ComprehensivemultidisciplinarypatientassessmentfrmComprehensive Multidisciplinary Patient Assessment / ANNA & NKF Version: 7/22/08 1American Nephrology Nurses Association Introduction to the CMPA The Department of Health and age (CfC) for End-Stage Renal Disease (ESRD) Facilities on Aprthe final publishing of the CfC l Kidney Foundation (NKF) and American Nephrology Nurses Association (ANNA) to estguidelines to assist facilities in complying with the requirement for a comprehensive, individual assessments by each
The latter of 30 calendar days or 13 outpatient hemodialysis sessions beginning with
3 months after the completi At least annually for stable patients
At least monthly for unstable patients, including but not limited to, patients with the following:
Extended or frequent hospitalizations;
Marked deterioration in health status;
Significant change in psychosocial needs; or
Concurrent poor nutritional status, unmanaged anemia, and inadequate dialysis.Initial and annual assessmassessments.
When a patient's unstable status triggers a new assessment, the reassessment will likely be more narrow in focus.
However, the reassessment needs to include some review patients dialysis prescription must be Hemodialysis Patients: At least monthly by calculating an equivalent
At least every 4 months by calculating delivered weekly Comprehensive Multidisciplinary Patient Assessment / ANNA & NKF Version: 7/22/08 2The CMPA must consist of the following minimum Evaluation of current health status and medical condition, including co-morbid
Evaluation of the appropriateness of the dialysis prescrip Laboratory profile, immunization hi Evaluation of factors associated with anemistores, and potential treatment plans for administration of erythropoiesis-stimulating agent(s)
Evaluation of factors associated with renal bone disease
Evaluation of nutritional
Evaluation of psychosocial needs by a social worker
Evaluation of dialysis accee, arteriovenous fistulas,
Evaluation of the patients abilities, intein the dialysis care process; the preferred modality (hemodialysis or peritoneal dialysis) and setting (for example, home dialysis), and the
Evaluation of suitability for a transplantation referral, based on criteria developed by the transplantation referral, the basis for nonreferral must be documented in the patients
Evaluation of family and other support systems
Evaluation of patients current physical activity level
Evaluation for referral to vocational and physical rehabilitation services The interdisciplinary team is responsible for the completion of the assessment.The team, as ing the patient for ESRD, a social worker and a dietitian
facility and treatment team will individually determine who is responsible for completing the remaining criteria based on thei expertise, and organizational d consult with each other in the process of completing the and to aid in the development of an effective plan of care.
For responses noted in shaded boxes it is anticipated that the item will need to be addressed in the plan of care.
Comprehensive Multidisciplinary Patient Assessment / ANNA & NKF Version: 7/22/08 3a list of problems.
The care team will create or adjust the plan of care to address the problems identified by the
Specify the services necessary to address the patients needs identified in the
Include measurable and expected outcomes
Include estimated timetables to achieve outcomes
Contain outcomes consistent with current evidence-base professionally-accepted The example assessment questions have been designemeasurement of progress, the use of evidenced-based assessment tools, and the engagement of the patient in the assessment process.
This example is in no way intended as the absolute sibility to meet the ilities.It is expected facilities will modify the documentation systems.intended to provide examples of the types of questions that physicians, registered nurses, dietitians, and social workers he requirements for a CMPA.
the questions have not been confirmed.dynamic process.
This document reflects the
of its version date.Please confirm with NKF procedures provided by dialysis providers to their facilities.Please check with your dialysis implementing any information provided here.Comprehensive Multidisciplinary Patient Assessment / ANNA & NKF Version: 7/22/08 4Reason for Assessment Complete for each assessment R1.
State Reason for day
Annual (stable patients)
Monthly (unstable patients)
R1a.If monthly, choose reason for unstable status.Choose all that apply.
Hospitalization frequent or extended stay
Marked deterioration in health status
Change in psychosocial needs
Poor nutritional status and unmanaged anemia and inadequate dialysis
Demographics ial assessment only
Preferred first name:
What is the patients date of birth?
What is the patients , transsexual, or other:
What is the patients gender > (2728 CodingWhat is their country/area of origin or ancestry?
What is the patients race? (2728 Coding)
Black or African American
American Indian/Alaska Native
What is the name of Enrolled/Principal Tribe?
Asian What is their county/area of origin or
What is the date of the patients first
What is the date the patient started chronic dialysis at the current facility?
What is the patients learning Multidisciplinary Patient Assessment / ANNA & NKF Version: 7/22/08 5Medical History ial assessment only heart disease:
Angina at rest
Angina on exertion
Angina on dialysis