QIPMO DON/ADMIN SUPPORT GROUP - TOPICS FOR TODAY - Nursing Home Help
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1/11/2021
QIPMO
DON/ADMIN
SUPPORT GROUP
I N F O R M AT I O N S H A R I N G S E R I E S
J A N UA RY 1 2 , 2 0 2 1
1
• CNA Exam Changes
• QSO 20-31 Revisions
TOPICS FOR
TODAY • Post-Covid GI Bleed
• Vaccinations
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1
1/11/2021
CNA EX AM
CHANGES
EFFECTIVE DEC 2020-JAN 2021
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CNA TESTING CHANGES FOR DEC
2020
• The Department of Health & Senior Services, Health Education Unit Announced the implementation of
the new CNA testing process to begin in December 2020
• https://health.mo.gov/safety/cnaregistry/
• This is an agreement with Headmaster D&SDT, who will manage CNA testing and registry
• TEST site agreement form: https://pdf.ac/7o0TJ
• Test site equipment form: https://pdf.ac/gQeNJ
4
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1/11/2021
TEST OBSERVER QUALIFICATIONS
• Website: https://hdmaster.com/testing/cnatesting/missouri/MO_CNA_Home.htm
Submit Forms (see next page) along with following:
• Copy of Resume’
• Image of ACTIVE unencumbered RN license/RN license verification to practice in MO
• Recent Missouri Criminal background
PER Missouri state Code-contracted RN observer MUST:
• Hold an active unencumbered Missouri RN license AND
• Minimum of two years experience and a Registered nurse with at least one year of LTC
experience or experience caring for chronically ill
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TEST OBSERVER APPLICATION
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3
1/11/2021
OBSERVER TRAINING
• Training guide and final exams, virtual training sessions demonstrating live testing and mock live
events
• Training at Live test events-
• Notified of live events in your area
• Observer will serve as the actor while D&SDT Headmaster RN Coordinator, Sara Skowronski,
is the test observer for live candidates. Then trainees will observe live candidates while Sara
serves as the actor
• Between each candidate there will be time to go through the documentation and ask questions
regarding the process
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• RN Test Observers are to be positive, confident, RN TEST
completely unbiased and professional in their words, O B S E RV E R S
actions and appearance.
• RN Test Observers will remain impartial during testing. Test observer application form:
https://tinyurl.com/RNTOinMO
• RN Test Observers must give their complete and full
attention to the candidate while the candidate is
demonstrating her/his tasks.
Confidentiality/Nondisclosure
• RN Test Observers are to set up a testing environment agreement form
that will give each candidate a fair, nonbiased, equal
https://pdf.ac/qhAKb
opportunity to demonstrate s(he) knows how to
perform the tasks.
• RN Test Observers will recheck each candidate’s ID as RN Test observer kit-
they enter the testing room to ensure s(he) has the
• Signage
correct candidate’s skill test up on her/his
• Checklists
computer/tablet/laptop screen.
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1/11/2021
STUDENT REQUIREMENTS
• ID Requirements
• Full Clinical Attire
• 3 attempts within ONE Year of start of training
– Failure to pass in that time student requires retraining
• NO Cell Phones, Smart watches, fitness monitors etc.
• May NOT leave testing rooms until finished
– Even the bathroom- they will not be allowed reentry to testing room
9
MANDATORY FIRST SKILL TASKS
• Catheter care for female
• Changing an adult brief and perineal care for a male
• Isolation gown and gloves-emptying a urinary drainage bag
• Perineal care for a female
• ALL include required handwashing
• Based on weight of total for 15 points
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5
1/11/2021
SKILL TASKS (2OR3 OF THESE)
• Abbreviated Bed Bath (whole face and one arm, hand and • Pivot Transfer a Weight Bearing, Non-Ambulatory
underarm) Resident from Bed
• Ambulation from Bed to Wheelchair using a Gait Belt • Wheelchair Using a Gait Belt
• Ambulation from Wheelchair to Bed to using a Gait Belt • Pivot Transfer a Weight Bearing, Non-Ambulatory
• Denture Care Resident from
• Dressing Dependent Resident • Wheelchair to Bed using a Gait Belt
• Feeding the Dependent Resident • Positioning Resident on Side
• Foot Care One Foot • Range of Motion – Hip/Knee
• Mouth Care – Brushing Teeth • Range of Motion – Shoulder
• Mouth Care of Comatose Resident • Vital Signs – Blood Pressure
• Nail Care One Hand • Vital Signs - Pulse and Respirations
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ADDITIONAL TRAINING TOOLS
• Ideas to Help Students Prepare For Testing (PDF)
• Practice exams available for purchase
Missouri Mock Skills
• Skills, tasks and steps
• https://hdmaster.com/testing/cnatesting/missouri/forms/MO%20MOCK%20SKILLS.pdf
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6
This is the paperwork required for the CNA examiner (the forms I mentioned attaching to the handouts
with today’s (1/12/21) webinar.
For anyone interested in becoming an RN test Observer, here is the list of paperwork needed:
• Resume
• RN License
• CBC
• 1500MO
• 1501MO
• 1505MO
• 1511 MO
• 1503MO
• Here is a drive folder with the PDFs for the five in italics above in it:
https://drive.google.com/drive/folders/1RnVIFRMoqiUUiwvVyqbC6oiMf9cwnZpg?usp=sharing
1/11/2021
MISSOURI INFORMATION
• Webinar recording link
• Webinar handout link
•
• DHSS Contact Information
• Phone: 573-526-5686
• Email: cnaregistry@health.mo.gov
• Website: https://health.mo.gov/safety/cnaregistry/
•
• Headmaster D&SDT Contact Information
• Phone: Testing Toll Free Phone: 888-401-0462
• Registry Toll Free Phone: 888-401-0465
• Fax: 406-442-3357
• Website: https://hdmaster.com/testing/cnatesting/missouri/MO_CNA_Home.htm
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QSO 20-3 1 A LL
~REVISED~ 1/4/2021
H T T P S : / / W W W. C M S . G O V / F I L E S / D O C U M E
N T / Q S O - 2 0 - 3 1 - A L L - R E V I S E D. P D F
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1/11/2021
SURVEY ACTIVITY
• Focused Infection Control (FIC) Surveys
• Onsite FIC surveys
– 3 or more new confirmed cases since last NHSN COVID-19 report OR
– 1 confirmed resident case in facility that was previously COVID-free AND
– Other factors that may place resident’s health and safety at risk these factors
include:
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WHAT FACTORS?
• Multiple weeks with new COVID-19 cases;
• Low staffing;
• Selection as a Special Focus Facility per Section 1819(f)(8)(B) of the Social Security
Act ;
• Concerns related to conducting outbreak testing per CMS requirements; or
• Allegations or complaints which pose a risk for harm or Immediate Jeopardy to the
health or safety of residents which are related to certain areas, such a abuse or quality
of care (e.g., pressure ulcers, weight loss, depression, decline in functioning).
CMS will work with State Survey Agencies to identify facilities that meet above
criteria
FIC Survey must start within 3-5 days of identification
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1/11/2021
REPEAT SURVEYS
• Facilities that meet the criteria above to trigger an FIC survey do not need to
be re-surveyed if a FIC survey was conducted (as a stand-alone FIC survey or
as part of a recertification survey) within the previous three weeks. For
example, if a facility is surveyed with a FIC survey within 3-5 days after
meeting the criteria, and the same facility meets the criteria for being surveyed
within 3-5 days in any of the next three weeks, the survey team does not need to
conduct another survey within those three weeks. However, if the facility meets
the criteria for a survey in the fourth week after a FIC survey was conducted,
an additional FIC survey must be conducted within 3-5 days.
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FIC SURVEYS
• Starting in FY 2021, perform annual Focused Infection Control surveys of 20 percent of nursing
homes based on State discretion or additional data that identifies facility and community risks.
To count toward the required 20 percent, these FIC surveys must be stand-alone surveys not
associated with a recertification survey. Additionally, FIC surveys conducted in FY 2021,
triggered by meeting the criteria in #2 above, may count toward meeting the State’s 20 percent
requirement.
• States that fail to perform these survey activities timely and completely could forfeit up to 5% of their
CARES Act Allocation, annually.
NOTE: When conducting FIC surveys, long-term care (LTC) facility surveyors should be alert to,
and investigate any concerns related to residents who have had a significant decline in their
condition (e.g., weight loss, mobility) during the PHE.
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91/11/2021
FAQ ON RESUMPTION OF SURVEY
ACTIVITIES
CMS has received questions from stakeholders as well as Federal and State
Surveyors related to the resumption of survey activities. We have attached FAQs
addressing questions on:
• LTC facility Health surveys,
• Emergency Preparedness surveys and
• Life Safety Code surveys (for all provider types),
• Guide to Waived F-Tags and K-Tags for clarification.
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FAQ HIGHLIGHTS
Survey agencies should supply surveyors with proper PPE.
Medicare and Medicaid certified facilities must allow surveyors to enter.
Surveyors must wear appropriate PPE and adhere to both COVID infection prevention practices and
facility screening protocols.
Surveyors are not required to be tested.
COVID suspected or confirmed residents should be included in sample selection.
One surveyor should be assigned to work with COVID-19 positive residents only, when possible.
Surveyors should not move between COVID positive, suspected positive, and non-COVID areas within
the facility.
Entrance activities and observations/interviews/record reviews should be done onsite and not by phone.
Tasks related to the resident council interview and dining may be modified if the facility is experiencing
an outbreak in order to limit the spread of the virus.
The exit conference may be conducted by phone if all parties agree (facility, ombudsman, officer of the
resident council).
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101/11/2021
BLANKET WAIVERS
• The memo provides a list of regulations/tags that have been waived or partially waived since
3/1/20.
• The only waiver that has been rescinded since that date is the one exempting facilities from
submitting staffing data. This requirement was fully restored on 6/25/20.
• All other waivers are still in effect.
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POST-COVID
GI BLEED
NEWS FL ASH
W E N DY B O R E N , B S N , R N
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111/11/2021
RED ALERT!! GI BLEED POST-COVID
Unexpected (problematic) post-COVID GI
symptoms
Expected GI symptoms of COVID-19 • Bleeding from teeth, gums
• Nausea • Hemataemesis
• Vomiting • Coffee-ground emesis *think about the smell
• Diarrhea • Melena
• Abdominal pain • Blood in the ears, nose
• Loss of appetite • Unusual fatigue
• Abnormal liver chemistry panel • Pallor
• SOB
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POST-COVID GI BLEED
“…critically ill patients were more likely to manifest digestive symptoms in
comparison with non-severe patients …even in the absence of respiratory
symptoms.…In this case, the clinical status of this patient deteriorated even
after respiratory condition continued to improve. Hence, the cause of the
patient’s death was considered to be strongly correlated with hemorrhagic
shock owing to acute massive GIB rather than ongoing pneumonia. “
Source:
A severe coronavirus disease 2019 patient with high-risk predisposing factors died from massive gastrointestinal bleeding: a case report | BMC Gastroenterology |
Full Text (biomedcentral.com)
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121/11/2021
INFECTION CONTROL WAKE-UP CALL!
SARS-CoV-2 RNA has been found in stool specimens and may
remain positive longer even after the clearance of the virus in the
respiratory tract.
This means better HANDWASHING!
Better disposal practices!
Better environmental services!
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POST-COVID GI BLEEDS—THE WHY
WHY??
So far seems to be about 50/50…
50% happening from intubation, feeding tubes, rectal tubes during the hospital stays
50% unknown, hx of GI bleed
What does that mean for YOU?
*Get DETAILS from the hospital stay…so you know where to look for problems
• Were they intubated?
• Were they given parenteral feeding or NG tube?
• Did they have a rectal tube placed?
• Were they given anticoagulation meds? What kind? For how long?
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131/11/2021
POST-COVID GI BLEED
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POST-COVID GI BLEED TREATMENT
• Upper and lower endoscopy will dx and cauterize ulcers if possible
• Rectal packing
• Surgery
• PPIs—Omeprazole, Zantac,etc
• Low- or no-acidic/caffeine diet
• Close nursing monitoring **MAKE YOUR CNAs AWARE!!
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141/11/2021
RESOURCES FOR POST-COVID GI
BLEED
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7446989/
•
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7241390/
•
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316116/
•
• https://www.medpagetoday.com/infectiousdisease/covid19/90379
•
• https://academic.oup.com/gastro/advance-article/doi/10.1093/gastro/goaa067/6029601
•
• https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-020-01458-x#availability-of-data-
and-materials
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VA CCI NATI O NS
A ND I NF OR M ATI O N
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151/11/2021
• December 22, 2020, HHS withdrew its prior requirement that nursing homes
REPORTING - report COVID-19 point-of-care (POC) test results to the NHSN. This does not
eliminate the requirement to report POC tests for those providers
CDC AND HHS with a CLIA waiver. Options:
– POC results through state and local public health departments
CHANGE ON – OR through NHSN.
REQUIREMENT – Should you choose to report to the state and local public health
departments, then obtaining SAMS Level-3 access to the NHSN is no longer
TO REPORT POC necessary.
– Still must report positive cases of COVID-19 through NHSN.
TEST RESULTS
TO THE NHSN • Best Choice: Report your POC test results in the same way you have been
reporting.
– If you have been reporting to the NHSN, continue to report your POC
testing results to the NHSN.
– If you were reporting your POC test results to the state, continue to report
to the state.
– If you were not reporting your POC test results because you were waiting
for your SAMS level 3, start reporting to the state to avoid any enforcement
action.
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NHSN REPORTING
• https://tmfnetworks.org/Portals/0/Resource%20Center/NHSN%20Situational%20Guide-Final%20508.pdf
• Step I – Registering with NHSN
• Step II – Registering with SAMS
• Step III – Applying for the SAMS Grid Card
• Step IV – You had an SAMS Grid Card but left it at your previous facility or misplaced it.
– Action:You must obtain a new SAMS Grid Card
• Step V – You are new to the facility and can log in using your SAMS Grid Card, but do not have access to report
COVID-19 data.Your facility is already registered and the designated team member who was reporting COVID-19
data to NHSN is no longer employed.
– Action:You must be added to NHSN at the new facility.
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161/11/2021
MISSOURI INCREASES HOURLY
MINIMUM WAGE RATE FOR 2021
• $10.30 as of January 1, 2021.
– This is an 85-cent increase from the hourly minimum
wage of $9.45 in 2020.
Part of the five-year series approved by Missouri voters in
2018. The minimum wage will increase each year until it
hits $12 an hour in 2023.
This Photo by Unknown Author is licensed under CC BY
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(ICAR) INFECTION CONTROL
ASSESSMENT AND RESPONSE
PROJECT
• A Collaboration Between MO DHSS and QIPMO
• The Quality Improvement Program for Missouri’s
Nursing Homes (QIPMO) is partnering with the Missouri
Department of Health and Senior Services (DHSS) in
response to the novel Coronavirus known as COVID-19.
In doing so, QIPMO has formed a new Infection Control
Assessment and Response (ICAR) Team with a primary
goal of assisting all Missouri Long-Term Care Facilities
(SNF, ICF, RCF, ALF) to navigate the challenges of the
COVID-19 pandemic and other infectious diseases.
This Photo by Unknown Author is licensed under CC BY-SA-NC
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171/11/2021
QIPMO ICAR TEAM
Sharon Thomas, BSN, RN, IP Clinical
Educator/Consultant thomassg@missouri.edu
Shari Kist, PhD, RN, CNE, IP
Project Supervisor (MOQI); Clinical Advisor
kistse@missouri.edu
Janice Dixon-Hall, IP
Database Coordinator (MOQI); Advisor
dixonhallj@missouri.edu
Nicky Martin, MPA, BS, LNHA, CDP, IP
LTC Leadership Coach martincaro@missouri.edu
Steve Miller, MA, IP
Payment Support Coordinator (MOQI); Advisor
millerst@health.Missouri.edu
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Employers should remember that guidance from
public health authorities is likely to change as the
COVID-19 pandemic evolves. Therefore, employers
should continue to follow the most current
information on maintaining workplace safety.
• READ
• https://www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-
rehabilitation-act-and-other-eeo-laws
CAN AN EMPLOYER Consider…
1. EEOC states employers can require employees be vaccinated so long as
REQUIRE VACCINE certain conditions are met (such as job related) and certain exceptions are
not applicable (such as medical or religious concerns).
• So long as it does not also seek information about the employee’s
impairments or health status.
• Take precaution against prying into an employee’s potential status as an
individual with a disability.
• All questions need to be job-related and consistent with business
necessity.
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181/11/2021
• If an employee has the vaccine
somewhere else, you have the right to
request proof from the employee and
keep that record in the employee’s
medical file.
• Under Title VII of the Civil Rights Act, the
employer must consider whether a
CAN AN EMPLOYER
reasonable accommodation can be made
without posing an undue hardship for a
REQUIRE VACCINE
religious objection.
• Unions – would need to look at their
collective bargaining agreements to
determine whether they have the right
to implement mandatory vaccinations.
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OSHA AND LIABILITY
• OSHA- There is discussion of course where employers
are to provide a workplace that is “free from recognized
hazards” that could cause serious harm or death to
employees. Question is with COVID whether providing
vaccine provides that place.
• With a mandate as employer will you be minimizing
potential liability by issuing that mandate, while ensuring
CDC guidelines and safety protocols are being followed.
• Advice is to seek your legal council before making this
decision.
This Photo by Unknown Author is licensed under CC BY-NC-ND
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191/11/2021
VACCINES AND STAFF CONCERNS
• Nobody wants to be first?
• How do we know the vaccine is safe?
• What are the side effects going to be?
COVID-19 Vaccine • Is it going to be effective?
Hesitation is real • How long is the protection going to last?
• The vaccine developed outside the
United States.
• Is there new technology being used and is
that dangerous to me?
• What if I’ve already had COVID-19?
• Where do I find the right information?
39
VACCINE CAMPAIGN
Protect Safeguard Help Set
Protect myself and Safeguard my Help stop Set the example for
my family residents community spread others, including
residents, families,
co-workers, and the
coummunity-at-
large
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201/11/2021
• The FDA is using the same standards that
it has for decades. It is important that the
vaccine is safe. That is priority.
• They are not “skipping” steps
• Side effects usually occur within 6 weeks
of administration of the vaccine, and the
FDA has required 8 weeks of safety
ARE THE COVID-19 monitoring. Monitoring for safety will
continue.
VACCINES SAFE? • The current phase 3 trials have 30,000 to
50,000 participants. Normally there are
a minimum of 3,000 participants to
assess safety. This shows how safety is a
high priority for the FDA and for all
medical personnel.
41
NEW TECHNOLOGY FOR
THE COVID 19 VACCINE
• mRNA Vaccines:
• Contain material from the virus that causes COVID-19
• Do NOT contain inactivated or weakened virus
• This material gives our cells instructions for how to make a harmless protein that is unique to the virus. This protein cannot
build a virus or cause infection.
• Our cells make copies of this protein, then destroy the genetic material from the vaccine
• Our bodies recognize that these proteins should not be there, and build antibodies that will remember how to fight the virus
that causes COVID-19 if we are infected in the future
• Can these new technologies give me COVID-19? No
• Can these new technologies change my DNA? No
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211/11/2021
• An Emergency Use Authorization (EUA) for a vaccine is based on the need
to use a vaccine quickly to save lives during a public health emergency.
• EUA is a shorter process but no steps are skipped in the safety evaluation
WHAT IS AN process.
EUA AND • The FDA will assess if the vaccine's known and potential benefits outweigh
the known and potential risks.
WHAT DOES • Both advisory boards (VRBPAC and ACIP) will also review all the data and
make recommendations
THAT MEAN • An EUA does NOT imply that the authorization was done too quickly or that
FOR ME? the vaccine is not safe
• Major reasons the vaccines were developed more quickly than usual:
– Global effort with the world’s leading scientists focused on a single task
– Nearly unlimited resources (money, knowledge, manpower, technology)
– A large pool of diverse adult volunteer trial participants
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POSSIBLE SIDE EFFECTS AND PROTECTION
• Short-term discomfort : headache, muscle pains, fatigue, chills, fever and pain at injection
site
• Side effects generally last 24-48 hours
• Similar symptoms as COVID 19 – THE VACCINE CANNOT GIVE YOU COVID-19!
• Side effects more pronounced with second dose
• Side effects are normal, common and expected
• Side effects are a good thing it means the vaccine is working you are making antibodies
• NEED THAT SECOND DOSE and REQUIRED THAT IT BE THE SAME VACCINE AS THE
FIRST DOSE
• Most of the vaccines are 2 doses, either 21 or 28 days apart
• Protection happens 1 to 2 weeks after the second dose
• Possible that vaccinations may be needed on a regular basis similar to the flu shots, that is
not known at this time.
Will you still need to wear a Mask???
YES
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221/11/2021
SPECIAL • It is safe to get the COVID-19 vaccine even if
you have had COVID-19
CIRCUMSTANCES: • Even if you have had COVID-19, it is
WHAT IF I HAVE important to get vaccinated. It could give you
longer or better protection against the
ALREADY HAD disease.
COVID-19?
• Even if you have positive antibodies, PLEASE
get the COVID-19 Vaccine
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RESIDENTS
REFUSAL
• What about those five residents that are not
taking the vaccine?
– Do they have to stay in their room?
– Quarantine every time they go out for
another 14 days?
– Not allowed to have any visitors and
how are you going to keep visitors out
of their room?
– QUARANTINE AND ISOLATION
This Photo by Unknown Author is licensed under CC BY
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231/11/2021
SICK DAYS
• Vaccine routinely is causing very
small side effects for one day.
Sore arms and temperatures.
• As an employer are you going
to pay for COVID-19 after you
have had the second vaccine
offered in your home?
– Many are not
This Photo by Unknown Author is licensed under CC BY-ND
47
WEBINAR
THE
POSSIBILITIES
O F D I A LY S I S I N
A NURSING
HOME SETTING
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241/11/2021
RESOURCES
Reliable sources: CDC, medical directors, providers
CDC Toolkit: https://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/downloads/answering-
staff-questions.pdf
CDC: https://www.cdc.gov/vaccines/hcp/covid-conversations/answering-questions.html
CDC: About COVID-19 vaccines: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/about-
vaccines.html
CDC: Provider Resources for COVID-19 Vaccine Conversations with Patients and Answering Patients’
Questions: https://www.cdc.gov/vaccines/hcp/covid-conversations/
State Site: https://covidvaccine.mo.gov/
49
QU ES T IO NS
This Photo by Unknown Author is licensed under CC BY-NC
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251/11/2021
QIPMO NURSES
Wendy Boren email: borenw@missouri.edu
Katy Nguyen email: nguyenk@missouri.edu
Crystal Plank email: plankcl@missouri.edu
Debbie Pool email: poold@missouri.edu
Melody Schrock email: schrockm@missouri.edu
CAT Team Carol Siem email: siemc@health.missour.edu
Region 6 & 7
RCF/ALF Nurses
COVID-19 Sharon Thomas email: thomassg@missouri.edu
Accountability Region 3, 4, & 5
Team Rob Siem: rws266@missouri.edu
Region 1 & 2
51
LTC LEADERSHIP
COACHES &
ADMINISTRATIVE
TEAM
Nicky Martin, BSA, LNHA, CDP, St.
Louis/Southeast/Southwest
573-217-9382 martincaro@missouri.edu
Marilyn Rantz, PhD, RN, FAAN, Curators’
Mark Francis, MS, LNHA, Kansas City/West/Southwest Professor Emerita, Project Director
417-499-9380 francismd@missouri.edu
Libby Youse, BGS, LNHA, CDP, North & Central
660-651-3778 youseme@missouri.edu
Jessica Mueller: Senior Program/Project Support
Coordinator
Ronda Cramer: Project Support 52
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261/11/2021
THANK YOU FOR JOINING US!
QUESTIONS? RE SO UR C ES
• Please take time to complete our
survey. Let us know how we are • https://covidvaccine.mo.gov/
doing and what future subject • https://health.mo.gov/living/healthcondiseases/com
matter you would like! municable/novel-coronavirus/pdf/visitation-
guidance.pdf
• https://www.cdc.gov/vaccines/covid-19/toolkits/long-
Take SURVEY term-care/index.html
• https://showmestrong.mo.gov/data/public-health/
HERE • www.nursinghomehelp.org
• https://health.mo.gov/living/healthcondiseases/com
municable/novel-coronavirus/cares-act-funding.php
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