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

    Tuesday, June 30, 2020 | CMS

    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 6/29/20) 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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  • Opioid Treatments for Chronic Pain (4/20)

    Friday, April 17, 2020 | AHRQ

    AHRQ systematic review

    Purpose of Review

    To assess the effectiveness and harms of opioid therapy for chronic noncancer pain, alternative opioid dosing strategies, and risk mitigation strategies. 

    Key Messages

    • Opioids are associated with small improvements versus placebo in pain and function, and increased risk of harms at short-term (1 to <6 months) followup; evidence on long-term effectiveness is very limited, and there is evidence of increased risk of serious harms that appear to be dose dependent.
    • At short-term followup, evidence showed no differences between opioids versus nonopioid medications in improvement in pain, function, mental health status, sleep, or depression.
    • Evidence on the effectiveness and harms of alternative opioid dosing strategies and the effects of risk mitigation strategies is lacking, although provision of naloxone to patients might reduce the likelihood of opioid-related emergency department visits, a taper support intervention might improve functional outcomes compared to no taper support, and co-prescription of benzodiazepines and gabapentinoids might increase risk of overdose.
    • No instrument has been shown to be associated with high accuracy for predicting opioid overdose, addiction, abuse, or misuse.
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  • Nonopioid Pharmacologic Treatments and Noninvasive Nonpharmacological Treatments for Chronic Pain (4/20)

    Friday, April 17, 2020 | AHRQ

    1. Nonopioid Pharmacologic Treatments for Chronic Pain

    AHRQ systematic review  

    Purpose of Review

    Evaluate the benefits and harms of nonopioid drugs in randomized controlled trials of patients with specific types of chronic pain, considering the effects on pain, function, quality of life, and adverse events.

    Key Messages

    • In the short term, improvement in pain and function was small with specific anticonvulsants, moderate with specific antidepressants in diabetic peripheral neuropathy/post-herpetic neuralgia and fibromyalgia, and small with nonsteroidal anti-inflammatory drugs (NSAIDs) in osteoarthritis and inflammatory arthritis.
    • In the intermediate term, evidence was limited, with evidence of benefit for memantine in fibromyalgia and for serotonin norepinephrine reuptake inhibitor (SNRI) antidepressants in low back pain and fibromyalgia.
    • In the long term, evidence was too limited to draw conclusions. In general, evidence on quality of life was limited and no treatment achieved a large improvement in pain or function.
    • Small to moderate, dose-dependent increases in withdrawal due to adverse events were found with SNRIs duloxetine and milnacipran, anticonvulsants pregabalin and gabapentin, and NSAIDs. Large increases were seen with oxcarbazepine. NSAIDs have increased risk of serious gastrointestinal, liver dysfunction, and cardiovascular adverse events.

    2. Noninvasive Nonpharmacological Treatment for Chronic Pain

    A Systematic Review Update

    Purpose of Review

    To assess noninvasive nonpharmacological treatments for common chronic pain conditions.

    Key Messages

    • Interventions that improved function and/or pain for ≥1 month:
    • Some interventions did not improve function or pain.
    • Serious harms were not observed with the interventions.

     

     

     


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  • Infection Control in Healthcare Personnel Guidelines (Part I) - Updated (10/19)

    Wednesday, October 23, 2019 | CDC
    Preventing the transmission of infectious diseases among healthcare personnel (HCP) and patients is a critical component of safe healthcare delivery in all healthcare settings. Today, CDC published Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services, an update of four sections of Part I of the Guideline for infection control in health care personnel, 1998 (“1998 Guideline“) and their corresponding recommendations in Part II:

    ·  C. Infection Control Objectives for a Personnel Health Service

    ·  D. Elements of a Personnel Health Service for Infection Control

    ·  H. Emergency-Response Personnel

    ·  J. The Americans With Disabilities Act

    The updated recommendations are aimed at the leaders and staff of Occupational Health Services (OHS) and the administrators and leaders of healthcare organizations (HCO) and are intended to facilitate the provision of occupational infection prevention and control (IPC) services to HCP and prevent the spread of infections between HCP and others. Additional updates to the 1998 Guideline are underway and will be published in the future. Updates in Part I include: 

    ·  a broader range of elements necessary for providing occupational IPC services to HCP;

    ·  applicability to the wider range of healthcare settings where patient care is now delivered, including hospital-based, long-term care, and outpatient settings such as ambulatory and home healthcare; and

    ·  expanded guidance on policies and procedures for occupational IPC services and strategies for delivering occupational IPC services to HCP.

    New topics include:

    ·  administrative support and resource allocation for OHS by senior leaders and management,

    ·  service oversight by OHS leadership, and

    ·  use of performance measures to track occupational IPC services and guide quality improvement initiatives.  

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  • Oct. 24 CDC Call With Free CE: Preventing the Spread of Novel or Targeted Multidrug-resistant Organisms (MDROs) in Nursing Homes through Enhanced Barrier Precautions

    Wednesday, October 23, 2019 | CDC

    At the conclusion of the session, the participant will be able to accomplish the following:

    • Describe the burden of multidrug-resistant organisms (MDROs).
    • Describe challenges to preventing MDRO transmission in nursing homes.
    • Define Standard Precautions, Enhanced Barrier Precautions, and Contact Precautions.
    • Identify which residents and activities meet criteria for Enhanced Barrier Precautions.
    • Discuss best practices for implementing Enhanced Barrier Precautions.
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  • HHS Guide for Appropriate Tapering or Discontinuation of Long-Term Opioid Use (10/19)

    Tuesday, October 15, 2019 | US Department of Health and Human Services

    The U.S. Department of Health and Human Services published a new Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics - PDF. Individual patients, as well as the health of the public, benefit when opioids are prescribed only when the benefit of using opioids outweighs the risks.  But once a patient is on opioids for a prolonged duration, any abrupt change in the patient’s regimen may put the patient at risk of harm and should include a thorough, deliberative case review and discussion with the patient. The HHS Guide provides advice to clinicians who are contemplating or initiating a change in opioid dosage.

    “Care must be a patient-centered experience. We need to treat people with compassion, and emphasize personalized care tailored to the specific circumstances and unique needs of each patient,” said Adm. Brett P. Giroir, M.D., assistant secretary for health. “This Guide provides more resources for clinicians to best help patients achieve the dual goals of effective pain management and reduction in the risk for addiction.”

    Clinicians have a responsibility to coordinate patients’ pain treatment and opioid-related problems. In certain situations, a reduced opioid dosage may be indicated, in joint consultation with the care team and the patient. HHS does not recommend opioids be tapered rapidly or discontinued suddenly due to the significant risks of opioid withdrawal, unless there is a life-threatening issue confronting the individual patient.

    Compiled from published guidelines and practices endorsed in the peer-reviewed literature, the Guide covers important issues to consider when changing a patient’s chronic pain therapy. It lists issues to consider prior to making a change, which include shared decision-making with the patient; issues to consider when initiating the change; and issues to consider as a patient’s dosage is being tapered, including the need to treat symptoms of opioid withdrawal and provide behavioral health support. 

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  • Consensus Recommendations to Prevent Secondary Fractures in Adults 65+ with Osteoporosis (10/19)

    Monday, October 14, 2019 | Hinda and Arthur Marcus Institute for Aging Research

    Coalition Reaches Consensus on Recommendations to Prevent Secondary Fractures in Adults 65+ with Osteoporosis

    Recommendations target all health care professionals who participate in the care of older adults at risk for osteoporotic fractures

    BOSTON (October 2, 2019) - A multistakeholder coalition assembled by the American Society for Bone and Mineral Research (ASBMR) has issued clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture - the most serious complication associated with osteoporosis. Douglas P. Kiel, M.D., M.P.H., Director of the Musculoskeletal Research Center in the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife and Professor of Medicine at Harvard Medical School, is senior author on the report and served as co-leader of the project. The recommendations were published last month in the Journal of Bone and Mineral Research to coincide with the annual meeting of the ASBMR where Dr. Kiel was honored with the 2019 Esteemed Frederic C. Bartter Award. This prestigious award is bestowed upon an ASBMR member in recognition of outstanding clinical investigation in disorders of bone and mineral metabolism. 

    The coalition developed 13 recommendations strongly supported by the empirical literature and recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction.
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  • New CDC Infection Control Training (9/19)

    Saturday, August 31, 2019 | CDC

     

    We are pleased to announce the launch of the Environmental Cleaning and Personal Protective Equipment courses, the latest in a series of 11 new infection control training courses. These courses are part of the new States Targeting Reduction in Infections via Engagement (STRIVE) curriculum intended for the infection prevention team, hospital leaders, clinical educators, nurse and physician managers, environmental services managers, all patient care staff, and patient/family advisors. Additional courses will be launched in the coming months. 

    These training courses were developed by national infection prevention experts led by the Health Research & Educational Trust (HRET) for the Centers for Disease Control and Prevention (CDC).

    All courses are free and offer continuing education (CE).

     

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  • CDC Infection Control Interactive Graphic Novel for Environmental Services (EVS) Personnel (6/19)

    Wednesday, June 19, 2019 | CDC

    EVS personnel play a critical role in preventing the spread of germs and healthcare-associated infections

    EVS and the Battle Against Infection” is an interactive graphic novel illustrating the important role of EVS personnel in the prevention of healthcare-associated infections. The online version of the training tool features real-world infection prevention and control scenarios and allows participants to choose options that affect the outcome of the story. 

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  • CDC Interactive Training: Reducing HAI Transmission Risk (6/19)

    Wednesday, June 19, 2019 | CDC

    Healthcare professionals are the first line of defense against healthcare-associated infections (HAIs) and the spread of germs in healthcare settings. CDC now offers a new online interactive infection control training, “Let’s Talk Patient Safety: Reducing HAI Transmission Risk,” to help healthcare professionals identify infection risks and prevent the spread of HAIs. The training provides free continuing education for healthcare professionals, including nurses, physician assistants, medical assistants, health educators, and other clinicians. (0.1 CEU and 0.6 CNE).

    The free online training can be completed anywhere. It has two modules and takes approximately 30 minutes to complete the entire training.

    Module 1: “What’s the Risk?” 

    This interactive module transports healthcare professionals into a scenario where they must identify infection risks and take action to protect patients, colleagues, and visitors. 

    Module 2: “Chain of Infection” 

    This story-based interactive module challenges professionals to break the chain of infection in a busy healthcare environment and educates them on the consequences of not following infection prevention and control recommendations.

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