Risk Management

In a SNF, there are a lot of moving pieces, a lot to manage, and a lot can go wrong. Mitigating the risk of adverse events is a daily task. From care systems review and root cause analysis to anticipatory management, the resources below are designed to help you do just that. Protect your staff and residents now before you have to pick up the pieces after the fact. 

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

    By WHO - September 17, 2020

    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)

    By CMS - September 16, 2020
    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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  • COVID-19 Testing and Reporting Requirements: Summary Slide Deck (9/20)

    By CMS - September 10, 2020

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

    By CMS - September 08, 2020

    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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  • COVID-19 CMS SNF/NF Calls for September 2020

    By CMS - August 31, 2020

    CMS COVID-19 Care SNF/NF Calls for September

    CMS hosts weekly calls for certain types of organizations to provide targeted updates on the agency’s latest COVID-19 guidance. One to two leaders in the field also share best practices with their peers. There is an opportunity to ask questions of presenters if time allows.

     

    Nursing Homes (twice a month on Wednesday at 4:30 PM Eastern)

    Wednesday, September 9th at 4:30 – 5:00 PM Eastern

    Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 5475686 Audio Webcast Link: https://protect2.fireeye.com/url?k=48d90a59-148d1325-48d93b66-0cc47adc5fa2-b3c6f167a0366d03&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2504

     

    Wednesday, September 23rd at 4:30 – 5:00 PM Eastern

    Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 5839938 Audio Webcast Link: https://protect2.fireeye.com/url?k=17d68a30-4b82a31b-17d6bb0f-0cc47a6d17cc-4dbada66ff7c346b&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2509

     

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  • COVID-19 Testing in Nursing Homes: Interim Final Rule Effective 9/02/20, Two QSO Memos With Related Survey Changes, & Algorithm for Interpreting Test Results (8/20)

    By CMS - August 30, 2020

    Medicare and Medicaid Programs, Clinical Laboratory Improvement Amendments (CLIA), and Patient Protection and Affordable Care Act; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

    ACTION: Interim final rule with comment period.

    SUMMARY: This interim final rule with comment period (IFC) revises regulations to strengthen CMS’ ability to enforce compliance with Medicare and Medicaid long-term care (LTC) facility requirements for reporting information related to coronavirus disease 2019 (COVID-19), establishes a new requirement for LTC facilities for COVID-19 testing of facility residents and staff, establishes new requirements in the hospital and critical access hospital (CAH) Conditions of Participation (CoPs) for tracking the incidence and impact of COVID-19 to assist public health officials in detecting outbreaks and saving lives, and establishes requirements for all CLIA laboratories to report COVID-19 test results to the Secretary of Health and Human Services (Secretary)in such form and manner, and at such timing and frequency, as the Secretary may prescribe during the Public Health Emergency (PHE).

    DATES: Effective date: These regulations are effective on 09/02/20.


    QSO-20-38-NH

    Memorandum Summary

    • CMS is committed to taking critical steps to ensure America’s healthcare facilities continue to respond effectively to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).

    • On August 25, 2020, CMS published an interim final rule with comment period (IFC). This rule establishes Long-Term Care (LTC) Facility Testing Requirements for Staff and Residents. Specifically, facilities are required to test residents and staff, including individuals providing services under arrangement and volunteers, for COVID-19 based on parameters set forth by the HHS Secretary. This memorandum provides guidance for facilities to meet the new requirements.

    • Revised COVID-19 Focused Survey Tool - To assess compliance with the new testing requirements, CMS has revised the survey tool for surveyors. We are also adding to the survey process the assessment of compliance with the requirements for facilities to designate one or more individual(s) as the infection preventionist(s) (IPs) who are responsible for the facility's infection prevention and control program (IPCP) at 42 CFR § 483.80(b). In addition, we are making a number of revisions to the survey tool to reflect other COVID-19 guidance updates.

     

    QSO-20-37-CLIA,NH

    Memorandum Summary

    • CMS is committed to taking critical steps to ensure America’s healthcare facilities are prepared to respond to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).

    • On August 25, 2020, an interim final rule with comment period (IFC) went on display at the Federal Register.

    • CLIA regulations have been updated to require all laboratories to report SARS-CoV-2 test results in a standardized format and at a frequency specified by the Secretary.

    • Failure to report SARS-CoV-2 test results will result in a condition level violation of the CLIA regulation and may result the imposition of a Civil Money Penalty (CMP) as required under §§ 493.1804 and 493.1834.

    • Long-Term Care (LTC) Enforcement requirements at 42 CFR part 488 have been revised to include requirements specific to the imposition of a CMP for nursing homes that fail to report requisite COVID-19 related data to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) per §483.80(g)(1) and (2).

    • LTC Facility Testing Requirements for Staff and Residents- Facilities are required to test staff and to offer testing to all nursing home residents.

     

    Considerations for Interpreting Antigen Test Results in Nursing Homes Algorithm pdf icon[PDF – 200 KB]  – August 26, 2020

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  • Voluntary CMS/CDC COVID-19 Infection Control Trainings for Frontline Staff and Management Certificate Program (8/20)

    By CMS - August 29, 2020
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  • CMS Breaks Down Distribution of $2.5 Billion in Planned COVID-19 Relief Funds (8/20)

    By CMS - August 28, 2020

    8/27/20

    The Trump Administration, through the U.S. Department of Health and Human Services (HHS), is announcing it has now distributed almost $2.5 billion of a planned $5 billion distribution to nursing homes to support increased testing, staffing, and personal protective equipment (PPE) needs. This funding allocation was made through the Health Resources and Services Administration (HRSA) as a targeted distribution from the $175 billion Provider Relief program funded through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act.

    This distribution of almost $2.5 billion in additional funding to over 15,000 nursing homes nationwide supplements the $4.9 billion that was previously distributed to skilled nursing facilities. HHS plans on distributing another $2 billion to nursing homes later this fall based on certain performance indicators that will be shared in the future.

    A state-by-state breakdown on the $2.5 billion that was distributed can be found here - PDF.

    Training and Mentoring for Nursing Homes

    To further support nursing homes, the Agency for Healthcare Research and Quality (AHRQ) will be partnering with America’s nursing homes to create the National Nursing Home COVID Action Network. Through the Network, AHRQ will offer training, and mentorship to the approximately 15,400 nursing homes across the country to supplement efforts aimed at protecting residents and staff. 

    The goals of the training and mentorship are to help nursing home professionals prevent COVID-19 from entering nursing homes via staff, visitors, and patients and prevent greater spread among patients, staff, and visitors if the virus is already present. This program will also guide nursing homes through best-practice care and treatment for patients who test positive for COVID-19; and protect staff from infection through evidence-based safety measures that will build their confidence in their ability to work and feel safe in the nursing homes.

    “AHRQ is proud to support HHS in this critical initiative,” said AHRQ Director Gopal Khanna. “AHRQ has a proven track-record in helping move evidence into practice to address critical needs like responding to COVID-19 and to achieve 21st century care for all Americans.”

    This program will provide interactive small-group, problem-based training and customized mentorship through an existing network of academic medical centers, health centers, and community organizations.  The training and mentorship program is designed to evolve as the needs of nursing homes continue to emerge though the fall.  AHRQ has already established a pilot test of small-group training and mentoring through a partnership with the University of New Mexico’s ECHO Institute. 

    Participation in training and mentoring will be voluntary and nursing homes that participate will receive compensation to cover the costs of staff training time.  Nursing homes will be able to begin signing up to participate in the Network in the coming weeks and training is expected to begin in September.

    Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) Additional Nursing Home Training Efforts

    Since April 2020, the CMS Quality Improvement Organizations (QIOs) have provided focused, one-on-one individualized technical assistance to over 1,400 nursing homes with identified needs based on inspection findings and data reported to the Centers for Disease Control and Prevention (CDC). This week, CMS also announced a voluntary online national training program developed in coordination with the Centers for Disease Control and Prevention (CDC), for Medicare and Medicaid certified nursing homes with modules focused on basic infection control practices, cohorting strategies, vaccine distribution, and a variety of other topics.

    “Under the decisive leadership of President Trump, the administration is pulling every lever at its disposal to keep nursing home residents safe,” said CMS Administrator Seema Verma. “Just this week, CMS deployed an unprecedented national training program for nursing home staff and management to deliver all the practical knowledge that nursing homes need to keep the virus out, and stop its spread.”

    Additionally, CMS and CDC have issued a number of guidance documents based on the latest science regarding the virus’ spread and strategies to combat it, all designed to help nursing homes keep their residents safe in the face of the pandemic. Given the plethora of resources being made available, this administration will continue to hold nursing homes accountable for failing to employ all precautions that safeguard older Americans from contracting COVID-19.

    For updates and to learn more about the Provider Relief Program, visit: hhs.gov/providerrelief

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  • AHRQ National Nursing Home COVID Action Network Mentorship Program Begins With Webinar Series (8/20)

    By AHRQ - August 28, 2020

    Training and Mentoring for Nursing Homes

    To further support nursing homes, the Agency for Healthcare Research and Quality (AHRQ) will be partnering with America’s nursing homes to create the National Nursing Home COVID Action Network. Through the Network, AHRQ will offer training, and mentorship to the approximately 15,400 nursing homes across the country to supplement efforts aimed at protecting residents and staff. 

    The goals of the training and mentorship are to help nursing home professionals prevent COVID-19 from entering nursing homes via staff, visitors, and patients and prevent greater spread among patients, staff, and visitors if the virus is already present. This program will also guide nursing homes through best-practice care and treatment for patients who test positive for COVID-19; and protect staff from infection through evidence-based safety measures that will build their confidence in their ability to work and feel safe in the nursing homes.

    “AHRQ is proud to support HHS in this critical initiative,” said AHRQ Director Gopal Khanna. “AHRQ has a proven track-record in helping move evidence into practice to address critical needs like responding to COVID-19 and to achieve 21st century care for all Americans.”

    This program will provide interactive small-group, problem-based training and customized mentorship through an existing network of academic medical centers, health centers, and community organizations.  The training and mentorship program is designed to evolve as the needs of nursing homes continue to emerge though the fall.  AHRQ has already established a pilot test of small-group training and mentoring through a partnership with the University of New Mexico’s ECHO Institute. 

    Participation in training and mentoring will be voluntary and nursing homes that participate will receive compensation to cover the costs of staff training time.  Nursing homes will be able to begin signing up to participate in the Network in the coming weeks and training is expected to begin in September.

    In related news, registration is now open for a free webinar series featuring expert-led discussions on infection prevention strategies, telehealth, and COVID-19 testing in nursing homes. The series “Nursing Home Best Practices During the COVID-19 Pandemic” is part of the launch of AHRQ’s National Nursing Home COVID-19 Action Network.

    National Nursing Home COVID-19 Safety Conversations TeleECHO Program

    In partnership with the Agency for Healthcare Research and Quality (AHRQ), Project ECHO is mobilizing our national network of ECHO partners to rapidly deploy COVID-19 ECHO programs to train mentor, and support nursing home staff on infection prevention and control. With support from the Agency for Healthcare Research and Quality (AHRQ), the ECHO Institute will provide training, mentorship, and support to nursing home staff on infection prevention and control to an estimated 15,000 nursing homes across the country.


    This initiative will kick off with our Nursing Home Best Practices During the COVID-19 Pandemic mini-series, with three interactive TeleECHO sessions:

    Aug 25, 2020:
    Optimizing Clinical Care in the Time of COVID in Skilled Nursing Home Facilities
    Terry Fulmer, PhD, RN
    Kathleen Unroe, MD, MHA

    NOTE: If you missed this training, it is available here.

    Aug, 26, 2020:
    The Latest News on Testing, Cohorting, and Critical Infection Prevention Strategies
    Nimale Stone, MD
    Additional speaker, TBA

    NOTE: If you missed this training, it is available here.


    Sept 2, 2020:
    Telehealth in the Time of COVID
    Cheryl Phillips, MD, AGSF

    NOTE: If you missed this training, it is available here.

    Recent Study on Infection at Skilled Nursing Facilities
    Lewis Lipsitz, MD

     


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  • CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management (8/20)

    By CMS/CDC - August 18, 2020

    Starting on August 20, using a pre-recorded, self-paced format, the new CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management training series will include 13 topics that nursing homes must know to manage the COVID-19 pandemic. These trainings will be housed on QIOProgram.org for 24/7 access.

    New, pre-recorded trainings will be released every Thursday at 4:00 p.m. EST through September 2020. CMS and CDC will have subject matter experts available on bi-weekly Q&A sessions through early January 2021 to answer questions you may have about the trainings.

    Critical Topics

    Establishing an Infection Prevention Program in a Nursing Home, with an emphasis on COVID-19
    Is your Nursing Home ready to handle the demands of the COVID-19 Pandemic? Assessing Readiness: Advice from the CDC 
    COVID-19 surveillance to enable early detection and response to outbreaks. Includes NHSN mandatory data collection
    COVID-19 Testing - coming soon
    Cohorting Strategies
    Cleaning Environmental Surfaces and Shared Equipment 
    Establishing a Dedicated COVID-19 Care Center - coming soon
    Hand Hygiene and Personal Protective Equipment (PPE) Strategies for COVID-19 Care: Supply, Use, Re-use, Removal, and Disposal
    Accepting new patients during an active pandemic: considerations of both transfers from hospitals, and admissions from the community - coming soon
    Telehealth in Nursing Homes
    Transparency: Resident and Family Notification. Department of Health and other Notifications
    Clinical Care/‚ÄčManaging COVID positive residents in the Nursing Home
    Managing Staffing Challenges, Including Employee Health Considerations

    Looking for which trainings you need? Take the Training Fundamentals Self-Assessment.

    What isn’t Changing: Access to certificates of participation are still available for those who complete Fundamentals trainings and those who have participated in the live training series. 

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  • FAQs About COVID-19 Testing in SNFs/NFs (8/20)

    By CMS - August 10, 2020

    Frequently Asked Questions: COVID-19 Testing at Skilled Nursing Facilities/ Nursing Homes includes 27 FAQs:

    1. Who will receive the testing platforms and U.S. Food and Drug Administration (FDA)- authorized antigen diagnostic tests?

    2. How is distribution of the testing platforms and FDA-authorized antigen diagnostic tests being determined? Will these devices be sent directly to the nursing homes or to states for distribution? 

    3. When will the testing platforms and authorized point-of-care tests be distributed?

    4. How many COVID-19 test kits will nursing homes receive?

    5. Who will provide training to nursing home staff? In what format will the training be provided in?

    6. How were nursing homes prioritized to receive a testing platform and FDA-authorized antigen diagnostic tests?

    7. Will HHS be providing more tests after the initial shipment?

    8. What safety precautions are required when performing these tests?

    9. Will every nursing home receive a point-of-care instrument and associated tests? 

    10. Which nursing homes will receive instruments and tests in the first wave of shipments?

    11. When will my nursing home receive the shipment of testing platforms and FDAauthorized antigen diagnostic tests?

    12. How will states be made aware that nursing homes within their states will receive instruments and supplies?

    13. What are antigen tests? Is it required to retest negative results with a PCR test?

    14. How many tests can be conducted with the Quidel Sofia 2 Instrument and the BD Veritor™ Plus System testing platforms?

    15. Why is the federal government sending antigen testing supplies to nursing homes if they cannot be used to rule out SARS-CoV-2 infection and should not be used as the sole basis for treatment?

    16. Are nursing homes required to report results of any COVID-19 tests?

    17. Can nursing homes keep the testing platforms? 

    18. How should facilities handle indeterminate results?

    19. Do facilities need a provider order to conduct the test?

    20. How should the materials be stored when they arrive?

    21. Does a Skilled Nursing Facility/ Nursing Facilities need a CLIA (Clinical Laboratory Improvement Amendments of 1988) Certificate of Waiver in order to perform testing of specimens for COVID-19?

    22. I understand that HHS will be distributing tests and test systems to Skilled Nursing Facilities/ Nursing Facilities. What type of CLIA certificate would my facility need in order to perform this testing?

    23. How do I apply for a CLIA Certificate of Waiver so that my Skilled Nursing Facility/ Nursing Facility can perform COVID-19 testing?

    24. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, can we begin performing COVID-19 testing?

    25. If my Skilled Nursing Facility/ Nursing Facility already holds a CLIA Certificate of Waiver, am I required to update my test menu with CMS?

    26. How does my Skilled Nursing Facility/ Nursing Facility obtain the instrument, test kits and disposables?

    27. My Skilled Nursing Facility/ Nursing Facility is located in a CLIA Exempt State (Washington or New York). Will we be able to get one of the new test systems? 

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  • COVID-19 Testing Guidelines for Nursing Homes (7/20)

    By CDC - July 17, 2020

    Testing Guidelines for Nursing Homes FRIDAY, JULY 17, 2020

    Revisions were made on July 17, 2020, to reflect the following:

    • Updated “Testing to determine resolution of infection” to add information about people who are severely immunocompromised.

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  • CDC Strategies for Optimizing the Supply of PPE and Other Equipment (7/20)

    By CDC - July 15, 2020

    The Centers for Disease Control and Prevention (CDC) offers strategies for optimizing the supply of:

    N95 respirators

    Face masks

    Isolation gowns

    Eye Protection

    Gloves

    Powered Air-Purifying Respirators (PAPRs)

    Elastomeric respirators

    Ventilators

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  • SNF QRP Comorbidity HCC Groups ICD-10 Codes Updated (7/20)

    By CMS - July 06, 2020

    These charts provide an update to the Comorbidity HCC groups used for the SNF QRP as covariates for the Change in Self-Care score, Change in Mobility score, Discharge Self-Care sore, and Discharge Mobility score.

    They appear to be an update/crosswalk to the ICD-10 codes listed in table A-5 of the SNF QRP Measure Calculations and Reporting User’s Manual.

    It's worth noting that, in the user guide, there are only 24 HCC Groups, but this updated crosswalk lists 190 groups.

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  • COVID-19 Testing: CDC Says Repeated Point Prevalence Surveys Can ID Asymptomatic Cases in SNFs (7/20)

    By CDC - July 01, 2020

    Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities — Detroit, Michigan, March–May 2020

    Early Release / July 1, 2020 / 69

    Guillermo V. Sanchez, MSHS, MPH1; Caitlin Biedron, MD1; Lauren R. Fink, MPH2; Kelly M. Hatfield, MSPH1; Jordan Micah F. Polistico, MD3,4; Monica P. Meyer, MS, MPH3,4; Rebecca S. Noe, MN, MPH1; Casey E. Copen, PhD1; Amanda K. Lyons, MS1; Gonzalo Gonzalez, DNP2; Keith Kiama2; Mark Lebednick2; Bonnie K. Czander2; Amen Agbonze2; Aimee R. Surma, MS2; Avnish Sandhu, DO3,4; Valerie H. Mika, MS4; Tyler Prentiss, MA5; John Zervos, JD5; Donia A. Dalal2; Amber M. Vasquez, MD1; Sujan C. Reddy, MD1; John Jernigan, MD1; Paul E. Kilgore, MD4; Marcus J. Zervos, MD4,5; Teena Chopra, MD3,4; Carla P. Bezold, ScD2; Najibah K. Rehman, MD2 (View author affiliations)

    View suggested citation

    Summary

    What is already known about this topic?

    Symptom-based screening in skilled nursing facilities (SNFs) is inadequate to detect SARS-CoV-2 transmission. Repeated point prevalence surveys (serial testing of all residents and health care personnel at a health care facility irrespective of symptoms) can identify asymptomatic cases during outbreaks.

    What is added by this report?

    Repeated point prevalence surveys at 26 Detroit SNFs identified an attack rate of 44%; within 21 days of diagnosis, 37% of infected patients were hospitalized and 24% died. Among 12 facilities participating in a second survey and receiving on-site infection prevention and control (IPC) support, the percentage of newly identified cases decreased from 35% to 18%.

    What are the implications for public health practice?

    Repeated point prevalence surveys in SNFs can identify asymptomatic COVID-19 cases, inform cohorting and IPC practices, and guide prioritization of health department resources.

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