• World Health Organization Healthcare Worker Safety Charter (9/20)

    Thursday, September 17, 2020 | WHO

    Keep health workers safe to keep patients safe: WHO

    17 September 2020 | GENEVA – The World Health Organization (WHO) is calling on governments and health care leaders to address persistent threats to the health and safety of health workers and patients.

    “The COVID-19 pandemic has reminded all of us of the vital role health workers play to relieve suffering and safe lives,“ said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “No country, hospital or clinic can keep its patients safe unless it keeps its health workers safe. WHO’s Health Worker Safety Charter is a step towards ensuring that health workers have the safe working the conditions, the training, the pay and the respect they deserve.“

    The pandemic has also highlighted the extent to which protecting health workers is key to ensuring a functioning health system and a functioning society.

    The Charter, released today for World Patient Safety Day, calls on governments and those running health services at local levels to take five actions to better protect health workers. These include steps to protect health workers from violence; to improve their mental health; to protect them from physical and biological hazards; to advance national programmes for health worker safety; and to connect health worker safety policies to existing patient safety policies.

    Mounting reports of infections, illness and attacks among health workers fighting COVID-19

    COVID-19 has exposed health workers and their families to unprecedented levels of risk. Although not representative, data from many countries across WHO regions indicate that COVID-19 infections among health workers are far greater than those in the general population.

    While health workers represent less than 3% of the population in the large majority of countries and less than 2% in almost all low- and middle-income countries, around 14% of COVID-19 cases reported to WHO are among health workers. In some countries, the proportion can be as high as 35%.  However, data availability and quality are limited, and it is not possible to establish whether health workers were infected in the work place or in community settings. Thousands of health workers infected with COVID-19 have lost their lives worldwide.

    In addition to physical risks, the pandemic has placed extraordinary levels of psychological stress on health workers exposed to high-demand settings for long hours, living in constant fear of disease exposure while separated from family and facing social stigmatization. Before COVID-19 hit, medical professionals were already at higher risk of suicide in all parts of the world. A recent review of health care professionals found one in four reported depression and anxiety, and one in three suffered insomnia during COVID-19[1].  WHO recently highlighted an alarming rise in reports of verbal harassment, discrimination and physical violence among health workers in the wake of COVID-19.

    5 steps to improve health worker safety and patient safety

    On World Patient Safety Day, WHO reminds governments that they have a legal and moral responsibility to ensure the health, safety and wellbeing of health workers. The Organization’s health worker charter calls on all Member States and relevant stakeholders to take steps to:

    1. Establish synergies between health worker safety and patient safety policies and strategies

    ·         Develop linkages between occupational health and safety, patient safety, quality improvement, and infection prevention and control programmes.

    ·         Include health and safety skills in personal and patient safety into education and training programmes for health workers at all levels.

    ·         Incorporate requirements for health worker and patient safety in health care licensing and accreditation standards.

    ·         Integrate staff safety and patient safety incident reporting and learning systems.

    ·         Develop integrated metrics of patient safety, health worker safety and quality of care indicators, and integrate with health information system.  

    2. Develop and implement national programmes for occupational health and safety of health workers

    ·         Develop and implement national programmes for occupational health for health workers in line with national occupational health and safety policies.

    ·         Review and upgrade, where necessary, national regulations and laws for occupational health and safety to ensure that all health workers have regulatory protection of their health and safety at work.

    ·         Appoint responsible officers with authority for occupational health and safety for health workers at both the national and facility levels.

    ·         Develop standards, guidelines, and codes of practice on occupational health and safety.

    ·         Strengthen intersectoral collaboration on health worker and patient safety, with appropriate worker and management representation, including gender, diversity and all occupational groups.

    3. Protect health workers from violence in the workplace

    ·         Adopt and implement in accordance with national law, relevant policies and mechanisms to prevent and eliminate violence in the health sector.

    ·         Promote a culture of zero tolerance to violence against health workers

    ·         Review labour laws and other legislation, and where appropriate the introduction of specific legislation, to prevent violence against health workers.

    ·         Ensure that policies and regulations are implemented effectively to prevent violence and protect health workers.

    ·         Establish relevant implementation mechanisms, such ombudspersons and helplines to enable free and confidential reporting and support for any health worker facing violence.

    4. Improve mental health and psychological well-being

    ·         Establish policies to ensure appropriate and fair duration of deployments, working hours, rest break and minimizing the administrative burden on health workers.

    ·         Define and maintain appropriate safe staffing levels within health care facilities.

    ·         Provide indemnity and insurance coverage for work-related risk, especially those working in high-risk areas.

    ·         Establish a ‘blame-free’ and just working culture through open communication, including legal and administrative protection from punitive action on reporting adverse safety events.

    ·         Provide access to mental well-being and social support services for health workers, including advice on work-life balance and risk assessment and mitigation.

    5. Protect health workers from physical and biological hazards

    ·         Ensure the implementation of minimum patient safety, infection prevention and control, and occupational safety standards in all health care facilities across the health system.

    ·         Ensure availability of personal protective equipment (PPE) at all times, as relevant to the roles and tasks performed, in adequate quantity and appropriate fit and of acceptable quality. Ensure an adequate, locally held, buffer stock of PPE. Ensure adequate training on the appropriate use of PPE and safety precautions.

    ·         Ensure adequate environmental services such as water, sanitation and hygiene, disinfection and adequate ventilation at all health care facilities.

    ·         Ensure vaccination of all health workers at risk against all vaccine-preventable infections, including Hepatitis B and seasonal influenza, in accordance with the national immunization policy, and in the context of emergency response, priority access for health workers to newly licenced and available vaccines.

    ·         Provide adequate resources to prevent health workers from injuries, and harmful exposure to chemicals and radiations; provide functioning and ergonomically designed equipment and work stations to minimize musculoskeletal injuries and falls.

    In addition to the Health Worker Safety Charter, WHO has also outlined specific World Patient Safety Day 2020 Goals for health care leaders to invest in, measure, and improve health worker safety over the next year. The goals are intended for health care facilities to address five areas:  preventing sharps injuries; reducing work-related stress and burnout; improving the use of personal protective equipment; promoting zero tolerance to violence against health workers; and analyzing serious safety related incidents. 

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  • Independent Nursing Home COVID-19 Commission Findings (9/20)

    Wednesday, September 16, 2020 | CMS
    The Centers for Medicare & Medicaid Services (CMS) received the final report from the independent Coronavirus Commission for Safety and Quality in Nursing Homes (Commission), which was facilitated by MITRE.  CMS also released an overview of the robust public health actions the agency has taken to date to combat the spread of the coronavirus disease 2019 (COVID-19) in nursing homes. The Commission’s findings align with the actions the Trump Administration and CMS have taken to contain the spread of the virus and to safeguard nursing home residents from the ongoing threat of the COVID-19 pandemic. Today’s announcement delivers on the Administration’s commitments to keeping nursing home residents safe and to transparency for the American people in the face of this unprecedented pandemic.

    Nursing homes and other shared or congregate living facilities have been severely affected by COVID-19, as these facilities often house older individuals who suffer from multiple medical conditions, making them particularly susceptible to complications from the virus. To help CMS inform immediate and future actions as well as identify opportunities for improvement, the Commission was created to conduct an independent review and comprehensive assessments of confronting COVID-19. The Commission’s report contains best practices that emphasize and reinforce CMS strategies and initiatives to ensure nursing home residents are protected from COVID-19.

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  • SNF Healthcare-Associated Infections (HAI) Measure: Public Comments Due by Oct. 14

    Monday, September 14, 2020 | CMS

    The Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) is seeking input from the public as part of the measure development process. CMS has posted Draft Measure Specifications: SNF Healthcare-Associated Infections Requiring Hospitalizations for the SNF QRP (SNF HAI measure).  This document contains conceptual and technical measure information and provides a link to the Final Technical Expert Panel Summary Report: Development of a Healthcare-Associated Infections Quality Measure for the SNF QRP for the public’s review.  Please review both of these documents and give us your feedback via the email:  SNFQualityQuestions@cms.hhs.gov.  

    CMS would also like to announce the SNF HAI measure will be a part of the Measures Under Consideration list later this year and it is our intention to present this measure for pre-rulemaking review at the Measure Applications Partnership Post-Acute Care/Long-Term Care Workgroup meeting in December.  CMS will be providing Confidential Dry Run Reports to alert each SNF of their SNF HAI performance score based on these draft measure specifications later this summer.

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  • COVID-19 Testing and Reporting Requirements: Summary Slide Deck (9/20)

    Thursday, September 10, 2020 | CMS

    CMS slide deck summarizing resident and staff testing  and reporting requirements, considerations for using and interpreting antigen tests, and educational resources and training available to nursing homes.

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  • SNF QRP Measure Calculations and Reporting User's Manual Plus Version 3.0.1 Addendum (9/20)

    Thursday, September 10, 2020 | CMS

     

    The SNF QRP Measure Calculations and Reporting User’s Manual Version 3.0.1 addendum and associated risk adjustment appendix and Hierarchical Condition Category (HCC) crosswalks are now available.

    This ZIP file includes:

    1. Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0.1 addendum provides measure-related changes specified in a change table format in lieu of a complete update to the overall manual. Use this addendum to update the v3.0 manual.
    2. Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0 Risk Adjustment Appendix File contains current and historical intercept values, coefficient values, and the risk-adjustment schedule for each risk-adjusted quality measure reported under the SNF QRP. 
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  • Resource: Discharge Planning During the COVID-19 Pandemic (9/20)

    Wednesday, September 9, 2020 | HHS

    HHS' Assistant Secretary for Preparedness and Response recently published Discharge Planning and Care Coordination during the COVID-19 Pandemic, a resource developed in partnership with ACL and the Centers for Medicare & Medicaid Services.

     

    This tool is designed to support nurses, social workers, case managers, and others conducting discharge planning for adults with disabilities after COVID-19 treatment.

    The resource:

    • Describes legal protections for people with disabilities including the Olmstead decision;
    • Explains the CMIST (Communication, Maintaining Health, Independence, Services and Support, Transportation) framework and person-centered planning;
    • Provides considerations for three potential discharge scenarios to facilitate person-centered discharge planning and care coordination to the most integrated setting; and
    • Highlights state and federal resources, including the aging and disability networks, to assist care coordinators and discharge planners.
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  • 10 Tips for Cultivating Resiliency in Facility Staff

    Tuesday, September 8, 2020 | Denise Winzeler, BSN, RN, LNHA, DNS-CT, QCP

    So far, 2020 has been a very trying year, to say the least. COVID-19 caught long-term care teams unaware and has not only affected staff physically, but emotionally as well. Illness and loss of life among both residents and employees, combined with lack of supplies, testing, staffing, and the fear of bringing the virus home to family has been very stressful and is affecting everyone. As part of the management team, the director of nursing services (DNS) needs to be able to measure their facility staff’s emotional health and aid them to adapt or “bounce back” from adversity. In other words, the DNS needs to cultivate resilience. This article will assist the DNS and other nurse leaders to have a better understanding of what resilience looks like and will provide tips on how to encourage staff to build resilience and find strength in this difficult time.

     

    What happens when the leadership team doesn’t build resilience?

    When staff lack resilience and that lack goes undetected, not only is it detrimental to the individual, but it also affects the facility in general. Staff who feel unappreciated or unsupported are more apt to experience burnout and become unable to function effectively, which compromises resident safety and care. These symptoms may also evolve into post-traumatic stress disorder or other chronic illness for the person later (Wu et al., 2020). If staff feel out of control or insufficiently trained, they are more likely to call off work, further straining a facility’s staffing issues. Individuals unable to bounce back may have an increase in mental health issues, such as anxiety, depression, and insomnia (Miller, 2020), which may affect their ability to work.

     

    What is resilience?

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  • USP <800>: What Is It, and Why Do DNSs Need to Know?

    Tuesday, September 8, 2020 | Caralyn Davis, Staff Writer

    Late last year, nursing homes gained additional time to deal with implementing United States Pharmacopeia (USP) general chapter <800>, “Hazardous Drugs—Handling in Healthcare Settings.” While COVID-19 has rightfully taken precedence through much of 2020, directors of nursing services (DNSs) still need to get up to speed on the USP <800> practice standards, which in the coming years could present a roadmap of liability for long-term care facilities if staff are adversely impacted by hazardous medications.

     

    The basics

    The independent, nonprofit scientific organization U.S. Pharmacopeia (also known as USP) writes compounding standards, says Dana Saffel, PharmD, CPh, BCGP, president/CEO of PharmaCare Strategies in Santa Rosa Beach, FL, and a member of the board of directors at the American Society of Consultant Pharmacists (ASCP). “As part of those compounding standards, the new USP <800> creates standards for managing hazardous drugs.”

     

    USP <800> was supposed to go into effect on Dec. 1, 2019, notes Saffel. “However, the only references to this new chapter come from revisions to existing chapters on sterile and nonsterile compounding. Those other two chapters were put back into revision at the end of last year due to the filing of appeals. Therefore, USP <800> will remain informational only and not be an official active chapter until the two preceding chapters that reference it become official. For now, you have a sanctioned bye that gives you more time until it is an official USP recommendation.”

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  • CMS COVID-19 Nursing Homes Best Practices Toolkit and New QIN-QIO Virtual Assistance UPDATED (9/20)

    Tuesday, September 8, 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 9/08/20) 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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  • Sept. 24 ASPR TRACIE Webinar: COVID-19: Optimizing Healthcare PPE & Supplies

    Tuesday, September 8, 2020 | HHS

    There has been a large increase in the need for healthcare personal protective equipment (PPE) and specialty supplies due to the COVID-19 pandemic. This increase in demand has led to shortages in PPE and changes in how PPE is used and optimized. ASPR TRACIE, in collaboration with the COVID-19 Healthcare Resilience Working Group, is hosting this webinar to highlight PPE preservation strategies, trends, challenges, and lessons learned/promising practices.

    Presenters from the public and private sectors will discuss strategies to optimize the healthcare supply of respirators and PPE, such as implementing crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. The webinar will take place from 2:30-4:00 PM (ET) on Thursday, September 24, 2020. 

    There has been a large increase in the need for healthcare personal protective equipment (PPE) and specialty supplies due to the COVID-19 pandemic. This increase in demand has led to shortages in PPE and changes in how PPE is used and optimized. ASPR TRACIE, in collaboration with the COVID-19 Healthcare Resilience Working Group, is hosting this webinar to highlight PPE preservation strategies, trends, challenges, and lessons learned/promising practices.

    Presenters from the public and private sectors will discuss strategies to optimize the healthcare supply of respirators and PPE, such as implementing crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. The webinar will take place from 2:30-4:00 PM (ET) on Thursday, September 24, 2020. 

    To register: https://register.gotowebinar.com/register/8859739761699442702

    There has been a large increase in the need for healthcare personal protective equipment (PPE) and specialty supplies due to the COVID-19 pandemic. This increase in demand has led to shortages in PPE and changes in how PPE is used and optimized. ASPR TRACIE, in collaboration with the COVID-19 Healthcare Resilience Working Group, is hosting this webinar to highlight PPE preservation strategies, trends, challenges, and lessons learned/promising practices.

    Presenters from the public and private sectors will discuss strategies to optimize the healthcare supply of respirators and PPE, such as implementing crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. The webinar will take place from 2:30-4:00 PM (ET) on Thursday, September 24, 2020. 

    To register: https://register.gotowebinar.com/register/8859739761699442702


    There has been a large increase in the need for healthcare personal protective equipment (PPE) and specialty supplies due to the COVID-19 pandemic. This increase in demand has led to shortages in PPE and changes in how PPE is used and optimized. ASPR TRACIE, in collaboration with the COVID-19 Healthcare Resilience Working Group, is hosting this webinar to highlight PPE preservation strategies, trends, challenges, and lessons learned/promising practices.

    Presenters from the public and private sectors will discuss strategies to optimize the healthcare supply of respirators and PPE, such as implementing crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. The webinar will take place from 2:30-4:00 PM (ET) on Thursday, September 24, 2020. 

    To register: https://register.gotowebinar.com/register/8859739761699442702


    There has been a large increase in the need for healthcare personal protective equipment (PPE) and specialty supplies due to the COVID-19 pandemic. This increase in demand has led to shortages in PPE and changes in how PPE is used and optimized. ASPR TRACIE, in collaboration with the COVID-19 Healthcare Resilience Working Group, is hosting this webinar to highlight PPE preservation strategies, trends, challenges, and lessons learned/promising practices.

    Presenters from the public and private sectors will discuss strategies to optimize the healthcare supply of respirators and PPE, such as implementing crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. The webinar will take place from 2:30-4:00 PM (ET) on Thursday, September 24, 2020. 

    To register: https://register.gotowebinar.com/register/8859739761699442702


    There has been a large increase in the need for healthcare personal protective equipment (PPE) and specialty supplies due to the COVID-19 pandemic. This increase in demand has led to shortages in PPE and changes in how PPE is used and optimized. ASPR TRACIE, in collaboration with the COVID-19 Healthcare Resilience Working Group, is hosting this webinar to highlight PPE preservation strategies, trends, challenges, and lessons learned/promising practices.

    Presenters from the public and private sectors will discuss strategies to optimize the healthcare supply of respirators and PPE, such as implementing crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. The webinar will take place from 2:30-4:00 PM (ET) on Thursday, September 24, 2020. 

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