Report from the executive director
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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


Community information outreach

Community Information & Outreach


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


Report from the executive director

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


My facility will make the expected disaster preparations

My facility will make the expected disaster preparations


Of compliant facilities emsystems 07 2009 to 03 2010

% of Compliant FacilitiesEMSystems – 07/2009 to 03/2010


Of compliant facilities emsystems 07 2009 to 03 20101

% of Compliant FacilitiesEMSystems - 07/2009 to 03/2010


Complaints grievances involuntary discharge ivd

Complaints, Grievances & Involuntary Discharge (IVD)


Nw 14 trends in negative contacts percent of total

NW 14 Trends in “negative contacts”Percent of total


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


Trends in complaints

Trends in complaints


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


Information management

Information Management


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


Dshs referral update

DSHS Referral Update


Number of cases levels

Number of Cases & Levels


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 that met mrb cut points at year end

Percent of DSHS Referral Facilities that Met MRB Cut Points at Year End


Percent of dshs referral facilities with improved outcomes using most current data

Percent of DSHS Referral Facilities With Improved Outcomes Using Most Current Data


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


Giving thanks there is always something to be thankful for

Giving thanksThere is always something to be thankful for

What didn’t happen


H1n1 the dialysis setting

“swine flu”

H1N1 & the dialysis setting


No devastating hurricane

No Devastating Hurricane

Galveston Island

Post Ike


Thank you for all that you do

Thank you for all that you do

[email protected]

469-916-3801


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