COVID-19 and LTC January 20, 2022 - Guidance and responses were provided based on information known on 1/20/2022 and may become out of date ...
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Guidance and responses were provided based on information known on 1/20/2022
and may become out of date. Guidance is being updated rapidly, so users should look
to CDC and NE DHHS guidance for updates.
COVID-19 and LTC
January 20, 2022
Presentation Information:
Panelists today are:
Dr. Salman Ashraf salman.ashraf@unmc.edu
Rebecca Fein, DHSc, MBA, MS Rebecca.fein@nebraska.gov
Kate Tyner, RN, BSN, CIC ltyner@nebraskamed.com
Margaret Drake, MT(ASCP),CIC Margaret.Drake@Nebraska.gov
Lacey Pavlovsky, RN, MSN, CIC lpavlovsky@nebraskamed.com
Sarah Stream, MPH, CDA, FADAA sstream@nebraskamed.com
Josette McConville, BSN, RN, CIC jmcconville@nebraskamed.com
Rebecca Martinez, BA, BSN, RN, CIC remartinez@nebraskamed.com
Jody Scebold, EdD, MSN, RN jodscebold@nebraskamed.com
Chris Cashatt RN, BSN, CIC ccashatt@nebraskamed.com
Daniel Taylor, DHHS Daniel.Taylor@nebraska.gov
Becky Wisell, DHHS Becky.Wisell@nebraska.gov
Cindy Kadavy, NHCA cindyk@nehca.org
Kierstin Reed, LeadingAge Kierstin.Reed@leadingagene.org
Melody Malone, PT, CPHQ, MHA Melody.Malone@tmf.org
Debi Majo, BSN, RN Deborah.Majo@tmf.org
Carla Smith, RN, CDP, IP-BC, AS-BC Carla.Smith@tmf.org
Moderated by Marissa Chaney MaChaney@nebraskamed.com
Slides and a recording of this presentation will be available on the ICAP website:
https://icap.nebraskamed.com/covid-19-webinars/
Use the Q&A box in the webinar platform to type a question. Questions will be read aloud by
the moderator. If your question is not answered during the webinar, please either e-mail it
to NE ICAP or call during our office hours to speak with one of our IPs.
Continuing Education Disclosures ▪1.0 Nursing Contact Hour and 1 NAB Contact Hour is awarded for the LIVE viewing of this webinar ▪In order to obtain nursing contact hours, you must be present for the entire live webinar and complete the post webinar survey ▪No conflicts of interest were identified for any member of the planning committee, presenters or panelists of the program content ▪This CE is hosted Nebraska Medicine along with Nebraska ICAP and Nebraska DHHS ▪ Nebraska Medicine is approved as a provider of nursing continuing professional development by the Midwest Multistate Division, an accredited approver by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation
TMF Health Quality Institute
CMS Quality Improvement
Organization
Melody Malone, PT, CPHQ, MHA
Quality Improvement Specialist
NHSN Required Reporting • CMS memo QSO-20-29-NH, May 6, 2020, Requires submission into all COVID 19 Modules: › Resident Impact and Facility Capacity › Staff and Personnel Impact › Supplies and Personal Protective Equipment • CMS memo QSO-21-19-NH, May 11, 2021 › Therapeutics • CMS memo QSO-21-19-NH, May 11, 2021 › Vaccine Status • CMS memo QSO-20-38-NH REVISED, August 26, 2020 › Point of Care Testing 5
NHSN FAQ: Is someone with a
religious exemption counted as
having a Medical contraindication
• NO: Question 3.1: Only medical exemptions are
counted.
• Interim Clinical Considerations for Use of COVID-19
Vaccines Currently Approved or Authorized in the
United States.
• Other facility leadership exemptions will be
counted in Question 3.2: Offered but declined
• Review the instructions, please
6
NHSN Vaccination Instructions
• Instructions for Completion of the COVID-19
Vaccination Module for Long-Term Care Residents
• Instructions for Completion of the COVID-19
Vaccination Summary Data Form for Healthcare
Personnel
TIP: You should have both eligible and boosted
residents and staff counted in NHSN.
7
NHSN Vaccination Data
Getting it right every time matters.
• Include the Resident’s Discharge Date and the
Staff’s Termination Date
•
8
NHSN Vaccination Data
Getting it right every time matters.
• Include the Resident’s Discharge Date and the
Staff’s Termination Date
• It removes them from the Report Summary Count
9
Join the TMF Group and Confer
Rights in NHSN
• We can see your data but we can’t do anything
with your data!
• Joining TMF Group and Conferring Rights
• Please join so you can help us, help you!
10Dialysis Centers Need Your Help!
• Please provide to them the COVID vaccination
details for any of your residents that go to dialysis.
• They need it for their own NHSN reporting.
11CMS-Targeted COVID-19 Training For Frontline Nursing Home Staff and Management Learning • Available through the CMS Quality, Safety & Education Portal (QSEP) • Five frontline nursing home staff modules with three hours total training time • Ten management staff modules with four hours total training time • QSEP Group Training steps - English • QSEP Group Training steps - Spanish
Five Star Technical Users’ Guide
• New: Nursing Home Compare Technical Users’
Guide January 2022
• It should open for you to the manual.
• If it doesn’t look down the page in Downloads.
13Join the TMF Website:
tmfnetworks.org
Our website Resources: QAPI Resources
14Upcoming TMF Training
• Jan. 20, 2022, 1:30-2 p.m. CT Navigating NHSN -
Part 4 Registration
• Jan. 25 10:30 a.m. CT Nursing Home Office Hours:
The 3 T’s of COVID: Testing, Treating, and Time to
go to Work - Registration
15Need Assistance? Email nhnetwork@tmf.org. Submit requests for help with NHSN reporting problems and/or quality improvement assistance. This material was prepared by TMF Health Quality Institute, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 12SOW-QINQIO-NH-21-64-10-20-21
Nebraska Statistics
Daily New Infection Positive Test ICU Capacity Vaccinated
Week
Nebraska Statistics
7/1/21
Cases/ 100K
2.5
Rate
1.17
Rate
4.3%
Used
63%
1+
51.7%
7/15/21 4.1 1.30 6.8% 62% 52.4%
7/29/21 10.4 1.35 12.8% 70% 53.5%
8/12/21 19.0 1.25 15.9% 75% 55.3%
8/26/21 32.1 1.22 17.2% 80% 56.7%
9/9/2021 35.8 1.07 16.0% 75% 58.0%
9/23/2021 40.0 1.00 14.4% 77% 58.8%
10/7/2021 31.7 0.95 11.5% 79% 59.7%
10/21/2021 29.7 0.95 10.3% 81% 60.4%
11/4/2021 32.8 1.00 13.9% 78% 61.0%
11/18/2021 44.7 1.09 14.9% 80% 62.6&
12/2/2021 38.1 0.94 17.6% 80% 63.7%
12/16/2021 46.1 1.01 16.2% 83% 65.3%
12/30/2021 46.1 1.04 16.2% 82% 66.3%
1/6/2022 96.7 1.35 25.8% 84% 66.7%
1/20/2022 215.0 1.31 35.6% 82.0% 67.4%
https://covidactnow.org/?s=22441170Nebraska Statistics
https://covidactnow.org/?s=22441170Nebraska LTC Facilities in Outbreak **Updated: 1/17/2022 Source: Unofficial Counts Compiled by Nebraska ICAP based on data reported by facilities and DHHS; Actual numbers may vary slightly
Nebraska Post-Acute and Long- Term Care Facility COVID-19 Cases **Updated: 1/17/2022 Source: Unofficial Counts Compiled by Nebraska ICAP based on data reported by facilities and DHHS; Actual numbers may vary slightly
COVID-19 Therapeutics
COVID-19 Treatment • Monoclonal Antibody Treatment (Sotrovimab) • Nirmatrelvir and Ritonavir (Paxlovid)
How to Order? Click on the REDCap survey link posted on the ASAP Website here https://asap.nebraskamed.com/covid19-treatment/ Link to Survey: https://redcap.nebraskamed.com/surveys/?s=4H9NA3C8LD9C8D4N On the survey section “COVID-19 Treatment Option”, you will be prompted to choose the preferred treatment option. If ordering for Monoclonal Antibody Therapy, choose option 1 If ordering for Paxlovid, choose option 2
COVID-19 Treatment Resources
Access treatment criteria, provider
fact sheets, patient & caregiver fact
sheets, treatment order form here:
https://asap.nebraskamed.com/mo
noclonal-antibody-resources/
https://asap.nebraskamed.com/pax
lovid-resources/
CONTACT INFORMATION
For any questions regarding monoclonal antibodies, Paxlovid, or
the request process, please contact Andrew Watkins at
Anwatkins@nebraskamed.com or Mounica Soma at
msoma@nebraskamed.comUpdates for LTC
Positive LTC Residents –
Retesting Not Needed to End Isolation
Most
Residents –
No Retesting
No Retesting
No Retesting Required – Unless Ordered
Interim Infection Prevention and Control Recommendations for Healthcare
Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic - CDCCMS Vaccine Mandate (QSO-22-09) Update https://www.cms.gov/files/document/qso-22-09-all-injunction-lifted.pdf
CMS Vaccine Mandate (QSO-22-09) Update
There are 30, 60 and 90 day requirements listed in this memo.
Please take time to review this document thoroughly.
https://www.cms.gov/files/document/qso-22-09-all-injunction-lifted.pdfCMS Vaccine Mandate (QSO-22-09)
Attachment A (LTC): Additional Precautions
1. Reassigning staff that are exempt or not fully vaccinated to non-
patient care areas and/ or duties or duties that can be done
remotely.
2. Follow additional CDC guidance such as universal source control
and physical distancing in non-patient areas (ex. meeting rooms)
for staff that are exempt or not fully vaccinated
3. Weekly testing for all staff that are exempt or not fully vaccinated
regardless of county transmission rates
4. Requiring staff who have not completed their primary series to
wear a NIOSH-approved N95 at all times, regardless of whether
they are providing direct patient care
https://www.cms.gov/files/document/qso-22-07-all-attachment-ltc.pdfResources for Vaccine Exemption 1. Statement on Medical Directors Being Requested to Evaluate Staff Applications for Medical Exemption to Receiving the COVID Vaccine [paltc.org] 2. Nursing Home Request for Medical Exemption from COVID-19 Vaccination [paltc.org] 3. Template for Staff with Vaccination Exemptions [paltc.org]
Use of KN95s in LTC • KN95s are NOT approved by NIOSH/ FDA to be used as respirators for clinical care • They should NOT be worn in red or yellow zones within a facility • They can be used as source control and in green zones if they are well fitting and you have supply • Ensure staff have been trained to identify the difference between a KN95 and an N95 and when/ where to use each mask https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control- recommendations.html#:~:text=Source%20control%20refers%20to%20us e,talking%2C%20sneezing%2C%20or%20coughing
COVID Test Result Reporting
Rebecca A. Fein, DHSc, MBA, MS
ELR Registry Technical Program Manager –
Public Health
January 2022
Helping People Live Better Lives.
33How do I report Covid Test Results to the State?
1. Reporting via excel spreadsheet.
2. Reporting via guardian – self-uploading on the guardian website.
3. National Health Safety Network (NHSN). – Recommend Signing
Up and Using NHSN to report.
Helping People Live Better Lives.
34The spreadsheet
CLIA # - Everyone doing testing needs to have one and needs to put it on their spreadsheet.
Medical Director – First name, last name, NPI – Many ALFs do not have a medical director or
medical director NPI, just leave it blank.
Patient information – First name, last name, date of birth – All required to match in the system and
please double check the dates.
Device name – name of the device you are using to test.
Test Performed – SARS-CoV-2 Rapid Antigen
Lab Result – Result of the test
Sample Collection date – date sample collected and testing performed.
Sample source – from where? Most of the time this will be nasal mid-turbinate.
Result sent date – date testing results sent to DHHS.
Gender, Race, and ethnicity
Rapid Testing:
Sample should
be collected, test
performed, and
result sent the
same date.
Helping People Live Better Lives.
35The spreadsheet
Patient address – for residents use the facility address, for staff use their residential address.
Patient City – residential city
Patient State – residential state
Patient Phone number – for residents use the facility phone number if no residential phone
number. For staff use their residential or mobile number.
Patient zip code – residential zip code
Facility phone number - Phone number of your facility Name the file
Name of facility that performed the test
facilityname.date
Facility city
Facility state Example:
Comments – put any notes here that you feel are necessary. NebraskaALF1.1.2021
Helping People Live Better Lives.
36Where do I begin?
• Email dhhs.epi@Nebraska.gov
• We will respond with the excel template, companion documents, and
other guidance.
• Submit your testing results within 24 hours of testing to
dhhs.epi@Nebraska.gov
• If positive results, please report the same day.
• Call your LHD so they can assist you ASAP
Helping People Live Better Lives.
37Things We Never Knew We Needed to Know
POC Do we have a Swab, Swab, Race
Test CLIA#? Swab
BD Veritor Ethnicit
NPI DHHS.Epi…
Plus y
Binax Mid-Turbinate = Using
report2020
NOW Nasaloscopy!! Guardian
Helping People Live Better Lives.
38How is it Going?
Number reporting to DHHS – 525
Building good relationships and collaboration
Big learning curve for all of us
Large # of Errors Rare Errors
Did I do it Right? We’ve got this!
Average # of Sheets Received Every Day = 100
Helping People Live Better Lives.
39Main Takeaways
• Reach out if you have questions/need help.
• Don’t be embarrassed if you see yourself in the ‘Common Errors’
slides.
• Double-check your sheets to make sure they don’t contain the
common errors, or previously submitted results.
• Please respond to us if we ask for corrections/updates.
Helping People Live Better Lives.
40Where We Need Your Help
• Incorrect entries
• Blank fields
• Multiple Tabs/Sheets
• Late reporting
• Reporting results already reported previously
Helping People Live Better Lives.
41Common Errors: Dates
Must be
Month/Date/Year
MM/DD/YYYY
Double check
dates for
accuracy!
Helping People Live Better Lives.
42Common Errors: Dates
Do NOT
Enter a
Time
Don’t
leave
Blanks
Helping People Live Better Lives.
43Common Errors: Excel Functions
Don’t use Excel functions. In
the example here, using the
“now” function creates an
inaccurate results sent date.
This is because “now” sets
the date to now.
Helping People Live Better Lives.
44Common Errors: Missing Contact Info
Helping People Live Better Lives.
45Common Errors: Missing Result
Helping People Live Better Lives.
46Common Errors: Invalid Results
• Result: Refused
• Result: NA
• Result: On Leave P, N, I, C, Y, D, ND, Positive,
• Result: Vacation Negative, Yes, Inconclusive,
Detected, Not Detected
• Result: Lost Sample
• Result: Off
• Result: Out of town
• Result: Out of
Facility (OOF)
Helping People Live Better Lives.
47Common Errors: Multiple tabs
Submit Just One Sheet Each Time
Our System can NOT process multiple sheets.
Helping People Live Better Lives.
48Common Errors: Race and Ethnicity
Acceptable Race fields: Asian (or A), Black (or B), American Indian
or Alaskan Native, White (or W), Other (or O), Unknown (or U)
Acceptable Ethnicity fields: Hispanic or Latino (or H). Not Hispanic
or Latino (or NH), Unknown (or U)
• Please use ‘Unknown’ sparingly – information is usually in
patient’s medical record
• If patient is Hispanic, please enter Race as Other (or White) and
Ethnicity as Hispanic or Latino
Helping People Live Better Lives.
49Common Errors: Gender
• Making up codes: MM, MF, FF, FM,
Neutral
M, F, U, Male,
• Blank Female, Unknown
• This data is important to policy
decisions, including funding
Helping People Live Better Lives.
50Common Errors: Other
• Hidden Rows
• Filtering
• Blank fields
• Incomplete rows
• Previously submitted results
Helping People Live Better Lives.
51Transition to NHSN Reporting
Helping People Live Better Lives.
52Disclaimer
Helping People Live Better Lives.
53NHSN Process
• Enroll if you have not done so already; no need to re enroll if already using the other Reporting
Modules
• Get the increased LTCF SAMS level access to NHSN
• Contact: NHSN@cdc.gov for assistance
• Link: https://www.cdc.gov/nhsn/ltc/covid19/sams-access.html
• Manual entry of data into NHSN – other options to upload a file is under development
Helping People Live Better Lives.
54Positive Aspects of NHSN Reporting for POC Tests
• ONE place for your facility to report multiple required pieces of
information
• Once data has been entered into NHSN; it will auto populate on
subsequent entries
• Will only need to fill in the test date and result once the person exists in
the system
• Address for persons auto populates the facility address. Must enter it for
staff and visitors the first time.
• Test ordered and specimen source defaults in based on type of device
used
• LTC that are not Medicare certified; Assisted Living and others can use
NHSN if want to - It is free
Helping People Live Better Lives.
55NHSN Known Issues
• Delays in getting SAMS change in security
• Intermittently, if the Test Date field is completed by typing in a date, rather than
using the calendar fill option, the system may present previously entered dates
from which a selection may be made. If one of these is selected, there may be an
inability to enter POC test results.
• To avoid this issue, please use the calendar option to enter Test Date. No
date yet identified for resolution.
• Usually the NHSN system creates what is called an ‘Accession Number’ for each
test. Each number is specific to the person being tested.
• Do NOT over write what the system assigned or enter the same number for
every person.
• We had one facility do this and it assigned over 100 results to one person
and did not report the other 99 results for others that were tested
• Contact: NHSN@cdc.gov for assistance
Helping People Live Better Lives.
565 Modules: Reporting Pathways are Not POC Test Results
The Point of Care Test
Reporting Tool replaces
the Excel sheets you
send us today.
Using the other
Reporting Pathways
does NOT replace the
Excel sheets you send
us.
Number transitioning to reporting via NHSN: 309
Helping People Live Better Lives.
57When to Stop Sending Test Results to DHHS
Do NOT stop sending us your Excel sheets with test results until you have
successfully submitted test results using the Point of Care Test Reporting Tool.
• NOTIFY DHHS.EPI EMAIL IF YOU NEED ASSISTANCE.
When you have successfully submitted POC Test Results using the POC Test
Reporting Tool
• Notify DHHS via the DHHS.epi@Nebraska.gov email
• Include the date you submitted your first POC test results via NHSN
• DHHS does NOT receive any notification from NHSN that you are sending
results to them
• Then stop sending the spreadsheets to DHHS
Must be no lapse in POC test
results reporting: to EITHER
DHHS OR NHSN
Helping People Live Better Lives.
58We admire your commitment to protect our most vulnerable
population and thank you for your patience as we continue to
work through these changes together.
Helping People Live Better Lives.
59Rebecca A. Fein, DHSc, MBA, MS
ELR Registry Technical Program Manager – Public Health
Rebecca.Fein@Nebraska.gov
Thanks for coming. Please reach out if you need assistance or have questions.
dhhs.ne.gov
@NEDHH NebraskaDHHS @NEDHH
S S
Helping People Live Better Lives.
60Helping People Live Better Lives.
61ICAP Updates and
InformationWebinar CE Process
1 Nursing Contact Hour and 1 NAB Contact Hour is offered for attending this LIVE
webinar.
Individual surveys must be completed for each attendee.
Nursing Contact Hours: NAB:
➢ Completion of survey is required. ➢ Completion of survey is required.
➢ The survey must be specific ➢ The survey must be specific to
to the individual obtaining the individual obtaining credit.
credit. (i.e.: 2 people cannot (i.e.: 2 people cannot be listed
be listed on the same survey) on the same survey)
➢ One certificate is issued monthly ➢ You must have a NAB membership
for all webinars attended ➢ Credit is retrieved by you
➢ Certificate comes directly from ➢ Any issues or
ICAP via email questions regarding your credit must
➢ Certificate is mailed by/on the 15th be directed to NAB customer service.
of the next month ➢ ICAP can verify survey
completion and check the roster
list
Contact Marissa with questions:
Machaney@nebraskamed.com
402-552-2881Questions about Crisis
Standards of Care?
Dr. Johnson and Dr.
Cawcutt from UNMC, Dr.
Nori from New York City
and Richard Estep, a
paramedic from Denver
join us to talk about what
Crisis Standards of Care
are and give a look into
our healthcare systems.
Amazon Music: https://music.amazon.com/podcasts/769c29a8-1e71-46a5-9ab3-94020d7af1f7/DIRTY-DRINKS
Apple Podcasts: https://podcasts.apple.com/us/podcast/dirty-drinks/id1574937193
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Google: https://podcasts.google.com/feed/aHR0cHM6Ly9waW5lY2FzdC5jb20vZmVlZC9kaXJ0eS1kcmlua3MInfection Prevention and Control
Hotline Number:
Call 402-552-2881
Office Hours are Monday – Friday
8:00 AM - 4:00 PM Central Time
On-call hours are available for emergencies only
Weekends and Holidays from 8:00 AM- 4:00 PM
**Please call the main hotline number only during on-call hours**Questions and Answer
Session
Use the QA box in the webinar platform to type a
question. Questions will be read aloud by the
moderator.
Panelists:
• Dr. Salman Ashraf
• Kate Tyner, RN, BSN, CIC
• Margaret Drake, MT(ASCP),CIC
• Lacey Pavlovsky, RN, MSN, CIC
• Sarah Stream, MPH, CDA, FADAA
• Josette McConville, BSN, RN, CIC COVID-19 Webinars - CDC Nebraska
• Rebecca Martinez, BA, BSN, RN, CIC Infection Control Assessment & Promotion
Program (nebraskamed.com)
• Jody Scebold, EdD, MSN, RN
• Chris Cashatt RN, BSN, CIC
• Daniel Taylor, DHHS Don’t forget to Like us on Facebook
• Becky Wisell, DHHS for important updates!
• Cindy Kadavy, NHCA
• Kierstin Reed, LeadingAge
• Melody Malone, PT, CPHQ, MHA
• Debi Majo, BSN, RN
• Moderated by Marissa Chaney
• Supported by Margaret Deacy
• Slide support from Lacey Pavlovsky, RN, MSN, CICYou can also read
