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.

  • The Importance of Device Selection, Education, and Training for Appropriate and Effective Inhalation Therapy in COPD

    By Shahin Sanjar, PhD., Sunovion Pharmaceuticals Inc. - January 13, 2021

    Inhalation treatment of respiratory conditions such as asthma and COPD is the predominant mode of therapy for the simple and logical reason that applying pharmacological agents to the target organ reduces the drug dose, maintains good efficacy, as well as reduces potential systemic adverse effects. To this end, there are now multiple systems for delivering therapeutic agents either as single or fixed dose combinations of two or three agents. The focus of this article is on the delivery devices and potential challenges with multiple device options rather than the therapeutic agents. It is important to recognize that even the best therapeutic agents cannot be effective unless they are delivered to the correct target organ or site. 

    Given the wealth of treatment and delivery options, it is surprising that treatment of COPD remains less than optimal and reported rates of device use errors remain high (Sanchis J et al. 2016, Molimard et al. 2017). This topic has been broadly discussed in the latest Global Initiative for Obstructive Lung Disease (GOLD 2021) report, with an emphasis on effective training and appropriate device selection for COPD patients. In a recent study, only 23% of patients discharged from the hospital demonstrated appropriate use of dry powder inhalers (Sulaiman et al. 2017). It is important to note that despite significant improvements in device design and a greater understanding of drug delivery issues, such as aerodynamics of particle flow as well as optimal particle size for pulmonary delivery, device error rates have remained high for decades (Sanchis et al. 2016). It is now well-recognized that education and training are key components of proper inhaler use, which requires regular assessment and the implementation of the “teach back” method (Dantic 2014). The importance of continued assessment is highlighted by the observation that the training effect does not persist (Press et al. 2016).

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  • Prioritize Infection Prevention Even After the COVID-19 Vaccine

    By Caralyn Davis, Staff Writer - January 13, 2021

    Nursing home staff members, like everyone in the United States and across the globe, want to go back to “normal.” However, directors of nursing services (DNSs) need to ensure that infection prevention and control remains a priority both in the short term as COVID-19 vaccinations occur and in the long-term as the public health emergency eventually ends. Steps that DNSs can take to further these objectives include the following:

     

    In the near term

    All providers are excited and grateful that COVID-19 vaccines are being rolled out to residents and staff, says Linda Behan, RN, BSN, CWCN, CIC, senior director of infection prevention and control at Genesis HealthCare in Kennett Square, PA. “However, the vaccine isn’t the be-all and end-all. Taking the vaccine doesn’t mean that everything is automatically all better.”

     

    Nursing homes will have to remain vigilant and continue with the same infection prevention and control practices that they have had in place throughout the pandemic, says Behan. “Whether it’s surveillance, personal protective equipment (PPE) use, or testing protocols—all of that needs to continue for a while. The COVID-19 vaccine will not provide immediate protection, and we need to see how the prevalence goes down in each nursing home’s local community. So, there is still a ways to go.”

     

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  • Section M: Skin Conditions - Assessment and Coding of Pressure Ulcers/Injuries: CMS Web-Based Training (1/21)

    By MX - January 13, 2021
    The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides an overview of the assessment and coding of pressure ulcers/injuries. This 90-minute course is intended for providers in Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs), and Skilled Nursing Facilities (SNFs), and is designed to be used on demand anywhere you can access a browser.
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  • Cross-Setting QRP Data Elements and Quality Measures: CMS Web-Based Training (1/21)

    By CMS - January 13, 2021

    From Data Elements to Quality Measures – Cross-Setting QRP Web-Based Training

    The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides a high-level overview of how data elements within CMS patient/resident assessment instruments are used to construct quality measures (QMs) across post-acute care (PAC) settings. The PAC settings included are those covered under the Centers for Medicare & Medicaid Services (CMS) Quality Reporting Programs (QRPs) for Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs) and Skilled Nursing Facilities (SNFs). Information covered will include a short review of the QRPs’ cross-setting quality measures (QM), how data elements feed into these cross-setting QMs, how QMs are calculated and appear on QM reports and how to access and use this data for quality improvement. 

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  • World Health Organization: Updated COVID-19 Interim Guidance for LTC Facilities (1/21)

    By WHO - January 12, 2021
    Infection prevention and control guidance for long-term care facilities (including NFs and SNFs) in the context of COVID-19 Interim guidance

    8 January 2021

    This document is an update of the guidance published on 21 March 2020 and contains new evidence and guidance, including the following:

    • updated results from published studies on:
      • the epidemiology and extent of SARS-CoV-2 infection among residents and staff in long-term care facilities (LTCFs);
      • the effectiveness of infection prevention and control (IPC) precautions to prevent SARS-CoV-2 transmission in LTCFs;
      • the impact of IPC precautions on mental and physical health and well-being of older people, and in particular people with dementia or other mental health or neurological disorders;
    • updated advice on IPC precautions to prevent the spread of SARS-CoV-2 and to protect health workers and caregivers of patients with suspected or confirmed COVID-19 in LTCFs;
    • advice on early detection of and testing for SARS-CoV-2 among residents and staff in LTCFs;
    • advice on policies for visitors to LTCFs and additional considerations on minimizing the mental and physical health impacts of restrictions and IPC precautions implemented in the context of COVID-19.
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  • jRAVEN 1.7.7 Free MDS Submission Software Updated (1/21)

    By QTSO - January 11, 2021

    The Resident Assessment Validation and Entry System (jRAVEN) was developed by the Centers for Medicare & Medicaid Services (CMS). jRAVEN is a free Java based software application which provides an option for facilities to collect and maintain MDS Assessment data for subsequent submission to the appropriate state and/or national data repository. jRAVEN displays the MDS Item Sets similar to the paper version of the forms. Please consult the jRAVEN Installation and User Guides for additional information.

    jRAVEN v1.7.7 is now available for download under the Downloads section at the bottom of this webpage. Users do not need a previous version of jRAVEN to download, install or use jRAVEN v1.7.7.

    jRAVEN v1.7.7 includes the following enhancements:

    • The new MDS VUT, v3.5.0, updated to support Issue #17 in Errata v3.00.6 and the new ICD Code files that are in effect as of 1/1/2021
    • The new PDPM Grouper, v1.0009, updated to include the ICD codes that are effective 01/01/202
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  • FDA Alert: SARS-CoV-2 Viral Mutation Could Cause False Negatives on Tests, but Overall Risk Is Low (1/21)

    By FDA - January 11, 2021

    The U.S. Food and Drug Administration is alerting clinical laboratory staff and health care providers that the FDA is monitoring the potential impact of viral mutations, including an emerging variant from the United Kingdom known as the B.1.1.7 variant, on authorized SARS-CoV-2 molecular tests, and that false negative results can occur with any molecular test for the detection of SARS-CoV-2 if a mutation occurs in the part of the virus’s genome assessed by that test. The SARS-CoV-2 virus can mutate over time, like all viruses, resulting in genetic variation in the population of circulating viral strains, as seen with the B.1.1.7 variant. The FDA is taking additional actions to ensure authorized tests remain accurate by working with test developers and conducting ongoing data analysis to evaluate all currently authorized molecular tests. The FDA believes the risk that these mutations will impact overall testing accuracy is low.

    “The FDA will continue to monitor SARS-CoV-2 genetic viral variants to ensure authorized tests continue to provide accurate results for patients,” said FDA Commissioner Stephen M. Hahn, M.D. “While these efforts continue, we are working with authorized test developers and reviewing incoming data to ensure that health care providers and clinical staff can quickly and accurately diagnose patients infected with SARS-CoV-2, including those with emerging genetic variants. At this time, we believe the data suggests that the currently authorized COVID-19 vaccines may still be effective against this strain. The FDA will continue to keep health care providers and the public informed of any new information as it becomes available.”

    The FDA has been monitoring SARS-CoV-2 viral mutations, and potential impact on testing, throughout the pandemic. The presence of SARS-CoV-2 genetic variants in a patient sample can potentially change the performance of a SARS-CoV-2 test. Tests that rely on the detection of multiple regions of the genome may be less impacted by genetic variation in the SARS-CoV-2 genome than tests that rely on detection of only a single region.

    Three currently authorized molecular tests, MesaBiotech AcculaTaqPath COVID-19 Combo Kit, and Linea COVID-19 Assay Kit, may be impacted by genetic variants of SARS-CoV-2, but the impact does not appear to be significant. Importantly, the detection pattern that appears with the TaqPath and Linea diagnostic tests when certain genetic variants are present may help with early identification of new variants in patients to reduce further spread of infection. The recently identified B.1.1.7 variant has been associated with an increased risk of transmission, therefore early identification of this variant in patients may help reduce further spread of infection.

    The FDA has reminded clinical laboratory staff and health care providers about the risk of false negative results with all laboratory tests, including molecular tests. Laboratories should expect some false results to occur even when very accurate SARS-CoV-2 tests are used. Today’s announcement also provides important information and recommendations for clinical laboratory staff and health care providers who use molecular tests for the detection of SARS-CoV-2.

    The FDA will continue to communicate with the public as we have additional information to share. The FDA encourages stakeholders to report any adverse events or suspected adverse events experienced with molecular tests for detection of SARS-CoV-2. Voluntary reports can be submitted through MedWatch, the FDA Safety Information and Adverse Event Reporting program. Health care personnel and clinical laboratory staff employed by facilities that are performing COVID-19 testing should follow the reporting requirements for authorized laboratories as specified in the test’s Emergency Use Authorization. Prompt reporting of adverse events can help the FDA identify and better understand the risks associated with medical devices.

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  • FY 2021 PDPM ICD-10 Mappings (1/21)

    By CMS - January 11, 2021

    The Mappings file contains: 

    • Mapping of the ICD-10-CM Recorded in Item I0020B of the MDS Assessment to PDPM Clinical Categories 
    • Mapping of Comorbidities Included in the PDPM SLP Component to ICD-10-CM Codes
    • Mapping of Comorbidities Included in the PDPM NTA Component to ICD-10-CM Codes

    These are the codes added in the January 2021 update:

    Z11.52 — Encounter for screening for COVID-19

    Z20.822 — Contact with and (suspected) exposure to COVID-19

    Z86.16 — Personal history of COVID-19

    M35.81 — Multisystem inflammatory syndrome (MIS)

    M35.89 — Other specified systemic involvement of connective tissue

    J12.82 — Pneumonia due to coronavirus disease 2019

    (Note that codes M35.81 and M35.89 replace code M35.8, which should no longer be used on assessments with target date on or after January 1, 2021.)

    This is the seventh release (sixth production release, since 1.0005 was a beta release).

    This release also adds six ICD-10 codes that were inadvertently excluded from the NTA calculation in V1.0006:

    • T8484XA

    • T8389XA

    • T8321XA

    • T82399A

    • T82392A

     • T83021A 

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  • National Healthcare Safety Network (NHSN) Long-term Care Facility COVID-19 Reporting Module Website UPDATED (1/21)

    By CDC - January 10, 2021

    CDC’s NHSN provides healthcare facilities, such as long-term care facilities (LTCFs), with a customized system to track infections and prevention process measures in a systematic way. Tracking this information allows facilities to identify problems, improve care, and determine progress toward national healthcare-associated infection goals.

    The NHSN Long-term Care Facility Component is supporting the nation’s COVID-19 response through the COVID-19 Module for LTCFs. Facilities eligible to report into the COVID-19 Module include nursing homes/skilled nursing, long-term care for the developmentally disabled, and assisted living facilities.

    The COVID-19 Module for LTCFs consists of four pathways within NHSN’s Long-term Care Facility Component:

    • Resident Impact and Facility Capacity
    • Staff and Personnel Impact
    • Supplies and Personal Protective Equipment
    • Ventilator Capacity and Supplies

    Data submitted into the Module pathways enables an assessment of the impact of COVID-19 through facility reported information, including: 1) counts of residents and facility personnel with newly suspected and laboratory positive COVID-19; 2) death counts among residents and facility personnel with suspected and laboratory positive COVID-19; 3) staffing shortages; 4) availability of personal protective equipment (PPE) and supplies; and 5) ventilator capacity and supplies for facilities with ventilator dependent units.

    In addition to the reporting pathways, the Point-of-Care (POC) Test Reporting Tool has been added to enable LTCFs to enter POC SARS-CoV-2 test results into the NHSN application.  NHSN will route the POC laboratory test data to the public health agency at the local or state level that has jurisdictional authority and responsibility to receive those data.  Health agencies, in turn, will use the data to fulfill their public health functions, which include reporting to the US Department of Health and Human Services, where the data will be used in the COVID-19 response. Participation in this pathway requires users to have secure access through Secure Access Management Services (SAMS), which includes having a SAMS grid card.

    LTCF data submission options include manual entry and/or CSV file submitted by individual facilities or bulk CSV file upload for multiple facilities. Note: CSV file submission is not currently available for the Point-of-Care (POC) Test Reporting Tool.


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  • CMS Online Platform for Submissions of 1135 Waiver Requests and Inquiries (1/21)

    By CMS - January 10, 2021

    • New Web Platform for 1135 Waivers and Inquiries – The Centers for Medicare & Medicaid Services (CMS) is announcing a new web-based tool to assist Medicare/Medicaid-participating providers and suppliers in submission of 1135 Waiver requests and inquiries. With very limited exception, the new web system should be used for all 1135 waiver requests and/or PHE-related inquiries submitted on or after January 11, 2021.

    • Waiver requests related to Physician Self-Referral (Stark Law) should not be submitted via the new web portal. For these requests, please visit:https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/Spotlightfor additional information.

    • This policy memorandum outlines the new changes to submission of 1135 Waiver requests/inquiries as well as resources available to providers and suppliers during the current COVID-19 Public Health Emergency (PHE) and future emergency events.

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  • COVID-19 Medicare FAQs Updated (1/21)

    By CMS - January 06, 2021

    Documents include: 

    • Frequently Asked Questions to Assist Medicare Providers
    • Medicare Telehealth Frequently Asked Questions (PDF) (now included in all-inclusive FAQs) 
    • Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction
    • Frequently Asked Questions (FAQs), CLIA Guidance During the COVID-19 Emergency

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  • CDC COVID-19 Vaccination Toolkit for SNFs/NFs (1/21)

    By CDC - January 05, 2021

    Long-Term Care Facility Toolkit: Preparing for COVID-19 Vaccination at Your Facility

    Answering Common Questions About COVID-19 Vaccines

    This toolkit provides long-term care facility (LTCF) administrators and clinical leadership with information and resources to help build vaccine confidence among healthcare personnel (HCP) and residents. You play a critical role in providing trusted information and ensuring high COVID-19 vaccination coverage in your facility.

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  • LTCSP Survey Resources: Surveyor Tools Updated (1/21)

    By CMS - January 05, 2021

    This ZIP file contains resources for surveyors conducting initial surveys under the Long-term Care Survey Process (LTCSP).

     

     

    01/04/2021 Survey Resource folder update: 

    1. Added FAQ on Resumption of LSC, EP, and LTC Health Surveys

    2. Added F tag Waiver Guide

    3. Added K tag Waiver Guide

     

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  • CMS Proposes Healthcare-Associated Infection and Staff COVID-19 Vaccination Measures for SNF QRP

    By CMS - January 04, 2021

    CMS has issued its 2020 measures under consideration (MUC) list. It includes two proposed SNF QRP QMs. The list includes more detailed info about proposed numerators, denominators, and rationales for each measure:

     MUC20- 0002: Skilled Nursing Facility Healthcare Associated Infections Requiring Hospitalization (outcome measure)

    This measure will estimate the risk-adjusted rate of healthcare-associated infections (HAIs) that are acquired during skilled nursing facility (SNF) care and result in hospitalizations. The measure is risk adjusted to “level the playing field” and to allow comparison of measure performance based on residents with similar characteristics between SNFs. It is important to recognize that HAIs in SNFs are not considered “never-events.” The goal of this risk-adjusted measure is to identify SNFs that have notably higher rates of HAIs that are acquired during SNF care and result in hospitalization, when compared to their peers

     

    More information:

    Draft Measure Specifications: Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalizations For The Skilled Nursing Facility Quality Reporting Program


    MUC20- 0044: SARS-CoV-2 Vaccination Coverage among Healthcare Personnel (process measure)

    This measure tracks SARS-CoV-2 vaccination coverage among healthcare personnel (HCP) in IPPS hospitals, inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), inpatient psychiatric facilities, ESRD facilities, ambulatory surgical centers, hospital outpatient departments, skilled nursing facilities, and PPS-exempt cancer hospitals.

    CMS press release:

    New Measures Under Consideration Mark a Milestone for CMS’s Reimagined Quality Strategy to Increase Digital Innovation and Reduce Burden

    Measures advance better quality care

    The Centers for Medicare & Medicaid Services (CMS) today unveiled its 2020 list of quality and efficiency measures under consideration. Quality measures are tools the agency uses to collect data from providers on the effectiveness, safety, efficiency, and timeliness of care beneficiaries receive. Every year, CMS evaluates all measures in its programs, proposing to remove those that have become less relevant and proposing new measures that may be more meaningful based on review by external health care experts. This year, almost all of the measures proposed would be collected digitally, meaning information comes from claims and other electronic sources, and would not require doctors to retrieve data manually. As a signal for CMS’s broader direction as the agency puts patients over paperwork in the push for quality and innovation, the 2020 list of measures under consideration represents “a first” on several important fronts, particularly where digital innovation and reducing administrative burden are concerned.

    Releasing the list is the first step in the “pre-rulemaking process,” when measures under consideration go to the National Quality Forum’s Measure Applications Partnership (MAP). Funded by CMS, the MAP is an independent, voluntary collaborative of organizations representing a broad group of stakeholders interested in or affected by the use of quality and efficiency measures and convened per statute to provide input on their selection. In a broader “CMS first,” a majority of measures under consideration in 2020 also rely on digital reporting of existing information, which can help providers spend more time with patients and less time collecting data. Coupled with a limited number of non-digital measures emphasizing patient-reported health outcomes, another priority for CMS, this digital innovation continues the reimagined quality strategy announced by CMS Administrator Seema Verma in 2017 as part of the Meaningful Measures initiative.

    “We launched Meaningful Measures because too many providers were wasting precious time and resources reporting on quality metrics, many of which were barely relevant to their specialty,” said CMS Administrator Verma. “Over the last four years, this initiative has delivered better, less onerous metrics that are actually useful to those who use them. The measures we are announcing today represent more of the same. They prioritize health outcomes, reduce burden, and give providers more time to do the work they entered medicine to do: treat patients.”

    Quality measures form the backbone of CMS’s ongoing effort to promote health for millions of Americans. The previously adopted measure for controlling high blood pressure, for example, helps CMS evaluate the quality of care by collecting data on the percentage of beneficiaries 18-85 years old whose high blood pressure has been adequately controlled during the measurement period, meaning their blood pressure readings were less than 140/90 mmHg. Additionally, reporting on these measures holds clinicians accountable for ensuring the best possible outcomes for beneficiaries.

    However, many quality measures have required intensive manual data collection and individual chart reviews, robbing doctors and other health professionals of valuable time spent caring for Americans. Over the last several years, CMS has been working to reduce provider burden by shifting toward measures that can be collected digitally using existing data. That strategy has the next iteration of the Meaningful Measures framework – or Meaningful Measures 2.0, the comprehensive initiative launched in 2017 to identify high-priority areas for quality measurement and improvement – at its heart.

    Though including a measure on the consideration list does not guarantee its adoption, the list represents a key first step and one built on collaboration between CMS and providers. Annually, the agency invites health care specialty societies and other stakeholder groups to submit candidate measures, due this year by June 30, narrowed down to identify promising candidates that warrant expert review as “measures under consideration.” The 2020 list – which includes a number of new measures, as well as several updates to modernize or replace existing measures – features:

    ·  Five outcome measures (measures that focus on the results of health care provided through Medicare), such as the rate of health care-associated infections requiring hospitalization for residents of skilled nursing facilities;

    ·  Five process measures (measures that emphasize efforts to promote standardized best practices), such as conducting kidney health evaluations or implementing interventions for patients with pre-diabetes (the medical term for blood glucose levels that are high but not yet high enough for a type-2 diabetes diagnosis). Importantly, the 2020 list includes three process measures for the coronavirus disease 2019 (COVID-19) vaccine. The measures under consideration list proposes looking at:

    ·  Vaccination coverage among health care personnel,

    ·  Vaccination by clinicians, and

    ·  Vaccination coverage for patients in End-Stage Renal Disease (ESRD) facilities;

    ·  Five cost/resource use measures (measures that evaluate how frequently health care items or services may be used, as well as how much they might cost) – including, for example, episode-based costs associated with addressing diabetes or asthma/chronic obstructive pulmonary disease;

    ·  Three composite measures (which summarize overall quality of care across multiple measures through the use of one value or piece of information); and

    ·  Two patient reported outcomes measures (measures where the information comes directly from the patient).

    All but three measures under consideration rely on digital rather than traditional “pen-and-paper” data collection. Of the non-digital measures, two are measures aimed at assessing COVID-19 vaccinations among health care personnel and patients in ESRD facilities, and the other reflects key patient-reported health outcomes, which help prioritize patient voices and empower patients to take an active role in their health.

    CMS expects to receive the MAP’s input on the 2020 measures under consideration by February 1, 2021. Experts at CMS and the Department of Health and Human Services will work collaboratively based on this assessment to select final measures available for further public comment through a notice of proposed rulemaking in the Federal Register.

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  • COVID-19 Vaccinations: Importance for Residents and Staff (12/20)

    By CDC - December 29, 2020
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