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. 

  • 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.

    Read more
  • 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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  • CMS QSO Memo: Enhanced Oversight and Enforcement of Non-Improving Late Adopters re: Antipsychotic Meds (3/19)

    By CMS - March 03, 2019

    • The National Partnership & Identification of Late Adopters – Since 2011, the Centers for Medicare & Medicaid Services (CMS) has seen a reduction of 38.9 percent in long-stay nursing home residents who were receiving an antipsychotic medication. Despite the success of the National Partnership, CMS identified approximately 1,500 facilities that had not improved their antipsychotic medication utilization rates for long-stay nursing home residents, referred to as late adopters. In December 2017, CMS notified these facilities of this identification.

    • Enforcement for A Segment of Non-Improving Late Adopters with Multiple Citations - As of January 2019, there are 235 late adopter nursing homes that have been cited for noncompliance with federal regulations related to unnecessary medications or psychotropic medications two or more times since January 1, 2016, and who have not shown improvement in their long-stay antipsychotic medication rates. If these facilities are determined not to be in substantial compliance with requirements for Chemical Restraints, Dementia Care, or Psychotropic Medications during a survey, they will be subject to enforcement remedies for such noncompliance.

    • Corporate Engagement - CMS is also looking for opportunities to engage with corporate chains that have significant numbers of nursing homes identified as late adopters.

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  • Antipsychotic Medication Use Quarterly Data Updated (3/19)

    By CMS - March 02, 2019
    CMS has released two reports: National Partnership to Improve Dementia Care in Nursing Homes: Antipsychotic Medication Use Data Report (January 2019) and National Partnership to Improve Dementia Care in Nursing Homes: Late Adopter Data Report (January 2019)
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  • FY 2021 SNF QRP Program Data Collection & Final Submission Deadlines - Revised (2/19)

    By CMS - February 21, 2019

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

    This table provides the data collection time frames and final submission deadlines for the Fiscal Year (FY) 2021 Skilled Nursing Facility Quality Reporting Program (SNF QRP). The first column 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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    • AHRQ Surveys on Patient Safety Culture Nursing Home Survey: 2019 Database Report (2/19)

      By AHRQ - February 14, 2019

      The most recent AHRQ Nursing Home Survey on Patient Safety Culture Database Report presents data from 191 nursing homes and 10,499 nursing home respondents who completed the survey between January 2016 and July 2018 and submitted data to the Nursing Home SOPS database. The report presents statistics (averages, standard deviations, minimum and maximum scores, and percentiles) on the patient safety culture composite measures and items from the survey. Appendixes A and B present overall results by nursing home characteristics (bed size, ownership, census region, and urban/rural status) and respondent characteristics (job title, nursing home work area, interaction with residents, shift worked most often, and tenure in nursing home). The report contains data voluntarily submitted by participating nursing homes and is not representative of all U.S. nursing homes.


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    • All Cause Harm Prevention Webinar Recording Available (2/19)

      By NNHQIC - February 14, 2019

      All Cause Harm Prevention in Nursing Homes Applying Strategies from the New CMS Change Package

      Thursday, January 24, 2019, 3:00pm ET (1 hour) Recording Available.

      One-third of SNF residents experience an adverse or temporary harm event, and the majority of those are preventable. As part of CMS’s focus on raising awareness of nursing home safety and to support safer nursing home care across the nation, CMS and the Quality Innovation Network National Coordinating Center released a new resource: a Change Package to prevent all cause harm in nursing homes. The Change Package is a compendium of successful practices of high-performing nursing homes, illustrating how they prevent harm while honoring each resident’s rights and preferences.

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    • Emergency Preparedness- Updates to Appendix Z of the State Operations Manual (1/19)

      By CMS - February 05, 2019

      CMS is updating Appendix Z of the SOM to reflect changes to add emerging infectious diseases to the definition of all-hazards approach, new Home Health Agency (HHA) citations, and clarifications under alternate source power and emergency standby systems.


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    • HIV Positive Nursing Home Patients: Changing Characteristics (1/19)

      By AHRQ - January 29, 2019
      Nearly 80 percent of nursing home residents with HIV are prescribed antiretroviral treatments, according to an AHRQ study that provides an updated snapshot of HIV positive nursing home patients in nearly 15 years. Researchers reviewed a nationwide database of Medicare claims linked to nursing home health assessments and prescription dispensing databases, comparing data from 2011-2013 and 1998-2000. Compared with statistics from 1998-2000, researchers found that patients with HIV are entering nursing homes at an average age of 60, as opposed to 44. New admissions had a higher prevalence of viral hepatitis (about 16 percent vs. 8 percent) and anemia (about 31 percent vs. 25 percent), but less pneumonia (about 11 percent vs. 14 percent) and dementia (about 9 percent vs. 21 percent). This population is expected to increase in the coming years as HIV treatments improve. Researchers believe these updated statistics will allow nursing homes to better anticipate the future health care needs of people living with HIV. 
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    • Q&A: How should I handle a family's request for pleasure eating for a resident who has NPO/tube feeding orders?

      By AADNS Network - January 29, 2019
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