CMS SOM App. H, Tag V629

Adequacy of dialysis.

Interpretive Guidance § 494.110(a)(2)(i):

The intent of QAPI in addressing adequacy of dialysis is to maximize the number of patients who

achieve the goals for adequate dialysis, which include both successful fluid volume management

and clearance of toxins.

To identify opportunities for improvement and track progress in adequacy of dialysis for its

hemodialysis and peritoneal dialysis population, the IDT should:

• Review aggregate patient data;

• Identify any commonalities among patients who do not reach the minimum expected

targets;

• Develop a plan to address those causes;

• Implement the plan;

• Monitor the effectiveness of the plan; and

• Adjust portions of the plan that are not successful.

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The IDT must use current professionally-accepted clinical practice standards as target values.

Refer to the Measures Assessment Tool (MAT) provided which lists these standards. If a data

report shows that the facility’s ranking for hemodialysis adequacy is below the expected

average, the facility must demonstrate QAPI review of global factors that might affect adequacy,

e.g. missed/shortened treatments, less-efficient dialyzers, and failure to achieve the ordered

blood flow rates.