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

    Tuesday, April 2, 2019 | CDC

    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)

    Tuesday, April 2, 2019 | AHRQ

    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)

    Wednesday, March 27, 2019 | CMS

    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)

    Wednesday, March 20, 2019 | CMS

    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)

    Tuesday, March 12, 2019 | CDC/CMS

    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)

    Monday, March 11, 2019 | AHRQ

    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)

    Sunday, March 10, 2019 | OIG

    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)

    Friday, March 8, 2019 | CMS

    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)

    Thursday, March 7, 2019 | CMS

    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)

    Monday, March 4, 2019 | CMS

    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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