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 QSO Memo: Some Expirations of COVID-19 Survey/Regulatory Waivers Begin May 10 (4/21)

    By CMS - April 09, 2021

    CMS continues to review the need for existing waivers issued in response to the Public Health Emergency (PHE). Over the course of the PHE, nursing homes have developed policies or other practices that we believe mitigates the need for certain waivers.

    • Therefore, CMS is announcing it is ending:
      • The emergency blanket waivers related to notification of Resident Room or Roommate changes, and Transfer and Discharge notification requirements;
      • The emergency blanket waiver for certain care planning requirements for residents transferred or discharged for cohorting purposes.
      • The emergency blanket waiver of the timeframe requirements for completing and transmitting resident assessment information (Minimum Data Set (MDS).
    • CMS is providing clarification and recommendations for Nurse Aide Training and Competency Evaluation Programs (NATCEPs).
    Read more
  • COVID-19 Blanket Waivers List Updated (4/21)

    By CMS - April 07, 2021

    COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers 

    The Administration is taking aggressive actions and exercising regulatory flexibilities to help healthcare providers contain the spread of 2019 Novel Coronavirus Disease (COVID-19). CMS is empowered to take proactive steps through 1135 waivers as well as, where applicable, authority granted under section 1812(f) of the Social Security Act (the Act) and rapidly expand the Administration’s aggressive efforts against COVID-19. As a result, the following blanket waivers are in effect, with a retroactive effective date of March 1, 2020 through the end of the emergency declaration. For general information about waivers, see Attachment A to this document. These waivers DO NOT require a request to be sent to the 1135waiver@cms.hhs.gov mailbox or that notification be made to any of CMS’s regional offices.

    Long-Term Care Facilities and Skilled Nursing Facilities (SNFs) and/or Nursing Facilities (NFs) 

    Updated April 9, 2021, the SNF/NF section now shows which regulatory waivers expire May 10, 2021.
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  • CDC Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes Updated (4/21)

    By CDC - April 05, 2021
    Summary of Recent Changes

    Updates as of March 29, 2021

    • Two prior guidance documents, “Responding to COVID-19 in Nursing Homes” and “Performing Facility-wide SARS-CoV-2 Testing in Nursing Homes” were merged with this guidance.
    • The criteria for health department notification was updated to be consistent with Council of State and Territorial Epidemiologist (CSTE) guidance for reporting.
    • Information on the importance of vaccinating residents and healthcare personnel (HCP) was added along with links to vaccination resources.
    • Visitation and physical distancing measures were updated.
    • Added  proper use and handling of personal protective equipment (PPE).
    • Added  universal PPE use to align with the interim infection prevention and control guidance for HCP.
    • Added considerations for situations when it might be appropriate to keep the room door open for a resident with suspected or confirmed SARS-CoV-2 infection.
    • A description was included about when it may be appropriate for a resident with a suspected SARS-CoV-2 infection to “shelter-in-place.”
    • Added management of residents who had close contact with someone with SARS-CoV-2 infection which includes a description of quarantine recommendations including resident placement, recommended PPE, and duration of quarantine.
    • Added addressing circumstances when quarantine is recommended for residents who leave the facility.
    • Added responding to a newly identified SARS-CoV-2-infected HCP or resident.
    • Added addressing quarantine and work exclusion considerations for asymptomatic residents and HCP who are within 90 days of resolved infection.
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  • Updated Guidance for Emergency Preparedness-Appendix Z of the State Operations Manual (SOM): CMS Memo QSO-21-15-ALL (4/21)

    By CMS - April 02, 2021
    Memo # QSO-21-15-ALL

    Posting Date 2021-03-26

    Fiscal Year 2021

    Summary

    Burden Reduction Final Rule Interpretive Guidelines: The Centers for Medicare & Medicaid Services (CMS) is releasing interpretive guidelines and updates to Appendix Z of the State Operations Manual (SOM) as a result of the revisions of the Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction (CoPs) (CMS 3346-F) Final Rule.

    Expanded Guidance related to Emerging Infectious Diseases (EIDs): CMS is also providing additional guidance based on best practices, lessons learned and general recommendations for planning and preparedness for EID outbreaks. 

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  • March 23 CMS Long-Term Care: Dementia-related Psychosis Call: Audio Recording and Transcript Available (3/21)

    By CMS - April 02, 2021
    Date 2021-03-23

    Event Long-Term Care: Dementia-related Psychosis Call

    Topic Dementia Care in Nursing Homes

    When: Tuesday, March 23, 2021, from 1:30 to 3 pm ET

    Description:

    National Partnership to Improve Dementia Care and Quality Assurance Performance Improvement

    During this call, learn about the appropriate assessment, accurate diagnosis, and approaches to care for dementia-related psychosis in the long-term care setting. Hear about customized care strategies for nursing home residents. A question and answer session follows the presentations.

    Speakers: Dr. George Grossberg, Dr. Alexis Eastman, Susan Scanland, and Dr. Chad Worz from the Gerontological Society of America’s Workgroup on Dementia-Related Psychosis

    Target Audience:

    • Consumer and advocacy groups
    • Nursing home providers
    • Surveyor community
    • Prescribers
    • Professional associations
    • Other interested stakeholders
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  • Postacute Sequelae of SARS-CoV-2 Infection (4/21)

    By ASPR TRACIE / HHS - April 01, 2021
    ASPR TRACIE (part of the US Department of Health and Human Services) received a request for information on clinical presentation, disease progression, and related information from clinicians in the field treating COVID-19 patients after the acute phase of the virus has passed, frequently referred to as “COVID long haulers.”
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  • SARS-CoV-2 Viral Mutations: Impact on COVID-19 Tests - New FDA Webpage (4/21)

    By FDA - April 01, 2021
    The FDA posted a new web page SARS-CoV-2 Viral Mutations: Impact on COVID-19 Tests for clinical laboratory staff and health care providers about the impact of viral mutations on COVID-19 molecular, antigen, and serology tests. This web page builds on the letter the FDA issued January 8, 2021, alerting clinical laboratory staff and health care providers to the potential for false negative results due to the impact of viral mutations on molecular SARS-CoV-2 tests. The web page includes specific molecular tests impacted by viral mutations and recommendations for those tests, including, new information on Cepheid Xpert Xpress SARS-CoV-2, Xpert Xpress SARS-CoV-2 DoD, and Xpert Omni SARS-CoV-2 tests. The FDA will update this page as significant new information about viral mutations and impact on COVID-19 tests becomes available. The FDA will announce any updates by email to CDRH In Vitro Diagnostics email list subscribers and in COVID-19 Update press releases.

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  • How to Implement Safe Visitation in Your Facility

    By Denise Winzeler BSN, RN, LNHA, DNS-CT, QCP - March 23, 2021

    The Centers for Medicare & Medicaid Services (CMS) has acknowledged the toll that separation and isolation have taken on residents living in long-term care. With increased vaccination numbers making nursing facilities safer, on March 10, CMS updated the September 2020 Nursing Home Visitation – COVID-19 memo. Read this article for steps facility leadership can take to ensure safe visitation while following the new guidelines.

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  • CMS COVID-19 Nursing Homes Best Practices Toolkit and New QIN-QIO Virtual Assistance UPDATED (2/21)

    By CMS - March 23, 2021

    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 (3/25/21) 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 Infection Prevention and Control Assessment (ICAR) Tool for Nursing Homes Preparing for COVID-19 UPDATED (3/21)

    By CDC - March 19, 2021

    Guidance released March 10, 2021 regarding Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination | CDC affects only select elements of the current Nursing Home ICAR tool until an updated version of the tool is available. Please reference this guidance when using the ICAR tool to ensure alignment with updated considerations for COVID-19 vaccination status (e.g., visitation, HCP work restriction, resident quarantine).

    -----------------------------------------

    Infection Control Assessment and Response (ICAR) tools are used to systematically assess a healthcare facility’s infection prevention and control (IPC) practices and guide quality improvement activities (e.g., by addressing identified gaps).

    This tool is an update to the previous ICAR tool for nursing homes preparing for COVID-19. Notable changes as of November 20, 2020 include:

    • Additions to reflect updated guidance such as SARS-CoV-2 testing in nursing homes
    • Increased emphasis on the review of Personal Protective Equipment (PPE) use and handling
    • Addition of sections to help guide a video tour as part of a remote TeleICAR assessment or in-person tour of a nursing home
    • Addition of an accompanying facilitator guide to aide with the conduction of the ICAR and create subsequent recommendations for the facility

    This updated ICAR tool is a longer but more comprehensive assessment of infection control practices within nursing homes. Due to the addition of example recommendations to aid the facilitator during the process of conducting an ICAR, the facilitator guide version of the tool appears even longer. Facilitators may decide whether to use the tool in its entirety or select among the pool of questions that best fit their jurisdictional needs and priorities as part of quality improvement efforts.

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  • OSHA Updates Enforcement Memorandum for Respirator Fit Testing Programs (3/21)

    By OSHA - March 18, 2021
    OSHA's interim enforcement response plan memoranda provide instructions and guidance to Area Offices and compliance safety and health officers (CSHOs) for handling COVID-19-related complaints, referrals, and severe illness reports. The Interim Enforcement Response Plan for COVID-19 was issued on April 13, 2020, updated on May 19, 2020. On March 12, 2021, the May 19, 2020, memorandum on this topic was rescinded, and the new Updated Interim Enforcement Response Plan for COVID-19 went into and remains in effect until further notice.
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  • CDC Study: Pfizer COVID-19 Vaccine Effectiveness During SNF Outbreaks (3/21)

    By CDC - March 15, 2021

    Summary

    ·         What is already known about this topic?

    Skilled nursing facility (SNF) residents, generally older and with more underlying medical conditions than community-dwelling adults, were not included in COVID-19 vaccine clinical trials. Little is known about COVID-19 vaccine effectiveness in SNF residents.

    ·         What is added by this report?

    A retrospective cohort analysis in two Connecticut SNFs found partial vaccination with Pfizer-BioNTech COVID-19 vaccine (from >14 days after dose 1 through 7 days after dose 2) to be 63% (95% confidence interval = 33%–79%) effective against SARS-CoV-2 infection.

    ·         What are the implications for public health practice?

    Even with partial vaccination, Pfizer-BioNTech COVID-19 vaccine provides protection to SNF residents. To optimize vaccine impact among this population, high coverage with the complete 2-dose series is recommended.

    Read more
  • Visiting Loved Ones in a Nursing Home – English and Spanish Graphic Available (3/21)

    By CMS - March 15, 2021

    On March 10, 2021, the Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), issued updated guidance for nursing homes to safely expand visitation options during the COVID-19 pandemic public health emergency (PHE). Today, CMS is releasing a graphic to further explain the expanded visitation options.

    According to the updated guidance, facilities should allow responsible indoor visitation at all times and for all residents, regardless of vaccination status of the resident, or visitor, unless certain scenarios arise that would limit visitation.

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  • Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination (3/21)

    By CDC - March 11, 2021

    CDC guidance for SARS-CoV-2 infection may be adapted by state and local health departments to respond to rapidly changing local circumstances.

    On this page

    Visitation

    Work restriction for asymptomatic healthcare personnel and quarantine for asymptomatic patients and residents

    SARS-CoV-2 Testing

    Use of Personal Protective Equipment

    Introduction

    This guidance applies to all healthcare personnel (HCP) while at work and all patients and residents while they are being cared for in a healthcare setting.

    CDC has released public health recommendations for vaccinated persons, which describe circumstances when non-pharmaceutical interventions (e.g., quarantine) could be relaxed for fully vaccinated persons in non-healthcare settings. CDC continues to evaluate the impact of vaccination and the emergence of novel SARS-CoV-2 variants on healthcare infection prevention and control recommendations; updated recommendations will be added to this page regularly as new information becomes available.

    Except as noted in Updated Recommendations, HCP should continue to follow all current infection prevention and control recommendations, including those addressing work restrictions, quarantine, testing, and use of personal protective equipment to protect themselves and others from SARS-CoV-2 infection.

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  • COVID-19 Prevention / Management in Long-Term Care: CMS Recommendations (3/21)

    By CMS - March 10, 2021

    NOTE: CMS revised guidance on March 10, 2021 for nursing home visitation during the COVID-19 Public Health Emergency, which supersedes the visitation guidance in this memo. See CMS memorandum QSO-20-39-NH Revised, Nursing Home Visitation-COVID-19. 

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    The new recommendations include:

    ·  Nursing homes should immediately ensure that they are complying with all CMS and CDC guidance related to infection control.

    ·  As nursing homes are a critical part of the healthcare system, and because of the ease of spread in long term care facilities and the severity of illness that occurs in residents with COVID-19, CMS/CDC urges State and local leaders to consider the needs of long term care facilities with respect to supplies of PPE and COVID-19 tests.

    ·  Nursing homes should immediately implement symptom screening for all staff, residents, and visitors – including temperature checks.

    ·  Nursing homes should ensure all staff are using appropriate PPE when they are interacting with patients and residents, to the extent PPE is available and per CDC guidance on conservation of PPE.

    ·  To avoid transmission within nursing homes, facilities should use separate staffing teams for residents to the best of their ability, and, as President Trump announced at the White House today, the administration urges nursing homes to work with State and local leaders to designate separate facilities or units within a facility to separate COVID-19 negative residents from COVID-19 positive residents and individuals with unknown COVID-19 status.

    “The Trump Administration is calling on the nursing home industry and state and local leaders to join us by taking action now to ensure the safety of their residents, who are among our most vulnerable citizens. The Administration urges them to carefully review our recommendations, and implement them immediately,” said CMS Administrator Seema Verma.

    Today’s recommendations will help State and local governments, and nursing homes, as they consider creative ways to stop the spread of the virus, such as designating units within facilities – or entire facilities – solely for residents with confirmed COVID-19. An example of such an arrangement is in Wilmington, Massachusetts, in which a 142-bed facility has been designated as a solely COVID-19-positive facility. Residents across the region who are infected with COVID-19 can be moved to this facility to receive appropriate care and avoid transmitting the virus within their facilities. This approach also eases the challenges of preventing transmission, like extensive PPE usage and isolation practices, for individual facilities. The Massachusetts arrangement, developed in coordination with the state’s government, is a prime example of the arrangements envisioned in the recommendations announced today.

    The recommendations also speak to enhanced screening and transmission prevention practices. Previous CMS guidance, developed with CDC and issued in mid-March, advised nursing homes to restrict all but the most urgent visitors and staff. Today’s guidance builds on this by recommending temperature screenings for all visitors and that all staff utilize adequate PPE when interacting with patients, to the extent PPE is available.

    Nursing homes are unique in the healthcare system because, unlike other healthcare facilities, they are full-time homes as well as settings of care. Importantly, nursing home residents, given their advanced age and corresponding health issues, are at particular risk of complications arising from COVID-19. Because they are large concentrations of particularly vulnerable individuals, nursing homes have been a major focus for the Trump Administration in its aggressive efforts to combat the virus.

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