The Dialysis Facility

CLINICAL/OPERATIONAL CONSULTING

COMPLIANCE AUDIT PROGRAM

Overview
The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) continues in its efforts to promote voluntarily developed and implemented compliance programs for the health care industry. Standards have been developed or accepted by the federal government to promote performance levels necessary to insure patient safety in the outpatient dialysis facility. Compliance with these standards is necessary to receive and maintain Medicare certification and subsequently Medicare reimbursement.
The frequency of surveys has been increasing over the past decade and that trend will continue. Large dialysis companies have compliance officers to assist their facilities at the local level to prepare for surveys. HDS provides a Medicare compliance program and mock survey to help dialysis providers prepare for the Medicare survey. Through an extensive library of clinical and technical manuals HDS can assist a dialysis provider in achieving compliance with federal and state regulations. HDS resource manuals include:
• Patient Care Policies And Procedures
• Infection Control Policies And Procedures
• Nursing Policies And Procedures
• Technical Policies And Procedures
• Quality Assurance Performance Improvement Policies And Procedures
• Emergency Preparedness Policies And Procedures
• Personnel Policies And Procedures

Clinical Management

As ESRD Networks adopt the DOQI guidelines to use as benchmarks to monitor the clinical outcomes of dialysis providers and assist dialysis providers in their CQI effort, it is imperative that dialysis facilities have processes in place that will:

  • Assess patients risk status (low, moderate, and high) and define appropriate prevention intervention strategies
  • Implement a multidisciplinary approach to the management of the individual patients needs
  • Define staff utilization based on patient acuity
  • Adequately define attainable clinical targets
  • Record clinical outcomes
  • Generate monthly, quarterly and annual clinical outcomes report

Risk Assessment Process
Risk Assessment is a process of identifying and intervening with individuals who are at risk for intensive service utilization. In order to implement a risk assessment program, HDS provides the dialysis facility the tools and resources to:

  • Organize data across time and around patients, not around organizational departments, sites of care, or episodes of care.
  • Gather data that includes key medical and non-medical risk factors.
  • Identify high cost and high-risk patients in order that care can be customized to the needs and preferences of individual patients.
  • Utilize its most knowledgeable and experienced staff to manage the highest cost and highest risk patients.
  • Track patients response to treatment

Care Coordination Process
This is multidisciplinary approach to managing the holistic needs of the individual patient and provides an integrated approach to the coordination of care of all dialysis patients. It also empowers the members of the multidisciplinary team to coordinate the use of resources across care settings and throughout the disease continuum. Care coordination seeks to achieve the maximum cost-effective use of resources.

HDS has the tools that will assist clients in:

  • Proactively identify patients at highest risk and attempt to intervene in health issues before major events occur
  • Provide education tailored to the patient’s needs and understanding about their comorbid conditions, treatment options, symptoms, side effects and general health.
  • Identify potential quality issues and concerns through the use of data and information analysis and work with the providers to resolve these issues and concerns
  • Facilitate the delivery of appropriate preventative health care promoting health screenings and health education.

Hemodialysis Staff Training (RN and Patient Care Technician)

HDS offers a comprehensive Hemodialysis Staff Training program that utilizes a customized manual developed to be used with a series of specially designed power point presentations. Power point allows students to visualize many of the concepts and procedures discussed. The combination of the print material and the presentations provides reinforcement-an important component of learning.
To obtain as much as possible from the program, the student should become familiar with and understand the following:

1. OBJECTIVES.
Judging the quality of a learning experience is difficult; however, a test of quality can be made by determining whether or not it has brought about the desired change in a learner’s behavior. Because of this, learning objectives precede each section of material. Clear and precise objectives make evaluation possible, thus, the quality and effectiveness of the learning experience can be determined. The two types of objectives utilized in this program are cognitive and effective.

Cognitive objectives are concerned with knowledge and comprehension. These objectives indicate what the student should be able to do upon completion of the specific section (e.g., identify, define, explain, etc.). The effective objective is concerned with how the student should organize, conceptualize, value, and respond to specific situations upon completion of the section. Together, these objectives give precise direction regarding the subject content and the attitude which you are expected to develop.

2. SELF-EVALUATION.
Questions related to the material follow each section. By completing the self-evaluations the student will know whether or not he/she understood the material accurately. The answers to the self-evaluations will be provided during class.

3. ASSESSMENT.
Formal assessment is accomplished by (1) classroom power point presentation and student participation, (2) written examinations and situational tests, and (3) instructor evaluation.

Written examinations and situational tests are given periodically during the training program. These help the instructor and the student determine his/her ability to make the proper application of the material learned.

A final evaluation by the instructor may be verbal as well as written: It will assess the student’s performance during the training period.

4. PROCESS.
First, the student is to read and study the written material. Second, in the class room the instructor will present to the student the power point segment relating to the written material.

5. SUCCESSFUL COMPLETION OF THE PROGRAM.
The student will complete a total of 80 hours of classroom study – 64 hours the first two weeks and 16 hours during the eight week clinical training. At the end of the week in the clinical area, the preceptor will complete a Weekly Preceptor Evaluation, during which the student will have an opportunity to comment on his/her progress. Upon the completion of the eight week clinical training, the preceptor will complete the Hemodialysis Skills Competency Checklist.

On week eight of the clinical training, the instructor will meet with the student for a minimum of two hours to a conduct a verbal evaluation of the didactic and clinical lessons covered over the course of training. Final completion of this course will include successful demonstration documented on the Skill Competency Checklist by the preceptor and a passing score on the written final exam of 75% or better.
In addition to the training manual and materials, HDS can conduct the 80 hour didactic training on site at the Client’s location of choice; however, to insure compliance with training objectives, the HDS instructor will conduct a two day workshop with the preceptor(s) chosen to work with the student(s) during the clinical rotation. During this workshop the preceptors will participate in a condensed version of the training program designed to ensure that the cognitive and effective objectives outlined in the training are met during the clinical rotation.

Advanced Dialysis Workshop

HDS offers an eight hour advanced dialysis workshop designed to enhance the knowledge base of the experienced dialysis nurse and patient care technician. Topics covered during the workshop include:

Anatomy and Physiology of the Kidney

  • Excretory Functions
  • Endocrine Functions
  • Fluid and Electrolyte Management
  • Acid Base Balance

Chronic Kidney Disease

  • Overview
  • Frequent Co-morbidities
  • Classifications and Stages of Chronic Renal Disease

Principles of Dialysis

  • Dialysate
  • Fluid Removal
  • The Dialysis Machine

Assessment of the Dialysis Patient

  • Weight
  • Blood Pressure
  • Pulse
  • Respiration
  • Temperature
  • Communication

Factors that Influence a Patient’s Response to Hemodialysis

  • Role of Sodium in Hemodialysis
  • Limitations of Fluid Removal
  • The Influence of Dialysis on the Determinants of Blood Pressure
  • Blood Volume
  • Decreasing Blood Osmolality
  • Total Peripheral Resistance
  • Myocardial Contractility
  • Vascular Access

Water Treatment Preparation

  • Water Quality Requirements
  • Equipment Requirements
  • Disinfection Systems

Common Risks and Side Effects Associated with Dialysis

  • Hypotension
  • Dialysis Disequilibrium
  • Nausea and Vomiting
  • Cramping
  • Headaches
  • Arrhythmias
  • Chest Pain
  • Fever and Chills
  • Pruritis
  • Restlessness and Insomnia
  • Complications of anticoagulant
  • Anaphylactic Reactions
  • Metabolic Acidosis
  • Hypoxemia
  • Air Embolism
  • Hemolysis

Vascular Access

  • Placement
  • Complications
  • Performance Standards

Clinical Management of the Dialysis Patient

  • Multidisciplinary Care Team
  • Comprehensive Patient Assessment
  • Plan of Care
  • Criteria for Stable versus Unstable

Quality Assurance Performace Improvement (QAPI)

  • Purpose
  • QAPI Committee
  • Quality Incentive Program
  • Performance Measures

Infection Control Precautions for Dialysis Centers

  • Universal Precautions
  • Prevention of the Spread of Blood Borne Diseases
  • VRE and MRSA Precautions for Dialysis Centers