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News Bulletins 2009 |
Strategies to Improve Complication Rates with the Buttonhole Technique - recommended for any facility using buttonhole cannulation;
Creating Secondary AV Fistulae from Grafts - recommended for any facility with AV Graft rates higher than the 14% Network average;
Assessing AVF Maturity - recommended for any facility with average AVF maturity times longer than 6-8 weeks.
*Reducing Long-Term Catheters* at 9am PST on Friday, Nov. 13;
Don’t forget to adjust for Mountain or Alaska Time. The live workshops will be open only to Network facilities, but they will be recorded and added to our website a few days after the live workshops. Register for the live seminars, at least one day beforehand, at
https://ifmcevents.webex.com. Note that this link uses “https” rather than “http,” and that there is no “www.” If you have questions or need technical assistance, call the Network.
There are earlier articles on Vascular Access, and on
Quality Improvement.
CMS has prepared a monograph on reimbursement for administration of the H1N1 vaccine; see
http://www.cms.hhs.gov/MLNMattersArticles/downloads/se0920.pdf.
The HHS "Flu.gov" website provides a central source of H1N1 information and resources for individuals and families at
http://www.pandemicflu.gov/individualfamily/index.html, and for professionals at
http://www.pandemicflu.gov/professional/index.html. The website includes resources in many languages.
The National Resource Center on Advancing Emergency Preparedness for Culturally Diverse Communities website has tabulated resources on H1N1 virus, at
http://www.diversitypreparedness.org/Influenza-A-H1N1-Swine-Flu/103/. The National Resource Center on Advancing Emergency Preparedness for Culturally Diverse Communities
also provides general emergency preparedness information in 50 languages: see
http://www.diversitypreparedness.org/Language/34/.
There are earlier articles on Pandemic Influenza and on
Emergency Preparedness.
Topic Index
Topic Index
Our Fistula First Goal Is in Sight
We've updated our monthly AVF progress chart, at http://www.nwrenalnetwork.org/fist1st/monsnap.htm. The Network AVF rate has been frozen two percentage points short of the Network and CMS goal of 66% for over a year. The Network is currently working on QI projects focused on increasing AVF rates, identifying maturation issues, converting grafts, and reducing catheters. Our website has educational Web-exes for your review to assist Network facilities in reaching the goal, at
http://www.nwrenalnetwork.org/QI/QI.htm#qip09.
There are earlier articles on Vascular Access.
Revisions to DPC Toolkit on Decreasing Dialysis Patient-Provider Conflict
The DPC Toolkit on Decreasing Dialysis Patient-Provider Conflict has also been updated, though the changes were minor, and the DPC DVDs were not modified. Find the DPC Toolkit at
http://www.esrdncc.org/index/decreasing-dialysis-patient-provider-conflict.
There are earlier articles on Communication and on
Conflict Resolution.
2009 Vocational Rehabilitation Toolkit
We've mailed the 2009 Vocational Rehabilitation Toolkit to facilities, and placed it on our website, at
http://www.nwrenalnetwork.org/SW/V/VocToolkit.htm. This year's toolkit includes an article from NN&I on "Vocational Rehabilitation: Is Your Facility on Track"
(http://www.nwrenalnetwork.org/SW/V/2009/VTKOnTrack09.pdf), and a survey on Barriers to Rehabilitation (http://www.nwrenalnetwork.org/SW/V/2009/VTKBarriers09.pdf). The survey requests social workers in the Network region to provide feedback with regards to rehabilitation barriers.
There are earlier articles on Vocational Rehabilitation.
Building an Emergency Supply Kit
We've added a new document to our Emergency Preparedness page at
http://www.nwrenalnetwork.org/E/emergency.htm, called "Breaking Down the Tasks to Building an Emergency Supply Kit (Or, How to Eat an Elephant)," which assigns weekly tasks for building an emergency kit over six months. This new document is at http://www.nwrenalnetwork.org/E/Elephant.pdf.
There are earlier articles on Emergency Preparedness.
CfC and PCT Website Updates
We've added three new documents to our Conditions for Coverage web page at
http://www.nwrenalnetwork.org/CfC/CfC.htm. The first is a new list of Frequently Asked Questions about the new Conditions; it's at
http://www.nwrenalnetwork.org/CfC/CfCFAQs0909.pdf. The other two deal with PCT certification: "CMS Approval of State and National Certification Programs for PCTs under the New ESRD Conditions" at
http://www.nwrenalnetwork.org/CfC/PCTcert1009.pdf, and a table of "State PCT Certification Programs" at
http://www.nwrenalnetwork.org/CfC/PCTStateGrid.pdf.
There are earlier articles on Conditions for Coverage.
Free Vascular Access Seminars Online
The Network has prepared online educational seminars or “WebExes” on Decreasing Long-Term Catheters (catheters in use more than 90 days with no other access in place) - recommended for any facility with long-
term catheter rates higher than the 10% KDOQI guideline and CMS goal;
Find the WebExes at http://www.nwrenalnetwork.org/QI/QI.htm#qip09. After you have attended the seminars, please email Lynda Ball (lball@nw16.esrd.net) and indicate which WebExes you have watched, so we can assess their effectiveness.
There are earlier articles on Vascular Access.
Life Safety Code Survey Phase-In Schedule
CMS has issued a schedule for phasing in surveys that include the NFPA Life Safety Code (LSC) 2000 Edition, for both existing dialysis facilities and new certifications. The schedule includes background information, instructions for feedback and questions, and other material useful to both facilities and surveyors. Find the schedule at
http://www.nwrenalnetwork.org/CfC/LSCPhasing.pdf.
There are earlier articles on Survey & Certification.
Vicks Sinex Nasal Spray Recall
New UNOS Policy Change Proposal for Public Comment
UNOS has added a second policy change proposal to the list for which public comment is due by February 5, 2010. For details see
http://www.unos.org/policiesAndBylaws/publicComment/proposals.asp.
There are earlier articles on Transplantation.
H1N1 Flu Update from CMS
2009 H1N1 INFORMATION: You’ve probably been hearing a lot this year about the H1N1 flu. And you may have questions. You may have even had the flu, or know a friend or neighbor who has been sick. This message features some tools suggested by the
U.S. Department of Health and Human Services to help you prevent the flu, know what to do if you get sick, and find a place to get vaccinated.
People recommended by the Centers for Disease Control and Prevention (CDC) to receive the vaccine as soon possible include: health care workers; pregnant women; people ages 25 through 64 with chronic medical conditions, such as asthma, heart disease, or diabetes; anyone from 6 months through 24 years of age; and people living with or caring for infants under 6 months old.
FLU.gov is a one-stop resource with the latest updates on the H1N1 flu. On this site, you can find information on
How to Prevent and Treat the Flu,
Flu Essentials, and
Why the H1N1 Vaccine is Safe and Recommended by Health Experts. To look up where to get vaccinated in your state, visit the
Vaccine Locator. This information is updated regularly as more doses are shipped each week.
An additional resource is the CDC hotline, 1-800-CDC-INFO (1-800-232-4636), which offers services in English and Spanish, 24 hours a day, 7 days a week.
Heard a rumor? Visit
Myths & Facts to run a fact check.
2009 H1N1 UPDATES: Flu activity is already higher than what is seen during the peak of many regular flu seasons. Almost all of the flu viruses identified this season so far are 2009 H1N1.
All states have placed orders for the 2009 H1N1 vaccine, and more orders are expected daily. Vaccine is arriving in thousands of places across the country. Because the vaccine distribution system varies by state, the vaccine situation on the ground may differ from community to community.
The 2009 H1N1 vaccine is taking longer to produce than manufacturers initially expected. Scientists, doctors, and manufacturers are working around the clock to produce this vaccine safely, effectively, and as quickly as the science allows. The
U.S. Department of Health and Human Services, through state and local health departments, will continue to make the vaccine available as soon as it comes off the production line.
Clinical trials conducted by the National Institutes of Health and the vaccine manufacturers have shown that the new H1N1 vaccine is both safe and effective.
In the past, flu pandemics have been characterized by multiple waves. Scientists and doctors recommend H1N1 vaccination even if flu activity slows, as it could resume later in the season.
There are earlier articles on Pandemic Influenza and on
Emergency Preparedness.
Potential Failure of Powerheart and CardioVive Defibrillators
The FDA advises that Cardiac Science Corporation has issued a “field correction” for certain of their Powerheart and CardioVive automated external defibrillators because the devices may fail to function, which could lead to serious adverse events or death. For details, model numbers, and instructions see
http://www.fda.gov/Safety/Recalls/ucm190605.htm.
There are earlier articles on Defibrillator Recalls.
New Clopidogrel/Plavix Interaction Safety Labeling
The FDA has advised that the anti-clotting effects of clopidogrel/Plavix may be reduced when any of the following drugs are also taken: omeprazole (Prilosec/Prilosec OTC), cimetidine, fluconazole, ketoconazole, voriconazole, etravirine, felbamate, fluoxetine, fluvoxamine, or triclopidine. For details see
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm190848.htm.
Facility Participation in Network QI Projects
Initial “Webex” online presentations have been recorded and are now available for the four 2009-10 Network Quality Improvement Projects. These initial presentations contain deadlines, materials necessary for completing the projects, and schedules of additional educational presentations. If your facility has been selected to participate in one of the Projects and you did not attend the live presentation, you will need to attend the online version as soon as possible. Find them at http://www.nwrenalnetwork.org/QI/QI.htm#qip09. The projects and presentations are on Decreasing Long-Term Catheters, Improving Sub-Optimal Hemoglobins, Declining AVF Rates, and Reducing Buttonhole Complications. Schedules for additional educational presentations can be found at
http://www.nwrenalnetwork.org/news_bulletins09D.htm#avf11c. The educational presentations are open to anyone, but if you are participating in the related Network Quality Improvement Project, please attend the
initial presentations prior to the educational presentations. If you’ve already missed your educational presentation, or if you have questions, please contact Lynda Ball at the Network office.
There are earlier articles on Quality Improvement and on
Vascular Access.
The Impact on Patients of Proposed Dialysis Services Bundling
AAKP’s HealthLine series of free educational conference calls for patients will present a call on “How Might the Proposed Bundling of Dialysis Services Affect Me and My Dialysis Treatment?” on November 18, 2009. For details and registration information see
http://www.aakp.org/events/HealthLine/Upcoming-calls/nov1809/.
There are earlier articles on Patient Education and on
Reimbursement.
Facility Survey MAT Revision
A new version 1.5 of the Measures Assessment Tool or MAT, used by State Surveyors to assess dialysis facilities, has been posted at
http://www.nwrenalnetwork.org/CfC/MAT15.pdf. We post information about the implementation of the new Conditions for Coverage at http://www.nwrenalnetwork.org/CfC/CfC.htm.
There are earlier articles on Conditions for Coverage and on
Survey & Certification.
September 2009 Modality Reports Ready
The September 30, 2009 Modality Reports (patient census) are now online at
http://www.nwrenalnetwork.org/modality/mode0909/modality.htm. In the past year the Network dialysis patient census has grown by 5.7% - 7.5% in Alaska, 6.3% in Oregon, 6.2% in Montana, 5.7% in Idaho, and 5.2% in Washington. Find historical data at http://www.nwrenalnetwork.org/modality.htm.
There are earlier articles on Modality Reports.
Prospective Payment System Comment Period Extended
CMS has extended the comment period for the ESRD Prospective Payment System Proposed Rule until December 16, 2009. For details see http://www.cms.hhs.gov/ESRDPayment/PAY/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=4&sortOrder=descending&itemID=CMS1228517&intNumPerPage=10.
There are earlier articles on Reimbursement.
New Byetta/Exanatide Label Warnings
Vascular Access Online Educational Presentations
The Network will be presenting four online educational “Web-ex” seminars on vascular access during November. The hour-long workshops are on
*Strategies to Improve Complication Rates with the Buttonhole Technique* at 10am PST on Tuesday, Nov. 17;
*Creating Secondary AV Fistulae from Grafts* at 10am PST on Thursday, Nov. 19; and
*Assessing AVF Fistula Maturity* at 1pm PST on Thursday, Nov. 19.
Network AVF Rate 63.8% in September
The Network AVF-in-use rate slid back to 63.8% in September, more than two percentage points short of the Network and CMS goal of 66%. We’ve mapped the latest progress at http://www.nwrenalnetwork.org/fist1st/fist1st.htm#progress.
There are earlier articles on Vascular Access.
Network Patient Advisory Board Vacancy
H1N1 Flu National Emergency Declaration
An H1N1 Flu National Emergency has been declared which allows healthcare providers to quickly implement disaster plans should they become overwhelmed. For further information, see http://www.cms.hhs.gov/h1n1, and contact your county health department, state health department, and state survey agency for local policies. You can find additional resources at
http://www.cdc.gov/H1N1flu and http://kcercoalition.com/h1n1.htm. There are earlier articles on Pandemic Influenza and on
Emergency Preparedness.
All Accusure Insulin Syringes Recalled
The FDA and Qualitest Pharmaceuticals have announced the recall of ALL Accusure Insulin Syringes because the needle can become detached from the syringe. For details see
http://www.fda.gov/Safety/Recalls/ucm188137.htm.
There are earlier articles on Insulin-Related Recalls.
Recall of Baxter PD Transfer Set
Public Comment Requested on UNOS Policy Change
UNOS has requested public comment on a proposed change to organ procurement and allocation policy, due by February 5, 2010. For details see
http://www.unos.org/policiesAndBylaws/publicComment/proposals.asp.
There are earlier articles on Transplantation.
FDA Warning on Medical Device Electrical Cords
FDA Warning on Parenteral Administration of Dexferrum
AAKP Seeks Speakers Bureau Volunteers, Presentations, and Topics for 2010 Convention
The AAKP will hold their 2010 Annual Convention on September 2-4, 2010 in Tampa FL, and is seeking individuals interested in telling their story to serve on its Speakers Bureau for the Convention. CKD, ESRD, and transplant patients, caregivers, and health care professionals are encouraged to apply, before April 30, 2010. They also seek educational session topics and/or presentations, on concerns such as living with CKD, therapy options, the wait list, diet, nutrition, or legislative issues. For details see
http://www.aakp.org/press/press-releases/2009-Press-Release/Topics-and-Speakers-Bureau.
There are earlier articles on Patient Meetings and on
Volunteering.
AAKP Survey Panel Seeks Volunteers
The American Association of Kidney Patients is seeking patients, family members, healthcare professionals, and other concerned individuals for participation in the AAKP Survey Panel. Survey Panel members provide input to AAKP about costs, insurance benefits, treatment options, and other issues. For details see
http://www.aakp.org/press/press-releases/2009-Press-Release/AAKP-Survey-Panel/.
There are earlier articles on Volunteering.
ESRD-Specfic Pain Management Protocol
The Mid-Atlantic Renal Coalition has added an
ESRD-specific pain management protocol to their
Kidney End-of-Life Coalition website. You can download the brochure detailing the protocol from
http://www.kidneyeol.org/painbrochure9.09.pdf, and the reference list for it from
http://www.kidneyeol.org/painbrochure_refs9.09.pdf.
There are earlier articles on End of Life and on
Quality Improvement.
Free Anemia Education on AAKP HealthLine Conference Call November 4
The AAKP's HealthLine series of free conference calls will feature a session on Anemia: Signs, Symptoms and Treatment Options on November 4, 2009. For more information see
http://www.aakp.org/press/press-releases/2009-Press-Release/Anemia-HealthLine-Call/. Past HealthLine calls are archived at
http://www.aakp.org/events/HealthLine/archive/.
There are earlier articles on Patient Education and on
Anemia.
Lab Data Report on National CPM Status and Trends
The Renal Network of the Upper Midwest, which compiles national dialysis lab data, has summarized the status of clinical performance measures in their 99-page report,
"Elab Project National 2008 and Trends Report, June 2009." Find the report at
http://www.esrdnet11.org/Elab/, and compare your own facility's HD and PD outcomes to national and Network results using the tools we've put on our website at
http://www.nwrenalnetwork.org/S/statscpm.htm. Our Network lags the nation in meeting hemoglobin targets, but does well in dialysis adequacy and nutrition, while our bone health results are mixed. The report compiles the status and direction of CPMs for HD, PD, and pediatric patients by Network and by year.
There are earlier articles on Clinical Performance Measures and on
Quality Improvement .
Continuing Glucose Test Strip Fatalities
The FDA reports that deaths are still resulting from the use of "GDH-PQQ" glucose test strips, which give potentially fatally inaccurate readings in the presence of sugar alcohols. The FDA is now recommending that healthcare facilities avoid using GDH-PQQ glucose test strips, which include several types of ACCU-CHEK, TRUEtest and Freestyle test strips; there is a complete list at
http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PatientAlerts/ucm177189.htm#attachment. For the FDA's latest warning, see
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/transcript.cfm?show=91#2. For our earlier summary of previous warnings, see
http://www.nwrenalnetwork.org/news_bulletins09C.htm#ins8b.
There are earlier articles on Insulin-Related Recalls.
Network Consumer News Patient Newsletter on Quality of Life
The October issue of Network Consumer News, on health-related quality of life (QOL), has been mailed to facilities for delivery to patients. You can find the issue at http://www.nwrenalnetwork.org/P/NCN/NCNv3.2.pdf in two-page format and http://www.nwrenalnetwork.org/P/NCN/NCNv3.2Big.pdf in four-page (big-print) format. This issue includes an update of the Network's Helpful Things to Know flyer
(http://www.nwrenalnetwork.org/P/NCN/Helpful.pdf), and a word-search puzzle at
http://www.nwrenalnetwork.org/P/NCN/QOLWordSearch.pdf on QOL. To find the solution to the puzzle, see http://www.nwrenalnetwork.org/P/NCNP.htm.
There are earlier articles on Network Consumer News and on
Quality of Life.
Philips HeartStart FR2+ Defibrillator Recall
The FDA has announced that Philips is voluntarily recalling some versions of its HeartStart FR2+ automated external defibrillator because they sometimes fail to operate. Model numbers include Philips M3860A and M3861A, and Laerdal/Philips M3840A and M3841A. For specific serial numbers and recall instructions, see
http://www.healthcare.philips.com/us/products/resuscitation/products/fr2plus/action.wpd. The FDA announcement is at
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm185179.htm
There are earlier articles on Defibrillator Recalls.
H1N1 Flu News: CDC VIS, Reimbursement, Resources
The CDC prepares Vaccine Information Statements (VIS) that must be given to vaccine recipients before they receive the vaccine. The H1N1 "swine" flu VIS can now be found at
http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-inact-h1n1.pdf. The Immunization Action Coalition (IAC) provides important information about VISs, at
http://www.immunize.org/vis/vis_howto.asp. The IAC translates VISs into 37 languages. Since the H1N1 VIS was just released, it's not been translated yet, but will be soon; you can sign up to be notified when it is, at
http://www.immunize.org/vis/.
Heparin Dosage Adjustment Requirement
The FDA has warned that a new reference standard has been established for Heparin that will result in an approximately 10% reduction in potency, which may require dosage adjustments in some situations. While the change is officially effective October 1, heparin that's labeled to the new standard may not be available till about October 8. Since heparin following the old standard and heparin following the new standard will be extant simultaneously, care must be taken to assure dosages are correct. Full details are at
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm184687.htm.
There are earlier articles on Heparin.
PPS Open Door Forum October 15, and Town Hall Meeting October 23, 2009
CMS will hold an Open Door Forum on October 15, and a Town Hall Meeting on October 23, to discuss the ESRD
Prospective Payment System (PPS) Proposed Rule. At the Open Door Forum, CMS will present information on the composition of the bundle, proposed
unit of payment, development of the system, case mix adjustment, outlier policy, and market basket. At the Town Hall Meeting, stakeholders will
be able to present oral statements in response to the Proposed Rule. For details see
http://www.cms.hhs.gov/OpenDoorForums/15_ODF_ESRD.asp.
There are earlier articles on Reimbursement.
Topic Index Page updated May 27, 2010