The Medical Education Institute is presenting a new online CE course for nurses on starting a home dialysis program. For details see https://mailchi.mp/meiresearch/lifeoptionsckdvisitors-1825697?e=a18a44c540.
As an example of new regulations that allow utilities to preemptively shut off power to areas with high temperatures, low humidity, and high winds, Southern California Edison has announced that it may shut off power to parts of the Coachella Valley later this week (July 2-4, 2019); see https://www.sce.com/outage-center/major-outages. Different regulations apply to different areas, depending on perceived risk, as defined by the California Public Utilities Commission. You can find a good summary of these issues, including a map of the areas most likely to be impacted, at https://microgridnews.com/california-utilities-plan-power-shutoffs-to-avoid-2019-wildfires/. While these issues currently apply to California, they may soon also apply to Network 16 states.
Dialysis facilities are already required to be prepared for power outages, though many facilities share backup equipment because outages have been more local in the past. Facilities will want to review their backup power plans to include preemptive outages and consider whether sharing backup power equipment is still practical when all nearby facilities have also gone dark. Dialysis facilities with patients on home dialysis modalities, particularly home hemodialysis, will want to assure that all of their patients have access to adequate dialysis even if power is out for a week or more, which could occur if hot, dry, windy weather persists in an area. Facilities will also want to assure that their home patients are well trained in how to respond to preemptive outages. The occurrence of preemptive outages is intended to be announced by utilities in advance, but if weather changes rapidly, or individuals are difficult to locate, it may not be possible to notify everyone before the fact, so facilities may want to develop their own phone trees or other strategies, being mindful of HIPAA.
Since dialysis is not the only situation where patients and facilities are vulnerable to preemptive power outages, it may be helpful to coordinate with your county or regional Healthcare Coalition; see https://www.kcercoalition.com/en/resources/professional-resources/cms-emergency-preparedness-rule/state-healthcare-coalitions-list/california-healthcare-coalitions/ for contact information, or check with your county Health Department (Tulare, King, Kern, Orange, and Riverside Counties are absent from the KCER list). CMS requires all facilities to report to their Network any lapse in the ability of patients to have access to dialysis because of emergency events; for details see https://nwrnbulletins.wordpress.com/2019/06/04/notify-network-of-emergencies/.
A few resources that may be useful for facilities and patients in this context:
The Renal Support Network has published a podcast on Tips for Home Dialysis Success. Find it at https://www.rsnhope.org/kidneytalk/tips-for-home-dialysis-success/. This website also includes links to a Spanish version, to the Home Dialysis Central blog, and to a number of previous kidney-related podcasts.
The ANNA Special Practice Networks have published a series of several-page Fact Sheets on a number of topics:
- Peritoneal Dialysis Fact Sheet at https://www.annanurse.org/download/reference/practice/pdFactSheet.pdf.
- Pediatric Peritoneal Dialysis Fact Sheet at https://www.annanurse.org/download/reference/practice/pedPDFactSheet.pdf.
- AKI Fact Sheet on Clinical Issues at https://www.annanurse.org/download/reference/practice/akiClinicalFactSheet.pdf.
- AKI Fact Sheet on Financial/Payment/Billing Issues at https://www.annanurse.org/download/reference/practice/akiFinancialFactSheet.pdf.
The National Forum of ESRD Networks has introduced or updated several Medical Advisory Council (MAC) Toolkits. Two new Kits include the Transplant Toolkit and the Medication Conversion Toolkit. The Transitions of Care Toolkit was updated in mid-April. Find them all at http://esrdnetworks.org/resources/toolkits/mac-toolkits-1, along with the existing Home Dialysis Toolkit, Medical Directors Toolkit, QAPI Toolkit, Medication Reconciliation Toolkit, Catheter Reduction Toolkit, Vaccination Toolkit, and Assurance of Diabetes Care Coordination Toolkit.
MEI’S Home Dialysis Central blog has published a post on Emergency Planning for Home Dialyzors. Find it at https://homedialysis.org/news-and-research/blog/302-emergency-planning-for-home-dialyzors.
The ESRD National Coordinating Council will host four January webinars to introduce 2019 QIA projects, all to be held at noon PST. Find more information and register at the links provided:
- BSI January 8, 2019, https://esrdncc.org/en/events/2019/january-2019/bsi-qia-lan/.
- Home Dialysis January 15, 2019, https://esrdncc.org/en/events/2019/january-2019/home-modality-qia-lan/.
- Transplant, January 22, 2019, https://esrdncc.org/en/events/2019/january-2019/transplant-qia-lan/.
- Patient Experience of Care, January 23, 2019, https://esrdncc.org/en/events/2019/january-2019/patient-experience-of-care-peoc-lan/.