Recovered file 1

1. Hospital Based Hemodialysis Unit: Phosphorus Initiative Tara DeGros NUR 610

2. Patient Demographics Department Number of Patients Hemodialysis 98 Peritoneal Dialysis 15 In house Acute Patients Varies

3. Patient Demographics Age Population % < 71 years old 52.2% 71-80 years old 31.0% 81-90 years old 16.8% Primary causes of CKD among this population: - Diabetes - HTN - Multiple comorbidities

4. Background Pts with compromised renal function are at greater risk for: Elevated phosphorus levels, decreased vitamin D levels, decreased calcium absorption and increased PTH levels. Abnormal mineral metabolism and bone dysfunction which contributes to significant Cardiovascular disease Significant bone loss and blood vessel calcification Bone fractures, breaks, chronic back and leg pain

5. Background Adults receiving chronic hemodialysis exhibit higher mortality rates compared to the age matched general public, with cardiovascular disease being the most common cause of death Cardiovascular disease has been linked to mineral imbalances which results in coronary calcification

6. Background Normal functioning kidneys remove excess phosphorus levels in the blood 70% of dietary phosphorus is excreted in the urine Dialysis pts are required to take a phosphorus binder with every meal Pts are also asked to eat a diet low in phosphorus in addition to taking oral binders

7. Project AIM To increase the target threshold for phosphorus compliance from the current quarterly average of 49.1% to the >61.2% issued by the Centers for Medicare & Medicaid Services (CMS), by December of 2015 among our Chronic Hemodialysis population.

8. Dialysis Department Dashboard Quality Measures Target % Hemodialysis unit Adequacy KT/V >1.2 97.6% 97.9% Anemia Hgb 10-11 g/dL %

Recovered file 1

Education

elevated phosphorus

excess phosphorus levels

phosphorus compliance

dietary phosphorus

phosphorus binder

background pts

years old

urine dialysis pts