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Report from the Executive Director. Glenda Harbert, RN, CNN, CPHQ. MISSION Statement. The ESRD Network of Texas, Inc. supports quality dialysis & kidney transplant healthcare through patient services, education, quality improvement & data exchange. 2003. ESRD Network #14.

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report from the executive director

Report from the Executive Director

Glenda Harbert, RN, CNN, CPHQ

mission statement
MISSION Statement

The ESRD Network of Texas, Inc. supports quality dialysis & kidney transplant healthcare through patient services, education, quality improvement & data exchange.

2003

esrd network 14
ESRD Network #14

The 2ndlargest Network in number of dialysis patients (35,415) behind Network 6 (37,143)

The 3rdlargest Network in number of dialysis Providers (456)

behind Network 6 (561) & Network 9 (490).

topics
Topics
  • Network activities
  • TEEC
  • DSHS Referrals
  • The Future
activities of the network
Activities of the Network
  • Quality Improvement
  • Community Information & Outreach
    • TEEC & Disaster preparedness
    • Patient & Provider Technical Assistance & Education
    • Complaints & Grievances
    • Averting Involuntary Discharge
  • Information Management
quality improvement
Quality Improvement
  • Quality Improvement Projects
    • Improving Phosphorus
    • Quality of Care Concerns, Elab Data Collection & CPM’s
      • Vascular Access Improvement Projects
      • 2 year outliers for clinical labs
      • Adequacy of HD
what is teec
What is TEEC?

The mission of TEEC is to ensure a coordinated preparedness, plan, response and recovery to emergency events affecting the Texas ESRD community.

teec steering committee
Brian Sanders, RN. MBA (Network 14 liaison)

John Dahlin

Eugenia De Los Reves, RN

Balbi Godwin, RN (Chair-Elect)

Vanessa Guillory, RN (Chair)

Glenda Harbert, RN (ED for Network 14)

Courtney Harman

Kelley Harris

Doug Havron, RN

Debbie Heinrich, RN

Becky Heinsohm, RN (consultant)

Derek Jakovich, JD (consultant)

Robert Leggington, MD

Minnie Malone, RN (consultant)

Connie Oden, RN

Glenda Payne, RN (consultant)

Alex Rosenblum, RN

Narendra Singh

Steven Tays

Jeff Thompson, MD

Karen Walton, RN

Mikki Ward, RN

TEEC Steering Committee
slide10

Coastal Counties

June 6, 2010

184 Facilities

14, 715 Patients

pre hurricane preparations
Pre-Hurricane Preparations
  • Independent facilities must pre-plan for backup dialysis with another provider
  • Patients should be STRONGLY encouraged to evacuate
  • Any patient with limited mobility, support systems and or transportation MUST be registered for evacuation with 211
  • Telling patients to go the hospital for dialysis is NOT a disaster plan!
annual preparations
Annual Preparations
  • Mail-out from NW
    • Template Disaster Plan
      • Forms
      • Letters
      • Checklists for pre & post disaster
  • Drills with EMSystem & DSHS
  • Webinar & mentoring for independent facilities
the packet informed me of the
The packet informed me of the:

Resources provided will be used to:

#responses: 260

drill down of quality of care beneficiary complaints and inquiries 09 10
“Drill down” of Quality of care beneficiary complaints and inquiries 09-10

New focus on caring Communications

trending number of complaints by facility
Trending Number of Complaints by Facility

14% decrease 08-09 in facilities with 1 complaint

cause of formal grievance
Cause of Formal Grievance

3 FG 2007, 8 FG 2008, 5 FG 2009

trending involuntary discharge
Trending Involuntary Discharge
  • 3 year trend in increase reversed
  • 22% decrease in # pts
  • 15% decrease in # facilities with IVD

Rate remains < 0.1% of total patients

averted ivd s
Averted IVD’s

7/09- 6/10

  • 12
what happened to crown web
What happened to Crown Web?
  • Phase II- Pilot Project with all Networks & 10 Facilities each
  • Full Implementation ??
  • For more information
    • Visit CW booth
    • Attend last session Saturday
common themes
Common Themes
  • Unsafe Infection Control Practices
    • Simultaneous care of Hepatitis B negative and Hepatitis B positive patients
    • Failure to follow vaccination program
    • Poor hand washing practices
    • Inappropriate use of Personal Protective Equipment (PPE)
    • Not disinfecting surfaces
  • Failure to implement Quality Assessment and Performance Improvement (QAPI)
    • Lack of tracking, trending and analyzing
    • Inconsistent participation of Interdisciplinary team

members

    • Failure to recognize, report and track Adverse Events
common themes1
Common Themes
  • Patient Safety Concerns
    • Lack of patient assessments (pre, during & post)
    • Lack of staff knowledge regarding emergency equipment
  • Vascular Access Outliers
    • High Catheter Rate/ Low AVF Rate
  • Unsafe Physical Environment
    • Dirty floors, broken tiles
    • Insects
    • Unlabeled hazardous chemicals
  • Water Treatment Practices
    • Not testing properly
    • Lack of staff knowledge
    • Unsafe Reuse practices
communication issues
Communication Issues
  • Nurses not following Physician’s orders
  • PCT’s not reporting critical treatment data/events to nurses:
    • Failure to report
      • Hyper & Hypo tension pre, during, and post dialysis treatments
    • Initiating Sodium Profiling with  BP
    • Failure to:
      • obtain accurate weights
      • identify wet transducers
      • communicate “Reportable Parameters” to physician or nurse
percent of dshs referral facilities with improved outcomes
Percent of DSHS Referral Facilities With Improved Outcomes

14/19 (73.7%) with improvement in fewer than 4/4 indicators met or exceeded MRB QOC cut point at time of referral

patients directly impacted with improved outcomes dshs referrals
Patients directly impacted with improved outcomes DSHS referrals
  • 494 patients with improved outcomes
    • Removal of Catheter > 90 days
    • AVF placed
    • Anemia improved
    • HD Adequacy improved
  • 2,513 patients potentially impacted
future
Future
  • Healthcare Acquired Infections (HAI)
  • Catheter Reduction
  • Disparities
  • Vulnerable populations
coming soon
Coming soon

DVD for patients

  • Short
  • Diverse patient presenters
  • Highlights benefits of exercise
no devastating hurricane
No Devastating Hurricane

Galveston Island

Post Ike

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