National Kidney and Transplant Institute

Contents 1

Organizational Profile

26

Core Services

46

Accreditation and

10

High Immunosuppression Care Unit (HICU) The first and only Hematopoietic Stem Cell Transplant Unit in a government hospital in the country that adheres to the requirements for a protective environment for the hematopoietic stem cell transplant patient.

Recognition 56

Quality and Safety Programs

78

Corporate Social

35

Responsibility 92

Center for Urology and Men's Health The CUMH is a one of a kind hospital within a hospital center that delivers the best and latest in the field of urology and men’s health.

Patient Engagement and Education

104

Emergency and Disaster Preparedness

110

Social Development Programs

114

47

Healthcare Asia Awards 2019 NKTI receives two awards from the Health Care Asia Awards this year.

Appendix

National Kidney and Transplant Institute Public Information Office © 2019

106

Managing a Leptospirosis Outbreak This year, NKTI takes a proactive approach to managing another upsurge of Leptospirosis cases at the Institute

NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

ORGANIZATIONAL PROFILE The National Kidney and Transplant Institute (NKTI), is a tertiary specialty center and a government-owned and controlled corporation (GOCC), created by virtue of Presidential Decree 1832 by President Ferdinand E. Marcos.

It has a three-fold mission of Service, Training and Research to provide the Filipino people afflicted with kidney and allied diseases with specialized health and medical services.

The NKTI is governed by a set of Board of Trustees (BOT) headed by the Secretary of the Department of Health (DOH) with members composed of one representative each from the Office of the President and Department of Budget and Management, all Undersecretaries of the DOH and with a lawyer acting as Corporate Secretary. Matters pertaining to budget, highend equipment, infrastructure, public private partnerships (PPP) as well as computerization projects, are referred to the BOT for approval.

The Executive Director, who is appointed by the President of the Philippines, manages hospital operations according to its purpose and objectives. Â

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NKTI takes pride in its modern diagnostic techniques: all modes of dialysis, minimally invasive surgery and surgical procedures, most notably, organ transplantation.

NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

HEALTHCARE SERVICE OFFERINGS NKTI is the center for referral of kidney patients from various regional hospitals nationwide and is recognized as the lead agency in voluntary blood services. It is a fourbuilding complex with a 380 bed capacity, and provides 24/7 emergency care, transplantation, hemodialysis, peritoneal dialysis, inpatient and outpatient basic and tertiary medical, surgical, diagnostic, intensive care and rehabilitative services.

It employs one of the region’s most experienced surgical transplant team and is home to the nation’s top transplant program. The Institute has a long and distinguished history of medical excellence with well-trained staff in the treatment of kidney and allied diseases.

It takes pride in its most modern diagnostic techniques, all modes of dialysis, minimally invasive surgery (laparoscopy and percutaneous) and surgical procedures, most notably, organ transplantation.

NKTI also holds the record of the most number of kidney transplants performed in the country since 1983. Other organ transplants have also been done in the institute namely, liver, pancreas, bone marrow and stem cell.

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healthcare service offerings The National Kidney and Transplant Institute (NKTI) is a government-owned and controlled corporation that operates a tertiary medical specialty center specializing in the prevention, diagnosis, rehabilitation and treatment of kidney and allied diseases under a three-fold mission of Service, Training and Research primarily for the benefit of the Filipino people in pursuance of the policy of the State to secure the well-being of the people by providing them with the specialized health and medical services.

At present, NKTI is a four-building complex situated on a 58,899 square meter parcel of land along East Avenue, Quezon City. It has a strategic objective of continuous facility and equipment enhancement, and excellent medical support services.

With 62 state-of-the-art hemodialysis machines, the Hemodialysis Center is capable of doing 4,000 dialysis procedures per month.

Aligned to NKTI’s commitment to healthcare excellence is its continuing expansion and growth both in terms of infrastructure and patient service.

NKTI was the first institution to have Total Laboratory Automation in the Philippines. The Diagnostic Center boasts of state-of-the-art radiology equipment such as a 256 slice Computed Tomography (CT) scan, 3.0 Tesla Magnetic Resonance Imaging (MRI), a cardiac catheterization lab using the advanced Allura XPER FD 20 machine, the Epic 7C 2D/3D transthoracic and transesophageal echo machine and digital mammography machine.

Information technology uses the Medsys Clinical Communications Module which shows the end user results of all laboratory, imaging and pathology.

Radiology uses the Picture Archiving and Communications System (PACS).

The newly acquired Positron Emission Tomography-Computed Tomography (PET-CT), Cyclotron equipment, linear accelerator and automated vacuum assisted mammotome aim to enhance the institute’s cancer diagnostic and treatment capacity.

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healthcare service offerings Department of Medical Imaging and Therapeutic Radiology (DMITRi) The National Kidney and Transplant Institute - Department of Medical Imaging and Therapeutic Radiology (DMITRi) is committed to provide excellent medical imaging and perform interventional procedures with timely and accurate diagnosis with the least economic impact to its patients. The combination of consultants and staff with the highest level of training in the field of Diagnostic and Interventional Radiology especially for genito-urinary, vascular diseases and organ transplantation and the acquisition of the latest advances in technology makes the Department one of the premier radiology centers in the country today.

Cutting-Edge Technology and Facilities: DMITRi is located at the NKTI Diagnostic Center Building which is a state of the art facility that houses all the cutting edge-technology in today’s modern medical imaging. It is the living “proof of concept” that the government can actually be at par with the private sector in terms of equipment and services, providing access to quality healthcare for all walks of life.

As a commitment in providing the best possible care to its patients, the NKTI has acquired the latest innovations in medical imaging technology in order to support the thrust of the Department of Health in providing access to quality “hi-tech” Diagnostic and Therapeutic procedures for the Filipino people

Computed Tomography (CT) Scan The 256-slice CT scan machine, one of the few in the country and the first in a government hospital, has superior imaging capabilities, allowing accurate diagnosis at greater speeds. Because of its 256slice feature, the machine can perform biopsies on nodules that measure less than a centimeter accurately, with minimal risk for complications.

Image post-processing (VRT) facilitates communication to patients and their attending physicians of the nature and extent of the patient's pathology/problem.

The 128-slice Dual Energy is capable of identifying some types of renal stones (stonecharacterization capability). For contrast examinations, Dual energy technology allows the user to skip the non-contrast sequence and go directly to the contrast phase. This will significantly reduce the total radiation dose received by the patient.

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healthcare service offerings Department of Medical Imaging and Therapeutic Radiology (DMITRi)

Cutting-Edge Technology and Facilities:

Magnetic Resonance Imaging (MRI) The NKTI has a 3.0 Tesla MRI machine, one of only a handful in the country and also the first in a government hospital. It is capable of high-level diagnostic capabilities.

Vascular and Non-Vascular Interventional Radiology (IR) The Department offers vascular and nonvascular interventional radiology procedures from simple angiography to cerebral angiography using digital radio fluoroscopy with Digital Subtraction Angiography. IR utilizes minimally-invasive image guided procedures to diagnose and treat diseases in nearly every organ system. The concept behind interventional radiology is to diagnose and treat patients using minimallyinvasive techniques currently available in order to minimize risk to the patient and improve health outcomes.

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healthcare service offerings Department of Medical Imaging and Therapeutic Radiology (DMITRi) Cutting-Edge Technology and Facilities:

Digital Radiography and Fluoroscopy

The Department offers routine x-ray, fluoroscopic studies providing real time imaging of your body, specialized x-ray and interventional procedures. Every special procedure is supervised by a radiologist and verified by a consultant, thereby ensuring quality service. It also provides much lower dose of x-ray exposure compared to conventional x-ray machines.

Digital Mammography System NKTI is the first government hospital to acquire a Digital mammography System capable of high-resolution images and can be utilized to guide invasive & interventional procedures.

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healthcare service offerings Department of Medical Imaging and Therapeutic Radiology (DMITRi) Cutting-Edge Technology and Facilities: General Ultrasound The Department is equipped with the latest innovation in ultrasound technology including 3D, 4D, volume scan, and elastography for breast and liver. It is manned by experienced and competent sonologists. The section continues to lead the way in ultrasound imaging not only within the institution but in the entire country.

Vascular Ultrasound The vascular ultrasound section of the NKTI is perhaps one of the best in the country. It offers a myriad of services, ranging from the color Doppler imaging of the renal graft, to mapping & screening of the upper and lower extremity vessels, to assessment of arterio-venous fistulas, vascular grafts used in hemodialysis, as well as vascular bypass grafts.

Intra-operative / Laparoscopic Ultrasound

The Department is equipped with an ultrasound machine with specialized intraoperative and laparoscopic probes to aid surgeons with surgical planning and decision-making during procedures. It can be wielded as an adjunct to laparoscopic nephrectomy, partial hepatectomy, hepatic segmentectomy, cholecystectomy and pelvic surgery.

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healthcare service offerings Department of Medical Imaging and Therapeutic Radiology (DMITRi) Our Commitment The NKTI is committed to continuously enhance these established healthcare facilities through the acquisition of new technology, medical knowledge and skills. Such medical technology that has grown significantly over the years is on the diagnosis and treatment of cancer. Cancer in the Philippines ranks third in leading causes of morbidity and mortality (Department of Health – Health Intelligence Service, 1992-1996). Moreover, the diagnosis of cancer and its eventual treatment are relatively expensive particularly to those belonging to the lowest quintile.

In support to this thrust, the NKTI embarked to major projects referred to as the NKTI RADIATION ONCOLOGY PROJECT (NKTI-ROP) and NKTI PET CT PROJECT (NKTI-PCTP). Both projects were implemented on a revenue sharing scheme.

The NKTI Radiation-Oncology Section

The establishment of the Radiation Oncology Section is a response of the NKTI to the challenge of providing access to high quality healthcare services. As of October 2015, the DOH has only three (3) hospitals with modern radiation oncology (linear accelerator) facilities – Jose Reyes Memorial Medical Center in Manila, Lung Center of the Philippines in Quezon City and Davao Regional Medical Medical Center in Tagum, Davao. The establishment of a radiation Oncology facility requires huge investments both in infrastructure and equipment.

A study was done in 2012 to ascertain the means of establishing the facility. The project was implemented through a “Public-Private Partnership” on a revenue sharing scheme and started offering its services to the public on October 2015.

The facility is capable of performing the following radiation oncology procedures: A. Radiation therapy procedures: 1. Conventional radiation therapy (2DC) 2. 3D Conformal radiation therapy (3DC) 3. Intensity Modulated radiation therapy (IMRT) B. CT Simulation and Treatment Planning 1. Conventional radiation therapy Planning 2. 3D Conformal radiation therapy Planning 3. Intensity Modulated radiation therapy Planning

A linear accelerator (LINAC) is use for external beam radiation treatments for patients with cancer. It delivers high-energy x-rays to the region of the patient's tumor. These xray treatments can be designed in such a way that they destroy the cancer cells while sparing the surrounding normal tissue (http://www.radiologyinfo.org/en/info.cfm? pg=linac).

The NKTI is the fourth (4th) government hospital to have a modern radiation oncology facility using a Linear Accelerator.

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healthcare service offerings Department of Medical Imaging and Therapeutic Radiology (DMITRi) The NKTI PET CT Section In order to complete the NKTI’s facility in managing cancer patients, the institute ventured into the establishment of a Positron Emission Tomography/Computed Tomography (PET/CT) Section. A PET CT is an advanced nuclear imaging technique combines positron emission tomography (PET) and computed tomography (CT) into one machine. A PET/CT scan reveals information about both the structure and function of cells and tissues in the body during a single imaging session (http://www.cancercenter.com/treatments/pet-ct-scan/).

Like the radiation oncology facility, the establishment of the PET/CT requires massive investment since it typically needs Fluorodeoxyglucose (18FDG) for the procedure. The 18FDG is produced using a Medical Cyclotron which is a separate facility outside the PET/CT. A parallel study was conducted in 2012 for the means to establish a PET/CT facility. The project was implemented through a “revenue sharing” scheme with a revenue 80:20 ratio in favor of the Private Proponent (Khealth Phils Inc.) and started offering its services to the public last November 2015.

The facility is capable of performing the following diagnostic imaging procedures:

1.

2.

3.

4.

5.

6.

Oncologic Oncologic Oncologic Oncologic Oncologic Oncologic

F18 F18 F18 F18 F18 F18

FDG PET/CT Scan FDG PET/CT Scan with Contrast Study Choline PET/CT Scan Choline PET/CT Scan with Contrast Study PSMA PET/CT Scan PSMA PET/CT Scan with Contrast Study

The establishment of the PET/CT facility at NKTI has provided a significant contribution to the society by breaking the monopoly in the healthcare industry in the Philippines for the last 13 years. This endeavour has paved the way to significantly bring down the prevailing market price of availing Oncologic PET/CT procedure, from P150,000.00 down to P50-70,000.00, providing access to quality healthcare for all walks of life.

NKTI’s PET/CT Scanner operates using the largest Cyclotron Facility in the country today.

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healthcare service offerings High Immunosuppression Care Unit (HICU)

Since the first hematopoietic stem cell transplantation (HSCT) in the Philippines in 1990, the number of HSCTs performed in the country remains to be low compared to its counterparts in the Southeast Asian region. One of the main reasons for the delayed progress of HSCT activity in the Philippines has always been inaccessibility due to the prohibitive cost and the limited number of transplant centers in the country. In the last 5 years however, there has been a steady increase in the number of transplants performed, with the opening of 3 new HSCT centers, the latest of which is the HSCT Unit at the National Kidney and Transplant Institute.

HSCT was first performed in the Philippines at NKTI, in 1990. Since then, only 5 transplants were performed in the institute until 2002. In 2014, there was a renewed interest in reviving the HSCT program in NKTI in line with its mandate to be the premiere organ transplant center in the country. The HSCT program revival was highly supported by the Worldwide Network for Blood and Marrow Transplantation (WBMT) and the AsiaPacific Group for Blood and Marrow Transplantation (APBMT).

i g h I m m u n o s u p p r e s s i o n C a r e U n i t ( H I C U ) . T h e Central to the HSCT Program in NKTI is the H HICU is the institute’s Hematopoietic Stem Cell Transplantation Unit, where the preparative regimen, infusion of hematopoietic stem cells, and post-infusion monitoring and care of the patient are conducted.

The HICU is located at the 3rd floor of the main building and consists of four (4) main patient’s rooms, 2 ante rooms, a nurses’ station, medication area and changing rooms. The entire unit follows a cleanroom technology design of ISO Class 5 (Federal Standard Class 100100,000) standard to provide a protective environment to the hematopoietic stem cell transplant patient. Supplies and equipment are of medical grade, and provisions for acute critical care available.

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healthcare service offerings High Immunosuppression Care Unit (HICU) In 2018, construction of the HICU was completed. In the same year, autologous collection and processing of stem cells were performed under the supervision of transplant specialists from St. Vincent’s Hospital- Sydney. In February, 2019, the 1st HSCT patient, a case of Multiple Myeloma underwent autologous HSCT. To date, all 8 patients that have been admitted were successfully transplanted. As a government hospital, the cost of care has been subsidized, with the patients given as high as 80% discount in their total hospital bills.

The High Immunosuppression Care Unit (HICU) of the National Kidney and Transplant Institute is the Institute's Hematopoietic Stem Cell Transplantation Unit. It was a project spearheaded by Dr. Honorata G. Baylon since 2014 to revive the Blood and Marrow Transplantation Program of NKTI. The HICU is the first and only Hematopoietic Stem Cell Transplant Unit in a government hospital in the country that adheres to the requirements for particle count, air exchange, temperature and air pressure of a protective environment for the hematopoietic stem cell transplant patient. Inside the HICU, the preparative regimen, infusion of hematopoietic stem cells, and post-infusion monitoring and care of the patient will be conducted.

The NKTI, is the first and only government hospital in the country to have a hematopoietic stem cell transplantation unit. As such, more Filipinos are now given access to this lifesaving procedure. In the future, the HSCT program in NKTI will include allogeneic hematopoietic stem cell transplantation and other forms of cellular therapy.

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healthcare service offerings

NKTI OPERATING COMPLEX

PROVIDING BETTER CARE WITH THE RIGHT EQUIPMENT

Moving Forward in the Changing Times

The Operating Room Complex remains to be one of the most advanced operating room systems in the country. Key services include kidney and liver transplantations, minimally invasive surgeries and endo-urology procedures on top of general surgical procedures.

EXPANSION In March 2014, the South Wing was opened with seven Operating Theaters equipped with high-technology equipment. The Operating Theater 7 is a full high definition, highly intuitive and ergonomic environment which allows integration of additional devices.

The Operating Theater 6 is equipped ready to be converted to an integrated operating room system.

The West Wing was completed and opened in March 2015 on the other hand, and is composed of five Major Operating Theaters, Nine (9) Recovery Rooms, One (1) Isolation room, One (1) Kidney Transplant Room and One (1) Liver Transplant Room.

The procurement of additional state-ofthe-art medical equipment in 2015 was crucial in complementing the infrastructure improvement, to complete the delivery of medical-surgical services and increase the competitiveness of the NKTI OR Complex.

As a result, the OR Complex is now at par with the best private hospitals in the country in delivering excellent care. This is a step forward in helping NKTI’s goal to be the best and the most equipped public or government hospital in the country.

THE HUMAN FACTOR Truly, the NKTI is well on its way to becoming one of the forces to be reckoned with in the medical-surgical field, and the OR Complex, aligned with the institution’s mission/vision, with its many achievements, is proving to be a key factor in its success.

The completion of the Operating Room Complex enabled the unit to expand its services and support the increase in the demand for surgical procedures among the patients and customers of the Institute.

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healthcare service offerings KARL STORZ

With the rising popularity of minimally invasive surgery, the NKTI acquired state-of-theart Karl Storz OR1 integrated operating room system. The system uses high resolution monitors with touchscreens to access data and perform function like controlling the lighting in the OR and video conferencing.

It has the ability to access information from other parts of the hospital without sending someone to physically retrieve it, thus improving patient care. In addition to making critical information available in the operating room in near real time, the system can be used for real time video consultations and teaching.

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healthcare service offerings Modular Total Laboratory Automation System (TLAS) project The Modular Total Laboratory Automation System (TLAS) project started in 2009 and has benefited both NKTI and the patients it serves in terms of assured quality of services and results as well as operational efficiency in the timeliness of laboratory test results.

With its new-generation trackbased automation, the Clinical Chemistry Section at the NKTI operates efficiently, accurately and systematically.

Furthermore, the TLA system is directly linked to the NKTI’s Hospital Information System (HIS) resulting in faster turnaround times and easy access of results. The system’s interface also allows requests from the nurses’ stations to migrate to the hospital laboratory information system (LIS). This results to error-free transcriptions with minimized manual procedures as a way to streamline the entire workflow.

Our experience shows that the introduction of a robotics system for perianalytical automation has brought a large improvement in productivity together with decreased operational cost. In addition, rush or “stat” specimens are handled quickly and easily. There are also other benefits such as safer working conditions and improved sample identification.

The state-of-the-art diagnostic laboratory was designed based on an intelligent and fully automated analyser which accelerates the laboratory process from charging to request generation of laboratory tests.

The chemistry laboratory services increased from 644,962 in year 2011 to 941,106 in year 2017. This significant increase can, to a certain extent, be attributed to the department's improved operational efficiency and assured quality of results.

benefits of total laboratory automation Improves utilization of laboratory resources, Consolidates multi-discipline testing into a single, fully automated solution, Improves spatial efficiency, tube utilization, or resource allocation making workflow to become more efficient and flexible, Accelerates processing with greater accuracy and precision, Achieves consistent turn-around time, Reduces human error, Has greater test volume capacity with more tests available, Quality results are released in a timely manner, Increased safety for laboratory staff, Environmental-friendly, Cost-effective, and Nonvalue-added steps such reducing sample touch points, manual bench sorting, aliquoting & transportation, and sample reruns are removed.

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NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

Organizational Structure and Governance System VISION, MISSION, and CORE VALUES Vision

Mission

To be the premier center for renal health and transplantation adhering to the highest standards of service, training, and research.

We are a health care institution that provides compassionate and quality care for all patients with renal and allied diseases, urologic conditions, and transplantation.

Core Values

Excellence/ Visionary Service with Integrity and Compassion

STRATEgy map

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Organizational Structure and Governance System Organogram

The 2018 NKTI Organizational Structure provides for the Institution’s hierarchical chain of command, responsibilities and obligations over various cost and service offices, including the degree of liability and accountability. It is a typical horizontal or “topdown” structure that shows the line of supervision and control of the subordinate offices as regards to the overall internal and external transactions or operations of the Institute.

NKTI is under the direct control and supervision of the Board of Trustees for the Four Specialty Hospitals (BOT), headed by the Secretary of the Department of Health (DOH).

The Executive Director is the highest-ranking public official at the NKTI and has four Deputy Executive Directors who are directly responsible for their respective subordinate cost and service centers and offices.

This structure is primarily based on the actual nature and type of organization the NKTI is as a health care institution which involves medical services, nursing services, hospital support services, and education training and research services in relation with its three-fold mission of service, training, and research as mandated by the law and dictates of public health.

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CORPORATE MEETINGS

THE BOARD OF TRUSTEES MEETING The National Kidney and Transplant Institute (NKTI) as a government-owned and controlled corporation (OGCC) and a specialty tertiary hospital operates under the control and supervision of the Board of Trustees (BOT) headed by the Department of Health (DOH) Secretary and its members are composed of all Undersecretaries of the same office and two representatives from the Office of the President (OP) and the Department of Budget and Management (DBM). The body is called the Board of Trustees for the Four Specialty Hospitals and convenes quarterly.

NKTI together with other specialty hospitals such as the Lung Center of the Philippines (LCP), the Philippine Heart Center (PHC), and the Philippine Childrens Medical Center (PCMC), are subject to the Board’s direction and administration wherein acts involving processes such as, budget proposals, infrastructure projects, contracts, intra and interagency transactions, and other dealings requiring the approval and concurrence of the Board.

In this arrangement, powers emanate from the Board and such authority is given to the respective heads of specialty hospitals to discharge its duties and functions in accordance with the will of the latter since liabilities arises from the same.

EXECUTIVE COMMITTEE MEETING (EXECOM) The Executive Committee Meeting is a meeting of the top officials of the Institution which is presided by the Executive Director and attended by the Deputy Executive Directors for Medical Services, Administrative Services, Nursing Services, and Research and Education. The meeting is held every first Monday of the month, and in special cases, the Committee convenes to resolve immediate and emergency matters.

Matters discussed by the EXECOM commonly require policy intervention and implementation such as but not limited to personnel actions, strategy execution, financial management and monitoring, establishing control mechanisms as regards operations and functional procedures, legal frameworks and its application, and all other matters consistent with the mandate of the Institute as a tertiary specialty hospital for kidney and allied diseases.

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CORPORATE MEETINGS MANAGEMENT COMMITTEE MEETING FOR MEDICAL AND ADMINISTRATIVE The Management Committee Meeting (MANCOM) is a meeting attended by middle managers i.e. Department Managers and Division Chiefs of all cost and service centers in the Institute, and presided by the Deputy Executive Directors for Medical Services and Administrative Services separately. The meeting is held every second and third Monday of the month, and the presiding officer may convene anytime should there be an urgent matter to be decided or resolved upon.

Cost and service centers are required to present during MANCOM their performance and targets semi-annually. Said reports are being evaluated whether it is in accordance with the key performance targets of the Institution and determine other factors as to how to further improve and develop systems and processes.

Other matters discussed are individual issues and concerns of each cost and service centers seeking resolution, guidance, and further decision making particularly those involving inter-office transactions, budgeting and other personnel requirements.

Likewise, unresolved issues that require decision from a higher body or those innovative process interventions that needs to be institutionalized are referred to the EXECOM.

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BUSINESS MAP

STAKEHOLDERS

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REGULATORY REQUIREMENTS NKTI is subject to and meets all national and local laws, regulations, and applicable health care accreditation designed to protect and promote health care quality, environmental safety, and occupational health and safety. NKTI also has to fulfill the needs and expectations of accrediting bodies of the medical training programs.

LIST OF ALL REGULATORY BODIES

Needs and Expectancies of Governmental institutions Compliance to regulatory requirements Updated licenses/permits Compliance to required standards On-time submission of reports / remittances

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REGULATORY REQUIREMENTS Accrediting Bodies for Training Programs

Needs and Expectancies Adherence to proper accreditation process and timelines Training programs that meet the minimal requirements for accreditation Graduates will be competent physicians in the respective field All graduates to take the certifying examinations Passing level at par with specialty boards standards

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REGULATORY REQUIREMENTS Suppliers and Partners

Needs and Expectancies Clear terms and reference Compliance to Memorandum of Agreement On-time processing of payments and release of checks

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WORKFORCE PROFILE As of March 2019, NKTI has a diverse workforce of 1,588 workforce (Table 1) composed of 978 permanent personnel, 229 outsourced or Job Orders, 381 inhouse contractual and with security and janitorial complement.

The medical staff are composed not only of “plantilla” consultants, but also of active or rotating consultants without plantilla (see Table 2) who have the privilege of admitting patients and holding out-patient clinics.

Residents and fellows in training are either with a plantilla position as medical officers or with a contract of service also as medical officers.

The residents and fellows in training render active care to patients who consult at the out-patient clinic or at the emergency room, or are admitted in the wards or intensive care unit, or in the dialysis units. Residents and fellows are in close supervision of the consultants when they manage patients.

Table 1. Human Resource Profile

Table 2. Breakdown of Medical Consultants and Residents/Fellows

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NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

REPORT on the INFRASTRUCTURE PROJECTS Build, Build, Build Program To support the need for expansions in the infrastructure component, over the last 2 years, NKTI started work on the following major projects:

1

Peritoneal Dialysis Warehouse facilities

Demand for peritoneal dialysis has exponentially increased with the number of End-Stage Renal Disease. Furthermore, with the Philhealth PD Z Benefit, patients can avail of this treatment modality for the whole year. There is a need for storage of the voluminous fluid requirement of the PD patients who now troop to NKTI. The supply and delivery of PD fluids are tied up with the provision of a warehouse under a contract that fixed the purchase price over a five-year term and the warehouse structure is turned over to NKTI after the contract period.

Procurement is through RA 9184.

Status: The site development is now on-going and the official groundbreaking is set for September 4, 2019. Construction is expected to be finished by....

2

Out-Patient Service Building

The OPD Services building is an 8-storey structure that supports the One-Stop shop concept for OPD patients with more clinics complemented by an ambulatory surgical unit, satellite Pharmacy and Laboratory services. In addition, service patients will be more efficiently serviced by the Medical Social Services Division and other help desks which will be providing services under the Universal Healthcare Law. Status: Phase I of the project (design and project management) has been awarded Bidding for Phase II (construction) scheduled by September when the engineering designs and bid documents are completed.

Funding for the project is supported in part by the DOH HFEP. Procurement is thru RA 9184.

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REPORT on the INFRASTRUCTURE PROJECTS Build, Build, Build Program

3

Medical Arts Building

An important support facility to the expansion projects of NKTI is the Medical Arts Building (MAB) facilities. The MAB is an eight-storey building that will provide medical clinics for NKTI doctors, parking spaces and dormitory facilities for employees (medical and non-medical), and "hospitels" for transient patients and guests.

The project will be implemented under EO No. 301 dated whereby the lot area will be offered to private proponents under a Lease agreement over a period of 20 years. The private proponent will build, operate and subsequently transfer the MAB project to NKTI after the lease period.

Status: Bid proposals had been submitted by interested private proponents and being evaluated.

4

Hemodialysis Services Building

The four-storey Dialysis Services Building aims to provide the advantages of a One-Stop shop in an expanded hemodialysis unit, an ambulatory vascular unit, satellite pharmacy, satellite laboratory and procedures. The project will be implemented through Private Sector Participation under a Supply Agreement that will tie-up design and construction of the building over a 10-year cooperation period. Transfer of ownership follows at the end of the period.

Status: The Business Case Study for the project has been completed, market sounding activities have been conducted, bid documents are for completion and the legal issues on the land is nearing resolution. The project should commence by year 2020.

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CORE services

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RENAL DISEASE CONTROL PrOGRAM (REDCOP) To accomplish its objectives, REDCOP conducts Advocacy Campaigns nationwide to enhance

The Renal Disease Control Program (REDCOP) is the public health unit of the National Kidney & Transplant Institute (NKTI). It was established and turned over to NKTI in 2000 after the completion of the 5 year Preventive Nephrology project of the DOH. It is the only preventive program fully funded by NKTI that undertakes activities and projects nationwide.

The REDCOP aims to promotte the health of the kidneys at the community level and engage the Primary Health Care providers in the early detection and management of CKD to retard its progression.

Over the years, REDCOP received several awards:

awareness about the kidneys, its functions and the dire consequences of kidney disease. It has developed and distributed IEC materials to increase the knowledge of the public and inspire them to care for their kidneys. It also provided training on good presentation skills for the allied medical personnel (nurses, midwives, barangay health workers) on how to conduct advocacy campaigns in their own communities.

In collaboration and in coordination with the DOH Regional Offices, REDCOP conducts educational programs to increase the capacity of its counterparts in the Local government (PHOs, CHOs, MHOs and rural health physicians) in screening and detecting early stages of CKD through proper assessment of simple diagnostic tests and managing these medical

AWARD

YEAR

conditions.

It is also the implementing agency of the Philippine

2001

Grand Prize, Gawad Oscar Florendo Awards for the

Renal Disease Registry (PRDR) of the DOH-

Most Outstanding Public Information Campaign

Epidemiology Bureau that collects data on how kidney diseases are managed nationwide. The data

2004

Gawad Oscar Florendo Awards for the Most Outstanding Information Tool

gathered by PRDR is used to plan the activities of REDCOP and utilized by policy makers and researchers.

Presidential Award by the Phil. Society of Nephrology

2005

(PSN) in recognition of its close cooperation with society for research and public information

2004 Award of Recognition as Best Organizational Unit for the

2006

effectiv and efficient implementation of its various projects that "made a difference" in the improvement of healthcare nationwide.

2010

Phil Council for Health Research & Development (PCHRD) Outstanding Health Research Award (OHRA) for Dr. Enrique T. Ona in Health Services Research Category

201 2012

United Arab Emirates Health Foundation Prize for outstanding contribution to health development World Health Organization

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Division OF ADULT NEPHROLOGY

The Division of Adult Nephrology of the National Kidney and Transplant Institute has active programs in health care services, training in clinical nephrology and research opportunities.

It focuses on multi-disciplinary and result oriented delivery of excellent renal health care system with the help of the department’s work forces that includes topnotch nephrologists trained here and overseas to bring world class health care delivery and mentorship to fellows to grow best, recognized and empowered in the field of renal health care. In order to provide high quality renal health care, the department develops advanced research programs that will impress upon the patients we cater and to the community.

As a training institution, the division upholds creation of globally competitive quality and relevant researches which aims to contribute and apply in the community the benefits of the outcomes.

The program produces fully equipped and knowledgeable Adult Nephrology fellows who prospers throughout the country leading renal health care delivery in their respective provinces.

The division involves units of Hemodialysis, Peritoneal Dialysis, Preventive Nephrology, Kidney Transplantation and General Nephrology with divisions of Glomerulonephritis clinic and Lupus Nephritis clinic.

The division caters to in-patient and out-patients with electrolyte and acid-base disorders, acute kidney injury, glomerulonephritis, urinary tract diseases and chronic kidney disease. As the leading tertiary renal referral center, we prioritize kidney transplant programs that greatly benefit our End Stage Renal Disease patients.

Our newest program, the Preventive Nephrology Clinic serves patients without renal disease and aims to perform disease screening, identification of risk factors and impart the practice of healthy and balanced lifestyle for the prevention of renal disease.

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division OF ADULT NEPHROLOGY As one of the major services of the Institute, the division primes the annual celebration of World Kidney Day and World Kidney Month in cooperation with other active agencies to uplift the advocacy of promoting awareness to a better renal health. The division sponsored medical mission to institutions like homes for the aged, encouraging renal patients gifted in painting for the annual painting contest.

As a specialty hospital in kidney disease, the National Kidney and Transplant Institute annually celebrates the World Kidney Day and it is being attended by more than 100 participants. To promote awareness, understanding on the importance of kidney to overall health, and education to reduce the rise of kidney disease and its associated problems, the celebration includes symposiums on Kidney Health, prevention of kidney disease and to discuss Life after Kidney Transplantation. A free Preventive Nephrology Consultation Clinic is also being rendered for the guests. In order to bring about the advocacy, participants are invited to join the FUN RUN for a healthier kidney, held at the Quezon City Circle and was attended by approximately 200 participants.

Being the lead hospital in the celebration of World Kidney Month, the Institute had a month long activities for the community and environment in line with the theme “Kalusugan ng Bato’y Makakamtan sa Pagaalaga ng Kalikasan”. A Linis Barangay and Lay Forum on Leptospirosis was held at Tullahan River Barangay North Fairview, Quezon City which was attended by the residents. It aimed to promote awareness and education of proper waste disposal and Leptopirosis prevention.

To partake in the advocacy of environmental sustainability in order to reduce greenhouse gas and fight climate change, a tree planting activity was held at the La Mesa Eco Park led by the executive officers of the institute together with its employees.

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THE NKTI HEMODIALYSIS PROJECT A Model for Health of the Public-Private Partnership

The NKTI’s Hemodialysis (HD) Centers were established in 2003 to provide an affordable and world-class outpatient health care service to address the increasing incidence of kidney failure. At that time, the Institute was purchasing its HD machines, and due to its limited capital expenditure was unable to procure a sufficient number of machines to serve the growing demand of patients. Problems with maintenance of the machines and difficulty in ordering spare parts led to a long machine downtime.

The Institute explored the appropriate procurement process that would be affordable by a governmentcontrolled corporation to upgrade the NKTI HD facility into a modern HD center.

The NKTI-Hemodialysis Centers performs more than 4000 treatments each month.

The out-patient HD Center runs at 4 shifts per day and serves about 180 patients daily.

The in-patient Center runs continuously every day, servicing all the dialysis needs of the in-patients, as well as patients from the Emergency Room.

By going through the public bidding process all HD suppliers were given the opportunity to supply 62 HD machines; 46 for the chronic HD Unit and 16 machines for the in-patient HD Unit for a 5year contract. This model resulted in a very successful relationship that is now on its third contract with a HD provider, running for the last 15 years.

The result was to enter into a public-private partnership that would result in a cooperative collaboration.

The NKTI would provide the infrastructure, personnel and utilities, while the private partner would provide all the HD machines, water treatment, dialyzer re-processing machines and all the materials needed to provide the treatment.

CONTINUOUSLY INNOVATIng The NKTI HD Center continues to innovate the terms of reference by adding hemodiafiltration (HDF) with online fluid substitution, as the new standard of care for chronic dialysis service in the Philippines.

Moreover provision for a therapeutic database system collecting data of all dialysis treatments was also included.

It is the pride of the Department of Health, and serves as a model dialysis facility that has been applied by other government facilities in the country.

In addition, it provides the highest standard and safety in HD, providing ultrapure dialysate for all treatments, whether HDF or standard HD. All Filipinos, including the less fortunate are provided the highest standard of dialysis at a most affordable cost.

Other innovations include transferring to the private partner disposal of linen and laundry, discarding of needles, and most recently providing HD personnel. This has allowed the NKTI HD Center to have continuous financial growth.

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PERITONEAL DIALYSIS (PD) PROGRAMS OF NKTI The Peritoneal Dialysis (PD) Unit of NKTI is a critical unit of the hospital. It is divided into the inpatient (CAPD Ward) and outpatient (CAPD Clinic).

One of the programs is the Dialysis Kalinga Program (DKP) which was launched in 2004.

The program aims to provide financial support among all service End Stage Renal Disease (ESRD) patients who require assistance in the commencement of dialysis.

This program has supported the PD First Policy that offers PD as the first option of renal replacement therapy to patients who are suffering from ESRD while awaiting or are found ineligible for a kidney transplant. The program was able to support and initiate an average of at least 40 patients per month on PD.

Another program is the PD Z Benefit of Philhealth which was spearheaded by NKTI. The Philhealth benefit which is P270,000.00 worth of PD supplies and services per year was fully implemented in January 2017.

There are currently 800 patients on PD who are benefitting from this program.

The aforementioned programs provide financial assistance to patients from PD initiation to their PD maintenance.

Thus it is very important to note that through the years there has been an improvement in the outcomes of NKTI PD patients in terms of survival, PD technique survival and PD-related infections. In the studies published by NKTI, the one and two-year survival of patients is 82% and 81%, respectively while the PD technique survival is 71% and 67%.

These results are comparable to the large studies conducted overseas like the CANUSA and ADEMEX trials. In terms of infection rates, significant improvements in PD practices have shown a significant decrease in infection rates which is 55% in the study conducted in 1999 down to 27% in 2011 to 2013.

CONTINUOUSLY EXPANDING A major recent development is the awarding of a 5-year exclusive contract to Baxter Healthcare, Philippines as the hospital’s PD provider. Though the PD Unit is small with only 27 dedicated PD staff members, the PD Unit is ever ready and willing to accept the challenges of personnel and patient training for the conversion of PD patients from the old PD system into the new Baxter PD system.

The future for the PD Unit is looking very bright as NKTI is further expanding its PD infrastructure by building a PD Warehouse that will be known as the NKTI-Baxter PD Center of Excellence. This is another feather on the cap of NKTI and a milestone for the country as the PD Unit continues to evolve and strive in its commitment to provide quality PD services.

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Division of Organ Transplant and Vascular Surgery The Division of Organ Transplantation and Vascular Surgery is the pioneer and premier Transplant Department in the Philippines. From its establishment in 1983 it is still the only recognized Transplant Fellowship Program in the country. Almost 6700 kidney transplants have been performed so far which is more than the total combined procedures of all the other transplant centers in the country.

Surgeons from all over the country who are diplomates of the Philippine Board of Surgery come to the Department for training. As a result, all the Transplant Centers in the country have in their staff a graduate of the NKTI Transplant and Vascular Fellowship Program.We have the only pulse perfusion machine in Southeast Asia and has improved the viability of kidneys from deceased donors

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Division of Organ Transplant and Vascular Surgery Aside from transplantation, an integral part of the services of the Division is its vascular services. With a total of more than 9,000 hemodialysis access procedures in 2018 alone the Institute through the Division delivers the most number of these operation in the whole country, saving thousands in acute distress due to renal failure and providing long term access for maintenance renal replacement therapy.

Endovascular surgery is now the mainstay of treatment of some vascular problems such as central vein stenosis, renal and peripheral artery stenosis and abdominal aortic aneurysms and has resulted in less patient discomfort, decreased length of confinement, morbidity and mortality.

The Division stays in the forefront of this cutting-edge specialty by participating in conventions here and abroad presenting in various forums our research papers. Thus, the latest and most effective treatment protocols in transplant and vascular surgery are part of the armamentarium of the surgeons in the Department.

Beyond the Institute, Department staff are regular participants in Congressional and Department of Health hearings and technical working groups and support advocacies for the preventions, diagnosis and treatment of renal disease.

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HUMAN ORgan preservation Effort (HOPE) Human Organ Preservation Effort (HOPE) is the pioneer in organ procurement organization in the Philippines. HOPE functions as the crucial link between the patients in need of an organ transplant and potential organ donors.

They mainly provide a 24/7 organ recovery services having transplant coordinators on-call to respond to referring hospitals in identifying potential deceased organ donors. Once consent is given, HOPE then further coordinates with the Philippine Network for Organ Sharing (PhilNOS), run by the Department of Health and is responsible for national organ allocation of kidney recipients.

NKTI acquired two (2) LifePort Kidney Transporter in 2014 and one (1) in 2016.

NKTI is the first in Southeast Asia to use the LifePort perfusion machine in preserving kidneys retrieved from deceased organ donors. It gently perfuses or pumps the kidney with a cold solution to to improve its condition before transplantation. It also showed advantages compared to the traditional cold static storage. It doubles storage time and increase the number of usable kidneys and improve patient outcomes.

HOPE also provides family services where assistance in any form is extended to the donor family relevant to the donation made; hospital development services that aims to provide logistic support to the network hospital to maximize the referral system; and community outreach services that aims to inform and educate the public about organ and tissue donation.

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Division of Urology The Center for Urology and Men’s Health (CUMH): Commitment to Filipino Healthcare The Beginnings

We are committed to the training of highly competent and well-rounded

The National Kidney Foundation of the Philippines, now popularly known as the National Kidney and Transplant Institute, was established in 1983. Being a center for kidney diseases and kidney transplantation, the opening of a Section of Urology was a necessity and inevitable.

Thus, Dr. Benjamin Magsino in his capacity as Chairman of the Department of Surgery organized a group of top urologists in the country (Dr. Abelardo Prodigalidad and Dr. Genaro Yusi) to run the Section of Urology. Dr. Abelardo Prodigalidad was appointed as the first Section Chief of Urology and subsequently appointed as the Chairman of the Department of Urology and served as such for eighteen years. He was tasked to find suitable specialists who were to spearhead what eventually became the premier center for Urology in the country. It provided the best in urologic training, research and healthcare.

urologists of the future who are destined to provide quality health care to all Filipinos in the outskirts of Metro Manila and big cities throughout the country.

Together, the three formed the so-called "triumvirate" of Urology in the NKFP who worked closely with the Department of Transplantation to perform the first successful Kidney Transplant in Asia.

The triad also succeeded in performing much of the milestones in this country's urologic history. Dr. Prodigalidad, in his capacity as Head of the Section of Urology, wasted no time in organizing a Urologic Residency Training Program at NKFP which was immediately accredited and recognized by the Philippine Board of Urology—a four year urology residency program for young aspiring surgeons. Drs. Nelson Patron and Eduardo Rivera were the pioneer residents who started their training in 1983.

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Division of Urology The Center for Urology and Men’s Health (CUMH): Commitment to Filipino Healthcare NKTI as a Fertile Ground for Training Unlike many other government hospitals in the country, the Department of Urology has a healthy balance between private and service (aka charity) patients.

As far as training is concerned, residents are exposed to a variety of urologic cases and learn varied surgical skills and styles peculiar to each consultant.

Through the years the Department of Urology boasts of having the most number of Urologic procedures everyday encompassing a very wide array of urological procedures like open radical and simple procedures, endourological techniques and minimally invasive approaches.

Indeed, it is NKTI who pioneered Laparoscopic Urology & PCNL into primetime services available to Filipino patients of all social classes.

NKTI, likewise, is equipped with the most advanced laboratory unit and a diagnostic center that are highly acclaimed as one of the best in the country.

These two centers complement our training program by providing the residents access to all the recent and most up-to-date diagnostic tools in diagnosing and treating urologic conditions.

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Division of Urology The Center for Urology and Men’s Health (CUMH): Commitment to Filipino Healthcare

Commitment to Filipino Healthcare The National Kidney and Transplant Institute is a living testimony of the Department of Health’s commitment and dedication to deliver quality health care to the Filipino people. Recent major projects have been completed like the Diagnostic Center which provides stateof-the-art diagnostic facilities catering to people in all walks of life.

The latest achievement of NKTI which is another significant milestone in its program of rapid development in infrastructure, equipment and total medical healthcare delivery is the Center of Urology and Men’s Health (CUMH).

The CUMH is a one of a kind hospital within a hospital center that delivers the best and latest in the field of urology and men’s health. The concept is to build the first “one-stop-shop” premier facility for urologic and other related illnesses of men and women. The Annex 1 Building of NKTI has been upgraded to house this center with a 100 bed capacity for adult and pediatric urologic cases.

An extension of the Operating Room Complex has also been constructed with two additional rooms dedicated for endoscopic procedures, a unit for the ESWL machine, a room for prostate biopsy and brachytherapy for prostate cancer, a unit for the new Laborie Urodynamic Machine and female urology, additional rooms for ambulatory minor urologic procedures, and the highlight of it all—two highly specialized operating rooms adopting the latest technology for minimally invasive urologic procedures, the modular OR 1 (by Storz).

The latter is provided with widescreen 2D/3D HD monitors controlled either by voice or touch of a finger. Operating room lights are LED technology with zero shadowing effect and all operating tables are the latest in German technology known for its durability, reliability, and ergonomic design.

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Division of Urology The Center for Urology and Men’s Health (CUMH): Commitment to Filipino Healthcare NKTI: The Innovator The Department of Urology of NKTI is a leader in innovation and research in the field of Urology. It is known for having the most number of kidney transplant related procedures (donor nephrectomies), endoscopic procedures for stone diseases and cancers (PCNL, mini PCNL, URS, laser ICL, laser prostate enucleation, urinary bladder and upper tract urothelial cancer ablation by laser), minimally invasive laparoscopic procedures (donor nephrectomy, simple and radical nephrectomy, nephroureterectomy, pediatric lap surgeries, laparoscopic stone removal, reconstructive procedures, and others), and all the major and minor open urologic procedures.

Corollary to this, NKTI has recently opened its Radiotherapy Section located at the Diagnostic Center to complete the Cancer Center of the Institute.

The Department has the most number of urologists in its roster with wide array of expertise and experience in the various subspecialties in urology and men’s health. At CUMH, patients are assured of being managed by the best and brightest urologists in the country today. In the latter part of 2015, NKTI has completed another first in government private-public partnership project with the introduction of a Cyclotron PET-CT Scan unit, an essential tool in the diagnosis and treatment of all sorts of urologic and non-urologic cancers making this test accessible and affordable to the majority of our countrymen.

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Integrated Vascular Services (iVASC) Complex: A Special Unit of its Kind Integrated Vascular Services Complex or iVASC is considered as one of the innovations in Infrastructure of the National Kidney and Transplant Institute. A brain child of the former DOH Secretary – then - Executive Officer of NKTI, Dr. Enrique T. Ona, he tasked Dr. Ricardo Jose T. Quintos to head the unit, along with Dr. Enrico P. Ragaza in 2005.

It was initially known as the “NKTI Vascular Laboratory, Wound Care and Ostomy Clinic.” The unit was created to address the rising and interconnected needs of patients with advanced and chronic wounds and stomas. Over time, it evolved to what it is now, an integrated, innovative unit which provides individualized treatments to patients with wounds, stomas and vascular conditions. iVasc has largely replaced the traditional fragmented manner the clinicians are oriented to in terms of delivering care. The patient need not to go out of the facility to get diagnosed and worked up and managed.

It has organized the flow of its services around what the patients need, and not toward the “services” a vascular specialist can do. The complex has six important divisions namely: wound and ostomy care unit, vascular diagnostic unit, vascular access unit, vein unit, aneurysm center and lastly, the translational research unit. These units are interconnected within the 100 sq. meter complex where the patient can move around, from one room to another, as he seeks consult for his condition.

The regular scenario for any patient who comes in the unit is compared to a person who comes to a one – stop shop, where he can get everything he needs, for a short span of time, at a very reasonable cost. The minute he enters the complex, he is seen by a vascular specialist where a diagnosis can be arrived at. Vascular ultrasound that will strengthen the diagnosis is already available in the next room.

Delivering quality VASCULAR SERVICES Dubbed by MIMS, a multi-channel provider of healthcare information, as “First in Asia”, iVasc becomes the first integrated practice unit dedicated for addressing the needs of patients with vascular diseases and its complications.

It employs a novel strategy in delivery of services in patients suffering from different vascular conditions, with chronic, non – healing wound and stomas. It highlights value for patients by achieving the best outcomes for each patient at the lowest cost.

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Integrated Vascular Services (iVASC) Complex: A Special Unit of its Kind Diagnostics are immediately interpreted by the clinician, and even before the patient comes out of the room, a well – thought of plan is already laid down by the clinician. With this kind of flow of management, diagnosis to initiation of definitive management is reduced to on-site, same day consultation compared to several days to weeks of going to different units for diagnostics and eventual management.

The annual number of patients availing of the services of the unit has increased exponentially over the years.

It can be attributed to the patient – centered strategy employed by the unit. In 2011, 4,156 procedures and patients were done. In 2017, 12,062 combined procedures and patients were performed. This also translated to increased revenues for the unit, increasing from P7, 234,000 in 2011 to P 17,609,000 in 2017.

A dedicated team of experts The unit also employs a dedicated team made up of doctors, nurses, vascular technologists and non – clinical personnels who are equipped to deliver efficient and effective care for the patient. They can provide full care cycle for each of the patients’ condition and its complications. Each proactively assumes a role that will facilitate engagement of the patient, their family members and even the community in the patient’s care. Management of the patient’s condition goes beyond providing care of the wound or stoma or advising appropriate medications.

It involves educating and counselling the patients and his family about his condition, where commitment and adherence to the management plans are constantly checked. The cost of management compared to the progression and improvement of the vascular conditon because of the intervention given are tracked and analyzed by the team. Changes in the management plans are adjusted to suit the status of the patient.

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Integrated Vascular Services (iVASC) Complex: A Special Unit of its Kind It has organized the flow of its services around what the patients need, and not toward the “services” a vascular specialist can do. The complex has six important divisions namely: wound and ostomy care unit, vascular diagnostic unit, vascular access unit, vein unit, aneurysm center and lastly, the translational research unit.

These units are interconnected within the 100 sq. meter complex where the patient can move around, from one room to another, as he seeks consult for his condition.

Wound and Ostomy Care Unit Has shortened the healing duration with customized evaluation and monitoring, and specialized management of chronic wounds. For instance, a patient with 5cm sacral, non - infected ulcer may need admission for approximately 6 weeks. This admission will entail regular debridement of the ulcer to eventual skin grafting of the lesion, translating to approximately P 300,000 for the entire time the patient is at the hospital.

However, at iVASC, the strategy for the wound management is dependent on the capacity of the patient to support the dressing and his commitment to adhere to the management plans. The dressing changes can be one on a once a week to twice a week for the next six weeks. The patient can spend as low as P10 – 15,000 for the entire course of treatment.

Vascular Access Unit Aims in prolonging patency of vascular access with individualized access planning, construction and surveillance. Through the combined expertise in ultrasonography, open and endovascular surgeries of the competent Vascular Access Team, improved rates of maturation of vascular access are assured. It has also greatly improved the quality of life of the ESRD patients. Employing ultrasound guided insertions of temporary and tunneled catheter has decreased the complications related to procedure. Before it became a mandatory practice of the institution, carotid artery trauma was as high as 10% per year, but starting 2010, it has decreased this complication to almost nil. The incidence of failure for the fistula/graft to mature was initially noted to be 25% per year, but now has decreased to 2 -3 % per annum because of the meticulous mapping of the upper extremity vessels by the team members of iVASC Vascular Access Unit.

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Integrated Vascular Services (iVASC) Complex: A Special Unit of its Kind

Vascular Diagnostic Unit Utilizes the newest technology in ultrasonography and pressure studies. The unit provides imaging studies for patients with vascular disease, that aid in rapid, improved and individualized therapy.

Vein Care Unit Utilizes advanced and appropriate vein removal technology that matches patient’s vein pathology.

It offers medical, non – surgical and surgical therapy like open and endovenous laser therapy and radiofrequency ablation for venous conditions.

Aneurysm Center Uses innovative, minimally invasive solution for repair of aortic aneurysms. The unit capitalizes combined experience of the NKTI Vascular Team, resulting to improved outcomes for patients with aneurysms. Quality of life of patients undergoing aneurysm repair has greatly improved. By utilizing the minimally invasive strategy of Endovascular Aortic Repair (EVAR), the days of admission in the hospital has decreased to 4 days. Patients can be functional as they were before the surgery, as early as day 3 after the procedure. .

The unit has gone a long way since its inception. It now known as a team highly trained professionals providing cost – effective, integrated, individualized and innovative management for vascular, wound and ostomy services. True to its core values, it represents a unit that is empathic but remains to be the authority in diagnosis and management of vascular diseases, simple and complex wound and stomas.

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TRAINING PROGRAMS

accredited and recognized training programs MEDICAL TRAINING PROGRAMS

NKTI has training programs for its core services, allied services, and nursing services. All 11 medical training programs are fully accredited by their respective specialties/sub-specialties.

NKTI ranks among the best training institution in all these specialties with an overall passing rate of more than 95% for all its graduates with most programs sustaining a 100% passing rate in its specialty board exams.

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TRAINING PROGRAMS NURSING TRAINING PROGRAMS

Excellence in training is true not only for its medical training programs but also for its nursing services. The Nursing Department has been recognized by the Department of Health and is PRC accredited for its competency development programs that the nursing division extends not only for in-house nurses but also for non-NKTI affiliated nurses.

In 2012, the Department of Health designated the National Kidney and Transplant Institute as the lead hospital in the training, assessment and certification of nurses for the Renal Nursing and Operating Room Nursing specialties

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RESEARCH Clinical Trial and Research Unit (CTRU) Research is a core function of the Institute. As such, the Clinical Trial and Research Unit (CTRU) is responsible for the supervision in the conduct of research trials and exploratory studies being done in this Institute. This Unit was established in 1990 and since then, it has been continuously re-organized in order to have a great number of commendable research output.

An annual budget of 2 million pesos is allotted for research by the Institute therefore research funding and incentives are subsidized. Medical Staff are exposed to research environment since it is one of the mandates of the Institute. All medical training programs require all residents- and fellows-in-training to submit at least 1 completed research before graduation from their specific training program.

NKTI is also the reference center for researches on renal diseases and kidney transplantation for protocol development and policy making. For the past 3 years, an average of 56 completed research studies was done annually and were presented in various fora and published in different journals. (see Appendix for the lists of researches presented and published 2015 to 2017) In addition, the Research Ethics Committee (REC) has Level-3 accreditation by the Philippine Health Research Ethics Board (PHREB) and Forum for Ethical Review Committees in Asia and Western Pacific (FERCAP) since November 25, 2014. The accreditation was a major step for the REC to be recognized by both the national and international organization overseeing patients’ rights during clinical trials.

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Accreditation and recognition NKTI’s commitment to quality started in 1998 with the crafting of its Mission and Vision and the creation of the Total Quality Management Office.

The institute pursued this quality journey through its ISO 9001:2000 certification and subsequently ISO 9001:2008 certification by TUV SUD. Trying to continue on its drive towards performance excellence, it embarked on the Philippine Quality Award in 2015 wherein NKTI was awarded as “Proficiency in Quality Management”. Going beyond quality, NKTI joined the Institute for Solidarity in Asia in a governance workshop for the PGS Initiation Stage which NKTI projects to have a revalida

by December 2018.

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Accreditation and Recognition HEALTHCARE ASIA AWARDS 2019 RECOGNISING TRAILBLAZING INITIATIVES IN THE HEALTHCARE SECTOR The National Kidney and Transplant Institute (NKTI) received the Service Innovation of the Year Award and Facilities Improvement Initiative Award of the Year.

OTHER AWARDS AND RECOGNITIONS

Healthcare Asia Awards that aims to honour hospitals and clinics that rise above industry challenges and to recognise their initiatives that maximised the lucrative opportunities in the market.

The Healthcare Asia Awards 2019 was held on May 23, 2019 at the Conrad Centennial Singapore.

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Accreditation and Recognition ISO INTEGRATED MANAGEMENT SYSTEM CERTIFICATION

OTHER AWARDS AND RECOGNITIONS

NKTI was awarded the ISO Integrated Management System with ISO 9001:2015 Quality Management System with ISO 14001:2015 EMS Environmental Management System; and OHSMS 18001:2007 Occupational Health and Safety Management System. Certifications for these management systems were awarded on June 25, 2018.

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Accreditation and Recognition

OTHER AWARDS AND RECOGNITION

Philippine Quality Award (Level 2: "Proficiency in Quality Management") 2016 National External Quality Assurance Scheme (NEQAS) Clinical Chemistry, 2016-2017 Certificate of Antimicrobial Resistance and Surveillance Program (ARSP) Accreditation, NKTI Bacteriology July 2018-June 2021

Philhealth Reference Center for PD and KT Z Package Outstanding Performance as Top Healthcare Provider, Philippine Health Insurance Company (PHIC), November 24, 2014 Excellence Award: Corporate Social Responsibility, Hospital Management Asia 2014, Project “Paper Reduction Initiative” Top 1000 Corporations in the Philippines, Business World, 2014 Top 10 Public-Private Partnership East Asia, Pacific, Southeast Asia, awarded by International Finance Corporation, World Bank, 2012 “Center of Excellence”, Philippine Hospital Association, November 24, 2010

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Accreditation and Recognition OHSAS 18001:2007 Health and Safety Management System

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Accreditations and Recognition ISO 9001:2015 Quality Management System

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Accreditation and Recognition ISO 14001:2015 Environmental Management System

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Accreditations and Recognition ISO 15189:2007 Medical Laboratories Standards, Philippine Accreditation Office

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Accreditation and Recognition FERCAP/PHREB Accredited Ethics Committee

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Accreditation and Recognition FERCAP/PHREB Accredited Ethics Committee

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Quality and safety Programs

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Quality and safety programs Infection Prevention and Control The Committee was organized in 1983, formerly named as Infection Control Committee under the office of the Executive Director. Based on Hospital Order No. 24, s. 2017, the committee was renamed “Infection Prevention and Control Committee” and shall be incharge of the IPC implementation.

An Infectious Disease consultant was designated as the chairperson, with membership that represents the different departments from the Clinical Services, Nursing Services, Pathology and Laboratory Medicine, Ancillary, Radiology, Administration, etc. Members work mainly for the following responsibilities: planning strategies to improve precautionary measures, educating / training healthcare workers, patients and visitors on the prevention and control measures through lectures/posters, monitor employees compliance on infection prevention and control measures, surveillance of health careassociated infections including those at risk of acquiring infection and assist / guide concerned departments/sections in the implementation of the program.

As a general precaution, communicable disease cases (with a few exceptions) are not admitted in the facility because of the vulnerability of immunocompromised patients (ESRD, kidney & liver transplants) whom the Institution primarily caters to. They are referred to other hospitals specialized in handling such cases (if/once stable).

The Committee adopts and continuously develops an Infection Prevention and Control (IPC) Program designed to enable its personnel to make an apt and prompt judgments in dealing with and preventing spread of communicable / infectious diseases. Leading the implementation of the IPC, the committee is tasked to create and execute policies which incorporate strategically planned precautionary measures i.e. education and training of staff, patients and visitors; and continuous routine surveillance.

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NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

Quality and safety programs Infection Prevention and Control Initiatives Below are some of the key features of NKTI’s IPC intended to address infectious hazards that are inevitably present or introduced in the facility.

STANDARD (HAND HYGIENE) AND TRANSMISSION-BASED PRECAUTIONS: Proper hand hygiene and the use of PPE are the core components of the hospital’s standard precaution policy. Hand rub dispensers are installed along patient care hallways and other strategic locations. In addition to standard precaution, additional precaution is applied in managing patient/s suspected / confirmed to have infectious disease/s. Each case is identified using colored signage (posted on patient’s chart and outside the room) with text specifying the appropriate transmission precaution to be applied (e.g. Airborne, Droplet, Contact, Reverse Isolation). This will serve as guide on what particular PPE to use when attending to the patient.

SURVEILLANCE AND MONITORING: Timely notification / reporting (within 8 hours) of suspected and confirmed cases of communicable / infectious diseases are required from all healthcare personnel (doctors, nurses in-charge of affected patient/s) using the “Notice of Referral” / “Hospital Acquired Infection (HAI) Checklist” for suspected healthcare acquired infection/s. Special investigations are instigated when incidence of hospital acquired infections reached the set threshold. Other factors essential to the IPC that are under routine surveillance are employees’ compliance to safety measures (random) i.e. hand hygiene performance; microbial culture of foods (cooked, raw, etc.), tap & R/O water, medical device, surgical intruments/sets, etc.

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Quality and safety programs Bundles of Care Program VAP BUNDLE

Assess readiness to extubate once a day.

Interrupt sedation once a day (Spontaneous awakening trials) if without contraindication.

Perform spontaneous breathing trials with sedatives turned off.

Change the ventilator circuit only if visibly soiled or malfunctioning.

Use selective decontamination of oropharynx to decrease the microbial burden of the aerodigestive tract (Optional)

SPECIAL REMINDERS Perform hand hygiene before and after touching the patient or equipment Disinfect equipment daily and as necessary Elevate the head of bed 30 to 45 degrees if without contraindication

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Quality and safety programs Nursing initiatives INFUSION THERAPY TEAM (ITT) Initially started on November 17, 2014, the Intravenous Therapy Team (IVT Team) Quality Initiative now the Infusion Therapy Team (ITT) was formally put to the test for the whole year 2015 as it underwent full implementation in all the different patient care areas. With the objectives of facilitating prompt initiation of intravenous (IV) access among patients with the least amount of discomfort, and preventing wastage of blood products and other parenteral solutions secondary to the lack of IV access; the ITT, composed of identified staff nurses for their skillfulness, IV insertion, became the second in line to the staff nurse in initiating the IV cannulation of admitted patients.

Truly, the ITT has gained reputation not only within the Nursing Services but among other health professionals. Doctors were frequently heard to direct their difficult to insert” patients with a referral to the ITT. From the initial 38 members in November 2014, the ITT is now composed of 79 nurses from different patient care areas ranging from clinical care, critical care to nursing research and education.

Regular skills calibration and continuous training on best practices in IV insertion are regularly conducted. This is in line with the objective of the Nursing Services to achieve greater success rate and response rate in the following years.

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Quality and safety programs Nursing initiatives IV INSERTION MONITORING LOGBOOK

In relation to the Infusion Therapy Team Initiative, the Nursing Services created the template for the monitoring logbook to track if the system of referral for IV insertion is being followed. Its scope is that all intravenous insertions will be documented. Its purposes are to determine the number of times the primary nurse facilitates IV insertion and to evaluate the outcome of the ITT outcome.

This also monitors that prompt IV insertion of patients in need of intravenous medications and fluids is being achieved.

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Quality and safety programs Nursing initiatives INFECTION CONTROL SIGNAGES This is a project of the Nursing Services since 2014 that is used to promote not only the safety of the patients but also of the visitors and other members of the healthcare team.

It alerts both the healthcare team and the patient and their visitors the precautions instituted for the patient thereby helping in the practice of safety measures.

Before, colored stars (red, yellow, green) were used and taped to the patient’s room number located at the door to indicate infection control precautions. This diamond signages were made to replace the stars used for infection control precautions and new signages for right arm and left arm precautions, “please limit visitors”, no visitors allowed, please wear mask at all times and no vital signs taking during sleeping hours have been included.

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Quality and safety programs Nursing initiatives MEDICATION SAFETY PROGRAM (MSP)/ MEDICATION VEST

One of the programs that was developed from the E3N Care Program was the Medication Safety Program (MSP). MSP was first introduced in 2014 as a pilot study of the Nursing Services which postulated that medication errors may be decreased and prevented by addressing one of the root causes of most medication errors: interruptions.

The main premise of the program is that by decreasing interruptions (physician, other personnel, phone call, other patient, visitor, noise, and conversation) from disturbing the staff nurse for the shift, medication errors can be prevented.

The program was designed to improve the focus of the nurse during medication management, this was achieved through the use of the medication vests.

The staff nurse is expected to wear a red medication apron bearing the words “Medication Nurse” and “Do Not Interrupt”, in big bold letters across the front and back panels of the apron.

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Quality and safety programs Nursing initiatives MEDICATION GUIDE: ANOTHER INITIATIVE IN MEDICATION SAFETY

Since August of 2015, Dr. Nerissa M. Gerial, the Deputy Executive Director for Nursing Services has expended efforts to adopt one of medication safety best practices that she observed in hospitals in the United States, when she attended the Convention of the American Organization of Nurse Executives (AONE) in Phoenix, Arizona.

This was the provision of a medication guide pertaining to commonly used drugs to all nursing units. The aim of this practice was to prevent medication variances by enabling nurses to have a ready access to important drug information like drug class, generic/brand name and common side effects.

Many nurses found the medication guide handy and useful. They were advised that before they enter the patient’s room, they should read the guide to be ready whenever the patient or their relatives ask the use of the medications being given to them and also the possible side effects that come with administration of such medications

The nurses also acquire knowledge about unfamiliar medications and are more confident in carrying out their duties and responsibilities as medication nurses for their patients thus another way to ensure safety in medication administration.

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Quality and safety programs Nursing Initiatives PROVISION OF HAND RUBS IN PATIENT CARE AREAS In coordination with the Infection Prevention and Control Committee of the Institute and with the support of the management, the Nursing Services initiated the installation of hand rubs along the hallways of the different patient care areas.

These alcohol-based hand rubs were provided to improve the hand hygiene compliance of members of the healthcare team, including patients and relatives, before and after interacting with and performing a procedure to the patient.

By providing wall-mounted handrubs in strategic areas along the hallways, hand hygiene facilities became more accessible to doctors, nurses, and allied health professionals, thereby promoting compliance and decreasing the risk of transfer of infection associated with non-compliance to hand hygiene protocol.

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LINK NURSES: PROVIDING A NETWORK OF CARE Quality and safety programs

Since 2014, the Infection Prevention and Control Committee (IPCC) have IPCC link nurses who are all the Nursing Leaders designated by the Deputy Director for their respective units. Their

Nursing Initiatives

responsibilities include:

Submit notice of referral to IPCC

LINK NURSES

office for the validation of the Infection Control Nurse;

(Infection Prevention and Control Committee link nurses, IVASC link nurses and Peritoneal Dialysis Link Nurses)

Accomplish the healthcareassociated infection checklist upon identification of possible healthcareassociated infection;

The idea of link nurses is an emergent trend and a recognized essential component in nursing practice.

See to it that the patient device monitoring sheet is accomplished

A link nurse is defined as “a nurse that is, or is moving towards being, an expert and resource person for an identified topic of specialty practice, in which they have an interest and passion”.

Through liaison with a specialist nurse, such in infection control, and regular scheduled meetings, the link nurse aims to increase awareness among the staff on their unit of new developments that will improve practice.

everyday;

Ensure availability of Personal Protective Equipment (PPE) and hand hygiene supplies at all times; and

Ensure implementation of infection control practices (i.e. signage posting, proper placement of patients, aseptic technique, hand hygiene etc.)

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FORGING CONNECTIONS with other departments Additionally, in 2017, two other specialties namely, vascular and wound care, and peritoneal dialysis, have expanded to adapt link nurses and allied health professionals to their field.

In order to capacitate the nursing staff and address the increasing care demand of Peritoneal Dialysis (PD) patients, the PD Link Nurse Program was established. It is aimed towards equipping the nurse and the nursing attendant the PD Care competencies and provide prompt, quality care to patients on peritoneal dialysis.

To date, there are 20 official PD link nurses and 15 official PD link nursing attendants who have attended the PD Workshop last September 26 and 27, 2017. The PD link nursing staff also have 1 month rotations to the PD unit for them to have hands-on experience with the guidance of the PD nurses.

The Integrated Vascular Complex or the IVASC in coordination with the IANAHP have conducted lectures to train IVASC link nurses in the different areas who will do wound assessment and management in the absence of IVASC staff during weekends or holidays.

Lectures and workshops increase awareness of nursing staff in the prevention of pressure sore occurrence or aggravation of existing pressure sore and help in the wound treatment plan and provision of health teachings to patients and their companions.

NURSING services KEY PERFORMANCE indicators (Kpi) monitoring The Nursing Services monitors the key performance indicators in addition to the E3N Care Program indicators. These are the turn-around time (TAT) in the administration of newly ordered oral and intravenous medications.

The monitoring of the TAT in the administration of newly ordered oral and intravenous medications Helps in the determination of the causes of delay and which then helps in planning and implementing appropriate

medication

safety.

67

measures to solve such problems, since timely administration is a predictor of

NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

Quality and safety programs E3N Program The Nursing Services developed the EFFECTIVE, EFFICIENT, EQUITABLE NURSING CARE PROGRAM, more popularly called as E3N Care Program, in 2012; with the aim of not only to promote the provision of safe and quality care, but also to ensure just and fair delivery of nursing care to all patients regardless of patient classification status, age, gender, race, ethnicity, and religion at NKTI. This program, with the assistance of Nursing Research and Continuous Quality Improvement programs of the Nursing Services, serves as the backbone of all safety initiatives of the Nursing Services.

The E3N Care Program started as a way to monitor the indicators of nursing care.

However, as data came in, the E3N Care Program evolved to a more comprehensive program that includes not only the monitoring of the indicators but also includes the analysis of root causes and implementation of solutions to address not only the seven (7) indicators but also for variances due to breakdown in communication such as those that occur during transfer of care or referral from one patient care unit to another, Infusion Therapy team’s response and success rate, and other incidents that are reported but are not variances of nursing staff.

The E3N Care Program expanded the three (3) generic patient safety indicators: medication variance, fall, and skin integrity to seven (7) quality indicators: Medication Variance, Patient Fall, Healthcare-Associated Skin Integrity Injury, Healthcare-Associated Burn Injury, Blood Transfusion-Related Variance, Diagnostic Test-Related Variance, and Injury related to Medical Equipment.

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Quality and safety programs E3N Program Last 2017, 2 indicators have been added to the program namely, treatment-related variance and surgery-related variance.

The seven (7) E3N Care Program indicators are:

MEDICATION VARIANCE PATIENT FALL MEDICATION VARIANCE HEALTHCARE- ASSOCIATED SKIN INTEGRITY INJURY HEALTHCAREASSOCIATED BURN INJURY BLOOD TRANSFUSIONRELATED VARIANCE

Any deviation from the twelve (12) rights of proper medication administration

Unintentional event resulting in a person coming to rest on the ground or other lower level not due to any intentional or extrinsic force such as stroke or cerebral or spinal lesions

Skin ulceration as a result of pressure acquired by patient during his/ her hospital stay

Injuries caused by contact with household or industrial chemicals such as galenicals and those caused by extravasation of vesicant or irritant solutions Complications of blood component transfusion and may be a risk to patients. The risks range from mild urticarial form reactions to fatal reactions if not recognized and dealt with promptly

DIAGNOSTIC TESTRELATED VARIANCE

An event in erroneous transcribing or encoding of a diagnostic test to a patient or transcribing or encoding a diagnostic test to a different patient

INJURIES RELATED TO MEDICAL EQUIPMENT

An event when an equipment poses a threat or harm to a patient

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Quality and safety programs E3N Program This program encourages reporting of incidents, advocates the no-blame and non-punitive culture, and promotes the proactive, over the reactive manner of addressing incidents.

This is supported by another initiative, which is now part of the policies of the Nursing Services, called the Compliance Measures.

Compliance Measures The compliance measures is a combination of Disciplinary and Learning and Development Interventions. It was adapted from three main sources: NKTI’s Employee’s Handbook, the Civil Service Commission’s Revised Rules on Administrative Cases, and the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) guideline and taxonomy for errors.

The compliance measures were designed to encourage and instill conformance to set policies, rules, and professional code of the Nursing Services. The institution of a fair and just discipline system for safety behaviors is a necessary step to follow through on the declaration that safety is important to the Nursing Services. It serves as an unbiased and objective method of applying corrective measure to erring staff which is detailed in the Quality Manual under Work Instructions of the Nursing Services Office.

MEDICATION VARIANCE

Learning and Development Measures In line with the Compliance Measures wherein disciplinary actions are given for variances in the Performance of duties, learning and development interventions are also set.

Learning and Development Interventions are measures taken by the Nursing Services to enhance knowledge, hone skills, and improve the attitude of nursing staff who have been involved in offenses for them to make better the quality of service they render to our stakeholders. These may include seminars, trainings, workshops, staff rotation and reassignment and are either conducted by the Human Resources and Management Division and/or the Institute of Advanced Nursing and Allied Health Professionals (IANAHP).

Situation- Background- Assessment- Recommendation (SBAR) Format in Reporting SBAR is a technique which had been adapted by the Nursing Services that can be used to facilitate prompt and appropriate communication. This has been employed both in the referral system to doctors and other members of the healthcare team and also in the process of incident-reporting.

It is a way for health care professionals to communicate effectively with one another, and also allows for important information to be transferred accurately to make sure that the appropriate interventions and treatment for patients are rendered. The implementation of the SBAR has minimized communication errors between healthcare providers to improve patient safety.

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Quality and safety programs INCIDENT REPORTING (PATIENT-RELATED) USING THE PATIENT RELATED INCIDENT ACTION SLIP (PRIAS) Reportable patient-related incidents are those that may affect the delivery of care to the patient and the practice of Nursing in the Institute. It includes, but is not limited to the incidents that pertain to the E3N quality indicators.

The Nursing Services has developed a culture of safety reporting with the following steps:

1 2

Reportable Patient-related incident is observed, detected by or reported to the Nursing Leader/OIC.

The Nursing Leader/OIC conducts further investigation

3

The Nursing Leader/ OIC submits the written result of investigation and letter of explanation, both in SBAR format, and received by the Administrative Staff of the Nursing Services Office.

4

NSO staff forwards the written result of investigation to the Division Chief concerned. The Division Chief reviews the written result of investigation and accomplishes the first column of the Action Slip.

Once accomplished, signature will be affixed.

5

The written letter of investigation is then forwarded to the Deputy Director, who will accomplish the second column of the Action Slip.

6

The written letter of investigation together with the completed Action Slip is then returned to the NSO staff.

7

If the staff involved has been proven to commit offenses applicable to the Nursing Services, the classification and the corresponding compliance measure shall be issued as stated in the Implementation of Compliance Measure document.

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Quality and safety programs CONTINUITY OF CARE Total Patient Care and End-of-Shift Handover

This project was initiated by the Nursing Services Office (NSO), Unit 3E and Unit 3F team composed of six members in 2017 with the aim to have an effective, efficient, and timely handovers for the outgoing and incoming nurses in a 12- hour or 8- hour shift in the clinical patient care areas thereby reducing the cost paid for overtime services. This was fully implemented and below are the guidelines stated in the work instructions.

In Total Patient Care (TPC), the primary nurse (PN) is responsible and accountable for providing all care to a group of patients during his/her duty shift and covers the following aspects of Total Patient Care:

MEDICATION V NA uRrIsAe N- PCaEt i e n t R e l a t i o n s h i p

Patient Assignment

and Decision Making

Nursing assignments are largely patient-based with nurse providing activities of care.

Decision-making occurs over a single shift either by a nurse caring for the patient or the charge nurse.

Nursing assignments may vary per shift based on the staffing, patient classification system and patient census while supporting continuity of care.

Communication between Healthcare Team Members

Communication is direct to the other members of the healthcare team.

Management of Unit or Environment of Care

Nursing Leaders serve as a resource and promote nurses having a stronger role in care decisions.

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Quality and safety programs CONTINUITY OF CARE Total Patient Care and End-of-Shift Handover For the handover, the Nursing Leader (Head Nurse/ Supervisor) or the Charge Nurse assigns each nurse-on- duty a group of patients, in which the nurse is responsible for their total patient care for a 12- hour or 8- hour shift.

The patient assignment is based on staffing, Patient Classification System and patient census. Each outgoing nurse endorses all the patients under his/ her care to one incoming nurse unless otherwise, there are changes in patient assignments and he/she will then need to endorse the patients to the assigned receiving nurse. The incoming nurse will then assume responsibility and accountability for all the patients endorsed by the outgoing nurse.

MEDICATION VARIANCE

Purpose To document the process of end-of-shift handover with the following purposes: Promote autonomy for nurses in accordance with the existing policies of the Nursing Services.

Provide clear lines of responsibility and accountability in nursing practice.

Provide holistic and unfragmented patient care per shift.

Ensure that there is less time spent on handover which would rather be spent on direct patient care.

Provide more time to accomplish tasks before the end of shift, for the nurses to be able to go home on time.

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Quality and safety programs CONTINUITY OF CARE Patient Reminder Board (PRB)

The PRB is a communication medium between the nurse and the patient and not between healthcare providers. The PRB supplements but not replaces spoken communication or reminder to the patient and significant others.

It is a must to explain first any reminders before writing it on the PRB. The Total Patient Care (TPC) Nurse must update the information written on the PRB at least once in every shift and as necessary. The TPC Nurse must ensure that only up-to-date information are included on the PRB. The use of such ensures that both the nurse and the patient understand important diagnostic and treatment activities and their preparation and indications. This promotes the safety culture in a way that the nurse is reminded of things to be done to the patient and the patient is aware of his or her plan of care. It opens up the line of communication between the two parties and eliminates uncertainties and miscommunication.

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Quality and safety programs CONTINUITY OF CARE

Patient Reminder Board (PRB) To avoid too much information on the board, the “Reminders” section must only include the reminders or special instructions for the day, such as but not limited to diet restrictions, increasing fluid intake, fluid restrictions, fasting and other preparation required for procedures or laboratory exams, use of equipment, blood sugar monitoring, urine/stool/sputum sample collection, fall precautions, etc.

In addition, to avoid complaints or issues related to patient confidentiality, engage patients and/or significant others on every information that will be written on the PRB. The nurses should only use terms that can be easily understood by the patient (English or Filipino).

To ensure privacy of patients, no protected or confidential information must be written on the PRB. Such confidential information includes, but not limited to, the following: Diagnosis Results of diagnostic tests done Statements relating to psychosocial/ psychological issues of the patient (e.g. Suicide Precautions, order for HIV test, Pregnancy Test, and Venereal Disease, etc.)

The TPC Nurse must ensure that the following additional elements of good written communication are observed in writing information on the PRB:

Conciseness – information is not too short or too long Organization of Information – orderly arrangement of instructions in the PRB Correct Spelling and Grammar Cleanliness of the PRBs, order for HIV test, Pregnancy Test, and Venereal Disease, etc.)

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Quality and safety PRoGRAMs National Reference Laboratory (NRL) for Hematology, Immunohematology, Automated Urinalysis, and Anatomic Pathology for Renal Disease and other Unassigned Organ System Diseases As the designated National Reference Laboratory (NRL) for Hematology, Immunohematology, Automated Urinalysis, and Anatomic Pathology for Renal Disease and other Unassigned Organ System Diseases by the Department of Health (DOH), NKTI was able to perform a significant number of specialty referral testing and conduct educational activities with the overall aim of improving the quality of laboratory testing services in the country.

The number of clinical laboratories served by the Hematology NRL in the annual Blood Count National External Quality Assessment Scheme (NEQAS) has increased to four thousand and one hundred seventy-two (4,172) in 2017 and four thousand and sixteen (4,016) in 2018, from one thousand and fiftythree (1,053) when the NRL first started conducting this quality assurance exercise in 2008.

Participation by laboratories in this activity is one of the licensing requirements of the DOH.

Region IV-B registered medical technologists and the NRL-NKTI resource persons in one of the workshop exercises in the Hematology, Immunohematology, and Urinalysis Quality Assurance Workshop, conducted by the NRL-NKTI and DOH-LRED region IV-B in Puerto Princesa City in February 20-23, 2018.

In October 10-12, 2017, Pathology consultant and medical technology staff of the NRL-NKTI conducted a quality assurance workshop in Hematology, Immunohematology, and Urinalysis in Butuan City, Agusan Del Norte, in collaboration with DOH Licensing, Regulations and Enforcement Division (LRED) CARAGA. A total of forty-six (46) registered medical technologists (RMTs) took part in this activity, which consisted of a series of lectures and workshop exercises on best practices in Complete Blood Count (CBC), blood typing, and urinalysis, with the NRL-NKTI representatives as resource speakers and facilitators.

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QUality and safety programs National Reference Laboratory (NRL) for Hematology, Immunohematology, Automated Urinalysis, and Anatomic Pathology for Renal Disease and other Unassigned Organ System Diseases

Region IV-B registered medical technologists and the NRL-NKTI resource persons in one of the workshop exercises in the Hematology, Immunohematology, and Urinalysis Quality Assurance Workshop, conducted by the NRL-NKTI and DOH-LRED region IV-B in Puerto Princesa City in February 20-23, 2018.

In February 7-9, 2018 and February 20-23, 2018, similar educational activities were again conducted by the NRL-NKTI in Tacloban City and Puerto Princesa City, in collaboration with DOH-LRED region VIII and DOH-LRED region IV-B, respectively. A total of fifty-three (53) region VIII RMTs and ninety-seven (97) region IV-B RMTs were in attendance in these activities.

The DOH National Center for Pharmaceutical Access and Management (NCPAM) has been referring breast cancer specimens to the Anatomic Pathology NRL-NKTI for Estrogen Receptor Assay (ERA), Progesterone Receptor Assay (PRA), and HER2 neu protein overexpression determination since 2011. A total of seven hundred and twenty-five (725) and four hundred and seventy-four (474) of these assays were tested by the NRL-NKTI in 2017 and 2018, respectively.

Since 2008, the Immunohematology NRL has been evaluating blood typing reagents and test kits of various diagnostic companies in coordination with the DOH Food and Drug Administration (FDA). A reagent or test kit is first subjected to a performance evaluation by the NRL prior to issuance of a Certificate of Product Registration (CPR) by the FDA. A total of fifty-seven (57) reagents and test kits are due for evaluation in 2018.

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Corporate social responsibilitY Bringing Sustainable and Quality Healthcare to Filipinos Everywhere

The National Kidney & Transplant Institute supports the Department of Health’s platform on “Boosting Universal Health Care via FOURmula One Plus.”

We are committed to a long-term vision to guarantee equitable, sustainable, and quality health care for all Filipinos, especially the poor and those of the distant regions.

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corporate social responsibility Preventive Nephrology Clinic The NKTI Department of Adult Nephrology launched the Preventive Nephrology Clinic last June 17, 2017 with the aim of providing a comprehensive management plan for persons identified with risk factors such as hypertension, diabetes, family history and those with early signs of renal disease.

Since its inception, the clinic has attracted relatives of patients and employees who are concerned about keeping their kidneys healthy.

This clinic, in collaboration with other allied specialties in the Institute, hopes to strengthen efforts in the prevention of kidney disease. It also aims to be able to replicate this advocacy into the communities in the future to lessen the growing local and global health and socio-economic burden of this disease.

The number of kidney patients that the Institute caters to is staggering and its predicted that it will continue to rise over the years. There are a lot of persons within the confines of the hospital who are already at the risk of developing CKD.

at the forefront of renal disease prevention and education It is NKTI's social responsibility to educate and encourage patients to be screened for renal problems because these patients are already within our reach.

This is the department's simple initiative which hopes to create a ripple of positive effect to decrease the number of patients who will end up with Chronic Kidney Disease and Dialysis in the future.

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Corporate social responsibilitY Capacity Building for Hemodialysis and Peritoneal Dialysis Conceived to promote world class education and training, primarily in renal nursing, the Institute of Allied Nursing and Health Professionals (IANAHP) is dedicated towards excellence, enabling professional nurses to meet the challenges facing their profession in today’s complex healthcare environment. The IANAHP has become the prime institute in the country for specialization in Renal Nursing.

Responsiveness to increasing healthcare information, technology, and clinical services together with client expectations, demand nursing competencies that must match these expectations and demand with dynamic changes. IANAHP has successfully risen to the training demands of such services. Because improvement of nursing must be sustained, a concerted effort is required towards staff development and continuing education attained through quality continuing professional development and training.

Long and Short Courses The IANAHP yearly conducts short and long courses, different fora, ward classes, Research, and Continuous Quality Improvement (CQI) lectures in coordination with the Nursing Services Office Quality Assurance Nurses and Focus Group Discussions (FGD’s) on operations and clinical topics according to position The long courses includes the following:

PROGRAM

MODULES

DURATION

FREQUENCY

Competency Development in Basic Nephrology Nursing (BNN)

5

4 months

3

Competency Development in Peritoneal Dialysis (CDPD)

9

2 months

6

Competency Development in Hemodialysis (CDHD)

7

4 months

3

Competency Development in Kidney Transplantation (CDKT)

6

2 months

6

Competency Development in Operating Room Nursing (CDOR)

3

4 months

3

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Corporate social responsibilitY Regional Transplant and Satellite Dialysis Center Development REGIONAL TRANSPLANT CENTERS

As part of the NKTI’s social responsibility and flagship program, we aim to capacitate regional health units in the archipelago to become transplant centers. To address the lack of specialists in the provinces to support a transplant program, we have initiated curricula, avenues for training of anesthesiologists, urologists, nephrologists and immunopathologists, transplant nurses and transplant coordinators. Our graduates in transplant surgery, nephrology, urology, and transplant anesthesia shall support the implementation of their transplant programs.

NKTI encourages trainees homegrown from their locality so that they shall return to their regions after training.

We envision that in the near future, between 2019 to 2026, the following transplant centers shall emerge: Baguio General Hospital , Batangas Provincial Hospital, Dr. Paulino J. Garcia Memorial Research and Medical Center, Mariano Marcos Memorial Hospital and Medical Center, Zamboanga City Medical Center, Cotabato Regional and Medical Center, and Eastern Visayas Regional Medical Center. The following hospitals shall strengthen their advocacy programs, preventive programs and be referral centers for deceased organ donation.

SATELLITE DIALYSIS CENTERS

For the creation of satellite dialysis centers, in cooperation with the DOH, we helped identify recipients of 25 packages of 10 hemodialysis machines and other equipment to run a dialysis center in remote provinces. General surgeons shall undergo training of vascular access creation as well as peritoneal dialysis catheter insertion.

Likewise, in places without nephrologists, we already initiated the training program for medical doctors (general practitioners) to become physician-on-duty (POD) and POD to become medical directors of dialysis centers. NKTI already has existing Competency Development Programs for allied medical services such as in Basic Nephrology Nursing, Peritoneal Dialysis, Hemodialysis, Operating Room Nursing, Kidney Transplantation, and Critical and Emergency Care.

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Corporate social responsibilitY Maria Corazon Torres y Javier (MCTJ) Foundation: An Act of Love, A Gift of Life There is nothing more tragic in this world for parents than losing their own child. But this was what happened to Atty. Vicente and Mrs. Juanita Torres on June 22, 1990 when their only daughter, Maria Corazon, suffered a ruptured cerebral aneurysm while studying at the Instituto de Cooperation Iberoamericana in Madrid. The couple was heartbroken when they were informed of their daughter’s irreversible condition at the hospital in Madrid where she lay dying.

Maria Corazon: A life lived to the fullest

Grief-stricken as they were, the couple agreed to donate their daughter’s organs in the hope that these would help other patients who need them to live. Eventually, her heart, liver, and two kidneys were donated to four people, allowing the recipients a second chance to continue their dreams and Maria Corazon’s memory to live on after her death.

A year later, during their daughter’s first anniversary, Atty. and Mrs. Torres launched the Maria Corazon Torres y Javier Foundation (MCTJ) in her honor.

MCTJ is a foundation involved in organ donation based at the NKTI. It serves as a coordinating body for organ donors and recipients who will undergo organ transplantation. The foundation provides financial assistance to indigent patients requiring expensive medical procedures for donor and recipient work-up prior to transplantation as well as post-operative medicine and follow-ups.

Since 1991, the foundation, with the help of NKTI’s Human Organ Preservation Effort (HOPE) program, has helped 102 patients with life-saving treatments that allow them to lead productive and meaningful lives.

The lives the foundation has touched would never replace the daughter that they lost, but the Torres couple's generous donation of love and self-sacrifice has opened the doors for organ donation awareness in the country. MCTJ has supported numerous organ donation awareness programs including NKTI's REGALO Organ Donation Advocacy, which was established in 2016, Through the MCTJ Foundation, the legacy of Maria Corazon will live forever in the lives of people she has helped and countless others the foundation will be helping in the future.

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NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

Corporate social responsibilitY

REGALO (Renal Gift Allowing Life for Others) The coalition REGALO, is an Organ Donation Advocacy group spearheaded by the Maria Corazon Torres Y Javier (MCTJ) Foundation, the Kidney Foundation of the Philippines, Kidney Transplant Association of the Philippines (KITAP), Transplantation Society of the Philippines (TSP), Philippine Society of Nephrology (PSN), the Philippine Society for Transplant Surgeons (PSTS) and partners in industry. Its goal is to raise awareness on organ donation with the hope of encouraging men and women to: GIVE, CARE & SHARE:

REGALO calls on all Filipinos to carry the organ donor card, so that in case of brain death, our organs can help save the life of patients who remain on lifetime dialysis. It affords patients with permanent kidney failure a chance for a second life with a transplanted kidney.

Organ donation advocacy is a continuing program of the NKTI together with REGALO. As a group, organ donor advocates can pool their resources together to promote this advocacy by increasing the awareness of Filipinos on organ donation, both from living donors and deceased donors.

GIVE of themselves through organ donation; CARE enough to sign up and become a willing organ donor; and SHARE their intention with family and friends.

The REGALO Coalition, established in 2016, has as its key partner the NKTI, the leading government tertiary renal referral center that prioritizes kidney transplantation as the best form of renal replacement therapy since patients become fully rehabilitated, have the highest quality of life and the greatest survival.

There are about 30,000 patients on dialysis today, and each year about 12,000 new patients start dialysis.

Unfortunately only about 500 receive a kidney transplant due to a lack of donors.

Deceased donors contribute to less than 5% of the total transplants done per year.

By encouraging people to carry the organ donor card, it is hoped that more patients with kidney failure will get that second chance!

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Green Hospital initiative PAPER REDUCTION INITIATIVES In line with the efforts of the Institute to ‘go green’ as well as save funds that can be allotted for other purposes, the then Executive Director assigned Deputy Executive Director for Nursing Services, Dr. Nerissa M. Gerial, to lead the Paper Reduction Initiative, with the goal of reducing paper transactions and consumption of the Institute (NKTI). This project was based on the C.Y. 2012 report on the consumption of mimeographing papers wherein 3,918 reams were consumed by the Institute, which is equivalent to 9.795 tons of paper or about 235 trees, according to the Paper Calculator.

With this directive, the Paper Reduction Committee was created with representatives from all divisions of the Institute, and collectively, they initiated strategies to reduce paper consumption which were disseminated in their respective areas. The Paper Reduction Committee is composed of representatives from the Medical, Nursing, Administrative, Laboratory, Radiology, Medical Records and Library, and Ancillary Departments, together with the Public Information Office of NKTI. The members were strategically chosen to make sure that every department is represented since all sections in the hospital have contributions to the Institute’s paper consumption. After analysis of present situation and target setting, the committee began to collate the suggestions from different employees on how we can reduce our paper consumption. These strategies were presented during the Management Committee Meeting which was attended by the Executive Committee as well as the different section heads. Awareness of the problem was promoted through the heads, and the proposed strategies were also shared to them for proper dissemination to their subordinates.

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Green Hospital initiative PAPER REDUCTION INITIATIVES Furthermore, inventory of current mimeographed records, spreading awareness of the problem, and monitoring and evaluation of the purposes of requested papers were also done to guide the regulation of paper requests.

Among the many paper reduction strategies also implemented were reuse of paper in compliance with the guidelines of the National Archives of the Philippines, advocating use of recycled paper, paper audit and review of current forms for improvement of print output formatting, dissemination of fax/printer/copier best practices and promotion of better printing behavior, reducing print frequency, and pooling of soft copy templates of forms in the hospital database to reduce mimeographed forms. Only fast-moving forms were allowed by the Committee to be maintained as mimeographed.

One particular long-term strategy of the Committee to ensure the sustainability of this project is the creation of a database of forms in the hospital information system, through which nurses can access and print a certain form only when they need it. We have also established the regulation of paper requests and the practice of recycling paper for internal communications.

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Green Hospital initiative PAPER REDUCTION INITIATIVES

After the policies and strategies have been laid down, the project relied on the initiative of every employee guided by their section heads to ensure that the paper-saving measures are being practiced; and no new budget had to be created or set aside for the dissemination of the project other than the current resources and manpower we already have in the Institute.

The primary end goal of the Paper Reduction Initiative is to contribute to the reduction of global warming by decreasing the number of trees cut to sustain our paper consumption.

Recognizing that we all have a contribution in preserving our environment, big or small, NKTI has been engaging in “go green” efforts in the past years through tree-planting activities, use of LED lights, etc. This initiative further strengthens our efforts by decreasing our contribution to the demand for deforestation to support the manufacture of paper.

Consequently, the project also aims to contribute to the reduction of the diseases and health problems associated with global warming.

These contributions are achieved while also reducing associated costs in buying paper, as well as treatment and disposal of wastes; with the problem on waste disposal as one of the major contributors to global warming.

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Green Hospital initiative PAPER REDUCTION INITIATIVES These contributions are achieved while also reducing associated costs in buying paper, as well as treatment and disposal of wastes; with the problem on waste disposal as one of the major contributors to global warming.

The paper consumption of the Institute in 2012 and 2013 were compared to evaluate the impact of the strategies implemented. Our mid-year evaluation (January-June) showed that there was a 28% reduction in the requests for mimeographed forms. By the end of the year, despite the overall 4% increase in the occupancy rate of the hospital and the establishment of new sections that also had their own forms, an accumulated 14% decrease in the consumption of paper was documented. This is equivalent to Php 143,353.69 in savings, and 63 trees saved, as computed using the Paper Calculator.

The 12 members of the Paper Reduction Committee only initiated, and facilitated the implementation of the strategies, but it is the entire workforce that made the achievements of the project possible. The Paper Reduction Initiative is not merely an activity-oriented project, but one that promotes culture building and employee empowerment; such that as they constantly observe paper saving measures at work, they would eventually adapt these practices wherever they are as their contribution to preserving the environment, and as part of their everyday life.

The impact of the Paper Reduction Initiative is evident, not just in the reduced overall paper consumption of the Institute, but more in the observable consistent practice of paper saving measures of NKTI employees that has already been part of their routines.

Also, the funds that were not spent for buying paper served as available funds for the improvement of services, as well as the quantified free service (QFS) given to less fortunate renal patients.

Through the QFS, the Institute is able to shoulder portions of the expenses incurred by patients who are in need of financial help, so that the medical assistance they need is still provided to them but at a lesser cost.

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Green Hospital initiative PAPER REDUCTION INITIATIVES The true, long-term aim of the Paper Reduction Initiative is to change the culture and mindset of our employees towards the use of paper by increasing their awareness of the problem on global warming, and the contributions they can all make to reduce it, not only in the workplace but also in their homes.

While it does not have an immediate observable impact to our environment within NKTI, we are confident that as we continue to raise awareness on the problem, Our little contribution would go a long way in preserving the environment and in reducing the diseases associated with global warming, redounding even to the homes of our employees, and the communities they live in.

This project was entered in the 2014 Asian Hospital Management Awards under the Corporate Social Responsibility Category and it won an excellence award.

The project is continuous and the Paper Reduction Committee regularly monitors the implementation, as well as add to the existing paper reduction strategies in the months and years to come so we can continuously achieve our set targets and maintain the paper-saving measures as part of our institutional processes.

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Green Hospital initiative HEALTHCARE WASTE MANAGEMENT

In response to NKTI - Environmental Management System (EMS) ISO 45001- 2015 the institute promotes Energy Conservation, Waste Reduction, Pollution Mitigation and Environmental Compliance. The Green NKTI program with a theme “Achieving Quality while Conserving Energy” was created with a Green NKTI logo adopting an image of water droplets and a leaf merged with NKTI logo symbolizing our advocacy and objectives on caring the environment.

Benefits and Expectations: The Institute ensures and assumes the responsibility that no adverse health effects and environmental consequences resulting from its generation handling, collection, storage, treatment and disposal of Health Care Waste.

Protection of human health by controlling/ reducing exposure to hazardous waste of health care workers, patients, visitors and the general public and minimizing direct impacts from environmental exposures to Health Care Waste (HCW).

Compliance with the set legal, laws, regulatory and statutory requirements including its implementing policies and guidelines.

Contribute in the prevention of pollution through waste minimization, reusing and recycling.

Promote a healthier and safer hospital environment

With the support of the Top Management, the program have created different responsibilities in the Department, Division and Section levels with emphasis on proper handling of infectious waste. We have classified the health care waste into Non-hazardous and Hazardous Waste generated in the institute.

All employees are required to participate in training on Health Care Waste Management seminar scheduled seven (7) times a year. This seminar promotes and gives awareness to all employees to commit, cooperate and participate in proper handling, segregating, storing, transport and disposal of their waste.

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Green Hospital initiative HEALTHCARE WASTE MANAGEMENT

Waste management plan: includes minimization of waste generated in the uses of its resources, materials, and supplies.

Recycle: Plastic drinking bottles, paper, cartoons as packages and soft-drink cans are sold to an accredited DENR/local transporter and recycling agency.

Reduce: All areas are encourage to use the no print at rear or back of coupon bond for unofficial communication to reduce the consumption of paper, the use of internal messages using computer or common media (email, outlook) reduces paper in the distribution of internal information.

Reuse : Non punctured plastics are used for sharps, syringe needles and ampoules. Treated, decontaminated these things before transported to storage area.

Note: Infectious waste for the 3R’s are subject to study by Infection Prevention and Control and Health Care Waste Management Committee for this plan.

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Green Hospital initiative HEALTHCARE WASTE MANAGEMENT

Labeling and Handling: All recyclable materials like office materials, used papers, envelops, cartoons, etc. were labeled as “Recyclable materials”.

M501: Medical Waste, Pathological were properly stored in yellow plastic bags and labeled as Infectious waste.

M503: Expired Pharmaceuticals & Drugs were stored in boxes and labeled as Toxic waste.

D406: Used Lead acid batteries were stored in plastic containers and labeled as Toxic waste.

D407: Mercury content.. CFL, Fluorescent lamps/bulbs stored in boxes and labeled as Toxic waste.

I101 : Used oil from Generator set were stored in drums and labeled as Flammable waste.

I102 : Used cooking oil were stored in tin cans and labeled as Flammable waste.

I104 : Used Oil filters were stored at plastic containers and labeled as Flammable waste.

J201 : Empty cans previously containing chemical substance, empty paint containers are stored in a well ventilated area and labeled as Flammable waste.

M506: WEEE were stored at Material Management and Inventory Division Warehouse and labeled as Toxic waste.

D499: Other waste with inorganic chemical such as AAA, AA, batteries were stored in plastic containers and labeled as Toxic waste.

M504 : Pesticides are stored at a well ventilated area and labeled as Toxic Waste.

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Patient engagement and education

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patient engagement and education Batong Bulilit In-House School The Department of Pediatric Nephrology is not only focused on the aspect of curing the body but also of healing the total child, in mind, body and spirit. A desire to transcend over the physical needs of our patients brought about the birth of Batong Bulilit School, conceptualized in 1994 and realized in 1996.

In the summer of 1997, the first Art

a party specially prepared and

Contest was held outdoors

organized by the ever dedicated

This informal in-house school was for

beneath the numerous towering

pediatric nephrology fellows.

the hospitalized children, to

trees of the NKTI grounds. Since

minimize idle moments and be

then, the department sponsors the

In 2003, Manulife Philippines and

taught by our volunteer

Annual Art Contest and Talent

Migi’s Corner Foundation donated

teachers/parents.

Search held every June as part of

a 50-meter square playground

the Kidney Month Celebration.

near the OPD, fenced by flowering

Activities included storytelling,

bushes with swings, see-saw,

coloring books, playing games,

The children are grouped into

slides and other pediatric activity

watching educational programs and

categories according to age,

paraphernalia.

enjoying camaraderie with the

interpreting the theme of the Art

volunteers and other patients. In

Contest showing their talents on

It was designed to provide

1999, the department received the

painting and drawing.

comfort and solace to 40-50

Civil Service Commission (CSC) Pag-

children seen every OPD day.

Asa Award for innovative ideas of

During the Christmas season,

government agencies as part of its

these kids also gather and

centennial celebration.

celebrate Jesus’ birth through

To date, the Batong Bulilit activities live on to support our children stricken with kidney diseases. A mini play and reading area is incorporated in the pediatric unit of the hospital and volunteer students come to provide activities for in-patients. These sick children deserve to be happy . They need to belong to a community that cares for them. Batong Bulilit is the answer.

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patient engagement and education Chronic Kidney Disease Education and Counseling Program (CKD Clinic) The rising incidence of End Stage

For the past 12 years, it has catered to the educational needs of our

Renal Disease in the Philippines has

Chronic Kidney Disease patients. The program has been

been a driving factor to deliver the

instrumental in delaying the progression of Chronic Kidney

best quality of care to our Chronic

Disease as well as transitioning the patient towards renal

Kidney Disease patients. In line with

transplantation as the need arises.

this, the National Kidney and Transplant Institute being the premier center in managing renal diseases in the country, has recognized the role of education in the prevention of Chronic Kidney Disease.

In 2006, the Chronic Kidney Disease Education and Counseling Program (CKD Clinic) was formed to improve the outcome of Chronic Kidney Disease (CKD) patients by providing planned educational pathways, which will enable them to comprehend the disease process and treatment. Specifically, to increase the level of knowledge and preparedness of patients in various stages of CKD, in various aspects of their illness, and its treatment.

In the coming years, the CKD clinic aims to bridge the institute’s educational resources to further equip our clinicians in the prevention and management of Chronic Kidney Disease in several areas of the country.

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patient engagement and education Human Organ Preservation Effort (HOPE) Pre-Transplant Orientation NKTI’s Pre-Transplant Orientation: An Institutional Requirement for Potential Kidney Transplant Patients and their Donors

The Pre-Transplant Orientation (PTO) seminar was conceived out of the need to adequately prepare both potential

NKTI's Pre-Transplant orientation

kidney transplant patients, the donors

prepares both patients and donors and

as well as their respective families for

their respective families to the processes

the whole procedure/process involved.

involved in a kidney transplantation

This is from the time of diagnosis of ESRD (End Stage Renal Disease), initiation of dialysis therapy to the better option of being given “a new

The best part of the seminar is a first hand

kidney” via a transplant. This is to

account or testimony of a successful

restore a better quality of life and

transplantee as well as that of the donor

functionality of the patient rather than

provided by the Kidney Transplant

be on lifetime dialysis.

Association of the Philippines (KITAP), the organization of transplant patients. An open

Historically, the seminar was started in

forum ensues where fears, doubts and a lot of

the early ‘90s by the Medical Social

misinformation peddled outside by people

Services Department (MSSD). It was a

not in the know are clarified/explained.

multidisciplinary committee headed by the medical social worker. This

The ultimate goal of the seminar is to make

included the nephrology fellow, the

the recipient and the donor sign a duly

pharmacist, the dietician-nutritionist ,

informed consent for the operation. This is a

and the physical therapist. Later a

requirement before the transplant is

transplant psychiatrist and the

eventually done.

representative of the chaplaincy were added to make the approach “Holistic.” Eventually the committee was placed under the Department of Organ Transplant. With the further development of organ donation and Transplantation in the country, the PTO was finally attached to the Organ Procurement Office (OPO) of NKTI called Human Organ Preservation Effort (HOPE) which is the case at present.

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patient engagement and education Out-patient Lectures The NKTI Out-Patient Service (OPS) is

The IANAHP, facilitates outreach programs usually in line

located at the ground floor of Annex II

with the kidney month celebration and the Nursing

building. Its main function is to provide

month celebration. Some were held off-site aside from

preventive, diagnostic, therapeutic and

the regular conduct of health teachings for patients at

palliative care to patients with non-urgent

the Out-Patient Services Unit. Nurses give health

complaints. The unit is operated on an

teachings on the promotion of kidney health, prevention

eight hour per day Monday through Friday.

of kidney disease, treatment and management of

The unit offers maximum space for

Chronic Kidney Disease, do random blood pressure

optimum patient comfort and streamlined

check, and sometimes give away goodies.

triage and registration process. They provide a wide range of services with clinics in (1) General Medicine and its Subspecialty: Cardiology, Dermatology, Endocrinology, Gastroenterology, Hematology, Neurology, Oncology, Psychiatry, Pulmonary & Rheumatology (2) Adult Nephrology with four categories: General Nephrology, PreKidney Transplant Work-up, Post-Kidney Transplant and Post Kidney Donor (3)Urology (4) Pediatric-Nephrology (5) Vascular Surgery (6) Ophthalmology. In the Transplant clinic, care is provided by a multidisciplinary team through all phases of the transplant process, from pretransplant evaluation through posttransplant long-term follow-up.

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patient engagement and education Lupus Nephritis Clinic Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder, which is devastatingly destructive to organs due to damage caused by tissue-binding autoantibodies and immune complexes.

Kidney involvement in lupus is usually this disorder’s most serious manifestation. Lupus nephritis (LN) is one of the leading causes of mortality in the first decade of the disease.

Being the premier institution for kidney diseases in the nation, the NKTI has seen a vast number of biopsied and treated LN cases. This prompted the need to establish a Lupus Nephritis clinic in the Out-Patient services in the year 2015.

Every Thursday of the week, LN patients are being seen by Nephrology fellows under the guidance of experienced Nephrologists.

Managing the unique challenge of LN patients requires expertise and dedication.

The LN clinic provides access to adept knowledge from seasoned consultants during one visit, and ensures proper management of the disease with immediate intervention if needed in order to delay progression to chronic kidney disease and end stage renal disease.

Furthermore, all newly diagnosed LN patients based on kidney biopsy are asked to have their check-ups done on this assigned day of the week, too.

The LN clinic is open every Thursday of the week and offers up to date evidence based treatments as well as psychological support to all newly diagnosed and known cases of LN patients.

MARIPOSA SUPPORT GROUP: WARRIORS All During weekly clinic visits, an LN support group called Mariposa (Marked by Improved and Positive SLE Adaptation) was born.

Within this small but strong community, different individuals from all walks of life were able to find a common thread with each other, enabling them to share coping strategies, to feel empowered, and to build a sense of community.

Founding members of this group organize activities to raise awareness and reach out to new members in their time of need.

These patients, or warriors as what they fondly call themselves, guide and encourage each other through the different stages of their medical journey. They have taken their disease into their own hands and have helped each other cope and live with their condition.

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patient engagement and education Kidney Transplant Association of the Philippines (KITAP) KITAP is a non-stock, non-profit, non-government association of kidney transplant recipients, donors, honorary members and families. It promotes the physical, social and emotional well-being of its members by encouraging them to become productive and healthy members of the society.

Founded in 1985, KITAP is dedicated to uplifting the lives and protecting the rights of kidney transplant recipients, donors, and the immediate family of recipients. It currently has 1,400 members.

VISION – A home for a quality life among kidney transplants.

MISSION – To be management-oriented leaders and stronghold empowered members vis a vis an efficient and sustainable organizational growth CORE VALUES K- Knowledge I- Integrity T- Truth and Transparency A- Acceptance and Accountability P – Partnership

AFFILIATIONS World Transplant Games Federation National Kidney & Transplant Institute

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patient engagement and education Kidney Transplant Association of the Philippines (KITAP) BEGINNINGS Sometime in August 1985, a transplant patient discovered the healing effect of sharing experiences among his peers during one of his post transplant check-ups. Realizing the need for mutual support in their return to the mainstream of society, the earliest kidney recipients gathered together to form an association.

Registered with SEC on May 12, 1986 as the Kidney Transplant Association of the Philippines Inc. (KITAP) the first set of officers were Joel, Aliviado, Armando Zabala Jr., Fr. Joe Dimaculangan, Wenceslao Gaijetos, Olive Solis, Josephine Tan, and Evelyn Tan. Dr. Antonio Paraiso, Jojie Rago, Chit Apura and Dory Madlangbayan of the National Kidney Foundation of the Philippines (NKFP) were included as advisers.

Below are the highlights of KITAP's humble beginnings: In 1987, with seed money donated by Mrs. Celia Diaz Laurel, wife of then Vice President Salvador "Doy" Laurel, KITAP put up a gif tshop as source of fund for its activities.

In 1989, KITAP officers Boy Zabala Jr., Baba Flores, Celia Atienza, Josephine Tan, Marilou Garcia and Dominador Fermin represented the Philippines at the 8th World Transplant Games. The international exposure inspired the members to establish the, the Philippine National Transplant Games (PNTG) in 1994. The PNTG is aimed at promoting camaraderie among its members and to showcase the capability of transplant patients to live normal and productive lives. PNTG is now on its 14th year.

Being tasked with informing the public about the importance of organ donation, the members lobbied for the passing of the Organ Donation Bill which was later signed into law by President Corazon Aquino in 1992.

The maiden issue of the newsletter PITAK was published in December 1991. The newsletter, which is scheduled quarterly, has now become the main source of information and communication among KITAP members.

KITAP has grown to more than three thousand members at present. It hopes to be able to reach out to more patients, including transplant recipients from other hospitals. This will allow the organization to be more responsive to the needs of the kidney transplant community as well as fulfill its mission of rising up to the challenges of being given a second lease on life.

KITAP members with Dr. Rose Marie Liquete, Executive Director of NKTI

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patient engagement and education Kidney Transplant Association of the Philippines (KITAP) PROJECTS AND ACHIEVEMENTS KITAP giftshop KITAP grugstore Nationwide promotion of kidney transplantation and organ donation.

Information dissemination on Kidney Awareness, its prevention and treatment.

Social activities and programs organized by the association to showcase the talents of members.

KITAP outreach activities to less fortunate brothers and sisters Rainbow fund assisting Medical Social Services of NKTI to help kidney patients.

Low-cost medicine for transplant patients.

Creation of two satellite chapters in Region V and Region X Procurement of ambulance for the mobilization of members during emergencies situation and transplant service for members involved in promoting kidney awareness, organ donation and transplantation.

Revision of By Laws Intensive campaign and support from policy makers from different government agencies such as DOH, Senate, Congress, PCSO and DSWD for a fair and universal healthcare access.

PITAK – Official newsletter Easy access and comfort in processing guarantee letters in National Kidney and Transplant Institute.

ER, medical and funeral assistance to members and families governed by KITAP By-Laws.

Participation in Asia, China, Japan and World Transplant Games.

Additional assistance to donors and back to dialysis and active KITAP Members Collaboration with NKTI, MCTJ, PKF in partnership with Novartis in promoting REGALO on Organ Donation Program KITAP Brochure KITAP Quilt Participation in Asia, China, Japan, and World Transplant Games

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patient engagement and education Kidney Transplant Association of the Philippines (KITAP) FUNDRAISING ACTIVITIES BINGO Bonanza Mr. & Ms. KITAP Piso Mo, Karugtong ng Buhay Ko Concert for a Cause KITAP Idol Block Screening Cake/Grocery/Cash Raffle for a Cause IPAD Raffle for a cause

OTHER ACTIVITIES

Patients’ Forum and Assemblies Mass for the Sick and Holy Hour Devotional Pilgrimage to our Lady of Manaoag Tribute to Donors Philippine National Transplant Games Year-End Reunion Mission Appeal KITAP Membership Orientation Pre-Transplant Orientation

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patient engagement and education Peritoneal Dialysis Patients Association, Inc. (PDPAI) PD Z Benefit Package

Strong bond: The officers and members of the Peritoneal Dialysis Patients Association, Inc. (PDPAI) at NKTI

From Cruise Ship to Leadership It was April 2011, when Luisito “Louie” Cordero, a seafarer, found out that his wife, Wilma, was diagnosed with EndStage Renal Disease (ESRD). Upon hearing the news of his wife’s illness, he immediately flew home to take care of her.

They went to NKTI to seek consultation where Wilma was referred by their medical consultant to undergo hemodialysis (HD). Unfortunately, the treatment didn’t go well and she was shifted from HD to Peritoneal Dialysis (PD).

While PD worked well for his wife, Luisito soon found out that the cost of treatment was slowly depleting their life savings. From being a pay patient, he eventually signed up her up to become a service patient of NKTI. With the help of Institute’s Medical Social Service Department and other government agencies such as DOH-MAP, Philhealth and PCSO, they were able to sustain Mrs. Cordero’s medical treatment.

A year after his wife’s diagnosis, Luisito felt he could help his wife’s fellow patients get through the struggles of treatment by providing a “support system” among patients. He taught of establishing an association that could become the voice of PD patients. To make everything legal, Luisito registered the organization with the Securities and Exchange Commission (SEC) using his own money. And with only about 40 active members during that time, the first PD Association was established. It was headed by Mr. Pastor Obed. Mr. Cordero served as an adviser to the organization.

When his wife passed in 2017, Luisito felt that his mission to help his wife’s fellow patients was already done. But since members still approach him whenever they encounter problems, this made him come to a realization that being able to provide assistance to those in need is indeed one of God’s calling.

Being aware that most of the PD patients can barely “make ends meet” with the cost of their treatment, Luisito thought of ideas on how he can help them financially. The association appealed for Philhealth’s help in creating a benefits package that will help give patients access to free PD solutions. This gave birth to the PD Z Benefit Package for Peritoneal Dialysis, Philhealth’s aid for a year supply of PD solutions for every Peritoneal Dialysis patient who are active members of Philhealth. The “PD Z-Benefit Package” which was approved in 2014 was one of the most significant victories, if not the most remarkable for the PD patient's organization.

On August 2016, Luisito called for an election of new set of PD Officers and established a new organization - The Peritoneal Dialysis Patients Association Inc (PDPAI). With the help of some friends, he crafted its by laws and duly registered it to the Securities and Exchange Commission. Since the organization does not solicit any funding, all expenses being incurred by the organization is currently being shouldered by Luisito. Since then, he has never failed to remind his members that the PD solutions being given by the government should be solely used by the patients and not be sold for profit.

Because of the members’ high regard for him as their leader, members of the organization has religiously abided to the core values of the organization.

Through the efforts of the Public Information Office and the support of NKTI's top management, a "PD Helpdesk” was put up which aims to answer new PD patients queries and concerns. Future projects include PD patients’ financial empowerment ideas such as trainings and seminars that can help members create business that will help augment them financially.

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patient engagement and education The Dialysis PH Support Group Inc.: Empowering Chronic Kidney Disease (CKD Patients)

Being a dialysis patient inspired Rey Abacan to establish an online support group for patients with Chronic Kidney Disease (CKD) on April 2015, through the social media networking site Facebook. His aim was to empower and give inspiration to people with CKD, that having hope and confidence, can become a key to fight the battle victoriously. The online community which is composed of more than 30,000 members to date, has become a powerful tool in sharing their experiences, photos and inspiring stories to fellow patients who are seeking for emotional refuge online.

Through his leadership, members of the Dialysis PH Support Group Inc., (DPSGI) are being taught how to augment financial necessities through the aid of government assistance programs such as the Department of Health’s Medical Assistance for Indigent Patients (MAIP) and PCSO Guarantee Letters.

Financial struggles struck them from time to time, but a true fighter never gives up and take every challenge as an opportunity to gain more. Bound with optimism and limitless possibilities, they would meet up with officials of government agencies to voice out important concerns directly affecting their needs as a patient and tirelessly monitor developments of laws that would affect the CKD community. They also conduct workshops focused on policy making and leadership.

All of these things keep Rey Abacan and the rest of DPSGI grow each day, as they refuel their energy through dialysis which they positively call “a blood spa”. Truly, a disease cannot make an optimistic person a handicap but rather a unique tool to reengineer oneself to find purpose in the simple joys of life.

About Dialysis PH Support Group, Inc. DPSGI is a Non-Profit, Non-Government Organization Support Group for Chronic Kidney Disease (CKD) Patients.

The group was created to be the cornerstone and advocate of CKD rights. Their mission is to informevery patient that they are not alone in their struggles with CKD. They provide information thru various activities and projects, integrating the participation of family members to raise awareness on the vital role of renal care to the over-all health of a person.

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NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

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Emergency and disaster preparedness ACCOMPLISHMENT REPORT 104

NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

Emergency and Disaster preparedness National Kidney and Transplant Institute (NKTI) was assessed to be vulnerable and exposed to internal and external hazards and disasters.

Having BS OHSAS 18001accreditation made the safety program and emergency preparedness of the institute become institutionalized.

This was mapped and identified through Risk Management with the use of hazard identification tool such as HIRADC (Hazard Identification Risk Assessment and Development of Control) and HSI (Hospital Safety Index). Earthquake, typhoons, industrial hazards, fire, hazardous materials and biological hazards are highly rated risk at NKTI. Floods, epidemics, pandemics, power outages, water supply disruption and technological hazards were rated average but considered significant. Although these hazards may not be totally prevented, its risk impact can be minimized through effective emergency and disaster management.

The first phase of emergency preparedness entails planning and preparation. These involves emergency drills, lectures, trainings and compliance to statutory, regulatory and safety requirements.

Preparing for an emergency and disaster on a health care facility is challenging for the Occupational Health and Safety Committee. The management shows its support to OHS through ISO-IMS (Integrated Management System) accreditation for Quality, Environmental and Occupational Health and Safety.

which is reflected in OHS calendar of activities which involves fire, earthquake drills, bomb threat and chemical spill drills.

Emergency drills and trainings for NKTI employees are programmed annually through Human Resource and facilitated by OHS committee

All drills are participated by NKTI employees in cooperation with local government such as DOH, BFP and PNP. NKTI has a well established disaster preparedness program and in fact, NKTI ratings for emergency simulation conducted by external agencies have gradually improved every year.

THE NKTI Incident COMMAND SYSTEM (ICS) An Employee Commitment to Safety New employees are made aware of the NKTI safety programs as part of their new employee safety orientation. The NKTI-OHS committee and its emergency management team deals with potential emergency and disaster and its effect to the hospital operation, the environment and its personnel.

An Incident Command System (ICS) was established to address disaster management.

ICS is available 24/7, composed of Senior House Officer (SHO), Safety Officer, Security Personnel, Fire Brigade Team, Engineering, Medical Team and Logistics are qualified and trained individuals responsible for Hospital Emergency Preparedness, Response and Recovery.

The present safety index of the hospital based on DOH-HSI report is rated “B” where intervention

measures are needed in short term.

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MANAGING A LEPTOSPIROSIS OUTBREAK ECMO was first successfully used during a surge in the number of leptospirosis patients last June 2018. It was the first successful use of ECMO in a government hospital in the Philippines.

Immediately, the Leptospirosis Emergency Policy was activated and the Institute’s gym was identified as the area to transform into a special ward for these patients.

In less than 2 hours, 50 cots were placed in the area, IV stands, oxygen tanks, a nurse’s station equipped with computers to connect with the hospitals laboratory and database system, Pharmacy delivered the needed medications including antibiotics, IV solutions, inotropes, methyl-prednisolone, cyclophosphamide and more, while Housekeeping brought in all the needed supplies and other equipment.

The hospital’s Purchasing Division equipped the area with 20 iwata fans, 10 industrial fans, a water dispenser for patients, and meals for all the personnel providing service to the area. Nursing and medical staffing were prioritized to provide sufficient care for the medical needs of the patients. DOH and its Health Emergency Management Bureau assisted in the provision of supplies and staffing. The provision of 5 hemodialysis (HD) machines was set-up by the HD Unit in the area to accommodate majority of the patients who required this life-saving treatment, together with peritoneal dialysis.

PROACTIVE APPROACH This year, in response to another upsurge of Leptospirosis cases at the NKTI, the gym was again identified as a designated ward to accommodate the growing number of patients with Leptospirosis.

A manual on upsurge policies and procedures was also published by NKTI to define actions and roles necessary to provide a coordinated response to managing Leptospirosis cases in the Institute.

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Emergency and Disaster preparedness EXTRACORPOREAL MEMBRANE OXYGENATOR (ECMO) IN THE MANAGEMENT OF PULMONARY HEMORRHAGE IN LEPTOSPIROSIS The most dreaded complication of patients with leptospirosis is pulmonary hemorrhage since it results in almost 100% mortality. Although acute kidney injury can be successfully managed with dialysis that allows treatment of the metabolic abnormalities while providing the kidney time to recover from the disease, once pulmonary hemorrhage ensues, mechanical ventilation may be insufficient to provide the patient with adequate oxygenation and carbon dioxide removal. Last 2018, among 468 patients admitted at the NKTI with leptospirosis there was a 7.67 % mortality, majority due to pulmonary hemorrhage.

With ECMO or Extracorporeal Membrane Oxygenator, the NKTI now has a treatment that can save patient’s lives even if they have massive pulmonary hemorrhage.

ECMO is a treatment where blood is oxygenated outside the body and allows adequate respiration while the patient’s lung is allowed to recover, through mechanical ventilation at lung rest settings.

This year, three simultaneous VV ECMO management and hemoperfusion in Leptospirosis were done at NKTI. NKTI has had 15 patients managed using ECMO since June 2018. Eight out of eleven patients survived to discharge as of August of this year.

These patients experienced cough, myalgia, fever followed by conjunctival suffusion and consulted nearby hospitals.

They were found to have an elevated creatinine, low urine output and progressive difficulty of breathing.

First successful use of ECMO in a leptospirosis patient with pulmonary hemorrhage and acute kidney injury in a government hospital in the country. (In the photo is Dr. J. Chavez, head of the Pulmonary ECMO team, with pulmonologists Dr. J. Chico, and Dr. J. Ginete-Garcia

While in the hospital they were started on IV steroids, blood component transfusions, antibiotics and dialysis. They soon developed hemoptysis, increasing infiltrates on chest xray and reduced arterial oxygenation and/or increased carbon dioxide eventually requiring mechanical ventilation.

Despite maximum ventilatory support however, they had severe respiratory and metabolic acidosis and were thus placed on ECMO. ECMO provided adequate oxygenation and carbon dioxide removal from 5 to 17 days, allowing time for the lungs to heal.

Patients were eventually extubated and discharged.

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Emergency and Disaster preparedness WATER SHORTAGE AT NKTI: A CRISIS AVERTED The water crisis that hit Metro Manila during summer this year brought the cistern levels of NKTI to 10% from its operational normal level of 100%. NKTI consumes an average of 1,600 cu.m of water per day with 100 cu.meters per hour on peak hospital operations. The hospital’s healthcare services rely mostly on water supplying patients wards, Operating Rooms, Laboratories and most especially its’ Hemodialysis facility.

Last March 11, 2019, the NKTI-General Services Division (GSD) received a notice from Manila Water informing that NKTI will be experiencing low pressure and worse, instances of no water services at certain hours of the day. The following day, on March 12, 2019 ,at 3:00pm, low water pressure to no water situation was experienced that resulted to rapid decline of NKTI’s cisterns from 100% to 30%.

As part of GSD’s protocol for any water supply interruption, the institute’s deep well was utilized to augment the water supply shortage. The deep well could deliver only a 300 cu.m of water per day that was insufficient to address the demands of the hospital. To address this shortage, the Executive Director, Dra. Rose Marie O. Rosete-Liquete wrote a letter to the Bureau of Fire and Philippine Red Cross to assist Manila Water for immediate additional water tanker services. GSD assigned personnel to hourly monitor its water supply and cisterns’ level and to institute remedial measures for water allocation internally.

Dr. Joseph Michael Jaro, Ancillary Services Department Manager and Dr. Rose Marie Liquete, Executive Director inspect a Red Cross Water tanker during the height of the water shortage crisis in the metro last March.

The Hemodialysis Center is one of the many important facilities of the hospital requiring reverse osmosis machines that require at least 50psi water pressure and demand a 5-10 cu.meters of water supply per hour. To cope with the Hemodialysis requirements alone, water cistern levels must be maintained at 35% minimum equivalent to 175cu.m.

On March 14, 2019, DOH Secretary, Dr. Francisco Duque met with four specialty hospitals including hospitals affected by the water crisis. He instructed MWCI to assure NKTI for four (4) - 10 cu.m tanker per hour water delivery during peak hours to augment NKTI’s and Lung Center’s deep well facilities. Water supply status report was submitted to DOH daily to update the Secretary of Health regarding this water issue.

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Emergency and Disaster preparedness WATER SHORTAGE AT NKTI: A CRISIS AVERTED NKTI was invited by the Senate for a hearing on Manila Water supply shortage last March 19, 2019 and was represented by Dr. Joseph Michael A. Jaro and Engr. Aj A. Sonza. Dr. Jaro briefly explained to the Senate committee how NKTI handled the crisis with the help from several agencies such as DOH, BFP, PRC and Maynilad.

The acute phase of the water crisis lasted for a week until it normalized with scheduled water supply at certain hours of day.

As a result of the water crisis, NKTI’s GSD formulated Water and Power Crisis Management teams to mitigate crisis impact and respond accordingly. Likewise, NKTI’s deep well system was replaced with brand new pump, motors, pipelines and control panel as part of infrastructure upgrade for water supply with the help of MWCI along with installation of new booster pump and redesign of its main pipeline serving NKTI to increase water pressure and supply.

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social development programs

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social development programs NKTI LIFESTYLE MEDICINE PROGRAM Cognizant of the needs of a maturing workforce, the Employee Wellnness Program was launched in June 2011 to provide activities that would enhance the physical and emotional well-being of the NKTI employees and improve their workplace productivity.

During its first years, programs included the Nutrition Month activities every July, weekly Zumba dance class, sports fest activities, Pinoy Biggest Loser contests. In addition, wellness seminars that provided lectures on medical, psychological health and wellbeing.

With the full-hearted support of the top management, a multi-purpose hall and gym were built and the completed Lifestyle Medicine Program was inaugurated on January 18, 2016 with the theme "Unang Hakbang sa Patuloy na Kalusugan".

The NKTI Multi-purpose Hall started operations in August 2016. It is currenty used by NKTI employees for Zumba classes (every Wednesday), basketball (every Monday and Friday), badminton games (every Tuesday), and volleyball (every Thursday). It is also the venue for the annual Sports Fest.

The NKTI Lifestyle Medicine Program consists of the following: Health Screening, Stress Management, Physical Fitness, Diet, and Weight Management, In June 2016, the NKTI Gym was opened for the exclusive use of employees. It is equipped with 4 elliptical machines, equipment for strenthening, conditioning, and circuit training. It is manned by a fitness coach, Mr. Ramiro Alvarez. A total of 72 assessments were performed, and 2 exercise programs (Weight gain and Weight loss) were formulated for employees by the fitness coach. From June to December 2018, the gym was utilized 1,370 times.

Among the activities of the Lifestyle Medicine Program are Employees' seminar held three times a year. The topics that were discussed include Recognizing Conduct Disorder, Change Management, Cumulative Disorders, Exercise in the Workplace, and Osteoporosis. Destressing activities like Ikebana (the art of flower arrangement) was carried out last November 2018. A special lecture given by Dr. Carisse Diana DrilonDalman on Basic Steps to Over-all Wellness was held last January 2019.

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social development programs GENDER AND DEVELOPMENT PROGRAM The Gender and Development Focal Point System of NKTI was established in February 2014.

Its purpose is to catalyze and accelerate gender mainstreaming across the organization to ensure that in its development, there is equality in the participation and empowerment of its people.

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social development programs GENDER AND DEVELOPMENT PROGRAM To promote gender awareness, regular orientations and gender-related strategies are implemented by the NKTI GAD-FPS. Every year specific activities to celebrate Women’s Month, Mothers’ Day and Fathers’ Day are conducted.

2016 March Essay Writing, Coloring and Cooking Contests May Forum: GAD, why is essential to the workplace?

Resource Speaker: Dr. Blesshe L. Querijero June Forum: Gender Equality Among Employees Resource Speaker: Dr. Enrique T. Ona To promote gender awareness, regular orientations and gender-related strategies are implemented by the NKTI 2017 March Makeover Challenge Work for Women Contest May Forum: Role of Mother for Better Health Care Resource Speaker: Dr. Maria Francia M. Laxamana Free Movie Screening: Everything About Her June Ang Handog ng Ama sa Anak Contest Free Movie Screening: Daddy Day Care

2018 March Makeover Challenge Work for Women, Season II Contest Forum: Personality Development and Mix and Match Fashion Resource Speaker: Ms. Teresita Alberto – Chiongbian

May Free Movie Screening: Hidden Figures Mothers’ Day Wellness Program: Free SPA and skin services June Fathers’ Day Wellness Program: Free SPA and skin services

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APPENDIX 2015 PRESENTED AND PUBLISHED RESEARCHES POSTER PRESENTATION IN LOCAL AND INTERNATIONAL MEETINGS (18) Division of Adult Nephrology Living Donor Nephrectomy at the National Kidney and Transplant Institute: Surgical Techniques, Perioperative Complications and Outcomes. Maria Regina Gregorio, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 One-Year Graft and Patients Survival of Highly sensitized Kidney Transplant Recipients in National Kidney and Transplant Institute. Mel-Hatra Arakama, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 Outcomes of Minimization of Cyclosporine and Timed Conversion to Everolimus Versus Standard Dose Cyclosporine in Primary Renal Transplant Recipients. Ruchelle Turqueza, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 The Down Fall of Transplant A Case Report of Myeloid Sarcoma in a Post Kidney Transplant. Sheena Ann Diloy, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015

Division of General Surgery Quality of life underwent Hepatectomy: A Single Centre Study. Jonathan L. Lumicday, M.D. A 5 year retrospective study on the histopathologic correlation of Filipino women with bi-rads/Category 4 lesions on Mammography in NKTI. Michael Tulaylay, M.D. A-PHPBA 5th Biennial Congress Asian Pacific Hepato-Pancreato Biliary Association March 18-21, 2016

Division of Internal Medicine Utility of Procalcitonin in Immunocompromised patients with Bacterial Sepsis. Maricris C. Garcia, M.D., Mryna T. Mendoza, M.D., Raquel Victoria M. Ecarma, M.D. Philippine College of Physician’s 45th Annual Convention, Marriot Hotel, May 2015 Electrocardiographic (ECG) changes and it’s correlation with degree of Hyperkalemia among end-stage renal disease (ESRD) patients. Jhoanna G. Marcelo, M.D., Neil D. Erguiza, M.D. Philippine College of Physician’s 45th Annual Convention, Marriot Hotel, May 2015 The Clinical profile, management and outcomes of patients diagnosed with clostridium difficile infection in the NKTI from September 2007 to December 2014. Issa Rufina L. Senga, M.D., Myrna T. Mendoza, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015

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APPENDIX 2015 PRESENTED AND PUBLISHED RESEARCHES POSTER PRESENTATION IN LOCAL AND INTERNATIONAL MEETINGS (18) Division of Organ Transplantation and Vascular Surgery Perforated Peptic Ulcer Disease in the early post peritoneal dialysis Initiation: Case Report. Jonathan John Tamin, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 Valacyclovir and Cytomegalovirus Disease among Kidney Transplant Recipients-NKTI Experience. Rophel T. Miguel, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 Outcome of Kidney Transplantation in Recipients with Pre-Transplant Donor Specific antibodies at the National Kidney and Transplant Institute: A Preliminary Study.

Juan Alejandro Sotto, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 Outcome of renal allograft transplant from machine perfused (LIFEPORT) deceased Kidney donor. Francis Honorato N. Osio, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 Graft and recipient outcome of cadaveric renal transplantation at NKTI from 2007-2010. Yusuf Joseph G. Overio, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015

Division of Pediatric Nephrology Survival Rates and Factors Affecting Outcome of Pediaric Renal Transplantation at the National Kidney and Transplant Institute from 1984 – 2011. Janice T. Tuazon, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 Outcome of Pediatric Kidney Transplants with Campath-1h as Induction Theraphy. Carmina Gerard Patio, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 Blood Pressure as a Predictor of Short-Term Allograft Function Among Pediatric Kidney Transplant Patients Seen at NKTI from January 2000 to August 2005. Christine Cabahug, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 Predictors of Patient Survival in Pediatric Living Related Kidney Transplants Recipients: A 10 year NKTI Experience. Nathan Bumanglag, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 Survival Rates and Fact Affecting Outcome Among Pediatric Kidney Transplant at National Kidney and Transplant Institute from 1984-2006. Carmina Gerard Patio, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 115

APPENDIX 2015 PRESENTED AND PUBLISHED RESEARCHES ORAL PRESENTATION IN LOCAL AND INTERNATIONAL MEETINGS (20) Division of Adult Nephrology A Study on the Directed Living Non-Related Donor Kidney and Transplantation Submitted to the Hospital Transplant Ethics Committee at the National Kidney and Transplant Institute. Grace Suguitan, R.N. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 Outcomes of renal allograft recipients with Hepatitis C. Rica Carpio, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 Pre-Transplant Donor-Specific HLA-Antibodies Detected by Luminex Single Antigen Bead: Risk Factors and Outcomes after Kidney Transplantation. Mel-Hatra Arakama, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 Kidney Transplantation under the Philippine Health Insurance Corporation’sType Z Benefit Package. Glenda Eleanor Pamugas, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015

Division of Internal Medicine Hepatitis B Surface Antigen Serum Qualification Distinguish Active from Inactive HbsAg-Negative Patients at National Kidney and Transplant Institute. Mark Lester S. Sy, M.D., Jade D. Jamias, M.D. Hepatology Society of the Philippines Annual Convention, Crowne Plaza, Ortigas January 27, 2015 The Correlation of HgbA1c Level to the Development of Cardiovascular Complications Among Diabetic Patients Undergoing HD at National Kidney and Transplant Institute. Minerva G. Nicolas, M.D., Ma. Teresa Plata-Que, M.D. Philippine College of Physician’s 45th Annual Convention, Marriot Hotel May 2015 Risk Factors for foot problems among Type 2 Diabetic Patients with Chronic Kidney Disease at the National kidney and Transplant Institute. Roy Raoul H. Felipe, M.D., Ma. Teresa Plata-Que, M.D. 1st Place of Annual Intradepartmental Research Contest, Dr. Filoteo A. Alano Auditorium November 25, 2015 1st Place of Annual Research Forum Dr. Enrique T. Ona Auditorium December 9, 2015 (Prospective study) Acute Kidney Injury among cirrhotic patients on non-selective beta-blocker after paracentesis: An incidence and risk association study. Jeffrey P. Mora, M.D., Jade D. Jamias, M.D. 2nd Place of Annual Intradepartmental Research Contest, Dr. Filoteo A. Alano Auditorium November 25, 2015

A Ten-Year Survival Analysis of Filipino Patients with Systemic Lupus Erythematous at the National Kidney and Transplant Institute. Emily Mae L. Yap, M.D., Charito Bermudez, M.D. 3rd Place of Annual Intradepartmental Research Contest, Dr. Filoteo A. Alano Auditorium November 25, 2015

Autoimmune Hepatitis: Clinical Profile of a Rare Disease. Emily Mae L. Yap, M.D., Ira I. Yu, M.D. 1st Place of Annual Research Forum Dr. Enrique T. Ona Auditorium December 9, 2015 (Retrospective study) A Case of Hemophagocytic Lymphohistiocytosis. Iss Rufina Senga, M.D. Young Investigational Oral Free Communication Session, Philippine College of Physicians 45th Annual Convention May 2015 The Blood Renegade: A Case Report on Primary Diffuse Large B Cell Lymphoma of the Bone Marrow Author. Eric Royd Talavera, M.D. Best Case Report of Annual Research Forum Dr. Enrique T. Ona Auditorium December 9, 2015.

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APPENDIX 2015 PRESENTED AND PUBLISHED RESEARCHES ORAL PRESENTATION IN LOCAL AND INTERNATIONAL MEETINGS (20) Department of Laboratory Medicine Assessment of the blood group serology practice in the Philippines through the National External Quality Assurance scheme (NEQAS): A pilot study by the NKTI-National reference laboratory for Immuno hematology. Dennis Jose Carbonell, M.D., Valerie Anne Tesoro, M.D., Pamela Delos Reyes, M.D., Januario Veloso, M.D., Ms. Adoraccion Sevilla, RMT Annual Presentation of Research Department NKTI- Claver Ramos Auditorium December 8, 2015 Achieving Quality in HER-2/neu Immunohistochemistry testing and Hematoxylin and Eosin Tissue staining in the Philippines: results of the pilot National External Quality Assurance Scheme. Jared Billena, M.D., Ricardo Quimbao, M.D., Erland Del Rosario, M.D., Pamela Delos Reyes, M.D., Januario Veloso, M.D. Annual Presentation of Research Department NKTI- Claver Ramos Auditorium December 8, 2015

Department of Nursing Services The Leader Empowerment Behavior of the Nurse Supervisor in a Tertiary Medical Specialty Center: Inputs to Strategic Planning. Ms. Hazel Villafranca, R.N., Ms. Katriana Paglicawan, R.N. 3rd Place of Annual Research Forum Dr. Enrique T. Ona Auditorium December 9, 2015 (Prospective study) Efficiency of Saline and Online Flushing on the Prevention of Extracorporeal Circuit Clotting. Mr. Kristian Noche, R.N., Ms. Beth Espiritu, R.N., Ms. Dell Lagura, R.N., Ms. Nerissa Gerial, R.N. 2nd Place of Annual Research Forum Dr. Enrique T. Ona Auditorium December 9, 2015 (Retrospective study)

Division of Organ Transplantation and Vascular Surgery Urologic Complications Among Renal Transplantation Patients with Double J Stents vs Patients without stent: A Single Center Retrospective Study. Edgar Macaraeg, M.D 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015 One Year Outcome of Living Donor Kidney Transplantation With Multiple Renal Arteries-NKTI Experience.

Arlene C. Duque, M.D. 14th Congress of the Asian Society of Transplantation, Suntec Convention Center, Singapore August 23-26, 2015

Division of Pediatric Nephrology Peritoneal Equilibration Test (PET) analysis among Filipino children on chronic peritoneal dialysis. Elmer Kent Lopez, M.D. PNSP 20th Annual Convention, Crowne Plaza Manila November 22-24, 2015 2nd Place of Annual Research Forum Dr. Enrique T. Ona Auditorium December 9, 2015 (Prospective study) The Observed Patterns in the Presentation and Latency Period of Acute Glomerulonephritis in Children in a Single Center. Irish C. Manguilimotan, M.D. PNSP 20th Annual Convention, Crowne Plaza Manila. November 22-24,2015

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APPENDIX 2016 PRESENTED AND PUBLISHED RESEARCHES PUBLISHED IN LOCAL AND INTERNATIONAL JOURNALS (5) Division of Anesthesia Comparison of intravenous nalbuphine and butorphanol in the treatment of epidural morphine – induced pruritis: A randomized open label phase IV Trial. Kristine Joy Agcaoili, MD Philippine Society of Anethesiologists, Inc Marriott Hotel, Manila Philippines

Division of Internal Medicine Acute Kidney Injury among Cirrhotic patients on non-selective beta-blocker after paracentesis: An incidence and risk association study. Jeffrey P. Mora, MD, Jade D. Jamias, MD American College of Gastroenterologist 2016 Annual Scientific Meeting, The Venetian Hotel, Las Vegas, Nevada, USA. October 14-19, 2016.

Prognostic Features, treatment and outcomes and survival of hepatocellular carcinoma patients in NKTI. Rei Joseph Prieto, MD, Jade Jamias, MD Asia Pacific Digestive Week 2016, Kobe Japan. November 2-5, 2016.

Autoimmune Hepatitis: Clinical Profile of Rare Disease. Emily Mae Yap, MD, Ira Yu, MD Asian Pacific Association of the Study of the Liver, Beijing China. December 16-18, 2016.

Strings of fury: A Case report of strongyloides hyperinfection syndrome in a Chemotherapy-naïve patients with extensive small cell lung carcinoma. Irene Roselllen P. Tan, MD, Myrna T. Mendoza, MD Philippine Society of Microbiology and Infectious Diseases Annual Convention, Crowne Plaza, Galleria.

November 23-25, 2016.

Liver Abcess HarborsMeliodosis: A Rare finding in a potentially endemic community. Emily Mae Yap, MD, Minette Claire O. Rosario, MD Asian Pacific Association of the Study of the Liver, Beijing China. December 16—18, 2016.

Division of Organ Transplant Percutaneous transluminal angioplasty for central vein stenosis in adults with Chronic Kidney Disease at the NKTI. Alexander Kent T. Achurra, MD ASVA 2016, Singapore. October 20-23, 2016.

Endovascular Aortic Aneurysm Repair: the NKTI Experience from 2013 to 2014. Edgar C. Macaraeg, MD ASVA 2016, Singapore. October 20-23, 2016.

Cannulation of Arterio-venous fistula after ultrasound evaluation-NKTI Experience. Rophel T. Miguel, MD ASVA 2016, Singapore. October 20-23, 2016.

Profile of hemodialysis patients with arteriovenous fistula presenting with venous hypertension at the NKTI. Eduardo T. Aro, Jr., MD ASVA 2016, Singapore. October 20-23, 2016.

Movement of intravascular catheters in a simulated hemodialysis environment. Joy M. Gali, MD ASVA 2016, Singapore. October 20-23, 2016.

Outcome of Deceased Donor Renal Transplantation patients who underwent induction therapy with basiliximab and rabbit anti-thymocyte globulin) at the NKTI from January 2007 to December 2011. Joel B. Benavidez, MD ATW 2016 – Incheon, Korea. October 28, 2016.

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APPENDIX 2016 PRESENTED AND PUBLISHED RESEARCHES POSTER PRESENTATION IN LOCAL AND INTERNATIONAL MEETINGS (15) Division of Pediatric Nephrology Peritoneal Equilibrium Test analysis among Filipino children peritoneal dialysis at NKTI: A Cross section study. Elmer Kent Lopez, MD Iguacu, Brazil. September 20-24, 2016.

Outcome of Children with IgA Nephropathy: A 15 year review. Ambrosio Palana, MD Iguacu, Brazil. September 20-24, 2016.

ORAL PRESENTATION IN LOCAL AND INTERNATIONAL MEETINGS (6) Division of Organ Transplant Initial outcome of Renal Allograft transplant from machine-perfused (LifePort) Deceased Kidney Donor from October 2014 to February 2016. Francis Honorato Osio, MD ATW 2016 – Incheon, Korea. October 28, 2016 Survival of HLA Class II positive recipients compared to standard risk recipients after Renal Transplantation at the NKTI from January 1, 2009 to December 31, 2013. Jonathan John Tamin, MD ATW 2016 – Incheon, Korea. October 28, 2016

Division of Pediatric Nephrology

Somatic Growth of Filipino Children after renal transplantation at the NKTI. Ma. Rowen Cuya, MD, Coe Dela Sena, MD Crown Plaza. November 20, 2016.

Clinical Outcome of nephrotic syndrome in Children 1-18 year old: A Single Center Study.

Mary Aimee Uson, MD Crown Plaza. November 20, 2016.

Prevalence of Hypercholesterolemia in nephrotic syndrome patients undergoing steroid treatment seen at NKTI pediatric out-patient Cinic. Ma. Rowena Cuya, MD Crown Plaza. November 20, 2016.

Clinical Profile of Pediatric Renal Mass in NKTI, a 10 year Retrospective Study. Kristen Ann C. Manalo, MD Crown Plaza. November 20, 2016.

PUBLISHED IN LOCAL AND INTERNATIONAL JOURNALS (1) Division of Internal Medicine Prognostic Features, treatment and outcomes and survival of hepatocellular carcinoma patients in NKTI. Rei Joseph Prieto, MD, Jade Jamias, MD Philippine Journal of Internal Medicine Volume 53 No. 3. October 5, 2016.

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APPENDIX 2017 PRESENTED AND PUBLISHED RESEARCHES POSTER PRESENTATION IN LOCAL AND INTERNATIONAL MEETINGS (19) Division of Adult Nephrology Graft and Patient Survival of Kidney Transplant Patients at the National Kidney and Transplant Institute.

Maria Victoria Catapang-Melo, MD, Concesa Cabanayan- Casasola, MD 15th Congress of the Asian Society Transplantation (CAST) 2017, Cebu, Philippines. November 27-30, 2017

Division of Internal Medicine Impact of Early Antibiotic Therapy (EAT) on Outcome of Patients with Sepsis in Emergency Room (ER) of National Kidney and Transplant Institute (NKTI). Irene Rosellen Tan, MD, Myrna Mendoza, MD Singapore International Infectious Diseases, Singapore. August 24-26, 2017 A Ten-year Survival Analysis of Filipino Patients with Systematic Lupus Erythematosus at NKTI. Emily Yap, MD, Charito Bermudez, MD Annual European Congress of Rheumatology (EULAR 2017) Madrid, Spain. June 14-17, 2017 Serum Albumin As a Predictor of Postoperative Morbidity And Mortality Among Patients Undergoing Abdominal Surgery: A Retrospective Cohort Study. Charisse Ruth Que, MD, Ernesto Que, MD Asian Pacific Digestive Week Convention, Hong Kong. September 25-26, 2017

Division of Organ Transplant A Review on the Effects of Arm Compression and Arm Flexion Exercises on Vein Diameter of Patients with Chronic Kidney Disease: A National Kidney and Transplant Institute Experience. Kristina Marie TrocioZapanta, MD CAST 2017, Cebu, Philippines. November 28, 2017 PCS Annual Research Congress 2017. December 3, 2017 Transposition and Superficialization of Basilic Vein for Branchio-basilic Fistula: The NKTI Experience. Joel B. Benavidez, MD CAST 2017, Cebu, Philippines. November 28, 2017 PCS Annual Research Congress 2017. December 3, 2017 Factors Influencing Development of Central Vein Stenosis in Patients Diagnosed with Central Venous Stenosis by Venogram from January 1, 2013 to December 31, 2015. The National Kidney and Transplant Institute Experience. Jonathan John F. Tamin, MD CAST 2017, Cebu, Philippines. November 28, 2017 PCS Annual Research Congress 2017. December 3, 2017 Renal Resistance and Flow Rates of Kidneys in Hypothermic Perfusion Devices as Viability Assessment tools for Kidney Transplantation in National Kidney and Transplant Institute. Rehana V. Pallingayan, MD CAST 2017, Cebu, Philippines. November 28, 2017 PCS Annual Research Congress 2017. December 3, 2017 5Graft and Recipient Outcome in Deceased Donor Renal Transplantation at National Kidney and Transplant Institute: Machine Perfusion vs Static Cold Storage. Noli V. Velasquez, MD CAST 2017, Cebu, Philippines. November 28, 2017 PCS Annual Research Congress 2017. December 3, 2017

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APPENDIX 2017 PRESENTED AND PUBLISHED RESEARCHES POSTER PRESENTATION IN LOCAL AND INTERNATIONAL MEETINGS (19) Division of Organ Transplant Outcome of Antithymocyte Globulin Use in Elderly Renal Transplant. Amabelle Q. Yuga, MD CAST 2017, Cebu, Philippines. November 28, 2017 PCS Annual Research Congress 2017. December 3, 2017 Preoperative Vein Mapping for Arterio-Venous Fistula Creation: A National Kidney and Transplant Institute Experience. Jonathan L. Lumicday II, MD Asian Society for Vascular Surgery (ASVS), Malaysia. October 28,2017 PCS Annual Research Congress 2017. December 3, 2017

Department of Pathology and Laboratory Medicine Myxoid Liposarcoma of the Thigh Metastasizing to the Breast: A Diagnostic and Therapeutic Challenge.

Elizabeth Jeremmie L. Reyes, MD, Arnold M. Fernandez, MD, Jennifer Ann D.C. Mercado, MD 15th Asian Breast Diseases, Association Annual Scientific Meeting 2017- Singapore. November 5, 2017 Childhood Acute Lymphoblastic Lymphomas Occurring in the Maxilla. Maria Cecilia M. Danguilan, MD, Januario D. Veloso, MD 66th Philippine Society of Pathologists Annual Convention: Empowering the Young Pathologist - Novotel Manila Araneta Center. April 26-28,2017 Co-expression of TTF-1 and p63 in a Lung Adenocarcinoma with Metastasis to the Small Intestines. Theresia Gail R. Galut, MD, Valerie Anne T. Teroso, MD 66th Philippine Society of Pathologists Annual Convention: Empowering the Young Pathologist Novotel Manila Araneta Center. April 26-28,2017

Division of Urology Mini-Percutaneous Nephrolithotomy in the Management of Allograft Nephrolithiasis. Dinno Mendiola, MD, Ernesto Gerial Jr., MD CAST 2017, Cebu, Philippines. November 5, 2017

Division of Pediatric Nephrology Somatic Growth of Filipino Children after Renal Transplantation in the National Kidney and Transplant Institute. Rowena O. Cuya, MD CAST 2017, Cebu, Philippines. November 5, 2017 Infections Following Kidney Transplant in Children at the National Kidney and Transplant Institute from January 1, 2008 to December 31, 2014. Michelle G. Cacayorin, MD CAST 2017, Cebu, Philippines. November 5, 2017

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APPENDIX 2017 PRESENTED AND PUBLISHED RESEARCHES POSTER PRESENTATION IN LOCAL AND INTERNATIONAL MEETINGS (19) Department of Nursing Services Perspectives on Patient Safety Culture Among the Workforce of the Ambulatory Urology and Endoscopy Center. Emily Grace Tolentino, RN Association of Nursing Service Administrators of the Philippines (ANSAP) 50th Annual Convention in Fiesta Pavilion, Manila Hotel. June 23, 2017 Improving the Reuse Rate of Dialyzer for Patient on Hemodialysis at the Out-Patient Unit of the National Kidney and Transplant Institute. A 2016 Quality Improvement Study. Kian Noche, RN Association of Nursing Service Administrators of the Philippines (ANSAP) Midyear Convention. August 25, 2017

ORAL PRESENTATION IN LOCAL AND INTERNATIONAL MEETINGS (15) Division of Adult Nephrology A Comparative Study between Low Dose Anti-thymocyte Globulin Versus Basiliximab as Induction Therapy for Kidney Transplant Patients under the PHIC Z-Benefit Package. Paolo Miguel David, MD, Glenda Eleanor P. Pamugas, MD CAST 2017, Cebu, Philippines. November 27-30, 2017 Renal Allograft Outcomes of Hepatitis B Positive patients at the National Kidney and Transplant Institute.

Camille Ng, MD, Glenda Eleanor P. Pamugas, MD, Romina A. Danguilan, MD, Ernesto Que, MD CAST, 2017, Cebu, Philippines. November 27-30, 2017 Outcome of Renal Transplant Recipients with Chronic Antibody Mediated Rejection at National Kidney and Transplant Institute from January 2006 to June 2011. Jane Wendolyn Lu, MD, Luis Limchiu, MD CAST, 2017, Cebu, Philippines. November 27-30, 2017 Patient and Graft Outcomes Among Kidney Transplant recipients who Underwent Pre-Transplant Coronary Angiography During Pre-Kidney Transplant Workup. Jason Paul Medina, MD, Concesa CabanayanCasasola, MD, Romina A. Danguilan, MD CAST, 2017, Cebu, Philippines. November 27-30, 2017 The Beliefs, Perceptions and Attitudes of Service Transplant Patients on Employment after Transplantation at the National Kidney and Transplant Institute. Vida Rose Acosta-Villanueva, MD, Benita S. Padilla, MD

Division of Internal Medicine Impact of Early Antibiotic Therapy (EAT) on Outcome of patients with Sepsis in the Emergency Room (ER) of National Kidney and Transplant Institute. Irene Rosellen Tan, MD, Myrna Mendoza, MD PCP 47th Annual Convention, SMX Mall of Asia, Pasay City. May 7-10, 2017 30th International Congress of Chemotherapy and Infection, Taipei, Taiwan. November 24-27, 2017

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APPENDIX 2017 PRESENTED AND PUBLISHED RESEARCHES ORAL PRESENTATION IN LOCAL AND INTERNATIONAL MEETINGS (15) Division of Internal Medicine Impact of Early Antibiotic Therapy (EAT) on Outcome of patients with Sepsis in the Emergency Room (ER) of National Kidney and Transplant Institute. Irene Rosellen Tan, MD, Myrna Mendoza, MD PCP 47th Annual Convention, SMX Mall of Asia, Pasay City. May 7-10, 2017 30th International Congress of Chemotherapy and Infection, Taipei, Taiwan. November 24-27, 2017 A Ten-Year Survival Analysis of Filipino Patients with Systematic Lupus Erythematosus at NKTI. Emily Yap, MD, Charito Bermudez, MD Annual European Congress of Rheumatology (EULAR 2017) Madrid, Spain Clinical and Microbiologic Profile of Bacteremia in National Kidney and Transplant Institute From January-December 2016. Mary Rose Anne Lacanin, MD, Myrna Mendoza, MD 39th Philippine Society for Microbiology and Infectious Diseases, PICC, Manila. November 28, 2017 Strings of Fury: A Case Report of Strongyloides Hyperinfection Syndrome in a Chemotherapy-naive Patient with Extensive Small Cell Lung Carcinoma. Irene Rosellen Tan, MD, Myrna Mendoza, MD PCP 47th Annual Convention, SMX Convention Center, Pasay City. May 7-10, 2017.

Incursion: An Interesting Case of Tuberculosis of the Bone Marrow. Jan Joel Simpauco, MD Intradepartmental Annual Research Contest, Dr. Enrique T. Ona Auditorium, NKTI, Quezon City.

December 12, 2017

Division of Organ Transplant and Vascular Surgery Renal Resistance and Flow Rates of Kidneys in Hypothermic Perfusion Devices as Viability Assessment tools for Kidney Transplantation in National Kidney and Transplant Institute: Rehana V. Pallingayan, MD CAST, 2017, Cebu, Philippines. November 27-30, 2017 PCS Annual Research Congress 2017. December 3,2017 Graft and Recipient Outcome in Deceased Donor Renal Transplantation at National Kidney and Transplant Institute: Machine Perfusion vs Static Cold Storage. Noli V. Velasquez, MD CAST, 2017, Cebu, Philippines. November 27-30, 2017 PCS Annual Research Congress 2017. December 3,2017 Preoperative Vein Mapping for Arterio-Venous Fistula Creation: A National Kidney and Transplant Institute Experience. Jonathan L. Lumicday II, MD ASVS 2017, Malaysia, PCS Annual Research Congress 2017

Department of Nursing Services Perspectives on Patient Safety Culture Among the Workforce of the Ambulatory Urology and Endoscopy Center. Julie Ann Romero, RN Department of Health Hospital Week in Lung Center of the Philippines. August 10, 2017

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APPENDIX 2017 PRESENTED AND PUBLISHED RESEARCHES PUBLISHED IN LOCAL AND INTERNATIONAL JOURNALS (6) Division of Adult Nephrology Resource utilization of financially disadvantaged kidney transplant recipients. Ana Mae H. Quintal-Quetua, MD, Roy Diamond Arco, MD, Romina A. Danguilan, MD. Transplantation Open, 2017 doi:10.15761/JTO.1000126 Volume 2 (2):1-3.

A Study on the Directed Living Non-Related Donor Kidney Transplantation Submitted to the Hospital Transplant Ethics Committee at the National Kidney and Transplant Institute. Romina A. Danguilan, MD, Mel-Hatra I. Arakama, MD, Grace Suguitan, RN. Transplantation Proceedings, 2017:49;267-269 Long Term Graft and Recipient Outcome of Deceased Donor Renal Transplantation at the National Kidney and Transplant Institute. Romina A. Danguilan, MD, Concesa C. Casasola, MD, Mark Javeson Tam, MD. Transplant Open, 2017 doi:10.15761/JTO.1000127 Volume 2 (2): 1-7 The Impact of HLA-ABDR Mismatch on acute rejection and graft function among Filipino kidney transplant recipients. Mel-Hatra I. Arakama, MD, Romina A. Danguilan, MD, Glenda Eleanor Pamugas, MD. Transplant Open, 2017 doi:10.15761/JTO.1000128 Volume 2 (3): 1-5 Living Donor Nephrectomy at the National Kidney and Transplant Institute: Surgical Techniques, Perioperative Complications and Outcomes. Concesa C. Casasola, MD, Maria Regina S. Gregorio, MD, Amor Rhea Quilala, MD, Ernesto Gerial Jr., MD, Romina A. Danguilan, MD. Urol Nephrol Open Access 3 (2): 1-6 Received: February 21, 2017; Accepted: May 16, 2017; Published: May 22, 2017

Division of Internal Medicine A Case of Hepatic Artery Thrombosis after Liver Transplantation. Ira-Inductivo-Yu, MD, Randall Isaac F. Tan, MD. J Liver Disease Transplant 2017, 6:2 doi:10.4172/2325-9612.1000150 Final Version was published last June 13, 2017 by SciTechnol Los Angeles, California, USA

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