durable Medical Equipment Regional Carrier

c. Fiscal Intermediary-Medicare Part A and Medicare Part B

5. Multi-Language Medicare Publications http://www.cms.gov/Partnerships/downloads/multilanguage.pdf

6. New Help with Employment Services - Assessment Tool

7. New Help with Services/Resources - Assessment Tool

8. State NKF - Contact Information

H. Links to Mental Health Services (Arkansas, Louisiana, Oklahoma)

Back to Table of Contents

10. Disaster Planning

A. ESRD Network 13 Disaster Planning Resource

1. Disaster Plan Template

B. Disaster Preparedness Tools (Arkansas, Louisiana and 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 WEB SITE http://www.network13.org/disaster.asp

1. Disaster Information

a. Kidney Community Emergency Response (KCER) Coalition

b. Patient ID Card: Dialysis and Transplant

c. Patient and Staff Placards for Vehicles / Checkpoints

d. Needs Assessment

e. Disaster Poster for Patient Waiting Areas (Posters available upon request)

2. Evacuation Resources (During Disaster) (Located in State Specific Tools Listed Above)

a. Region

b. Dialysis Facility and Patient Counts by Parish/County

c. Emergency Contact Information by City

d. Evacuation Routes and Potential Dialysis Units

3. Post Disaster

a. Triage Information for Shelters as Needed

b. ESRD Fact Sheet for General Public

c. Public Service Announcement (Sample)

d. American Red Cross Safe and Well List Web site https://disastersafe.redcross.org/

C. Disaster Supplies Kit (Please NOTE that supply kits are generic, not renal-specific)

1. Family Supply Kit http://www.fdem-mediacenter.org/PDF/Family_Disaster_Supplies.pdf

2. Disaster Services - Disaster Supplies Kit

http://www.fema.gov/areyouready/assemble_disaster_supplies_kit.shtm

3. Workplace Disaster Supply Kit

D. Disaster Preparedness for People with Disabilities
1. Emergency Meal Planning for Diabetics http://www.kidney.org/atoz/content/emergencymealdb.cfm

2. Disaster Preparedness For People With Disabilities http://www.fema.gov/pdf/library/pfd_all.pdf

3. Assisting People With Disabilities In A Disaster http://www.fema.gov/plan/prepare/specialplans.shtm

E. Fact Sheets

1. Hurricanes: Key Facts About Hurricane Readiness

http://www.bt.cdc.gov/disasters/hurricanes/pdf/readiness.pdf

2. Tornadoes: Being Prepared http://emergency.cdc.gov/disasters/tornadoes/prepared.asp

3. Winter Weather: Winter Storm Facts http://www.bt.cdc.gov/disasters/winter/pdf/factsheet.pdf

F. Bioterrorism Readiness Plan: A Template for Healthcare Facilities

1. Bioterrorism Agents/Diseases http://www.bt.cdc.gov/agent/agentlist.asp

2. Bioterrorism and Public Health Preparedness http://www.cdc.gov/ncidod/EID/vol9no4/pdfs/02-0593.pdf

3. Chemical Agents: Facts About Sheltering in Place http://www.bt.cdc.gov/planning/Shelteringfacts.pdf

4. Chemical Agents: Facts About Evacuation http://www.bt.cdc.gov/planning/evacuationfacts.pdf

5. Chemical Agents: Facts About Personal Cleaning and Disposal of Contaminated Clothing

http://www.bt.cdc.gov/planning/personalcleaningfacts.pdf

6. General Information About Terrorism (Red Cross Power Point Presentation)

7. Guide For All-Hazard Emergency Operations Planning – Terrorism

G. Pandemic Checklist for Hemodialysis Centers

1. Medical office Influenza checklist http://www.flu.gov/professional/pdf/medofficesclinics.pdf

2. Business Pandemic Influenza Planning Checklist “Modified for ESRD Providers”

3. Influenza General Information http://www.disasterprepped.com/

4. Pandemic Preparedness tools

http://www.pandemicpractices.org/practices/article.do;jsessionid=50F5947D9C878EA846B0553DCE890102?page=home

5. Guidance on Allocating and Targeting Pandemic Influenza Vaccine (Large File)

http://www.flu.gov/individualfamily/vaccination/allocationguidance.pdf

H. Other Disaster Websites

1. CDC Emergency Preparedness and Response http://emergency.cdc.gov/

2. Kidney Community Emergency Response (KCER) Coalition http://www.kcercoalition.com/

3. Emergency Preparedness Tools & Disaster Solutions for Organizations & Families

http://www.disasterprepped.com/

4. FCC Public Safety and Homeland Security Bureau http://www.fcc.gov/pshs/health-care.html

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11. Medicare Part D

A. Medicare Part D Web Links

B. 2009 CMS Formulary Guidance http://www.medicare.gov/Publications/Pubs/pdf/11136.pdf

C. YOUR gUIDE TO mEDICARE pRESCIPTION dRUG cOVERAGE

http://www.medicare.gov/Publications/Pubs/pdf/11109.pdf

D. Coverage Gap

E. SSA Premium Info

a. Medicare Part D Coverage Determination Request Form: enrollee

http://www.cms.gov/MedPrescriptDrugApplGriev/Downloads/ModelCoverageDeterminationRequestForm.pdf

b. MEDICARE PART D COVERAGE DETERMINATION REQUEST FORM: PHYSICIAN

http://www.cms.gov/MedPrescriptDrugApplGriev/Downloads/PhysicianCoverageDeterminationRequestForm.pdf

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12. Kidney Transplants

A. Transplant Web Links

B. United Network for Organ Sharing (UNOS):
(http://www.unos.org/whatWeDo/patientServices.asp)

1. What every Patient Should Know http://www.unos.org/SharedContentDocuments/WEPNTK2008.pdf

2. Transplant Living http://www.transplantliving.org/

3. Living Kidney Donor Evaluation Guidelines

http://www.unos.org/ContentDocuments/Living_Kidney_Donor_Evaluation_Guidelines2(1).pdf

4. Q & A’s about Multiple Listing & Waiting Time Transfer

a. English – (Large File) http://www.unos.org/SharedContentDocuments/multiple_listing(2).pdf

b. Spanish – (Large File) http://www.unos.org/SharedContentDocuments/span_multiple_listing.pdf

C. Infection Control Issues:

1. Adult Shingles Immunization Information http://www.immunize.org/catg.d/p3092.pdf

2. Prevention of Herpes Zoster http://www.cdc.gov/mmwr/PDF/rr/rr57e0515.pdf

D. Kidney Transplant Disaster Preparedness Resources (Also found in Section 9, above):

1. Disaster Information

a. Kidney Community Emergency Response (KCER) Coalition http://www.kcercoalition.com/

b. Patient ID Card

c. Disaster Poster for Patient Waiting Areas

2. Evacuation Resources (During Disaster) (Located in State Specific Tools Listed in Section 9B)

a. State Specific Emergency Contacts by Parish or County

b. Emergency Contact Information by State

3. Post Disaster

a. ESRD Fact Sheet for General Public

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13. Network Patient Representative (NPR) Program

A. New NPR Orientation Packet

1. NPR Brochure

2. NPR Role

3. HIPAA and Confidentiality

4. Facility / NPR Agreement (Must be completed to participate in program)

5. NPR Activity Suggestion List

6. NPR Index Card Information Sheet

7 Index/Business Card example

8. NPR Photo Release

9. NPR Orientation Packet Evaluation

10. Social Worker Evaluation for NPR Packet

B. Web site Resources

C. Bulletin Board Posters

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14. Clearinghouse Library for Professionals and Patients: 2010

A. Clearinghouse Item List

B. Order Form

C. NW 13 Web site LINK http://www.network13.org

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Updated 7/22/2010