Situation Station
HD CVC ESRD patient runs 5/1 - 7/18 & expires 7/20/20. Impact July DQI metric?
No, not under the current DQI rules due to expiration
Schedule an intervention if Rule of 6's are not met at ____ weeks post surgery.
4
Full name of our CAAM (spelling must be accurate)
Martha Broersma
CVC In-Use Rate Calculation
Total # of CVC In-Use/Total # of Metric Eligible Patients
Two Part Question:
True or False: Scrubbing the hub is only required prior to placement of ClearGuardHD caps, but optional any time CVC is connected/disconnected from bloodlines such as during line reversal, or if the patient is disconnected during treatment for any reason.
Hub Scrub time is ____ seconds,
False and 15
ESRD PD patient with PD treatments in April & May at Facility A, becomes CVC ICHD patient at Facility B with first HD run 6/30/21.
When and which facility (A or B) will patient impact CVC DQI metric?
Requires 3 consecutive months with a DQI assigned modality of ICHD or HHD. In this scenario, they’d probably be assigned to ICHD in July so the clock starts in July and would first become eligible at Fac B in September.
Policy: Cannulation of New Arterial Venous (AV) Fistula” says to start with ____ gauge for first ____ weeks; BFR not to exceed _____ml/min.
17; 2; 250
CVC In-Use rate accounts for ____% of DaVita ICHD DQI
20
3 EXLCUSION reasons for CVC In-Use rate not counting towards DQI
AKI, PEDS, Visitor, Inactive in SNAPPY; less than 90 days; PD Modality Assignment; Interruption of Service
Use the ‘Rule of 6s’ to determine if an AVF is mature
<0.6 cm deep; >0.6 cm wide; >600 ml/min
AKI CVC patient starts 3/15/21, turns ESRD 5/30/21. When will patient impact CVC DQI metric?
90 days from FDODD is 6/13, 90 days from FDODE is 8/28, so they will become eligible in August based on tenure, assuming no other exclusions apply
Pre-Pump Arterial negative pressure, if > ___% of BFR result indicates insufficient access blood flow. If Arterial Needle is well tolerated cannulate with Venous Needle note Venous Pressures, if >____% of BFR result indicates outflow resistance check for Stenosis
50;50
October Preliminary Month End CVC Rate (Region)
15.33%
The INCLUSION criteria to be consider metric eligible
greater or equal to 90 days from FDODD or DRCDB
This is the cause when CVC arterial limb has insufficient inflow (pulling) but tolerates infusion (pushing)
Fibrin Occlusion
HD CVC/AVF ESRD patient has AVF cannulated with 2 needles on 7/20/21, but access infiltrates and the AVF needs to rest for 2 weeks and CVC only is used for the rest of July. Impact July DQI metric?
Yes, only looking at the access used in the last treatment of the month
Two important steps data steps to ensure CVC is permanently removed in our systems
1. Removal event in SNAPPY
2. D/C orders for CVC lumen locks per physician order
CVC In-use rate accounts for ____% of 5 Star rating
40
The assessment period for CVC In-Use
Last 1M ( in use for the month reported, but looks back a prior 3 months for consecutive use)
NOTE: Not a 3 month rolling average
List the # of supplies needed for a Standard CVC Kit (Initiation/Put-on):
Chux; Sterile Gauze Pads (4x4); Sterile Gauze Pads (2x2); Alcohol Prep Pads; 1.5 Roll of Single use tape; 10 ml syringe without needle; 10 ml prefilled syringes; Germicidal/antiseptic solution or swab
8 items listed above
2; 1; 1; 4;1;2;2; 1
HD CVC ESRD patient starts 4/30/20 at Fac. A, patient goes on vacation and runs 3 weeks (Aug.12th - Sept 4th) at Fac. B. (Pt. listed as a visitor in Reggie) Which facility (A or B) will patient impact CVC Aug. DQI metric?
Complicated. It would depend on the DQI Facility Assignment rules and the number of treatments. Most likely scenario is the patient would retain the Fac A assignment for August. They would likely not be eligible for the Visitor (<13 txs over 90 days) exclusion if they treated regularly at Fac A previously so Fac A would be impacted.
List all AVF/G Pathway Steps to CVC Removal (in order)
1. Access Education
2. Vessel Mapping
3. Surgical Evaluation
4. Surgery
5. Maturation
6. Cannulation
7. CVC Removal
CVC exit site infection may be characterized by these 3 observations.
Erythema
Tenderness
Induration in the tissues overlying the catheter and > 2 cm from the exit
The # of times glove changes should occur, per policy, when performing (initiating) CVC care (do not count termination.)
4-5 times (If patient mask needs adjustment at start of treatment that would require separate glove change)
___% fewer infections in patients without a CVC vs. alternative access.
38