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“ Standardization of Guidelines for the Non-dialysis Renal Patient Receiving Erythropoietin” “confidential:quality improvement Material”

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Presentation on theme: "“ Standardization of Guidelines for the Non-dialysis Renal Patient Receiving Erythropoietin” “confidential:quality improvement Material”"— Presentation transcript:

1 “ Standardization of Guidelines for the Non-dialysis Renal Patient Receiving Erythropoietin” “confidential:quality improvement Material”

2 Team Members Cathy Knowski RN Jan Schroeder RN Dian Gruber RN Rita Guenther RN EPIC Marybeth Harms RN Finance Donna Morin Production Support Jan Boykin Patient Finance Renal Department MD’s “confidential:quality improvement Material”

3 Background ErythropoeitinErythropoeitin is a high potency stimulating factor for the creation of red blood cells for the treatment of anemia. “confidential:quality improvement Material”

4 Background ErythropoeisisErythropoeisis-stimulating agents increase the risk for death and for serious cardiovascular events when administered to target a hemoglobin of greater then 12/dl 1. In non-dialysis patients with CKD receiving ESA therapy, the selected HGB target should generally be in the range of 11-12g/dl.(Clinical Practice Guidelines) 2 1.http://wwwext.amgen.com. Prescribing Information Medication Guide http://kidney.org/professionals/KDOQI/guidelines.anemia.”NKF KDOQI Guidelines” “confidential:quality improvement Material”

5 Project Aim Statement erythropoetinThe goal of this project was to standardize the guidelines for the safe and effective administration of erythropoetin (as determined by lab value) to the renal patient. To ensure proper coding for the medication and increase reimbursement to 100% “confidential:quality improvement Material”

6 MAGNET FORCES OF MAGNETISM Force # 7 Quality Improvement “confidential:quality improvement Material”

7 Measurement of Success Decrease the number of reimbursement denials due to incorrect coding Increase appropriate ordering and administration of this medication to current guidelines Decrease the number of days between hemoglobin and administration of medication “confidential:quality improvement Material”

8 Timeline

9 Aranesp Held “confidential:quality improvement Material”

10 Denials For Inappropriate ICD9 Codes “confidential:quality improvement Material”

11 Number Of Patients Medicare Payment Denied “confidential:quality improvement Material”

12 Solutions Implemented Obtain Hemocue Machine for onsite Hemoglobin –Increases timeliness of the test –Less cost to the patient (hemocue is less expensive then CBC) –Faster turn around time for patient –Greater patient satisfaction with point of care service “confidential:quality improvement Material”

13 Solutions Implemented Educate staff RN’s on the use of the hemocue machine and QA monitoring of these RN’s Redesign nurse visit schedule sheet to prompt nurse to perform hemocue Build Hemoglobin/Hemocue flow sheet into EPIC lab Monitor ICD-9 codes prior to administration of medication “confidential:quality improvement Material”

14 Solutions Implemented Collaborated with the Renal MD’s to obtain best practice parameters Build Epic Smart Phrase into orders to include medication dose, parameters for holding medication,when to notify MD and for frequency of Hemoglobin. Educate MD’s on coding for Renal patients “confidential:quality improvement Material”

15 Analysis Frequency of hemoglobin prior to medication has increased to met guidelines % of medication held above 12g/dl has slightly increased in keeping with guidelines % of denial for reimbursement decreased thus increasing revenue “confidential:quality improvement Material”

16 Outcome Obtaining the Hemocue machine allowed for a more timely process with immediate HGB results We need to collaborate with the lab so patients do not have a hemocue the same day as a CBC (double charges) Educating the nursing staff and the MD’s needs to be reinforced including the use of the EPIC Smart Phrase Having parameters has brought about a more efficient process for nursing to administer this medication safely “confidential:quality improvement Material”

17 Continue to Educate Staff Nurses and MD's of most current best practice and documentation Incorporate guidelines with parameters across the GI and Hepatology Service for the administration of erythropoeitin Our next goal is to have all renal patients have same day hemoglobin prior to the administration of this medication What Now?? “confidential:quality improvement Material”


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