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. 

  • April 8 CMS Call: COVID-19 in Nursing Homes

    By CMS - April 07, 2020

    Please join the Centers for Medicare and Medicaid Services (CMS) for a call on COVID-19 with Nursing Homes tomorrow, Wednesday, April 8th at 4:30 PM EST. CMS leadership will provide updates on the agency’s latest guidance and we will be joined by leaders in the field interested in sharing best practices with their peers. The call will be recorded if you are unable to join us.

    Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership.

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  • CDC PPE Burn Rate Calculator (4/20)

    By CDC - April 01, 2020

    This is a spreadsheet-based model that provides information for healthcare facilities to plan and optimize the use of PPE for response to coronavirus disease 2019 (COVID-19). Similarly, non-healthcare facilities (e.g., correctional facilities) may find this tool useful for planning and optimizing PPE use as part of the response to COVID-19. This tool can also be used for planning PPE use outside the context of COVID-19, where PPE shortages may also occur due to supply chain issues related to the COVID-19 response (e.g. manufacturing facilities).

    To use the calculator, you enter the number of full boxes of each type of PPE that you have in stock (e.g., gowns, gloves, surgical masks, respirators, and face shields). This tool then calculates the average consumption rate, also referred to as a “burn rate,” for each type of PPE entered in the spreadsheet. This information can then be used to estimate the remaining supply of PPE based on the average consumption rate. The spreadsheet is open-ended and can also be used to calculate the use of other types of PPE as well.

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  • COVID-19: Sample Universal Mask Policy and FAQs (3/20)

    By Nebraska Medicine - April 01, 2020
    Sample hospital policy for all employees working in inpatient units, ambulatory clinic spaces, and procedural areas to wear procedural/surgical face masks, at all times, while in their respective clinical care settings.
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  • CMS Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit

    By CMS - March 27, 2020
    The Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. The benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19, are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus.
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  • CDC Updated List of People at Higher Risk for Severe COVID-19 Illness (3/20)

    By CMS - March 23, 2020

    Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.

    Based upon available information to date, those at high-risk for severe illness from COVID-19 include:

    • People aged 65 years and older
    • People who live in a nursing home or long-term care facility
    • Other high-risk conditions could include:
      • People with chronic lung disease or moderate to severe asthma
      • People who have serious heart conditions
      • People who are immunocompromised including cancer treatment
      • People of any age with severe obesity (body mass index [BMI] >40) or certain underlying medical conditions, particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk
    • People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk

    Many conditions can cause a person to be immunocompromised, including cancer treatment, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications.

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  • 3/24 CDC COCA Zoom Link/Call-in Info Changed for Underlying Medical Conditions & People at Higher Risk for COVID-19

    By CDC - March 23, 2020

    During this COCA call, presenters will focus on current information about people who are higher risk for COVID-19 complications because of their age or underlying medical conditions, particularly those that are not well-controlled. 


    Due to the high demand we anticipate for this COCA Call, we encourage participants to consider viewing on Facebook. To see the call live, please click on COCA's Facebook Page


    There will only be a few slides for this COCA Call. Slides will not advance during the presentation portion of this webinar. You can find the slides under the "Call Materials" tab here.


    Advanced registration is not required.

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  • March 25 CDC Call, COVID-19 Update: Optimization Strategies for Healthcare PPE

    By MX - March 23, 2020

    When: Wednesday, March 25, 2020, 2 p.m. to 3 p.m. (Eastern Time)

    During this COCA Call, presenters will provide a COVID-19 update and discuss strategies for healthcare facilities to optimize personal protective equipment (PPE) supplies such as eye protection, isolation gowns, facemasks, and N95 respirators.

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  • How to Don and Doff Personal Protective Equipment (PPE) for COVID-19 Response UPDATED (3/20)

    By CDC/Nebraska Medicine - March 19, 2020

    Understanding how to put on (don) and remove (doff) personal protective equipment (PPE) will be critical in mitigating risk for COVID-19.

    The CDC offers basic instructions.

    Nebraska Medicine and the University of Nebraska Medical Center, which have been providing care for COVID-19 quarantined cruise ship passengers, offer additional guidance:

     Personal protective equipment (PPE):

    PPE for the Care of Patients Infected or Suspected with COVID-19 [VIDEO] (updated 03/12/2020)

    PPE for COVID-19 infographic (updated 03/06/2020)

    Donning: Step-by-step process (updated 03/06/2020)

    Doffing: Step-by-step process (updated 03/12/2020)

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  • March 13 CMS REVISED Guidance for Infection Control and Prevention of COVID-19 in Nursing Homes (3/20)

    By CMS - March 15, 2020


    On Mar 13, 2020, the Centers for Medicare & Medicaid Services (CMS) announced critical new measures designed to keep America’s nursing home residents safe from the 2019 Novel Coronavirus (COVID-19). 

    CMS has again revised the QSO memorandum Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes based on the newest recommendations from the Centers for Disease Control and Prevention (CDC). It directs nursing homes to significantly restrict visitors and nonessential personnel, as well as restrict communal activities inside nursing homes. The new measures are CMS’s latest action to protect America’s seniors, who are at highest risk for complications from COVID-19. While visitor restrictions may be difficult for residents and families, it is an important temporary measure for their protection.

    “As we learn more about the Coronavirus from experts on the ground, we’ve learned that seniors with multiple conditions are at highest risk for infection and complications, so CMS is using every tool at our disposal to keep nursing homes free from infection,” said CMS Administrator Seema Verma. “Temporarily restricting visitors and nonessential workers will help reduce the risk of Coronavirus spread in nursing homes, keeping residents safe. The Trump Administration is working around the clock to ensure the continued safety of America’s health care system, particularly nursing homes.”

    The new measures CMS announced on March 13, which supersede prior CMS guidance, constitute the agency’s most aggressive and decisive recommendations with respect to nursing home safety in the face of the spread of COVID-19. They include:

    • Restricting all visitors, effective immediately, with exceptions for compassionate care, such as end-of-life situations;
    • Restricting all volunteers and nonessential health care personnel and other personnel (i.e. barbers);
    • Cancelling all group activities and communal dining; and
    • Implementing active screening of residents and health care personnel for fever and respiratory symptoms.

    The guidance directs nursing homes to restrict visitation except in certain compassionate cases, like end-of-life. In those cases, visitors will be equipped with personal protective equipment (PPE) like masks, and the visit will be limited to a specific room only.

    CMS’s guidance is based upon CDC recommendations informed by real-time information being gathered from experts on the ground in areas with large numbers of COVID-19 cases, like Washington and California. According to CDC, seniors with multiple health conditions are at highest risk for complications. With large congregations of that particularly vulnerable population, nursing homes are extremely susceptible to quick spread of the virus. There have already been reports of large numbers of cases of COVID-19 spreading quickly through nursing homes, such as the Life Care Center in Kirkland, Washington. The spread of COVID-19 in a nursing home can amplify or seed further spread to other facilities when patients are transferred and when staff and visitors come and go. According to CDC, visitors and health care personnel who are ill are the most likely source of introduction of COVID-19 into nursing homes, necessitating today’s change in guidance to restrict visitors and personnel.

    CMS understands the vital importance of keeping nursing home residents connected with their loved ones. However, the rapid spread of COVID-19 and its transmission through visitors and health care workers – as well as nursing home residents’ high risk – has made it necessary to restrict nonessential visitation in order to protect the health and safety of residents. In lieu of visits, CMS encourages nursing homes to facilitate increased virtual communication between residents and families. CMS also encourages nursing homes to keep residents’ loved ones informed about their care. This could include assigning a staff member as a primary contact for families to facilitate inbound communications, as well as regular outbound communications. Nursing homes are expected to notify potential visitors to defer visitation until further notice through signage and other outreach, such as emails and phone calls.

    CDC has made several additional recommendations for nursing homes as they work to keep their residents safe. Nursing homes should put alcohol-based hand sanitizer with 60-95 percent alcohol in every resident room – both inside and outside the room if possible – and in every common area. Additionally, nursing homes should ensure sinks are well-stocked with soap and paper towels for hand washing. They should make tissues and facemasks available for people who are coughing, and make necessary PPE available in areas where resident care is provided. Finally, they should ensure hospital grade disinfectants are available to allow for frequent cleaning of high-touch surfaces and shared resident equipment.


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  • CDC Long-term Care COVID-19 Preparedness Checklist AND Interim Additional Guidance for Infection Prevention and Control for Suspected or Confirmed COVID-19 in Nursing Homes (3/13/20)

    By CDC - March 15, 2020

    COVID-19 Preparedness Checklist for Nursing Homes and other Long-Term Care Settings

    Nursing homes and other long-term care facilities can take steps to assess and improve their preparedness for responding to coronavirus disease 2019 (COVID-19). This checklist should be used as one tool to develop a comprehensive COVID-19 response plan, including plans for:

    • Rapid identification and management of ill residents
    • Considerations for visitors
    • Supplies and resources
    • Sick leave policies and other occupational health considerations
    • Education and training
    • Surge capacity for staffing, equipment and supplies, and postmortem care

    The checklist identifies key areas that long-term care facilities should consider in their COVID-19 planning. Long-term care facilities can use this tool to self-assess the strengths and weaknesses of current preparedness efforts. This checklist does not describe mandatory requirements or standards; rather, it highlights important areas to review to prepare for the possibility of residents with COVID-19.


    Interim Additional Guidance for Infection Prevention and Control for Patients with Suspected or Confirmed COVID-19 in Nursing Homes

    Summary of Changes to the Guidance:

    Updated guidance to recommend that nursing homes:

    • Restrict all visitation except for end of life situations.
    • Restrict all volunteers and non-essential healthcare personnel (HCP), including non-essential healthcare personnel (e.g., barbers)
    • Cancel all group activities and communal dining
    • Implement active screening of residents and HCP for fever and respiratory symptoms

    COVID-19 is being increasingly reported in communities across the United States. It is likely that SARS-CoV-2 is circulating in all communities even if cases have not yet reported. As such, nursing homes should assume it is now in their community and move to restrict all visitors and unnecessary HCP from the facility. Cancel group activities and communal dining and implement active screening of residents and HCP for fever and respiratory symptoms.

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  • Kaiser Family Foundation Study Looks at Which States COVID-19 May Hit LTC Residents the Hardest (3/20)

    By Kaiser Family Foundation - March 15, 2020

    Data Note: How might Coronavirus Affect Residents in Nursing Facilities?


    While knowledge about COVID-19 continues to evolve daily, experts agree that certain populations are particularly vulnerable to severe cases of the infection – those with chronic conditions, compromised immune systems, and of old age. Nursing facilities provide care to populations with those characteristics, and residents in these facilities are particularly at risk of developing serious illness or dying if infected. In 2017, there were approximately 1.3 million residents receiving care across 15,483 nursing facilities in the US (Table 1). This data note provides key data points to highlight the potential implications of COVID-19 on nursing facility residents and overall operations.

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  • March 13 CDC Call: COVID-19 Update and Infection Prevention and Control Recommendations

    By CDC - March 12, 2020

    During this COCA Call, presenters will focus on current information about COVID-19 and provide clinicians with updated information on implementing infection prevention and control measures, assessing risks for exposures, and optimizing the use of personal protective equipment supplies.

    Special Request: Due to the high demand we anticipate for this COCA Call, we kindly ask participants to access it in a group format, if possible, to allow for the maximum number of people to participate.


    Watch on Facebook: You may also participate in this COCA Call by joining COCA's Facebook Live.  


    Advanced registration is not required.


    Continuing Education will not be offered for this COCA Call. 


    There will only be a few slides for this COCA Call. Slides will not advance during the presentation portion of this webinar. You can find the slides under the "Call Materials" tab on the call page.         

    Date: Friday, March 13, 2020

    Time: 2:00pm–3:00pm (ET)

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  • CMS Guidance for Use of Certain Industrial Respirators by Health Care Personnel (3/20)

    By CMS - March 10, 2020
    Guidance expands types of facemasks healthcare workers can use to protect themselves and patients

    The Centers for Medicare & Medicaid Services (CMS) took additional action to ensure America’s healthcare workers are prepared to fight the spread of Novel Coronavirus 2019 (COVID-19). Specifically, CMS sent a memorandum to State Survey Agencies (SAs), which are responsible for inspecting nursing homes and other healthcare facilities serving Medicare and Medicaid beneficiaries. The memo clarifies the application of CMS policies in light of recent Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) guidance expanding the types of facemasks healthcare workers may use in situations involving COVID-19 and other respiratory infections. These are proactive steps to take as part of the White House Task Force’s efforts to ensure a maximum supply of facemasks and respirators are available to enable healthcare providers to safely treat patients without exposing themselves or others to COVID-19.

    “CMS is working in lockstep with the CDC, FDA, and other Trump Administration partners to protect both patients and the dedicated healthcare workers who are battling the spread of Coronavirus,” said CMS Administrator Seema Verma. “Today we provided practical information to state inspectors and healthcare facilities on the range of facemasks that can be temporarily used. CMS has been rapidly adapting our guidance to strengthen our nation’s defense against Coronavirus, and today’s action is no exception. We’re working to make sure the healthcare system has the equipment it needs to keep patients and healthcare workers safe.”

    The memo CMS issued today aligns CMS policy with recent changes to CDC and FDA facemask and respirator guidance in light of COVID-19 and supply demands. To help reduce burden on healthcare facilities at this time, the CMS memo implements CDC guidance by stating that facemasks, which protect the wearer from splashes and sprays, are an acceptable temporary alternative to respirators, which filter the air, for most medical services until demand for respirators lessens.

    Due to the updated CDC guidance on allowable facemasks and respirators, CMS is also alerting state surveyors that they are not required – on a temporary basis – to validate the date of a facility’s last annual test of the fit of N95 masks worn by workers in Medicare- and Medicaid-certified facilities. CMS is temporarily suspending surveyor validation of the test to minimize the discarded masks associated with such testing. 

    Additionally, the FDA approved a CDC request for an emergency use authorization (EUA) to allow healthcare workers to use certain industrial respirators during the COVID-19 outbreak in healthcare settings. The FDA concluded that respirators approved by the National Institute for Occupational Safety and Health (NIOSH), but not currently meeting the FDA’s requirements, may be effective in preventing healthcare workers from airborne exposure to serious or life-threatening disease, including COVID-19. This FDA approval allows healthcare personnel to use the NIOSH-approved respirators not currently regulated by the FDA. As a result, in addition to N95 respirator masks, healthcare personnel have other masks at their disposal in order to safely treat patients without exposing themselves or others to COVID-19.

    The CMS memo on facemask and respirator guidance issued today, and earlier CMS actions in response to the COVID-19 virus, are part of ongoing White House Task Force efforts. To keep up with the important work CMS is doing in response to COVID-19, please visit the Current Emergencies Website

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  • AHRQ Report Reviews 47 Practices To Improve Patient Safety (3/20)

    By AHRQ - March 10, 2020

    A new report from the Agency for Healthcare Research and Quality (AHRQ) reviews 47 practices that target patient safety improvement in hospitals, primary care practices, long-term care facilities and other healthcare settings. The report, Making Healthcare Safer III, was published as AHRQ joins others in observing Patient Safety Awareness Week.

    “As we implement 21st century healthcare, we need to make sure that all patients are getting the highest quality and safest care possible,” said AHRQ Director Gopal Khanna, M.B.A. “With this report, AHRQ is seeking to support a culture of safety across the entire healthcare ecosystem. We expect this report to shape the national, regional, and local patient safety agendas for years to come.”

    The 47 patient safety practices (PSPs) are categorized in major topic areas, such as:

    • Medication management.
    • Healthcare-associated infections (HAIs).
    • Nursing-sensitive practices.
    • Procedural events.
    • Diagnostic errors.
    • Crosscutting factors.

    These areas include PSPs such as clinical decision support technologies, use of rapid-response teams, special hygiene and disinfection interventions to prevent HAIs, and several practices designed to prevent medication errors and reduce opioid misuse and overdose.

    Despite sustained national attention and notable successful interventions in recent years, patient safety remains a significant problem in the United States. Harms such as adverse drug events, HAIs, falls and obstetric adverse events are blamed for thousands of deaths and hundreds of thousands of injuries each year. AHRQ statistics (PDF) estimate that in 2017, there were 86 hospital-acquired conditions per 1,000 hospital discharges—a figure that has fallen steadily in recent years but remains alarmingly high.

    Making Healthcare Safer III addresses this by supporting the implementation of PSPs where appropriate, advancing a framework for patient safety transformation and considering the contextual factors that can lead to successful use of patient safety interventions.

     “Before clinicians commit to implementing a patient safety practice, they want to know that they won’t be wasting their precious time and resources,” said Jeffrey Brady, M.D., director of AHRQ’s Center for Quality Improvement and Patient Safety. “This report provides information the field needs to evaluate how to prioritize efforts to keep patients safe.”

    The report calls for more research specifically into what makes for successful implementation of a patient safety intervention, a call that Dr. Brady echoed. “With patient safety, we increasingly know what to do—but often the challenge is how to make improvements work in the context of a specific facility or setting and have them succeed in the real world,” he said.

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  • Mental Health Considerations during COVID-19 Outbreak (3/20)

    By WHO - March 10, 2020
    These mental health considerations were developed by the Mental Health Department at the World Health Organization (WHO) as support for mental and psychological well-being during COVID-19 outbreak.

    The document covers:

    • The general population;
    • Healthcare workers
    • Team leaders or managers in a health facility;
    • Caretakers of children;
    • Caretakers of older adults; and
    • People in isolation
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