Pain Awareness Month

September is Pain Awareness Month.  CMS is committed to reducing opioid misuse by promoting person-centered care that encourages safe and effective pain management including opioid and non-opioid pain treatments.  Medicare Part B helps pay for physical therapy, occupational therapy, manual manipulation of the spine (when medically necessary), and behavioral health services like depression screening, that may help your patients manage their pain.  Prescription pain drugs can also be used to help relieve moderate-to-severe pain.  For More Information see:

NW16 9/12 Quality Conference Early Registration

Late fees take effect on September 12 for the 2019 Comagine ESRD Network 16 Annual Quality Conference, to be held September 19, 2019 in Des Moines WA.  Among other issues of interest, the Conference will include a session, led by a patient who dialyzes at home, on the importance of patient engagement, dialysis without pain, and teaching how to operate a home dialysis machine.  Other topics include Care Transitions, Staff Concerns, Best Practices, Patient Perspective, Transplant, and Patient Safety.  Six continuing education credits will be available to all facility staff.  Register for the conference at kwkrab, and find full details at

NW16 9/19 Quality Conference

The September 19, 2019 Comagine ESRD Network 16 Annual Quality Conference will be held in Des Moines WA. Topics include Care Transitions, Staff Concerns, Best Practices, Patient Perspective, Transplant, and Patient Safety.

The session on Staff Concerns, for instance, will be led by a psychiatric mental health nurse experienced at speaking on burnout prevention, resilience, patient/family experience, and effective management.  She’ll be talking about empowering staff to seek joy and satisfaction, personal triggers and coping, and effective leader-staff relationships.

Six continuing education credits will be available to all facility staff.  Register for the conference at kwkrab, and find full details at

NW16 8/25 NKF/PKG Wellness Fair, Free BBQ Picnic

NKF and the Portland Kidney Group will present NKF’S Annual Kidney Wellness Fair & BBQ Picnic in Portland OR on August 25, 2019, featuring wellness exhibits, an art show, resources, prizes, and a free BBQ lunch.  Volunteers to help arrange the festivities are requested.  Find full details and registration information at

Fire Weather Preemptive Power Outages

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  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  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 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

A few resources that may be useful for facilities and patients in this context:

8/7 CCCC Webinar on Medical Cannabis

The Coalition for Compassionate Care of California will present an August 8, 2019 webinar on Medical Cannabis: Patient Education for Safe and Effective Use.  Continuing Education credits are available for nurses and social workers.  For details and registration see

Diabetic Foot Care

A recent study published in the American Diabetes Association’s (ADA) journal Diabetes Care ( using 2000-2015 USRDS data has shown that the rates of nontraumatic lower-extremity amputation (NLEA) among adults with ESRD and diabetes fell 44% between 2000 and 2013 from 7.5 to 4.2 NLEA per 100 person-years, while NLEA among ESRD patients without diabetes declined 31% over the same period, from 1.6 to 1.1 per 100 person-years.  Both reductions were highly statistically significant.  However, both rates flat-lined after 2013.

We want to stress the importance of improving patient and staff education on diabetes self-management and preventive foot care, in order to resume the reductions in these rates.  CDC’s recommendations on diabetic foot care can be found at  The ADA’s input is at in English and in Spanish.