AADNS News Feed

Sorting through all that is happening in LTC and then figuring out just what you need to know can be a daunting task. Luckily, we’re here to help. Our nursing experts scour through mountains of information to identify the breaking news and important updates and changes that you need to know today. Find the latest on important topics with links to resources, websites, and tools to keep you up-to date.

  • 3 Tips Every DNS Needs to Understand Data and Improve Their Facility's Performance

    By Alexis Roam, MSN, RN-BC, DNS-CT, QCP - February 19, 2020

    Do five pressure injuries mean a facility has a problem? What about 10 pressure injuries? What if the number of pressure injuries increases in a week—is this a problem that requires the initiation of a performance improvement project (PIP) or action plan? Answering these questions requires more substantial data, which must then be translated into actionable information.

    Data Should Tell A Story

    The clinical data the DNS uses must tell a story and give context to the situation. It’s all just numbers, unless there is a reason behind collecting the data and until the right questions are asked to clarify what the data represents. A change in a number doesn’t necessarily mean something is good or bad. Rather, it’s an indicator to prompt the DNS to start asking questions. Without this translation from data to information, or “telling the story,” the DNS reacts to random ups and downs, trying to manage a number without considering why they are managing it.

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  • Adverse Event Investigation 101: How to Reduce Your Legal Risk

    By Caralyn Davis, Staff Writer - February 19, 2020

    The Centers for Medicare & Medicaid Services (CMS) defines an adverse event as “an untoward, undesirable, and usually unanticipated event that causes death or serious injury, or the risk thereof, which includes near misses,” according to the surveyor guidance at F867 (QAPI/QAA Improvement Activities) in Appendix PP of the State Operations Manual. Potentially preventable adverse events can involve medication issues (e.g., change in mental status/delirium related to use; ketoacidosis related to use of antidiabetic medication; etc.), resident care issues (e.g., falls, abrasions/skin tears, or other trauma related to care; elopement without injury of a cognitively impaired resident; etc.), or infections (e.g., respiratory infections, such as pneumonia or influenza; urinary tract infections, including catheter-associated and non-catheter-associated UTIs; etc.).

     

    CMS makes identifying, reporting, tracking, investigating, analyzing, and preventing adverse events a priority of every facility’s quality assessment and assurance (QAA) committee and quality assurance and performance improvement (QAPI) program under F865 (QAPI Program/Plan, Disclosure/Good Faith Attempt) and F866 (QAPI/QAA Data Collection and Monitoring) in addition to F867.

     

    However, the ability to conduct effective investigations into adverse events is crucial from a risk perspective as well to reduce the incidence and impact of negligence lawsuits related to sentinel events (i.e., the most severe form of adverse events), which the Joint Commission defines as resident safety events that cause death, permanent harm, or severe temporary harm, says Laura Ginett, a healthcare attorney and partner at Hall, Prangle, and Schoonveld LLC who will be co-presenting the session Anatomy of an MDS/Care Planning Lawsuit at the 2020 AAPACN Conference in April.

     

    Ginett offers directors of nursing services (DNSs) the following suggestions for optimizing investigations to limit risk:

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  • FY 2022 SNF QRP Quick Reference Guide (2/20)

    By CMS - February 18, 2020
    Quick Reference Guide for FY 2022 is now available. The Quick Reference Guides provide high-level information on the SNF Quality Reporting Program, including frequently asked questions and helpful links.
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  • FY 2021 SNF QRP Quick Reference Guide (2/20)

    By CMS - February 18, 2020

    Quick Reference Guide for FY 2021 is now available. The Quick Reference Guides provide high-level information on the SNF Quality Reporting Program, including frequently asked questions and helpful links.

    Read more
  • CMS Proposes PASRR Changes (2/20)

    By CMS - February 18, 2020

    DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 431, 433, 435, 441, and 483 [CMS-2418-P] RIN 0938-AT95 Medicaid Program; Preadmission Screening and Resident Review

    AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

    ACTION: Proposed rule.

    SUMMARY: This proposed rule would modernize the requirements for Preadmission Screening and Resident Review (PASRR), currently referred to in regulation as Preadmission Screening and Annual Resident Review, by incorporating statutory changes, reflecting updates to diagnostic criteria for mental illness and intellectual disability, reducing duplicative requirements and other administrative burdens on State PASRR programs, and making the process more streamlined and person-centered.

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  • CMS QSO Memo Explains 2 New Toolkits to Ensure Safety and Quality in Nursing Homes (2/20)

    By CMS - February 18, 2020

    CMS developed optional toolkits to aid nursing home teams with reducing adverse events and improving dementia care. These toolkits were the result of CMS work with nursing home Breakthrough Communities—a learning collaborative design where a subset of nursing homes joined learning sessions and team calls to learn about quality improvement concepts.

    Memorandum Summary

    The Centers for Medicare & Medicaid Services (CMS) is announcing the release of two toolkits that align with the CMS strategic initiative to Ensure Safety and Quality in Nursing Homes.

    • Developing a Restful Environment Action Manual (DREAM) Toolkit – CMS has created a toolkit that offers education and person-centered, practical interventions that nursing home administrators, directors of nursing, and bedside staff can implement to promote high-quality sleep for residents living with dementia.

    • Head-to-Toe Infection Prevention (H2T) Toolkit – CMS has created a toolkit that offers educational materials and practical interventions for bedside staff designed to prevent common infections by improving activities of daily living (ADL) care.

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  • Developing a Restful Environment Action Manual (DREAM) Toolkit From CMS (2/20)

    By CMS - February 18, 2020

    As many as 70% of adults with dementia experience sleep disturbances, which are associated with various negative health outcomes. High quality sleep is necessary for optimal cognitive and physical functioning, especially for residents who already experience cognitive decline due to dementia. The DREAM Toolkit provides educational material and practical tools for nursing home staff to help all residents living with dementia improve sleep quality. Nursing homes can choose from a variety of strategies in the DREAM Toolkit to help improve quality of life and quality of care, especially for residents living with dementia.

    The DREAM Toolkit consists of the following components:

    1) Implementation Guide

    2) Handbook

    3) Sleep Matters Video: https://youtu.be/2Ub55iKej84  

    4) Pocket Guide for Clinical Teams

    5) Sleep Environment Improvement Tool

    6) Resident Preferences Tool

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  • Head to Toe Infection Prevention (H2T) Toolkit From CMS (2/20)

    By CMS - February 18, 2020

    Infections comprise a large share of adverse events in nursing homes. The Head to Toe Infection Prevention Toolkit contains educational materials and practical tools to support the clinical team in providing person-centered care that helps prevent and control common infections like pneumonia, skin infections, and urinary tract infections. The Toolkit aims to educate licensed nurses and nurse aides on infection prevention practices and provide tools that can be integrated into their daily work.

    The H2T Toolkit consists of the following components:

    1) Implementation Guide

    2) Infection Prevention Handbook

    3) Staff Presentation

    4) Resource for Residents and Loved Ones

    5) Observation Guide

    6) Customizing Care Tool

    7) Suspected Infection Investigation Tool

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  • 4 Simple Ways to Support Staff Retention

    By Jessica Kunkler, MA, Staff Writer - February 11, 2020

    One in four nursing assistants and one in five home health aides report that they are actively looking for another job. That’s a lot of unhappy employees.

    This turnover comes at a high price for facilities. It costs an estimated $2,200 to replace a nursing assistant or home care worker, according to the Recruitment and Retention Guide For Employers by PHI (formerly the Paraprofessional Healthcare Institute).

    Moreover, frustration in the workplace can be contagious; unsatisfied staff members have a negative impact on residents and their peers alike.

    There are books and guides devoted to programs for staff retention. Better hiring processes, rewards systems, and staff training can yield positive returns for facilities—but overhauling an entire program can feel daunting for busy nurse managers.

    Here are four simple ways to promote staff retention, starting right where you are.

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  • Is Your Antibiotic Stewardship Program Ready for Prime Time?

    By Caralyn Davis, Staff Writer - February 11, 2020

    Through the first four months of fiscal year (FY) 2020, F881 (Antibiotic Stewardship Program) is the 46th most cited F-tag nationwide. That’s up from 49th overall in FY 2019, according to the Quality, Certification, and Oversight Reports (QCOR) from the Centers for Medicare & Medicaid Services (CMS). This possibly increased scrutiny occurred as CMS issued the November 22, 2019, Quality, Safety, and Oversight (QSO) memo QSO-20-03-NH, which highlighted the importance of antibiotic stewardship programs and announced a new training, Development of an Antibiotic Stewardship Program for Nursing Home Providers, and a new resource list to support antibiotic stewardship compliance as part of a package of actions designed to assist nursing homes to improve their entire infection prevention and control program.

     

    “The requirement for nursing homes to have an antibiotic stewardship program that includes antibiotic use protocols, a system to monitor antibiotic use, and education for prescribers, residents/representatives, and nursing staff—and that is reviewed annually and as needed—became effective on November 28, 2017, as part of the Phase 2 rollout of the revised Medicare/Medicaid requirements of participation,” says Deb Patterson Burdsall, PhD, RN-BC, CIC, FAPIC, an infection prevention and control consultant and faculty member at the Association for Professionals in Infection Control and Epidemiology (APIC) in Arlington, VA.

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  • ACIP Immunization Recommendation Change for Pneumococcal conjugate (PCV13) for > 65 (2/20)

    By ACIP - February 10, 2020

    Changes in the 2020 Adult Immunization Schedule

    Changes in the 2020 adult immunization schedule for persons aged ≥19 years include new or revised recommendations for hepatitis A vaccine (HepA) (2); human papillomavirus vaccine (HPV) (3); influenza vaccine (4); serogroup B meningococcal vaccine (MenB); pneumococcal vaccine (5); and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) (6). Following are the changes to the cover page, Table 1, Table 2, and Notes.

    Cover page

    • Trademark symbols (®) were added to all vaccine trade names.
    • PedvaxHIB was added to the table of trade names for Haemophilus influenzae type b vaccine.
    • The footnote on the cover page has been edited and now reads “Do not restart or add doses to vaccine series if there are extended intervals between doses.”

    Table 1

    • Age ranges: The columns for age groups 19–21 years and 22–26 years have been combined, thereby reducing the number of columns for age ranges from five to four. This change was made because of the change in recommendation for catch-up HPV vaccination for all adults aged ≤26 years.
    • Tetanus, diphtheria, pertussis row: This row has been edited to state that tetanus and diphtheria toxoids (Td) or Tdap may be used for the decennial tetanus booster.
    • Human papillomavirus (HPV) row: The rows for males and females have been combined, reflecting that catch-up vaccination is now recommended for all adults aged ≤26 years. In addition, a blue box has been added for persons aged 27–45 years to indicate that shared clinical decision-making regarding vaccination is now recommended for this group.
    • Pneumococcal conjugate (PCV13) row: The box for persons aged ≥65 years who do not have an additional risk factor or another indication has been changed to blue to indicate that shared clinical decision-making regarding vaccination is now recommended for this group.
    • Meningococcal B (MenB) row: A blue box has been added for persons aged 19–23 years who are not at increased risk for meningococcal disease, indicating that shared clinical decision-making regarding vaccination is now recommended for this group.
    • Legend: A blue box has been added to indicate that shared clinical decision-making is recommended regarding vaccination. The text defining the gray box has been edited and now reads “No recommendation/not applicable.”

    Table 2

    • Tdap or Td row: This row has been revised to read that Td or Tdap may be used for the decennial tetanus booster.
    • Human Papillomavirus (HPV) row: This row has been combined into a single row including both males and females, reflecting that HPV vaccine is now recommended for all adults aged ≤26 years.
    • Hepatitis A (HepA) row: The box for persons living with human immunodeficiency virus (HIV) infection (regardless of CD4 count) is now yellow, reflecting the new recommendation that previously unvaccinated persons in this group should be vaccinated.
    • Legend and bar text: The gray box in the Legend has been edited and now reads “No recommendation/not applicable.” The red box has been edited and now reads “Not recommended/contraindicated — vaccine should not be administered.” The text appearing in the red bars has been changed from “Contraindicated” to “Not Recommended.”
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  • CMS QSO Memo re: Coronavirus and Healthcare Facility Expectations (2/20)

    By CMS - February 10, 2020

    Memo #20-09-ALL

    Posting Date 2020-02-06

    Fiscal Year 2020

    Summary

    • Information Regarding Patients with Possible Coronavirus Illness: the U.S. Centers for Disease Control and Prevention (CDC) has issued information on the respiratory illness caused by the 2019 Novel Coronavirus (2019-nCoV). Links to these documents are provided.
    • Healthcare Facility Expectations: CMS strongly urges the review of CDC’s guidance and encourages facilities to review their own infection prevention and control policies and practices to prevent the spread of infection.
    Read more
  • Do You Know Who Your New QIN-QIO Is? (2/20)

    By Staff - February 05, 2020

    In November 2019, the Centers for Medicare & Medicaid Services quietly implemented the 12th Statement of Work for the Quality Improvement Network Quality Improvement Organizations (QIN-QIOs).

    This five-year contract includes a shift in how/where the QIN-QIOs operate. There are now 14 Medicare-funded QIN-QIOs nationwide. For example, IPRO is a lead contractor partnering with two other QIOs to cover 11 states and the District of Columbia. IPRO will direct activities in New York, New Jersey, and Ohio; Healthcentric Advisors will cover all six New England states (Maine, New Hampshire, Vermont, Massachusetts, Connecticut, and Rhode Island); and Qlarant will handle Maryland, Delaware, and the District of Columbia.

    "QIN-QIOs serving under the 12th Statement of Work will provide customized quality improvement to nursing homes and providers, serving rural communities and the most vulnerable populations. Through this body of work, CMS is focusing on results, protecting taxpayer dollars, and most importantly, ensuring the safety and quality of care delivered to every Medicare beneficiary," says HealthCentric Advisors.

     The QIN-QIOs will address nursing home and community coalition quality improvement in the following areas:

    • Improving Behavioral Health Outcomes – Including Opioid Misuse
    • Increasing Patient Safety
    • Increasing Chronic Disease Self-Management
    • Increasing the Quality of Care Transitions
    • Improving Nursing Home Quality
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  • MDS 3.0 Quality Measures (QM) User's Manual V13.0 (2/20)

    By CMS - February 05, 2020

    The MDS 3.0 QM User’s Manual V13.0 and Quality Measure Reporting Module Table V1.8 have been posted. The MDS 3.0 QM User’s Manual V13.0 contains detailed specifications for the MDS 3.0 quality measures. The MDS 3.0 QM User’s Manual V13.0 can be found in the Downloads section of this webpage and the MDS 3.0 QM User’s Manual V12.1 has been moved to the Quality Measures Archive webpage.

    The Quality Measure Reporting Module Table V1.8 documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module, with a unique CMS identification number specified for each QM. The Quality Measure Reporting Module Table V1.8 can be found in the Downloads section of this webpage and the Quality Measure Reporting Module Table V1.7 has been moved to the Quality Measures Archive webpage.

    Two files related to the MDS 3.0 QM User’s Manual have been posted:

    1. MDS 3.0 QM User’s Manual V13.0 contains detailed specifications for the MDS 3.0 quality measures. MDS 3.0 QM User’s Manual V13.0 is included in the zip file titled User Manuals - Updated 01-21-2020 (ZIP).
    2. Quality Measure Identification Number by CMS Reporting Module Table V1.8 documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module. A unique CMS identification number is specified for each QM.

    The MDS 3.0 QM User’s Manual V13.0 and Quality Measure Reporting Module Table V1.8 have been posted. The MDS 3.0 QM User’s Manual V13.0 contains detailed specifications for the MDS 3.0 quality measures. The MDS 3.0 QM User’s Manual V13.0 can be found in the Downloads section of this webpage and the MDS 3.0 QM User’s Manual V12.1 has been moved to the Quality Measures Archive webpage. The Quality Measure Reporting Module Table V1.8 documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module, with a unique CMS identification number specified for each QM. The Quality Measure Reporting Module Table V1.8 can be found in the Downloads section of this webpage and the Quality Measure Reporting Module Table V1.7 has been moved to the Quality Measures Archive webpage.

    Two files related to the MDS 3.0 QM User’s Manual have been posted:

    1. MDS 3.0 QM User’s Manual V13.0 contains detailed specifications for the MDS 3.0 quality measures. MDS 3.0 QM User’s Manual V13.0 is included in the zip file titled User Manuals - Updated 01-21-2020 (ZIP).
    2. Quality Measure Identification Number by CMS Reporting Module Table V1.8 documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module. A unique CMS identification number is specified for each QM.
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  • PAC/SNF QRP Web-Based Training From CMS on Oct. 1, 2020 Changes

    By CMS - February 04, 2020

    The Centers for Medicare & Medicaid Services (CMS) is offering a quick web-based training to walk providers through upcoming changes to the Quality Reporting Programs (QRPs) for the following post-acute care settings along with an overview of existing and upcoming training activities designed to support providers in successfully complying with associated reporting requirements:

    o    Home Health

    o    Inpatient Rehabilitation Facility (IRF)

    o    Long-Term Care Hospital (LTCH)

    o    Skilled Nursing Facility (SNF)


    This web-based training will:

    • Demonstrate how the quality measures used in the Home Health, IRF, LTCH, and SNF QRPs tie to CMS’ Meaningful Measures Initiative;  
    • Provide a detailed list of data elements that have already been incorporated into the post-acute care QRPs along with those being implemented in the IRF, LTCH, and SNF care settings on October 1, 2020, and the Home Health care setting on January 1, 2021;
    • Provide links to training resources to support providers in implementing existing reporting requirements associated with the QRPs; and
    • Offer a preview of upcoming training activities to support the implementation of new reporting requirements, including dates, so that providers can begin to plan to incorporate these important training events into their busy schedules.

    If you have technical questions or feedback regarding the training, please email the PAC Training mailbox. Content-related questions should be submitted to the Quality Reporting Program Help Desk for your care setting.

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