The NHSN Vaccination Team will be hosting two webinars to review important changes to the surveillance definition of up to date with COVID-19 vaccines. These webinars are geared toward long-term care facilities reporting vaccination data through the NHSN COVID-19 Vaccination Modules.

Key Points:

What are the new recommendations?

  • ACIP and CDC provided new recommendations of COVID-19 vaccines for individuals aged 65 years and older.
  • Individuals aged 65 years and older are up to date when they have received 2 doses of the updated 2023-2024 COVID-19 vaccine or received 1 dose of the updated 2023-2024 COVID-19 vaccine in the past 4 months.
  • There is no change to the up to date definition for individuals younger than 65 years. Therefore, individuals aged less than 65 years are up to date when they have received 1 dose of the updated 2023-2024 COVID-19 vaccine (any time since it was approved in September 2023).
  • The new definition applies to both the NHSN Weekly HCP and Resident Vaccination Forms.
  • The up to date definition change for individuals aged 65 years and older will occur at the start of Quarter 2 of 2024 (week of April 1 – 7, 2024).

How should facilities report data beginning with Quarter 2 of 2024?

  • Residents and healthcare personnel aged 65 and older should NOT be counted as up to date with COVID-19 vaccines until they receive a second dose of the 2023-2024 updated COVID-19 vaccine; or if they have received 1 dose of the updated 2023-2024 COVID-19 vaccine in the past 4 months.
  • Be careful not to incorrectly over-report the number of residents who are up to date. Residents aged 65 and older who previously had 1 dose of the 2023-2024 COVID-19 vaccine greater than 4 months ago, should NOT be counted as up to date (question #2).
  • Continue to count residents and healthcare personnel age less than 65 as up to date if they have received 1 dose of the updated 2023-2024 COVID-19 vaccine.

Webinar dates and registration

Topic: Updates to Weekly COVID-19 Vaccination Data Reporting: Long-term Care Facilities

When: Wednesday, March 27, 2024, 2:00 PM Eastern Time (US and Canada)
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN__F98eZSGSReD3vznNL2tzg

When: Tuesday, April 2, 2024, 2:00 PM Eastern Time (US and Canada)
Register in advance for this webinar: https://cdc.zoomgov.com/webinar/register/WN_rjHZrnezSaqzTUzZ0jagxQ

After registering, you will receive a confirmation e-mail containing information about joining the webinar. Both webinars will cover the same information.

Questions
Please use NHSN-ServiceNow to submit questions to the NHSN Help Desk. The new portal can be accessed here and should be used in place of nhsn@cdc.gov, nhsntrain@cdc.gov, and nhsndua@cdc.gov. ServiceNow will help the NHSN team respond to your questions faster. Users will be authenticated using CDC’s Secure Access Management Services (SAMS), the same way you access NHSN. If you do not have a SAMS login, or are unable to access ServiceNow, you can still e-mail the NHSN Help Desk at nhsn@cdc.gov.

HQIN is presenting an educational series tailored for nursing home stand-up meetings, aimed at decreasing preventable emergency room (ED) visits and hospital readmissions. HQIN is sending out talking points that can be included in daily stand-up meetings to increase staff knowledge on relevant topics like effective communication, adverse drug events and infection prevention. The program is designed to empower nursing home staff with practical knowledge to foster a safer environment.

This week’s strategies include Discharge Analysis. Below is an overview of information and resources.

  • Any time an emergency department (ED) visit, unplanned discharge or adverse event occurs, we can identify areas where improvement is possible.
  • Do you have a process in place to review ED visits and unplanned discharges?
  • Does an interdisciplinary team conduct these reviews?
  • Are they done after each transfer or adverse event?

Discuss current strategies for improvement.

If not already established, consider assembling an interdisciplinary team consisting of leadership, the medical director and direct care staff to review these events.

  • A resident may discharge unexpectantly for a number of different reasons. It might seem like there was nothing that would have prevented an ED visit or hospitalization but often processes could have identified a problem before it resulted in discharge. Facilities must have processes in place for early identification of changes in condition and to communicate those changes to ensure timely interventions.

Assess your facilities communication processes. Do you have a huddle meeting with frontline staff to share and discuss important information? If not, consider using the HQIN Huddle Toolkit to implement huddles at start of shift and end of shift, quality improvement huddles, new resident huddles or “Everyone Stands Up Together” huddles where the daily standup meeting is conducted on the unit(s) with frontline staff.

Also, INTERACT® (Interventions to Reduce Acute Care Transfers) offers communication tools at no cost including Stop and Watch Early Warning Tool, SBAR (Situation, Background, Appearance and Review and Notify) and the Medication Reconciliation Worksheet.

  • Other adverse events should trigger the same evaluation as unplanned discharges. Reviewing adverse events helps to find opportunities for improvement that can prevent future ED visits or hospitalizations.
    • When issues are identified or communicated, how are these issues reviewed?
    • Are they reviewed at risk management meetings?

Discuss how possible opportunities are communicated to the risk management team. Use the EMR to help identify factors like changes in condition, falls, medication errors, etc. to include in risk management meetings.

  • Residents and families play an important role in preventing ED visits and hospitalizations. Care planning and advanced care planning should be discussed with patients and families regularly. Review CMS’ Go to the Hospital or Stay Here Decision Guide for patients and families. Make use of the resource to assist patients and families to plan for future care.

INTERACT® (Interventions to Reduce Acute Care Transfers) also offers care planning tools at no cost including the Advance Care Planning Communication Guide and Identifying Residents who may be Appropriate for Hospice or Palliative/Comfort Care Order. Choose your favorite resources as a team and make sure they are available to assist with care planning.

  • Sometimes the root cause of an adverse event is not immediately clear. Root cause analysis can help uncover the cause, and a fishbone diagram can assist with finding it. Fill out the problem (adverse event) at the head of the fish. As you brainstorm possible causes, group them into categories. Use these categories to identify areas where improvement would be beneficial.

When you have identified a problem and root cause, you will want to implement quality improvement interventions. Consider the problems and root causes you have noted this week. Use the QAPI Sustainability Decision Guide to assist with choosing effective interventions.

INTERACT® Version 4.5 Tools For SNFs/Nursing Homes also offers quality improvement resources including an Acute Care Transfer Log, Calculating Hospitalization Rates, Hospitalization Rate Tracking Tool, Quality Improvement Tool for Review of Acute Care Transfers and Quality Improvement Summary Worksheet.

The Missouri Department of Social Services has contracted with Myers and Stauffer to conduct provider training. This webinar will be divided into two sessions. You may choose to participate in one or both sessions.

The Morning Session (9:00 am – 10:00 am CST) will include:

    • Case Mix Review Process
    • Web Portal Access and Submissions

The Afternoon Session (1:00 pm – 2:30 pm CST) will include:

    • Supportive Documentation Requirements

Please plan to join us during one or both of the scheduled sessions. Registration is required.

March 19, 2024
Morning Session: 9:00 am – 10:00 am CST
To register for this webinar, click here!
To join by phone, dial: 1-844-740-1264
Access Code: 2421 836 0727
Event Password: MOTraining

Afternoon Session: 1:00 pm – 2:30 pm CST
To register for this webinar, click here!
To join by phone, dial: 1-844-740-1264
Access Code: 2428 242 0685
Event Password: MOTraining

March 26, 2024
Morning Session: 9:00 am – 10:00 am CST
To register for this webinar, click here!
To join by phone, dial: 1-844-740-1264
Access Code: 2438 288 2508
Event Password: MOTraining

Afternoon Session: 1:00 pm – 2:30 pm CST
To register for this webinar, click here!
To join by phone, dial: 1-844-740-1264
Access Code: 2437 705 7018
Event Password: MOTraining

March 27, 2024: Supporting Person Centered Cultures
Special Guest: Stacey Bergmann, Director of Community and Network Relations, Center for Innovation (CFI)

In her role at CFI, Stacey is carrying on the mission of Pioneer Network, working together with leaders from the state culture change coalitions. Together with MC5 board member and conversation host, Kim Fanning, attendees will explore with Stacey what is happening around the country as CFI, along with state coalitions, work to find ways to help providers grow their person-centered cultures.

April 3, 2024: Care Connection – Opportunities to Create Positive Aging Experiences
Location: First United Methodist Church Celebration Center, Sedalia
Presenters: Wendy Martin, MHA; Rona McNally, Care Connection; Marilyn Gunter, BSW,MSW

Join facilitators from Care Connection who will provide information about their person-centered approach to services. During this presentation it will be shared how Care Connection maintains a person-centered focus in the development and delivery of services. Attendees will learn the importance of family caregiver support for person-centered care and how the Long-Term Care Ombudsman program supports individuals’ rights and choices, serving as advocates and educators. Also, the Missouri SMP (Senior Medicare Patrol), will inform attendees of current Medicare/Medicaid fraud trends and the importance of protecting health care benefits.

HQIN is presenting an educational series tailored for nursing home stand-up meetings, aimed at decreasing preventable emergency room (ED) visits and hospital readmissions. HQIN is sending out talking points that can be included in daily stand-up meetings to increase staff knowledge on relevant topics like effective communication, adverse drug events and infection prevention. The program is designed to empower nursing home staff with practical knowledge to foster a safer environment.

This week’s strategies include Medication Reconciliation. Below is an overview of information and resources.

  • If a resident’s medication orders reflect the wrong medication, the wrong dose, the wrong time, or the wrong route, adverse drug events are likely. Review which staff reconciles medication on admission. Discuss with the team the policy for admission medication reconciliation.
    • How many times are admission orders reviewed?
    • Is the contacted pharmacy made aware when orders are for a new admission?
    • How are diagnoses, indications and allergies identified?

Are medications reviewed with the previous facility during report?
Review the Interact Medication Reconciliation Worksheet. How does this compare to the facility’s medication reconciliation processes?

  • After admission, every nurse that gives medication is responsible for giving medication correctly. Along with the Five Rights of medication administration (right patient, right drug, right dose, right route, right time), nurses will need to be aware of the indications for medications, any needed lab work or monitoring and possible adverse reactions.
    Discuss the systems in place at your facility to ensure medications are given properly. Review the Five Rights with staff.
  • Doctors, nurse practitioners and pharmacists should be involved in medication reconciliation.
    Ask your team these questions:
    • When is this review triggered in your facility?
    • If there has been a behavior change, is medication reviewed for possible side effects?
    • Who can you reach out to internally and at the contracted pharmacy if you are unsure if orders or administration are appropriate or with any other questions?
  • Medication reconciliation should not stop at admission. Changes in condition or changes in locations should trigger a medication review.
    Are physicians or pharmacists notified when a resident’s condition changes?
    Are they notified when a resident becomes more or less compliant with medication or diet?
    These changes could result in the need for closer monitoring or changes to medications. Residents with over eight scheduled medications are at higher risk for drug-to-drug interactions. Do you have a process to handle those higher risks?
  • Medication needs to be administered according to company policy. Using a computer system to assist with medication administration helps prevent medication errors. Discuss the drawbacks staff see in using the computer system.
    Do you experience fatigue due to repeated drug interaction alerts? How can those drawbacks be eliminated? Review some lessons learned about implementing and using technology in a clinical setting.

The SLCR Health Education Unit will be conducting another Instructor Information Meet Up.

March 12, 2024: Instructor Meet Up
Time: 2:00 p.m.-3:00 p.m.

Please see the CNA Registry webpage for past meetings and more information.

If you have questions, please call our office at 573-526-5686.

April 17-18, 2024: SNF ICD-10 Workshop
Location: Capitol Plaza Hotel, Jefferson City

This session is designed for both individuals new to their role in ICD-10 coding and those who have some experience but need to further their ICD-10 coding knowledge.

HQIN is presenting an educational series tailored for nursing home stand-up meetings, aimed at decreasing preventable emergency room (ED) visits and hospital readmissions. HQIN is sending out talking points that can be included in daily stand-up meetings to increase staff knowledge on relevant topics like effective communication, adverse drug events and infection prevention. The program is designed to empower nursing home staff with practical knowledge to foster a safer environment.

This week’s strategies include Adverse Drug Events – Opioids. Below is an overview of information and resources.

  • Adverse drug events are commonly experienced by people taking opioids as well as anticoagulants. Like anticoagulants, you will want to ensure staff caring for residents know which residents are at risk and what risk factors and sign/symptoms of adverse events may be. Discuss opioid risk factors, adverse event signs/symptoms and interventions using the Opioid Tip Sheet for Frontline Nursing and CMT Staff.
  • Using non-medication pain relief methods can decrease the need for opioids. Communicating with residents and families will help find the most effective pain relief methods for each patient. Sometimes facilities use methods like applying heat/cold, massage, ultrasound, or stretching exercises to help ease pain. Remember to evaluate things like positioning, bed choice and seating choice when you are working to reduce pain.
  • Knowledge of risk factors, signs and symptoms of adverse drug events, and the best ways to stay safe can prevent them and assist with early identification. Review your policy for medication education and explore Opioid Resources for Patients and Caregivers.
  • Opioids can be useful for controlling pain, but it is important to remember they carry a high risk for adverse events. Review the Opioid Adverse Drug Events Self-Assessment with your team. Use the Plan-Do-Study-Act Worksheet to work toward improvements.
  • Narcan (Naloxone) is a medication used to reverse the effects of opioids. It is often discussed for treatment of overdose with illicit drugs but is often needed for people who are prescribed opioids. Every nursing home should have a policy for Narcan use. Review your facility’s policy with staff. Can staff identify where Narcan is kept and when it should be given? Post the Opioid Information Card to educate residents and caregivers.

Attention Mandated Reporters: Missouri’s Adult Abuse and Neglect Hotline online reporting application is being upgraded and the link will change on Monday, February 26 If you have saved the old link, it will no longer work after February 26; however, the online reporting application can still be accessed at Health.Mo.Gov/abuse. As a mandated reporter we encourage you to access the link on the webpage to report adult abuse, neglect, self-neglect, and financial exploitation.

Missouri Department of Health and Senior Services, Division of Senior and Disability Services is dedicated to providing you with the support you need, when you need it. If you have any questions or concerns, you may send them to DSDSOfficeofConstituentServices@health.mo.gov.

HQIN is presenting an educational series tailored for nursing home stand-up meetings, aimed at decreasing preventable emergency room (ED) visits and hospital readmissions. HQIN is sending out talking points that can be included in daily stand-up meetings to increase staff knowledge on relevant topics like effective communication, adverse drug events and infection prevention. The program is designed to empower nursing home staff with practical knowledge to foster a safer environment.

This week’s strategies include Adverse Drug Events – Anticoagulants. Below is an overview of information and resources.

  • An adverse drug event (ADE) is harm that results from medication use. These events can be due to allergic reactions, side effects, overmedication and medication errors. Anticoagulant medications are necessary for the treatment of some conditions but are also a leading cause of ADEs resulting in ER visits or hospitalization. Review ADE risk factors and sign/symptoms on this Anticoagulant Antithrombotic Tip Sheet.
  • Also, review the Centers for Disease Control and Prevention’s (CDC) Adverse Drug Events in Adults for more safety information.
  • Review your policy for medication education. Blood Thinner Pills: Your Guide to Using Them Safely provides resources for educating residents and families.
  • Evaluating your facility’s anticoagulant program can assist you with identifying and addressing opportunities for improvement.
  • This Anticoagulant Adverse Drug Events Self-Assessment provides a checklist for anticoagulant programs.

The Missouri Antimicrobial Stewardship Educational Collaborative is working with Washington University on an antibiotic stewardship project and are seeking input from Skilled Nursing Facility and other Long Term Care Facilities (Intermediate, Assisted, and Residential Care Facilities), in addition to MO hospitals. Please take a few minutes to complete their survey.

Washington University School of Medicine is performing a survey on behalf of the Missouri Department of Health and Senior Services, Hospital Associated Infections and Antimicrobial Resistance Program.

The survey can be found at the attached link here: Survey Link. It should take approximately 15 minutes to complete.

This survey is intended to evaluate the current state of antimicrobial stewardship activities at Missouri long-term care facilities. Please forwards it to whomever at your facility is most involved with the antimicrobial stewardship and the management of antimicrobial use, or if no such person exists your medical director or pharmacy leadership. We request this survey be completed by March 1, 2024.

For any questions regarding this facility antimicrobial stewardship survey, please submit a new email to mo.stewardship@wustl.edu; use “MO DHSS Antimicrobial Stewardship Survey” in the subject line.

We appreciate the time you take to complete these surveys!

Long-Term Care Facilities (all levels of care) are strongly encouraged to complete an electronic survey weekly to report how many beds they have available, and which residents they can serve, i.e., memory care, behavioral health, bariatric, etc. This information is used to generate a dashboard that is beneficial to facilities, families, hospital discharge planners and the general public to determine bed availability and services throughout the state. Please access the survey at this link: survey. To view the dashboard access this link: dashboard.

If you have any questions about the survey, please contact the Long-Term Care Ombudsman Program via email LTCOmbudsman@health.mo.gov or call 800-309-3282.

This is a great opportunity to share what your facility has to offer!

March 5, 2024: Registration
March 14, 2024: Registration
March 20, 2024: Registration

Tools of Choice is an evidence-based program focused on the implementation of universal positive practices. This two-hour introductory training is open to community members, parents, and professionals. It covers key concepts of the Tools of Choice curriculum, including: What is behavior, building positive relationships, and how to increase desirable behavior. Join the Positive Support Consultants in learning strategies to make positive change by implementing universal positive practices.

Registration is also available on the Upcoming Webinar Webpage.

 

The SLCR Health Education Unit will be conducting Instructor Information Meet Ups again.

March 5, 2024: Instructor Meet Up

Please see the CNA Registry webpage for past meetings and more information.

If you have questions, please call our office at 573-526-5686.

May 9, 2024: All Boats Rise HealthCare Workforce Summit
Location: Renaissance at the Airport, St. Louis

LeadingAge Missouri, along with other Missouri association partners are pleased to announce the All-Boats Rise: 2024 Healthcare Workforce Summit. This Summit is about collaboration for high quality workforce solutions. The Summit’s programmatic goals are to present content that is insightful, thought provoking, innovative, and above all, actionable. Carefully curated topics will be probed by expert moderators, panelists, and speakers. Their willingness to share is hugely appreciated. We are also indebted to volunteer industry professionals and to the many sponsors highlighted in this program and from the Summit stage. All Summit participants are encouraged to thank and connect with these sponsors during multiple networking opportunities throughout the day. While you come to learn, we hope you take advantage of engagement opportunities that may foster relationships and lead to productive collaboration.

We have recently received in influx of questions related to the qualifications for director of food and nutrition services in skilled nursing facilities. The federal regulation (F801) requires one of the following qualifications (if a qualified dietician or other clinically qualified nutrition professional is not employed full-time):

  1. A certified dietary manager; or
  2. A certified food service manager; or
  3. Has similar national certification for food service management and safety from a national certifying body; or
  4. Has an associate’s or higher degree in food service management or in hospitality, if the course study includes food service or restaurant management, from an accredited institution of higher learning; or
  5. Has 2 or more years of experience in the position of director of food and nutrition services in a nursing facility setting and has completed a course of study in food safety and management, by no later than October 1, 2023, that includes topics integral to managing dietary operations including, but not limited to, foodborne illness, sanitation procedures, and food purchasing/receiving.

CMS has noted that the approved certifications and course requirements would be the equivalent of a ServSafe Food Manager certification. Additional food manager courses we have found to meet the requirements include: AAA Food Handler, Learn2Serve, and State Food Safety.

The Missouri Antimicrobial Stewardship Educational Collaborative is working with Washington University on an antibiotic stewardship project and are seeking input from Skilled Nursing Facility and other Long Term Care Facilities (Intermediate, Assisted, and Residential Care Facilities), in addition to MO hospitals. Please take a few minutes to complete their survey.

Washington University School of Medicine is performing a survey on behalf of the Missouri Department of Health and Senior Services, Hospital Associated Infections and Antimicrobial Resistance Program.

The survey can be found at the attached link here: Survey Link. It should take approximately 15 minutes to complete.

This survey is intended to evaluate the current state of antimicrobial stewardship activities at Missouri long-term care facilities. Please forwards it to whomever at your facility is most involved with the antimicrobial stewardship and the management of antimicrobial use, or if no such person exists your medical director or pharmacy leadership. We request this survey be completed by March 1, 2024.

For any questions regarding this facility antimicrobial stewardship survey, please submit a new email to mo.stewardship@wustl.edu; use “MO DHSS Antimicrobial Stewardship Survey” in the subject line.

We appreciate the time you take to complete these surveys!

April 25-26, 2024: MO Immunization Conference: Building Immunity in Missouri Communities
Location: Holiday Inn Executive Center, Columbia

The Conference brings together bright minds to give talks that are action-oriented on a wide range of subjects related to immunizations to foster learning and inspiration, as well as provoke conversations that matter and actions that lead to increased vaccination rates for Missourians. We aim to empower the public health workforce by offering a stage for stakeholders to share innovative ideas, equitable solutions, and their personal experiences promoting immunizations.

February 20, 2024: Put the Care in Caregiving

The pressures of caregiving, whether inside or outside the home, can lead to a lack of empathy and several physical symptoms, known as caregiver compassion fatigue or burnout. In the wake of a pandemic that claimed over 5.5 million lives, knowing your limits and what to do when you’ve reached them is essential. Learn the signs of caregiver compassion fatigue to identify them in yourself or others and explore options for relief.

February 29, 2024: Summit to Protect Older Adults and Adults with Disabilities

This summit is a conversation with the community, professionals, older adults, and others to learn what needs to be fixed in the adult protection system.

March 18, 2024: Navigating Long-Term Care Choices and Understanding Nursing Home Residents’ Rights

A Professional Care Manager helps to develop care plans while resolving family conflicts. Find out how a care manager can help you to have autonomy in your life. An Ombudsman Professional will be on hand to understand Residents’ Rights in the long-term care facility.

March 19, 2024: Community Education: Driving Yourself Lonely

Loneliness and lack of connection in older adults have recently been reported as a public health crisis in the United States, the consequences of such potentially being an increased risk of heart disease, stroke, dementia, and premature death. What role does transportation play in exacerbating this problem, and how is this being addressed in St. Louis? Get your questions answered in this webinar!