06/03/2021

Today's COVID-19 Report: Thursday, June 3, 2021

Thursday, June 3, 2021

Here are the latest need-to-know updates for Thursday, June 3 regarding the COVID-19 pandemic and other topics of importance.

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Off the Record

“My CFO and I have some very interesting conversations in the shower each morning!” 

At today’s Philanthropy Gathering, Oxford Seniors Executive Director Steve Schnabl spoke to the many roles that executives of small organizations must fill, as they simultaneously wear the CEO hat, the CFO hat, the fundraiser’s hat … and more.

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In Today's Report

• 2021 Activities/Life Enrichment Summit June 22
• ODH confirms Ohio Orders do not include nursing homes and assisted living facilities
• Survey Tip of the Week: Antibiotic Stewardship
• LeadingAge Ohio Compensation Survey results compiled
• LeadingAge Need to Know

2021 Activities/Life Enrichment Summit June 22

The 2020 #ActivitiesStrong Virtual Summit was the largest and most successful virtual event for activity and life enrichment professionals in senior living. Following this success, the Summit returns on June 22 as a way to continue to acknowledge, educate, and empower activity and life enrichment professionals. Participants this year will be able to learn what the state of resident engagement will be post-COVID19 pandemic, explore best practices, and understand the long-lasting changes that will impact how we build person-centered experiences for older adults.

Please forward this information to the Activities team in your community.

ODH confirms Ohio Orders do not include nursing homes and assisted living facilities

The Ohio Department of Health (ODH) in a news release yesterday confirmed that the Ohio Orders rescinded on June 2 would not include the Orders affecting nursing homes and assisted living, which include: 

• The Director’s Seventh Amended Order to Permit Access to Ohio’s Nursing Homes, with Exceptions signed March 22, 2021.
• The Amended Director’s Order to Permit Access to Ohio’s Residential Care Facilities, with Exceptions signed March 22, 2021.
• The Director’s Amended Order for the Testing of the Residents and Staff of all Residential Care Facilities signed May 4, 2021.
• The Director’s Amended Order for the Testing of the Residents and Staff of all Nursing Homes signed May 4, 2021.

LeadingAge Ohio continues to advocate regarding concerns where the Ohio Orders are inconsistent with the Centers for Medicare & Medicaid Services (CMS) and/or the Centers for Disease Control and Prevention (CDC), especially when the inconsistencies add extra burden, such as with the escorting requirement.

LeadingAge Ohio has asked ODH Bureau of Survey and Certification to respond to the following question:

The order says fully vaccinated residents can have close contact as long as wearing face mask whereas the updated guidance says they don’t have to wear source control if fully vaccinated. One additional thing that makes this confusing - the first item in the Ohio Order says to follow QSO-20-39 which has been updated with the CDC guidance. So, since the Order itself now conflicts within itself, can nursing homes allow fully vaccinated visitors in the designated visitation area to not wear a face mask?

ODH responded to the question by stating:

We would look at the QSO memo for compliance determination.

Survey Tip of the Week: Antibiotic Stewardship

Antibiotic Stewardship is a focus area for the Centers for Medicare and Medicaid Services (CMS) as outlined in the Updates and Initiatives to Ensure Safety and Quality in Nursing Homes QSO-20-03-NH memo. Failure to follow the organization’s own policies results in the most common Antibiotic Stewardship citations. Examples of these citations include:

• The order gave no ending date for use of the antibiotic and the pharmacy failed to recognize/question/make recommendations to the physician regarding the continued use of an antibiotic with no stop date indicated.
• Resident was on an antibiotic for prevention of a urinary tract infection. Further review lacked any documentation of a urine culture being completed or signs and symptoms of a UTI. There lacked any use of the McGeer's form as required for antibiotic use as required per the antibiotic stewardship program policy and procedure.
• The facility did not conduct and implement an annual facility assessment. The facility did not track all residents on an antibiotic, only those meeting McGeer’s criteria. The facility did not track antibiotic orders for new admissions that are admitted with the order.
• The nurse practitioner and/or physician did not follow and was not aware of the facility’s antibiotic stewardship program.
• The facility’s infection control log did not contain results of cultures and did not always indicate if a culture was obtained.

The unnecessary medications and infection survey pathways provide the following surveyor guidance to determine compliance:

• Demonstrates use of written protocols or resources to guide antibiotic use.
  • The use of infection assessment tools for antibiotic use for one or more infections (e.g., use of a Situation, Background, Assessment and Recommendation (SBAR) communication tool for UTI assessment, application of the Loeb minimum criteria for initiation of antibiotics).
• Antibiotics – interactions with other medications (e.g., warfarin), adverse events (e.g., rash, diarrhea); prescriptions must include documentation of indication, dose, route and duration and be reviewed 2-3 days after antibiotic initiation to assess response and labs, and prescriber should reassess antibiotic selection as appropriate.
• Ask staff what protocols they have in place (e.g., lab to monitor for adverse events and drug interactions related to use of antibiotics).
• Written antibiotic use protocols on antibiotic prescribing, including the documentation of the indication, dosage, and duration of use of antibiotics should include;
  • Protocols to review clinical signs and symptoms and laboratory reports to determine if the antibiotic is indicated or if adjustments to therapy should be made and identify what infection assessment tools or management algorithms are used for one or more infections (e.g., SBAR tool for urinary tract infection (UTI) assessment, Loeb minimum criteria for initiation of antibiotics);
  • A process for a periodic review of antibiotic use by prescribing practitioners: for example, review of laboratory and medication orders, progress notes and medication administration records to determine whether or not an infection or communicable disease has been documented and whether an appropriate antibiotic has been prescribed for the recommended length of time. Determine whether the antibiotic use monitoring system is reviewed when the resident is new to the facility, when a prior resident returns or is transferred from a hospital or other facility, during each monthly drug regimen review when the resident has been prescribed or is taking an antibiotic, or any antibiotic drug regimen review as requested by the QAA committee;
  • Protocols to optimize the treatment of infections by ensuring that residents who require antibiotics are prescribed the appropriate antibiotic;
  • A system for the provision of feedback reports on antibiotic use, antibiotic resistance patterns based on laboratory data, and prescribing practices for the prescribing practitioner.

The survey pathways can be found on the CMS Nursing Home webpage, under the download section, and within the zip file called LTC Survey Pathways.

The Appendix PP State Operations Manual can be found under the download section.

As the survey process continues, LeadingAge Ohio is sharing tips each week to assist members during the survey process. Send questions you’d like addressed in future Tips of the Week to Stephanie DeWees at sdewees@leadingageohio.org.  

Please join us for the monthly STAT: Survey Tips and Tactics webinar which occurs on the second Wednesday of every month at 10:00AM.

LeadingAge Ohio Compensation Survey results compiled

To all who participated in the 2021 LeadingAge Ohio Compensation Survey, Brad Webber from L.R. Webber reported that those who participated will be receiving their individual organization’s reports in the next few days. LeadingAge Ohio will be highlighting results in a future COVID-19 report. If you have questions about the survey, please contact Brad at bwebber@lrwebber.com.

LeadingAge Need to Know

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's Need to Know featured a new CAST case study and new insights and tools from LeadingAge.

Check out today's complete Need to Know here.                                             

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Questions

Please send all questions to COVID19@leadingageohio.org. Additionally, members are encouraged to visit the LeadingAge Ohio COVID-19 Working Group facebook gro up to pose questions to peers and share best practices. LeadingAge is continuing its daily calls for all members.  To participate in these daily online updates, members should register here.  

LeadingAge Ohio is working to ensure that the information in our daily alerts, on our website, and all coronavirus-related communications is as accurate as possible. However, LeadingAge Ohio makes no guarantees about the accuracy of the information.