QAPI Resources: SUNY Downstate's QAPI rules

ebaumann

SUNY Downstate Parkside Dialysis Center
710 Parkside Ave.
Brooklyn, NY 11226

The following applies to any patient appearing in our QAPI:

1. No personal information on any patient will be discussed.

2. No identifying information that relates or could connect to a particular patient or a staff member shall be discussed when a patient representative is present.

3. Patient representatives are given first priority in QAPI and they need to share their positive and negative experiences during the preceding month.

4. The Nurse Manager on the floor for the shift when their patient representative is going to be present in QAPI needs to be present for the meeting. Such schedule would be made a year ahead of time.

5. Patient representatives are rotated every month. One representative is present from each shift in each month. So, by 8 months (M/W/F and T/T/S) all representatives would have experienced what a QAPI is all about and how important their presence is to this process.

6. QAPI should serve as a platform to address big issues and not minor individual and personal concerns. For that we have the grievance process. Patient representatives need to help redirect what the focus of improvement in QAPI should be that concerns patients directly.

7. The role of the patient representative is to voice any general comments, concerns "top of list" issues that matter to most patients on dialysis. Such issues may be related to facilities structural problems, massive late arrivals and late discharges, delays in being placed on the machines constantly, recurrent water and/or blood spills if being ignored, temperature conditions and comfort levels of patients affecting many patients chronically, chronic noise and alarm issues, chronic poor staff behavior towards them, lack of respect by staff members towards them, preferential treatment of some patients over others chronically, use of cellular phone while providing direct patient care repeatedly by any specific staff member, overall hygiene of the facility, infection control issues and staff breaking infection control rules, cleanliness of the machines, vaccination questions, lighting issues, reasons for patients refusing vaccinations, awareness of emergency preparedness, awareness of access to critical staff members in emergencies, awareness to report a change in patients contact information, education on renal diet inclusive of what a low salt, low potassium and fluid restrictive diets consist of, awareness that eating while being on dialysis is not permitted due to risk for aspiration, front desk greeting behavior, waiting room area cleanliness, temperature conditions in waiting area, foul smells in the unit, awareness that patients are not supposed to throw gloves, pads, dressings, or any solid materials down drain lines and commodes, but trash it in bins, awareness of all options for renal replacement therapies such as home dialysis, transplant listing process, transplant referral process, any particular comments about AV access follow up's and cannulation by any staff members, any input that they feel some staff are not competent, etc.

8. Any suggestions for further improvements that will make their visit to our facility enjoyable, calm and comfortable.

9. Any suggestions that they feel need more education on particularly on Insurance changes, Medicare or Medicaid rules, travel rules and requirements, etc.

10. Awareness what can constitutes an Involuntary Discharge process, inclusive of non-payment of co-payments, or threats to staff members and any are provider, etc.

11. Awareness of Health Care proxy requirements and updates as well as DNR status is needed by dialysis facilities including awareness that palliative care and end of life decisions are important and for such a referral to SUNY DMC is required. Awareness that dialysis facility cannot entirely adhere to DNR request but only when an event happens, basic CPR will still be done and patient will be transferred to a hospital, and that only the hospital can enforce the full DNR policy. This is because dialysis facility is not equipped not does it have room to store bodies and is not a morgue, and full declaration of death can only be accomplished by experts and a team in a hospital. But dialysis facilities still need a copy of their DNR forms if one had been done and it needs yearly renewal/assessment if plans change.

12. Patient representatives in their assigned shifts need to greet and meet new patients starting their treatments and advise them on options, transplant referral process and AV access care, resources available to them for proper diet, requirements to be adherent to dialysis sessions, and requirements that communications between them and their direct care provides must be maintained at all times even when they are hospitalized or going for any procedures.