Adequacy
What is ICHD and PD Minimum Adequacy
spKt/V for 3x/week frequency
stdKt/V at 4x/week
PD Kt/V
spKt/V at ≥1.2, for 3x/week frequency
stdKt/V at ≥2.0 for >3x/week frequency
PD Kt/V at ≥1.7
How many points is CVC in Use in 2025?
35 points
TOC
Target weight assessment completed by...
Medication review completed by.......
Within 2 tx for ICHD or 5 days for Home.
Within 7 days of discharge.
Miss treatments due to No Show is monthly rate (L1M) or 3 month rolling rate (L3M)?
a 3 month rolling rate (L3M)
Name at least 4: What factors influence KT/V
• Correct blood flow • Correct needle size (gauge of needle should match the blood flow) • Evaluate needle site placement: tips 1.5” apart • Heparinization process • Access function assessment • Correct Dialysate flow • Correct dialyzer size Full time (ensure that dialysis Rx is delivered as ordered and encourage compliance) • Prevent alarms that effect treatment time: replace bicarb/bicart before treatment
What patients are excluded from CVC in use DQI metric?
AKI, Pediatric, Visitors, Inactive patients (based on CWOW inactivation), PD Modality Assignment, Interruption of service.
Must be ≥90 days from both FDODD and DRCDB
What is the definition of Readmission?
Any hospital admission within 30 days of a prior discharge
Are new patients, regardless of whether or not they are in their first 90 days, included in the missed treatment rate for DQI?
Yes or No
New patients are indeed includedi in the existing DQI missed treatment metric. They also count in the readmissions and hospitalizations metrics. It does NOT matter if those patients are day 1, day 35, or day 122. Making every treatment is absolutely critical for our new patients in order to start them off on the right foot and reduce their risk of hospitalization.
CVC, adequacy, and several other DQI metrics exclude these<90day patients.
How many points is ICHD Adequacy in 2025?
15 Points
New AVF Maturation Evaluation - What is the rule of 6's?
6-8 week postop check
Access blood flow >600ml/min - determined by ultrasound
Diameter of vessel >0.6cm
Depth below skin <0.6cm
What is Hospital Definition?
If discharge records available – document as indicated in discharge summary (Admit vs. Outpatient ER Visit).
If discharge records NOT available – document as Admission if >2 midnights; Outpatient ER Visit if <2 midnights
Facility Level BDP's
Name at least 4 BDP's that can help ensure teammates are prepared to manage, document, and track missed treatments.
Weekly: o Validate HMT data by reconciling patient treatment log, HMT, and DQI report for errors o Ensure that new ‘frequent missers’ patients are being discussed in Core Team meetings o Utilize the No Show Scoreboard to set facility goals and review progress with FA Monthly: o Support team in completing missed tx documentation and HMT data validation by deadline (EOD 2 nd Monday of following month) o Work with FA to monitor facility’s missed treatment metrics using HMT & DQI reports. ▪ Use Missed Tx Playbook activities to support improvement efforts when appropriate o Debrief with FA after FHM meeting to identify missed tx follow-ups o Ensure ‘frequent misser’ patients are engaged (MSWs and RDs may be leveraged to support these patients given their skillset) Quarterly: o Lead or ask FA to lead a Missed Treatment Homeroom from the Missed Treatments Webpage Holidays: o Work with FA to implement Holiday Planning BDPs o Proactively engage all patients to help with rescheduling, especially those that missed treatment during the holiday the year prior (list will be provided by email to FA prior to holiday)
Kt/V is a measure of dialysis adequacy
What does KT/V stand for?
K= clearance—the amount of urea your dialyzer can remove (liters/minute)
T= time—the duration of treatment (minutes)
V= volume—the amount of body fluid (liters)
What does B.E.S.T.I.P.S. stand for?
bleeding, erosion, stenosis, thrombosis, infection, pseudoaneurysm/aneurysm, steal syndrome
What is the day when final Hospitalizations and Missed Tx (HMT) data must be entered.
No later then the end of the second Tuesday of the month?
Miss treatments affect ____ % of Five Stave and ___% of QIP.
Missed treatments affect 30% of Five Star and 18% of QIP.