February - Long Term Catheter Use Reduction QIA - Track 3: Forum's Toolkit Workgroup
Facility Name and CMS Certification Number:
Select your unit's name and CCN from the drop down list below.
162525 - FMC Midwest Dialysis
162532 - Fresenius Medical Care Dialysis Services Des Moines
162535 - Fresenius Medical Care Dialysis Services Des Moines South
162538 - Fresenius Medical Care Ottumwa
162546 - LE MARS AREA DIALYSIS SERVICES
162556 - FMC Cline Family Dialysis Center
172506 - Renal Care Group - Hays
172507 - FMC - Pittsburg Midwest
172515 - Renal Care Group - Liberal
172531 - Renal Care Group - Newton
172547 - RAI - Parallel Parkway - Kansas City Dialysis
172558 - FMC - Fort Scott
262548 - FMC - Joplin East
282520 - RAI Care Center
282521 - RAI Care Center - Ames Ave
282532 - FMC - Nebraska Home Dialysis
Use the drop down box to select the month you want to report your data.
Form Submitted By:
Enter the name of the person completing this form.
Enter the email address of the person completing this form.
Enter the phone number for the person completing the form (in case the Network has any questions on your data)
Reduce the use rate of long term catheters in select dialysis facilities by focusing on the Forum of ESRD Network's Catheter Reduction Toolkit.
A "long term catheter" is defined as a catheter in use as a hemodialysis patient's access for 90 days or more.
Monthly Surveillance Questions
the number of patients using a catheter as their vascular access (for 90 or more days) as of the patient's last hemodialysis treatment of the month
total number of hemodialysis patients receiving treatment at the dialysis facility as of the last hemodialysis treatment of the month (total facility hemodialysis patient census)
#3) Share with us your participation with the kick off of this project in February
select one from the options below
Attended one of Kick Off Webinars held in February
Downloaded and reviewed the Kick Off Webinar PowerPoint Slides
Watched / Reviewed the Kick Off Webinar recording (online)
Send me a copy of my responses
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