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. 

  • FAQs About COVID-19 Testing in SNFs/NFs (8/20)

    By CMS - August 10, 2020

    Frequently Asked Questions: COVID-19 Testing at Skilled Nursing Facilities/ Nursing Homes includes 27 FAQs:

    1. Who will receive the testing platforms and U.S. Food and Drug Administration (FDA)- authorized antigen diagnostic tests?

    2. How is distribution of the testing platforms and FDA-authorized antigen diagnostic tests being determined? Will these devices be sent directly to the nursing homes or to states for distribution? 

    3. When will the testing platforms and authorized point-of-care tests be distributed?

    4. How many COVID-19 test kits will nursing homes receive?

    5. Who will provide training to nursing home staff? In what format will the training be provided in?

    6. How were nursing homes prioritized to receive a testing platform and FDA-authorized antigen diagnostic tests?

    7. Will HHS be providing more tests after the initial shipment?

    8. What safety precautions are required when performing these tests?

    9. Will every nursing home receive a point-of-care instrument and associated tests? 

    10. Which nursing homes will receive instruments and tests in the first wave of shipments?

    11. When will my nursing home receive the shipment of testing platforms and FDAauthorized antigen diagnostic tests?

    12. How will states be made aware that nursing homes within their states will receive instruments and supplies?

    13. What are antigen tests? Is it required to retest negative results with a PCR test?

    14. How many tests can be conducted with the Quidel Sofia 2 Instrument and the BD Veritor™ Plus System testing platforms?

    15. Why is the federal government sending antigen testing supplies to nursing homes if they cannot be used to rule out SARS-CoV-2 infection and should not be used as the sole basis for treatment?

    16. Are nursing homes required to report results of any COVID-19 tests?

    17. Can nursing homes keep the testing platforms? 

    18. How should facilities handle indeterminate results?

    19. Do facilities need a provider order to conduct the test?

    20. How should the materials be stored when they arrive?

    21. Does a Skilled Nursing Facility/ Nursing Facilities need a CLIA (Clinical Laboratory Improvement Amendments of 1988) Certificate of Waiver in order to perform testing of specimens for COVID-19?

    22. I understand that HHS will be distributing tests and test systems to Skilled Nursing Facilities/ Nursing Facilities. What type of CLIA certificate would my facility need in order to perform this testing?

    23. How do I apply for a CLIA Certificate of Waiver so that my Skilled Nursing Facility/ Nursing Facility can perform COVID-19 testing?

    24. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, can we begin performing COVID-19 testing?

    25. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, am I required to update my test menu with CMS?

    26. How does my Skilled Nursing Facility/ Nursing Facility obtain the instrument, test kits and disposables?

    27. My Skilled Nursing Facility/ Nursing Facility is located in a CLIA Exempt State (Washington or New York). Will we be able to get one of the new test systems? 

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  • Engaging Residents and Overcoming Loneliness during the COVID-19 Public Health Emergency

    By AADNS - July 28, 2020

    The COVID-19 pandemic is a strange and difficult time for long-term care residents. There is a lot happening in their environment that is unfamiliar, and nurse leaders have the difficult job of ensuring residents’ physical safety while also addressing the importance of combating resident loneliness. Leaders have to adapt, be strategic, and find clever ways to engage residents. Joan Devine, RN, director of education for Pioneer Network, offers some insights, resources, and ideas that nurse leaders can utilize to improve person-centered care and resident well-being during this time.

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  • Advance Care Planning: How to Have the Conversation

    By Caralyn Davis, Staff Writer - July 28, 2020

    Editor’s note: This is the third article in a multipart series about advance care planning and how to operationalize an effective program in nursing homes. Find the first article explaining the basics of what it is and why it matters here and the second article explaining how to use advance care planning for maximum effectiveness in providing person-centered care here.

    Advance care planning involves more than completing documents, such as advance directives and POLST (Physician Orders for Life-Sustaining Treatment) forms, says Shigeko (Seiko) Izumi, PhD, RN, FPCN, associate professor in the School of Nursing at Oregon Health & Science University in Portland, OR; presenter of the April 22 webinar “COVID Conversations: Team Approach To Assisting Patients With Advance Care Planning” from the Coalition for Compassionate Care of California; and co-author of “A Model to Promote Clinicians' Understanding of the Continuum of Advance Care Planning” in the Journal of Palliative Medicine (2017; 20(3):220-22). 

    “It’s a mistake to fixate on the paper documents. Without conversation, the documents alone don’t help much because they can be overlooked in times of crisis,” stresses Izumi. “The most important part of advance care planning is having the conversation to learn the resident’s values, goals, and treatment preferences—and making sure the people around that resident also know what is important to them so that even without documentation, they can advocate for the resident when the resident cannot express their own wishes.” 


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  • July 28 CDC COVID-19 Call: Diabetes: The Importance of Prevention, Management, and Support

    By CDC - July 20, 2020

    Coronavirus Disease 2019 (COVID-19) and Diabetes: The Importance of Prevention, Management, and Support

    You may participate in this COCA Call via Zoom

    During this COCA Call, presenters will focus on current information about the impact and increased risk for COVID-19 complications in people with diabetes and the importance of diabetes prevention, management, and support.

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  • CMS COVID-19 Nursing Homes Best Practices Toolkit and New QIN-QIO Virtual Assistance UPDATED (7/20)

    By CMS - July 20, 2020

    New tool provides innovative solutions for states and facilities to protect our nation’s vulnerable nursing home residents during emergency

    CMS has released a new toolkit (updated 7/15/20) developed to aid nursing homes, Governors, states, departments of health, and other agencies who provide oversight and assistance to these facilities, with additional resources to aid in the fight against the coronavirus disease 2019 (COVID-19) pandemic within nursing homes. The toolkit builds upon previous actions taken by the Centers for Medicare & Medicaid Services (CMS), which provide a wide range of tools and guidance to states, healthcare providers and others during the public health emergency. The toolkit is comprised of best practices from a variety of front line health care providers, Governors’ COVID-19 task forces, associations and other organizations, and experts, and is intended to serve as a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19.

    “The coronavirus presents a unique challenge for nursing homes. CMS is using every tool at our disposal to protect our nation’s most vulnerable citizens and aid the facilities that care for them. This toolkit will support state, local leaders and nursing homes in identifying best practices to protect our vulnerable elderly in nursing homes” said CMS Administrator Seema Verma.  

    The toolkit provides detailed resources and direction for quality improvement assistance and can help in the creation and implementation of strategies and interventions intended to manage and prevent the spread of COVID-19 within nursing homes. The toolkit outlines best practices for a variety of subjects ranging from infection control to workforce and staffing. It also provides contact information for organizations who stand ready to assist with the unique challenges posed by caring for individuals in long-term care settings. Each state was involved in the creation of this toolkit, resulting in a robust resource that may be leveraged by a variety of entities serving this vulnerable population.

    Additionally, CMS has contracted with 12 Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) to work with providers, community partners, beneficiaries and caregivers on data-driven quality improvement initiatives designed to improve the quality of care for beneficiaries across the United States. The QIN-QIOs are reaching out to nursing homes across the country to provide virtual technical assistance for homes that have an opportunity for improvement based on an analysis of previous citations for infection control deficiencies using publicly available data found on Nursing Home Compare.

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  • CDC COVID-19 Interim Infection Prevention and Control Recommendations for Healthcare Personnel Updated (7/20)

    By CDC - July 19, 2020

    Below are changes to the guidance as of July 15, 2020:

    • Added language that protective eyewear (e.g., safety glasses, trauma glasses) with gaps between glass
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  • COVID-19 Testing Guidelines for Nursing Homes (7/20)

    By CDC - July 17, 2020

    Testing Guidelines for Nursing Homes FRIDAY, JULY 17, 2020

    Revisions were made on July 17, 2020, to reflect the following:

    • Updated “Testing to determine resolution of infection” to add information about people who are severely immunocompromised.

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  • CDC Strategies for Optimizing the Supply of PPE and Other Equipment (7/20)

    By CDC - July 15, 2020

    The Centers for Disease Control and Prevention (CDC) offers strategies for optimizing the supply of:

    N95 respirators

    Face masks

    Isolation gowns

    Eye Protection

    Gloves

    Powered Air-Purifying Respirators (PAPRs)

    Elastomeric respirators

    Ventilators

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  • OIG to Assess Trends Re: the Use of Psychotropic Drugs in Nursing Homes (7/20)

    By OIG - July 15, 2020

    Assessing Trends Related to the Use of Psychotropic Drugs

    Previous OIG work found that elderly nursing home residents who were prescribed antipsychotic drugs—a type of psychotropic drug—were at risk for harm. CMS concurred with some OIG recommendations and developed new initiatives. However, policymakers continue to raise concerns about whether CMS has made sufficient progress in reducing the use of antipsychotic drugs to care for the elderly. We will report the changes over time for the following: (1) the use of psychotropic drugs for elderly nursing home residents; (2) citations and civil monetary penalties assessed to nursing homes regarding psychotropic drugs; and (3) the presence of diagnoses that exclude nursing home residents from CMS's measure of the use of antipsychotic drugs.

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  • CMS Will Increase Use of QIOs to Fight COVID-19 Hot Spots (7/20)

    By CMS - July 13, 2020

    The Centers for Medicare & Medicaid Services (CMS) announced the agency’s targeted approach to provide additional resources to nursing homes in coronavirus disease 2019 (COVID-19) hotspot areas.  Specifically, CMS plans to deploy Quality Improvement Organizations (QIOs) across the country to provide immediate assistance to nursing homes in the hotspot areas as identified by the White House Coronavirus Task Force. QIOs are CMS contractors who work with healthcare providers to help them improve the quality of healthcare they provide to Medicare Beneficiaries. In addition, the agency is implementing an enhanced survey process tailored to meet the specific concerns of hotspot areas and will coordinate federal, state and local efforts to leverage all available resources to these facilities. The purpose of these efforts is to target facilities with known infection control issues by providing resources and support that will help them improve quality and safety and protect vulnerable Americans.

    Nursing homes are especially vulnerable to the prevalence and spread of COVID-19.  Additional resources are needed to ensure nursing homes take proactive steps to enhance infection control policies and practices to limit potential transmission and prevent widespread outbreaks within these facilities.

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  • COVID-19 Testing: CDC Says Repeated Point Prevalence Surveys Can ID Asymptomatic Cases in SNFs (7/20)

    By CDC - July 01, 2020

    Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities — Detroit, Michigan, March–May 2020

    Early Release / July 1, 2020 / 69

    Guillermo V. Sanchez, MSHS, MPH1; Caitlin Biedron, MD1; Lauren R. Fink, MPH2; Kelly M. Hatfield, MSPH1; Jordan Micah F. Polistico, MD3,4; Monica P. Meyer, MS, MPH3,4; Rebecca S. Noe, MN, MPH1; Casey E. Copen, PhD1; Amanda K. Lyons, MS1; Gonzalo Gonzalez, DNP2; Keith Kiama2; Mark Lebednick2; Bonnie K. Czander2; Amen Agbonze2; Aimee R. Surma, MS2; Avnish Sandhu, DO3,4; Valerie H. Mika, MS4; Tyler Prentiss, MA5; John Zervos, JD5; Donia A. Dalal2; Amber M. Vasquez, MD1; Sujan C. Reddy, MD1; John Jernigan, MD1; Paul E. Kilgore, MD4; Marcus J. Zervos, MD4,5; Teena Chopra, MD3,4; Carla P. Bezold, ScD2; Najibah K. Rehman, MD2 (View author affiliations)

    View suggested citation

    Summary

    What is already known about this topic?

    Symptom-based screening in skilled nursing facilities (SNFs) is inadequate to detect SARS-CoV-2 transmission. Repeated point prevalence surveys (serial testing of all residents and health care personnel at a health care facility irrespective of symptoms) can identify asymptomatic cases during outbreaks.

    What is added by this report?

    Repeated point prevalence surveys at 26 Detroit SNFs identified an attack rate of 44%; within 21 days of diagnosis, 37% of infected patients were hospitalized and 24% died. Among 12 facilities participating in a second survey and receiving on-site infection prevention and control (IPC) support, the percentage of newly identified cases decreased from 35% to 18%.

    What are the implications for public health practice?

    Repeated point prevalence surveys in SNFs can identify asymptomatic COVID-19 cases, inform cohorting and IPC practices, and guide prioritization of health department resources.

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  • CDC 2020 On-Demand Video Schedule for Vaccination Series that Runs July 1 - October 14

    By CDC - July 01, 2020
    Pink Book Series

    CDC is offering a series of weekly one-hour web-on-demand videos that will provide an overview of vaccination principles, general best practices, immunization strategies, and specific information about vaccine-preventable diseases and the vaccines that prevent them. Each video will include updated information from recent Advisory Committee on Immunization Practices (ACIP) meetings and votes.

    Audience

    Immunization providers: Physicians, nurses, nurse practitioners, pharmacists, physician assistants, DoD paraprofessionals, medical students, state and local immunization programs, etc.

    Continuing Education

    Continuing education will be available for each event.

    2020 Videos

    This year, because of limited staff availability during the ongoing COVID-19 response, the series will be prerecorded rather than live events. There is no registration process to view the sessions. The link to each course can be accessed on/after the indicated date. Questions about the material presented can be submitted to nipinfo@cdc.gov.

    2020 Release Schedule

    2018 webinar schedule with presentation information

    Date

    Topic

    July 1

    Principles of Vaccination

    July 8

    General Best Practice Guidelines, Part 1

    July 15

    General Best Practice Guidelines, Part 2, and Vaccine Safety

    July 22

    Immunization Strategies

    July 29

    Vaccine Storage and Handling and Vaccine Administration

    August 5

    DTaP/Tdap

    August 12

    Rotavirus and Hepatitis A

    August 19

    Meningococcal Vaccines

    August 26

    Measles, Mumps, Rubella

    September 2

    Polio and Hib

    September 9

    Varicella and Zoster

    September 16

    Hepatitis B

    September 23

    HPV

    September 30

    Pneumococcal Vaccines

    October 14

    Influenza

     


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  • CMS FAQs Detail Recommendations for Allowing Nursing Home Visits (6/20)

    By CMS - June 25, 2020

    CMS has issued seven Frequently Asked Questions to supplement existing guidance about the rules for nursing home visitations during the COVID-19 pandemic, starting with No. 1:

    1. What steps should nursing homes take before reopening to visitors? 

    Nursing homes should continue to follow CMS and CDC guidance for preventing the transmission of COVID-19, and follow state and local direction. Because nursing home residents are especially vulnerable, CMS does not recommend reopening facilities to visitors (except for compassionate care situations) until phase three when: 

    • There have been no new, nursing home onset COVID-19 cases in the nursing home for 28 days (through phases one and two) 

    • The nursing home is not experiencing staff shortages 

    • The nursing home has adequate supplies of personal protective equipment and essential cleaning and disinfection supplies to care for residents 

    • The nursing home has adequate access to testing for COVID-19 

    • Referral hospital(s) have bed capacity on wards and intensive care units

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  • Advance Care Planning Basics: What Is It, and Why Does It Matter?

    By Caralyn Davis, Staff Writer - June 23, 2020

    Editor’s note: This is the first article in a multipart series about advance care planning and how to operationalize an effective program in nursing homes.

     

    The surveyor guidance under F578 (Request/Refuse/Discontinue Treatment; Formulate Advance Directives) in Appendix PP of the State Operations Manual defines and discusses advance care planning as follows:

     

    “Advance care planning” is a process of communication between individuals and their healthcare agents to understand, reflect on, discuss, and plan for future healthcare decisions for a time when individuals are not able to make their own healthcare decisions. …

     

    The ability of a dying person to control decisions about medical care and daily routines has been identified as one of the key elements of quality care at the end of life. The process of advance care planning is ongoing and affords the resident, family, and others on the resident’s interdisciplinary health care team an opportunity to reassess the resident’s goals and wishes as the resident’s medical condition changes. Advance care planning is an integral aspect of the facility’s comprehensive care planning process and assures re-evaluation of the resident’s desires on a routine basis and when there is a significant change in the resident’s condition. The process can help the resident, family and interdisciplinary team prepare for the time when a resident becomes unable to make decisions or is actively dying.

     

    But what exactly does that mean? “The commonly used definition of advance care planning is that it is a process to support a person in understanding and ensuring their values, goals, and preferences regarding future medical care,” says Shigeko (Seiko) Izumi, PhD, RN, FPCN, associate professor in the School of Nursing at Oregon Health & Science University in Portland, OR; presenter of the April 22 webinar “COVID Conversations: Team Approach To Assisting Patients With Advance Care Planning” from the Coalition for Compassionate Care of California; and co-author of “A Model to Promote Clinicians' Understanding of the Continuum of Advance Care Planning” in the Journal of Palliative Medicine (2017; 20(3):220-22).

     

    “It’s very important to know the resident’s values, goals, and preferences of future care and then to share that information with families and other healthcare providers so they understand what kinds of care the resident wants when that resident is unable to make their own decisions or cannot express their wishes,” she explains.

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  • CDC Long-term Care COVID-19 Resources Updated (6/20)

    By CDC - June 22, 2020

    Preparing for COVID-19 in Nursing Homes

    Updated June 25, 2020

    Summary of Changes to the Guidance:

    • Tiered recommendations to address nursing homes in different phases of COVID-19 response
    • Added a recommendation to assign an individual to manage the facility’s infection control program
    • Added guidance about new requirements for nursing homes to report to the National Healthcare Safety Network (NHSN)
    • Added a recommendation to create a plan for testing residents and healthcare personnel for SARS-CoV-2

    Related Pages

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