Clinical Surveillance Resources

When it comes to resident care, your role is to see the bigger picture and to put systems in place that not only protect your residents but also promote their best possible function. Preventing and identifying medical errors and adverse events is imperative for facility leaders. Using the latest technologies to synthesize resident care outcome data -- in complement with implementing proper bedside and clinical decision-making protocols -- are part of a strong clinical surveillance system that bolsters quality assurance. Find out what you need to know and how your facility can take evidence-based steps to improve care. 

  • CDC Training: Legionella Water Management Programs (5/19)

    By CDC - May 02, 2019
    Preventing Legionnaires’ Disease: A Training on Legionella Water Management Programs (PreventLD Training)
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  • OIG Assessment of Nursing Home Deficiency Trends Finds Need for Improvement (5/19)

    By OIG - May 02, 2019

    Trends in Deficiencies at Nursing Homes Show That Improvements Are Needed To Ensure the Health and Safety of Residents (A-09-18-02010)

    In this data brief, we analyze nursing home deficiencies that were identified by State survey agencies (State agencies) across the Nation for calendar years 2013 through 2017 (review period). This data brief offers the Centers for Medicare & Medicaid Services (CMS) and other stakeholders (e.g., State agencies and nursing home management) insight into deficiency trends at nursing homes nation-wide. It also complements our previous report on State agencies' verification of correction of nursing home deficiencies.

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  • CDC: Outbreak of Multidrug-Resistant Shigella sonnei Infections in a Retirement Community (5/19)

    By CDC - May 02, 2019

    Strysko J, Fialkowski V, Marsh Z, et al. Notes from the Field: Outbreak of Multidrug-Resistant Shigella sonnei Infections in a Retirement Community — Vermont, October–November 2018. MMWR Morb Mortal Wkly Rep 2019;68:405–406. 

    On October 22, 2018, the Vermont Department of Health (VDH) notified CDC’s Waterborne Disease Prevention Branch of an outbreak of diarrhea caused by Shigella sonnei among residents, visitors, and staff members of a retirement community in Chittenden County, the state’s most populous county. High-quality single nucleotide polymorphism (SNP) analysis predicted initial isolates were multidrug resistant (MDR), and were closely related to a concurrent multistate cluster (differing by 0–11 SNPs). In the United States, rates of MDR shigellosis are increasing (1); outbreaks of MDR shigellosis are more common among men who have sex with men and are rare in retirement community settings (2). CDC collaborated with VDH to identify additional cases, determine transmission routes, and recommend prevention and control measures.

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  • May 30 Webinar Early Identification of Sepsis in Nursing Facilities: Opportunities and Hurdles: Register Now

    By NNHQIC - May 01, 2019

    Please join Christine LaRocca, MD and the National Nursing Home Quality Improvement Campaign to learn more about sepsis, who is at risk and the signs and symptoms for early detection. In addition, we will:

    ·        Review examples of sepsis screening tools commonly used in hospital settings;

    ·        Learn what tools to use while recognizing the limitations of sepsis screening tools in the nursing home population; and 

    ·        Understand the elements of evidence-based treatment for optimal outcomes.

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  • FY 2020 and FY 2021 SNF QRP Program Data Collection & Final Submission Deadlines (5/19)

    By CMS - April 23, 2019

    Skilled Nursing Facility Quality Reporting Program Data Collection & Final Submission Deadlines for the FY 2020 and FY 2021 SNF QRP

    These two tables provide the data collection time frames and final submission deadlines for the Fiscal Year (FY) 2021 Skilled Nursing Facility Quality Reporting Program (SNF QRP) and FY 2021 SNF QRP. The first column  in each table displays the measure name, the second column displays the data collection time frame, and the third column displays the final data submission deadlines.


     

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    • CDC Issues Health Advisory re: Influenza (3/19)

      By CDC - April 02, 2019

      CDC reminds clinicians to have a high suspicion for influenza and recommends rapid antiviral treatment of high-risk patients with suspected influenza.

      From https://emergency.cdc.gov/han/han00419.asp

      Summary
      The Centers for Disease Control and Prevention (CDC) is issuing this health advisory to notify clinicians that influenza activity remains high in the United States, with an increasing proportion of activity due to influenza A(H3N2) viruses, continued circulation of influenza A(H1N1) viruses, and low levels of influenza B viruses. Influenza should be considered as a possible diagnosis for patients with respiratory illness while local influenza activity remains elevated. Because influenza A(H3N2) viruses may be associated with severe disease in older adults, this health advisory serves as a reminder that early empiric treatment with influenza antiviral medications is recommended for hospitalized and high-risk patients, especially those 65 years and older. Antiviral treatment should be started as soon as possible after illness onset and should not wait for laboratory confirmation.

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    • AHRQ: Adverse Effects of Pharmacological Treatments of Major Depression in Older Adults (3/19)

      By AHRQ - April 02, 2019

      Purpose of Review

      To assess adverse events of antidepressants in the treatment of major depressive disorder in adults 65 years of age or older.

      Key Messages

      In people 65 years of age or older:

      • Serotonin norepinephrine reuptake inhibitors (SNRIs) (duloxetine and venlafaxine) cause adverse events more often than placebo and most likely lead to discontinuation of therapy during treatment of up to 12 weeks.
      • Selective serotonin reuptake inhibitors (SSRIs) (escitalopram and fluoxetine) most likely cause adverse events at a similar frequency to placebo therapy but still may lead to discontinuation of therapy during treatment of up to 12 weeks.
      • Duloxetine most likely increases the risk of falls over longer treatment (<24 weeks)
      • Adverse events contributing to discontinuation of therapy were rarely reported in a way that allowed clear characterization of what adverse events to expect.
      • Few studies compared other antidepressants to placebo or to each other, or reported other outcomes. Trial data were sparse, and trials were short in duration, underpowered, and studied low doses of antidepressants. Observational studies had limitations related to their design. Long-term, rigorous comparative studies are needed.
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    • Nursing Home Compare Claims-based Measures Technical Specifications Plus Appendix Updated (3/19)

      By CMS - March 27, 2019

      Nursing Home Compare Claims-based Measures Technical Specifications, including Five-Star QMs -Update March 2019  plus Appendix


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    • CMS Early Findings Report: Initiative to Reduce Avoidable Hospitalizations in Nursing Facility Residents (3/19)

      By CMS - March 20, 2019

      Evaluation of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents – Payment Reform (NFI 2) Initiative Year 1 (FY 2017)

      CMS is pleased to share the second annual report of the “Evaluation of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents—Payment Reform.”

      Early findings in the report are preliminary and should not be considered conclusive. Nevertheless, the evaluation found some promising evidence that payment reforms have led to a consistent pattern of improved outcomes in newly-recruited facilities. Facilities that had participated in an earlier phase of the Initiative did not show further improvements beyond what was expected based on the trends established during that phase.

      For both groups, additional years of data and analysis should provide more definitive insight about Initiative effects.

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    • CDC/CMS Free Infection Preventionist Training Course and CMS QSO Memo (3/19)

      By CDC/CMS - March 12, 2019

      Specialized Infection Prevention and Control Training for Nursing Home Staff in the Long-Term Care Setting is Now Available

      The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) collaborated on the development of a free on-line training course in infection prevention and control for nursing home staff in the long-term care setting.

      The training provides approximately 19 hours of continuing education credits as well as a certificate of completion (i.e., free CME, CNE or CEUs).

      The course introduces and describes how to use IPC program implementation resources including policy and procedure templates, audit tools, and outbreak investigation tools.

      The course is made up of 23 modules and sub-modules that can be completed in any order and over multiple sessions.

      The course covers:

      • Core activities of effective IPC programs
      • Recommended IPC practices to reduce
      • Pathogen transmission
      • Healthcare-associated infections
      • Antibiotic resistance
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    • Nurse Involvement Can Boost Antibiotic Stewardship Efforts (3/19)

      By AHRQ - March 11, 2019

      From AHRQ News Now:

      Including bedside nurses in antibiotic stewardship activities has been identified by professional nursing groups and the CDC as an important—but missing—element in the success of these programs. To help fill this void, a new AHRQ-funded study published in the journal Infection Control and Hospital Epidemiology identifies several areas where bedside nurses could play an enhanced role in improving antibiotic prescribing practices.

      Nurses’ expertise can be used to: ensure appropriate testing for Clostridiodes difficile (C. diff) infection through accurate documentation and medication reviews; assess relevant indications before obtaining urine culture specimens to prevent the use of unnecessary antibiotics; ensure optimal antibiotic administration by helping patients transition from intravenous to oral therapies; obtain and document accurate patient histories of penicillin allergies; and use a team-based review to ensure that antibiotic therapies are not unnecessarily prolonged.

      The authors also identified ways to integrate nurses into an organization’s stewardship program, including on-the-job learning about antibiotics, potential drug interactions and adverse drug events.


      From AHRQ News Now:

      Including bedside nurses in antibiotic stewardship activities has been identified by professional nursing groups and the CDC as an important—but missing—element in the success of these programs. To help fill this void, a new AHRQ-funded study published in the journal Infection Control and Hospital Epidemiology identifies several areas where bedside nurses could play an enhanced role in improving antibiotic prescribing practices.

      Nurses’ expertise can be used to: ensure appropriate testing for Clostridiodes difficile (C. diff) infection through accurate documentation and medication reviews; assess relevant indications before obtaining urine culture specimens to prevent the use of unnecessary antibiotics; ensure optimal antibiotic administration by helping patients transition from intravenous to oral therapies; obtain and document accurate patient histories of penicillin allergies; and use a team-based review to ensure that antibiotic therapies are not unnecessarily prolonged.

      The authors also identified ways to integrate nurses into an organization’s stewardship program, including on-the-job learning about antibiotics, potential drug interactions and adverse drug events.

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    • Do You Know How To Access CMP Funds? (3/19)

      By OIG - March 10, 2019

      The OIG report, Michigan Disbursed Only Part of Its Civil Money Penalty Collections, Limiting Resources To Protect or Improve Care for Nursing Facility Residents (02-28-2019 | Audit (A-05-17-00019) | Complete Report | Report in Brief) found that the state of Michigan did not fully use available civil monetary penalty (CMP) collections to support nursing facility residents. While the report is specific to Michigan, it suggests some providers across the United States may not be aware of/know how to apply for CMP funds or know what types of projects are likely to receive funding.

      How to Apply for CMP Funds

      The application process for CMP funds is determined by the state in which the nursing home is located. The process for each state may differ therefore states have their own applications for CMP funds and applicants should use their state specific application and instructions.

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    • CMS Online Immediate Jeopardy Update Training (3/19)

      By CMS - March 08, 2019

      The Immediate Jeopardy Update Training introduces surveyors and non-surveyors to the revised Appendix Q–Core Guidelines to Determining Immediate Jeopardy. The Core Appendix Q focuses on the key components necessary to establish immediate jeopardy (IJ) under the regulations. 

      These key components are:

      • Noncompliance.
      • Serious harm, injury, impairment, or death that has occurred or is likely to occur. 
      • Immediate need for action by the provider/supplier to address the noncompliance.

      The Core Appendix Q also contains information about how surveyors should determine whether IJ exists, and it includes a template that surveyors must use to ensure that sufficient evidence exists for each key component of IJ.

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    • CMS Revises Appendix Q, Guidance on Immediate Jeopardy / State Operations Manual (3/19)

      By CMS - March 07, 2019

      Memorandum Summary

      Core Appendix Q and Subparts - Appendix Q to the State Operations Manual (SOM), which provides guidance for identifying immediate jeopardy, has been revised. The revision creates a Core Appendix Q that will be used by surveyors of all provider and supplier types in determining when to cite immediate jeopardy. CMS has drafted subparts to Appendix Q that focus on immediate jeopardy concerns occurring in nursing homes and clinical laboratories since those provider types have specific policies related to immediate jeopardy. 

      Key Components of Immediate Jeopardy – To cite immediate jeopardy, surveyors determine that (1) noncompliance (2) caused or created a likelihood that serious injury, harm, impairment or death to one or more recipients would occur or recur; and (3) immediate action is necessary to prevent the occurrence or recurrence of serious injury, harm, impairment or death to one or more recipients.

      Immediate Jeopardy Template – A template has been developed to assist surveyors in documenting the information necessary to establish each of the key components of immediate jeopardy. Survey teams must use the immediate jeopardy template attached to Appendix Q to document evidence of each component of immediate jeopardy and use the template to convey information to the surveyed entity.

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    • Appendix Z, State Operations Manual: Additional Revisions (3/19)

      By CMS - March 04, 2019

      SUBJECT: Revisions to State Operations Manual (SOM) Appendix Z, Emergency Preparedness for All Provider and Certified Supplier Types

      I. SUMMARY OF CHANGES: CMS is making minor revisions to Appendix Z to correct errors and changes in citation numbers as reflected in the table below. CMS has also added areas of clarification to E-0015 related to use of alternate source power and changes to the citations for Home Health Agencies (HHAs).

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