Heartland Kidney Network - Quality Improvement - Hot Topics

Hot Topics and Heads Up

August 2006 - State Survey Readiness

It is our goal that all dialysis facilities in Heartland Kidney Network will be survey-ready at all times! The State Survey agencies routinely send the Network copies of the certification surveys that are completed during their visits to the dialysis facilities. Here are some common things that facilities are cited for during a survey. Consider involving your continuous quality improvement committee to assist your facility in becoming even more survey-ready! Note: This is only a guide. The Network assumes no responsibility for dialysis facility performance on state surveys.

Water Treatment

There is a wonderful educational resource for dialysis staff located on the ESRD Network 16 website! (www.nwrenalnetwork.org/watermanual.pdf). It reviews every part of the water treatment equipment. Is your Medical Director signing off on culture reports, LALs, AAMI reports, etc.? Is there a routine disinfection schedule? Is it documented? Who oversees water quality testing? Is it documented daily and between shifts of patients? Are periodic in-service training classes provided for the staff members? Is it documented? Does the Medical Director participate? Are there written policies covering failed water checks?

Patient Care Plans (Long Term and Short Term)

Each patient must have an individualized care plan. New and unstable patients must have more frequently updated and revised care plans. Are each of the team members and the patient signing the care plan? Does the patient have any input as to his/her care plan? Some states are requiring physicians orders for the use of clamps post treatment. See also this PowerPoint on Dialysis Patient Transfers.

Preventative Maintenance

There are many types of equipment is a dialysis facility! These range from elaborate dialysis machines to simple blood sugar testing machines and pH meters. Remember to always follow the manufacturers recommended preventative maintenance plans for each type of machinery (even the smallest ones!) and document when maintenance or repair occurs.

Facility Maintenance

Take a critical look around your facility. Is it in good repair? Is it dirty? Are the dialysis chairs broken? Is the floor in good condition? Look for any potential safety hazards for both staff members and patients. Is the lighting adequate? Is the space between patients enough to allow for emergency equipment such as a crash cart?

Patient Confidentiality

When discussing issues or examining a patient, is privacy being provided? Can other people hear the conversation or view the patient? Many dialysis facilities are basically arranged in one big room. Is your facility being sensitive to the needs of the patient by providing a private environment?

Infection Control

The spread of blood borne pathogens and other disease can happen rapidly in the dialysis environment! Remember to adhere to infection control practices and to document all of your efforts! Are the staff immunization records up to date? Are all opened vials of medication labeled properly? Is the refrigerator the proper temperature – is it documented? Is it monitored? Are there forgotten vials of medications in exam room drawers?

Medical Director Involvement

The Medical Director must be kept-in-the-loop of every aspect of the efficient running of the facility! He/she is also responsible for the training of the staff members. Don’t forget to obtain his/her signature on training certificates and in-services! The Medical Director is a great resource – utilize their expertise!

Disaster & Emergency Planning

Be sure to document any in-services and drills that you provide for your staff! Is there a written plan for your facility? Do you have back-up dialysis facilities planned?