QAPI
How Many Action plans should you have at one time and How often do they need to be updated?
3-4 Action plans per program and Update Monthly.
Who makes up a quorum in GB
CM, DO, RVP, MD need 3 of them.
What is the goal for kt/v for qip and who is excluded in this calculation?
Goal is 1.2. Excludes AKI, <90 days at facility and <or>3 times per week dialysis.
What are some best practice for fluid management at facility?
1. correct bp cuff placement and size
2. timely adjustments of EDW 1/2 - 1kg
3. IDT approach
4. Know the action groups
5. 85-90% of HTN is fluid related.
What is the area goal for fluid management?
6 CQS points 36%
What should you use to prepare for your QAPI Meeting?
What is the medical directors role in Governing Body?
1. Direct management and oversight
2.QAPI
3. Staff Education and Training
4.Adoption of policies
5. Medical Staff compliance with bylaws and policy
For qip hypercalcemia what does calcium level have to be to meet and how long does it effect a clinic?
<10.2 and it will effect a clinic for 12 month calendar year.
within 1 week of them choosing a modality.
What are the minimum AF for AVF and AVG and if AF drops what % should you be concerned?
AVF 400
AVG 600
25% reduction from baseline.
How can you show a state surveyor you are providing safe treatments from your QAPI?
Clinic audit checklist are completed and if trends addressed
Water Logs up to date and on time if trends noted they are addressed
Action Plans are in Place and up to date.
What is the minimum amount of times a Governing Body should meet in a year?
4 time per year. Quarterly minimum.
What is the minimum TPS (total performance score) a facility has to have to not get a payment reduction.
57
If you have a patient running 2 times per week what do you want the wstdkt/v to be and what needs to be done every 3 months to get credit?
wstkt/v 2.0 you want to do a urea clearance at least every 3 months for residual to count.
How often should an action plan be updated? And what do you do if you have continued to trend down but have done 3 updates?
Update monthly and if you have trended down resolve the action plan and reopen it identifying new root causes and interventions.
Give an example of a root cause for CVC and an intervention for it.
Will take many things for this. Root cause has to go with intervention.
Where can you go to print off many of your state ready documents?
Equip (top right hand corner core survey dashboard)
What is the impact of a 2% payment reduction to a clinic for 1 patient for the year?
$70,980
Where can you find educational handouts for a patient post hospitalization?
On the quality page (the post hospital red flags)
According to the volume management algorithm what do you do if a patient is having symptoms during treatment cramping, hypotension during tx, or vomiting and leaves >1kg above EDW. They are on bp meds?
If patient is on antihypertensive therapy and not tolerating ultrafiltration: o Consult physician/NP/PA for antihypertensive medication adjustment
How can you audit to make sure you have your workbooks completed for the month?
Utilize the QAPI calendar to verify there are no red X and green checks are present.
How can you show a state surveyor your facility is operating safely?
1. Staff Education and skills up to date
2. Water checks completed per policy
3. Clinic audit checklist are completed
4. Fire/Disaster drills completed
5. Action Plans in place and up to date in QAPI
What metrics do you need to be near perfect on (3) and what is a good practice to have at clinic to not get unnecessary deductions?
kt/v, calcium, NHSN BSI
When a patient transfers, discontinues, recovers or dies complete the ecc discharge assessment in a timely manner.
What valuable information does the fluid dashboard have on it? Name 5 things. (there are several)
A1C, UFR, signs of hypervolemia present, pre and post weight, pwv, IDWG, symptoms during tx, bp meds, meds that increase thirst, meds that cause hypotension. lowest bp during tx.
According to the CVC algorithm if a pt refuses access what do you do?
Patient refuses Access or PD – Schedule quarterly education: Caring for your Lifeline to Last a Lifetime & Selecting a Treatment Option Patient Sign Permanent Access Declination Form Document in TAC Proper: 1. Incomplete Appointments 2. Rescheduled Appointments 3. Patient Education