Quality Insights Renal Network Three 2017 Project Improving Transplant Coordination. Karen Ripkey BSN, RN, CNN Quality Improvement Coordinator

Transcription

1 Quality Insights Renal Network Three 2017 Project Improving Transplant Coordination Karen Ripkey BSN, RN, CNN Quality Improvement Coordinator

2 Improving Kidney Transplant Coordination

3 Someone Once Said There s no place like home. I Say There s Nothing Like Knowing the Way

4 Welcome to Project Call: This is Part 1 Project overview: Stats Who: Partners What: Educate, improve communication, numbers Where: NJ & PR When: Now-September 2017 How: Closer look at referrals and processes Why: Regulation and the right thing to do Goals: see what Part 2 Materials: To be ed after call- Project Menu, Inventory tool and instructions.

5 Project Call Part 2 (1:1 Coaching Call)-Next Week: Coaching call needs to be completed from 2/27 through 3/3-so arrange ASAP Contact Karen starting after today s call to make a telephone appointment for Project Call Part 2 (first coaching call) for next week Appoint facility project contact for calls and activities Karen s Contact info: ext 2425 or kripkey@nw3.esrd.net Materials needed for call: Current facility census, copy of facility s submission of pt. referrals (submitted to NW in January by project facilities)

6 Transplant Numbers in US: We Came This Far-Can We Go Further?

7 NJ Data

8 Closer Look at Numbers Increase in transplants over four years: Renal community effort to raise awareness and educate professionals and the public Increased use of deceased donors includes donors after circulatory death (DCD), and donors at higher risk of blood borne diseases and who may have died of drug overdose- CDC higher risk. Kidney transplant data in NJ Steady increase since 2014 for all donor and deceased donor Living donor transplants dipped slightly rose in 2016

9 Looking Ahead Increased awareness of transplant and advancements in science and technology make this an exciting time for eligible patients. But patients need to be assessed, referred timely and make it to the wait list or their transplants will not happen. Transplant Coordination: Is there room for improvement in what we do and or how we do it? What are the barriers? How to overcome?

10 Who, Where and Why? NJ and PR stakeholders NW3 PAC, SMEs-Subject matter experts Shared experiences and suggestions Motivated by desire to smooth the way for others Transplant Centers-NJ, PR Dialysis Centers-NJ, PR

11 Why? Federal Regulations V458: Patients rights: to be informed about all treatment modalities and settings V512: Evaluation of family and other support systems-ability, treatment goals of patient V562: (d) Standard: Patient education and training. in home dialysis and self-care, quality of life, rehabilitation, transplantation, and the benefits and risks of various vascular access types V553: Plan of care: Suitability for transplant and patient interest

12 Why? NJ State Regulations 8:43A Patient care plan (b) Within one calendar month of initiation of dialysis treatment at the facility, a written plan of care shall be developed for each ambulatory dialysis patient by a multidisciplinary team The multidisciplinary team shall analyze patient outcomes on a regular basis to assess the patient s progress and evaluate current and future treatment modalities and modify the plan as necessary. (c) Every six months at minimum, the multidisciplinary team shall discuss and review and shall revise as needed.

13 Why? NJ State Regulations 8:43A Chronic kidney disease counseling services (a)(1) Development of a patient educational program which shall include, but is not limited to, the following: (iii) Renal replacement therapy options (that is, hemodialysis, peritoneal dialysis, transplantation);

14 Why? Network Three Goal Statement on Treatment Modalities Assess and refer in a timely manner medically suitable patients to treatment modalities that increase rehabilitation and independence including in-center self-care, home self-care and transplantation. Source: CFC page 281

15 Why? CMS Project Choices : Improve Transplant Coordination Selection and Goals Facilities with <25% referral rate (self reported data from scan) Disparity-Hispanic/non-Hispanic (5%) Improvement is: Increase overall referral rate by 5% Reduce Disparity by 1% Work with 5% of NW3 population (20,100) 1495 patients in 14 facilities Counts first-time transplant referrals Not referred already Not listed Relisting after transplant failure

16 What and How: Project at a Glance Scan of referral data-completed 14 facilities chosen-8 in NJ; 6 in PR Project rollout 2/23 Focus on staff, patient & family education and interaction Develop plan to identify opportunities to improve coordination of referral process-communication and follow-up Trial/Adoption of Patient Inventory Tool Current patients, not referred and all new patients Assess for status, identify needs and communicate with IDT, Transplant Center

17 What and How: Facility Requirements- Overview Appoint facility contact/designee for project Attendance on project calls-rollout, Midpoint, Wrap-up Regular Coaching calls-nw and Facility contact (TBS) Staff and patient education activity (both optional and mandatory)-document to be provided Complete Survey Methods activities (2) Monthly collection of referral activity on tool provided and submission to NW via FAX (patient level data) Create and submit facility sustainability plan post project

18 What and How: Tools and Resources Project Map- required and choice of two activities Inventory tool and Instruction page-monthly activity Coaching calls as needed-patient review, questions 5 Diamond Patient Safety Program Complete Transplant Module Transplant Center partners-available for staff and pt. education, resources Auxilio Mutuo (Puerto Rico) Barnabashealth Our Lady of Lourdes Robert Wood Johnson HackensackUMC

19 What and How: Monthly Activities Inventory Tool (Review instruction page before using). By March 6, 2017, complete for patients not assessed since January scan and fax to NW3 March 7-September-Complete for all new patients within first month of admission and fax to NW3 by 5th of following month (March due 4/5, April due 5/5, etc.) Complete for patients discussed during coaching call as agreed. Schedule first coaching call with Karen to review current census between 2/27 and 3/10/2017. Call or me. Other activities-per Project Map

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24 Addendum: Project Referral Definition A Transplant Referral is defined as a first-time referral for a patient who has not been referred for or placed on a transplant waitlist and for which either a dialysis facility or transplant center provides an indication that the patient has been referred.

25 Questions