CAHF’S MARY JANN TO SPEAK AT NURSES COUNCIL MEETING FEB. 11
January 25, 2010
CAHF’S MARY JANN TO SPEAK AT SACRAMENTO CAHF CHAPTER NURSES COUNCIL MEETING FEB. 11
Due to uncontrollable circumstances at the Department of Health Services, Gerrie Cassey will be unable to speak at the Thursday, Feb. 11, meeting of the CAHF Sacramento Chapter Nurses Council.
Instead, Mary Jann, CAHF director of regulatory affairs, has graciously agreed to speak in Gerrie’s place — still providing the same topic information, “Survey Preparedness for the Charge Nurse.”
NEW VENUE Because of the overwhelming response for this meeting, we have also had to switch venues to accommodate everyone. The Feb. 11 meeting will now be held at The Courtyard by Marriott, 1782 Tribute Road, Sacramento, CA 95815 — west of Cal Expo, off Exposition Boulevard.
PLEASE RSVP If you have not already RSVP’d, please do so no later than Feb. 8 to Patti McVay, (916)214-2892, rhcpatti@sbcglobal.net. If you have RSVP’d and are no longer able to attend, please let Patti know as well by Feb. 8.
The fee is $25 per person for CAHF members and $35 for nonmembers. But you can save money: Bring four staff from your facility and pay for only three. Thank you all so much for the overwhelming support and response for this meeting.
Response shows this topic is of a great deal of interest to many of you, and Mary Jann’s presentation will be very helpful to all who attend!
THANKS TO GULF SOUTH
Thanks to CAHF member Gulf South Medical Supply of Roseville for sponsoring this presentation.
QCHF Goes Electronic
January 13, 2010
QCHF is moving into the electronic age! In 2010, they will no longer be printing binders for conferences. Instead materials will be posted online prior to the conference, and a CD will be provided to attendees on-site. Attendees will be emailed a link, and will be able to print the materials needed.
QCHF did this for the Disaster Preparedness Conference last September with great success, and is excited about introducing the process to both the DONs and DSDs this year.
Anyone planning to come to the DON Conference will need to print out their materials prior to the conference.
DON Conference Hotel Cut-Off Date and Early Registration
The hotel cut-off date is rapidly approaching for the 11th Annual DON Conference. Don’t miss out on this great rate at the Hilton Palm Springs Resort – register for the conference, and then make your hotel reservations before January 20th!
The price of conference registration will go up by $100 after January 31st, 2010. Take advantage of early bird prices and register now.
Two days of great speakers, classes, networking and exhibitor tabletop show. Conference topics include: Leadership for DONs, Infection Control, Cultural Diversity, Pressure Ulcers, a CDPH update, and much much more. This is a great opportunity for new DONs to learn from the best and make new connections, it is a chance for veterans to hone their skills and see old friends. Brochure available at the QCHF website (www.qchf.org) – register now!
Staff contact: Laura Thomas 916.441.6400 ext 118 or via email at: lthomas@cahf.org
Help Evaluate Geriatric Nursing Knowledge Assessment Tool
November 16, 2009
- Complete the online assessment tool (70 questions)
- Answer questions regarding the assessment tool such as the amount of time it took to complete, ease of use, technical difficulties, problems with specific assessment questions.
Culture Change Educational Opportunities
October 31, 2009
“Culture change” is a term used to refer to care that focuses on people and relationships. A resident-centered or culture changed nursing home can be defined as an organization that has:
- Close relationships existing between residents, family members, staff, and community;
- Residents direct their own care and living choices (e.g., daily schedules, food choices, other decisions);
- Personnel organized around the needs and desires of clients rather than by departments;
- Management that allows collaborative and group decision making;
- Processes/measures that are used for continuous quality improvement;
- A living environment that is designed to be a home rather than an institution
Nursing home professionals have a unique chance in 2010 to do the right thing, and adopt person directed care in their facilities. The California Culture Change Coalition invites you to join our Regional Collaboratives, an innovative program that guide nursing homes through their Culture Change journey. Register now at http://www.calculturechange.org/index.html , new sessions will begin in January 2010.
Some benefits our Regional Collaboratives provide are:
- Insight from expert faculty about how culture change practices meet regulatory requirements.
- On-going conversations about work place practices that better meet the needs of residents and staff.
- CEU’s for Nurses, CNA’s and NHA P Credits.
- Register up to 6 team members per home.
- Knowledge about sustaining change with action planning and on-going support.
- Networking with other nursing homes
Quarterly Topics include
- The Process of Change
- Person-Centered Care Practices
- Putting the Home in Nursing Homes (environment)
- Building Community
Participating nursing home staff get education, networking and expert support to succeed on their culture change journey and CEUs as well!
Visit http://www.calculturechange.org/index.html today to find out more, and look for the Regional Collaborative link on the home page for pricing and registration
SAVE THE DATE!
Building Community: Tearing Down Walls. Focus on Culture Change in the Environment.
The California Culture Change Coalition third annual conference is March 2nd in Foster City and March 4th in Anaheim. Registration information will be available soon so watch this site for mor
CDC AND OSHA ISSUE REVISED H1N1 GUIDANCE
October 16, 2009
The American Health Care Association reports that the federal Centers for Disease Control and Prevention and he Occupational Safety and Health Administration on Oct. 14 jointly announced release of CDC “Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel.”
As expected, the guidance continues to recommend the use of respiratory protection that is at least as protective as a fit-tested disposable N95 respirator for health-care personnel who are in close contact with patients with suspected or confirmed 2009 H1N1 influenza.
The recommendation includes the following statement: “This recommendation applies uniquely to the special circumstances of the current 2009 H1N1 pandemic during the fall and winter of 2009-2010, and CDC will continue to revisit its guidance as new information becomes available, within this season if necessary.”
CDC Director Thomas Frieden emphasized that the guidance specifically applies to the H1N1 2009 pandemic. He noted that respiratory protection is the last line of defense in a hierarchy of controls to prevent influenza transmission, and he stressed that facilities should have a comprehensive plan that includes the other important mechanisms to protect health-care workers.
Acknowledging the N95 shortage, Dr. Frieden pointed out that the new guidance gives significant consideration to supply issues. He also announced the release of a second document, “Regarding Respiratory Protection for Infection Control Measures for 2009 H1N1 Influenza among Healthcare Personnel,” that provides, in question-and-answer format, information to assist health-care facilities to optimize implementation of recommended respiratory-protection practices in the context of shortages.
OSHA Assistant Secretary Jordon Barab stated that, upon worker request or complaint, OSHA will inspect health-care institutions to make sure that they are following CDC guidance and that OSHA may issue citations under the Respiratory Protection Standard, as well as the General Duty Clause to keep workers free from hazards. OSHA will issue a detailed compliance document for inspectors within a couple of weeks.
Regarding the N95 supply problem, Barab stated that employers who make a good-faith effort to obtain N95s will not be cited, although they may receive a hazard-alert letter that would enumerate other protection methods. A good faith-effort, according to Barab, could be demonstrated by documents showing attempts to place orders or statements from suppliers.
The updated guidance expands on earlier guidance by emphasizing that successfully preventing transmission requires a comprehensive approach. Additional revisions from earlier guidance include: Recommended time away from work for health-care personnel, recommending facemasks when N95s are not available and recommending establishing policies to manage visitors. The revised guidance also expands upon information on the hierarchy of controls.
RECOMMENDED TIME AWAY FROM WORK FOR HEALTH-CARE PERSONNEL
According to the revised guidance, health-care personnel who develop a fever and respiratory symptoms should be excluded from work for at least 24 hours after they no longer have a fever, without the use of fever-reducing medicines.
FACEMASKS
The revised guidance recommends facemasks for health-care personnel who are not provided a respirator as a result of N95 supply shortages. Facemasks should be chosen over no protection. Routine chemoprohylaxis is not recommended for personnel wearing facemasks during the care of patients with suspected or confirmed 2009 H1N1 influenza.
VISITORS
The updated guidance recommends establishing procedures for managing visitor access and movement within a facility to include limiting visitors for patients in isolation for influenza to persons who are necessary for the patient’s emotional well-being and care.
The guidance also recommends scheduling and controlling visits to allow for screening for symptoms of acute respiratory illness before entering the facility, along with instruction, before entering the patient’s room, on hand hygiene, limiting surfaces touched and use of PPE according to current facility policy while in the patient’s room. Visitors should also be instructed to limit their movement within the facility
HIERARCHY OF CONTROLS
The revised guidance recommends a hierarchy of controls approach to prevent exposure of health-care personnel and patients and prevent influenza transmission within health-care settings. The guidance ranks the preventive interventions in the following order: 1) Elimination of exposures; 2) engineering controls; 3) administrative controls; and 4) personal protective equipment.
The new interim guidance is available on the CDC Web site at http://www.cdc.gov/h1n1flu/guidance/ill-hcp.htm. The question-and-answer supplement is available at http://www.cdc.gov/h1n1flu/guidance/ill-hcp_qa.htm.
VACCINE SHORTAGE FOR SEASONAL FLU
This year’s demand for the seasonal influenza vaccine appears to be substantially higher than last year, although hard evidence of increased demand and supply is not available.
Approximately 77 million doses of seasonal flu vaccine were distributed as of Oct. 2. This is only about 61 percent of the doses that are expected to be distributed for this season, so facilities that have pre-booked vaccine, AHCA is told, should still be able to receive their order by the end of November.
Manufacturers estimate that a total of 114 million doses will be available on the U.S. market. Manufacturers did not stop manufacturing seasonal influenza early to accommodate production of H1N1 Influenza vaccine. Manufacturers completed their planned seasonal flu doses (to about 97 percent) and then moved on to H1N1 vaccine production.
That said, we are aware that many facilities are being told that they will not be receiving their pre-booked orders. In that case, CAHF and AHCA suggest:
• Check in with the public-health department to see if it has seasonal influenza vaccine available for your vulnerable residents.
• Check the Influenza Vaccine Availability Tracking System (IVATS) at www.preventinfluenza.org/ivats, which is updated weekly.
• Let AHCA know that you are having trouble receiving your pre-booked order and include, if you can, the names of your distributor and manufacturer.
Staff contact: Jocelyn Montgomery, (916) 441-6400, ext. 214, jmontgomery@cahf.org .
CA LANE: Correction to Date of PR Webinar
September 30, 2009
Time to Vaccinate for Seasonal Influenza and Get Ready for H1N1
September 13, 2009
The Centers for Disease Control (CDC) and the California Department of Public Health (CDPH) recommend that seasonal influenza vaccinations be provided to residents, clients and staff of long term care facilities as soon as the vaccine becomes available this fall. The purpose of this early vaccination is twofold:
1. To provide early protection against what is predicted to be a difficult flu season
2. To free up vaccine storage space and vaccinating personnel to be available to administer the H1N1 vaccine, expected to be available beginning in mid Oct.
Long term care providers should order seasonal influenza vaccine through their regular suppliers if they have not already and be sure to order enough for all eligible residents/clients and staff. It is important to note that the new Cal/OSHA Aerosol Transmissible Disease Standard (Title 8 CCR, Section 5199) became effective in August of this year, and it requires SNFs and ICF/DDs to establish, implement, and maintain effective procedures for providing vaccinations against seasonal influenza and other airborne or droplet spread diseases to all employees at risk for occupational exposure. This standard makes it mandatory for employers to offer employees seasonal and H1N1 vaccinations at no cost to them, and employees who refuse to be vaccinated, to fill out a declination form that is acceptable to CDPH. Examples of employee declination forms can be accessed on the Cal/OSHA website at http://www.dir.ca.gov/title8/sb7g16a109.html. (See §5199, Appendix C1 and C2) and the CDPH Recommendations For Influenza in Long-Term Care Facilities 2008-2009, Appendix 1 (http://www.cdph.ca.gov/certlic/facilities/Documents/LNC-AFL-08-33Attachment.pdf). For purposes of reimbursement, the provision of employee seasonal influenza vaccinations may be considered as an employee benefit. H1N1 vaccine and the immunization equipment to administer it will be provided free of charge through the federal government.
H1N1 Vaccine
H1N1 vaccine will be available this fall but initially only in extremely limited quantities. Because of the limited supplies, the vaccination efforts will initially focus on 5 target groups:
* pregnant women,
* people who live with or care for children younger than 6 months of age,
* healthcare and emergency medical services personnel with direct patient contact,
* persons between the ages of 6 months through 24 years, and
* people ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.
Once the demand for vaccine for the prioritized groups has been met at the local level, programs and providers should also begin vaccinating everyone from the ages of 25 through 64 years. Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups. However, once vaccine demand among younger age groups has been met, programs and providers should offer vaccination to people 65 or older. (see http://www.cdc.gov/h1n1flu/vaccination/acip.htm)
CalPanFlu.org is California’s H1N1 Vaccine Website
The 2009 Influenza A (H1N1) influenza vaccine is being made available in California through the California Department of Public Health in partnership with local health departments. Healthcare providers and organizations interested in providing this vaccine can pre-register to receive vaccine, place their initial vaccine request, and report doses used through this site. The 2009 Influenza A (H1N1) influenza vaccine cannot be ordered through private organizations. Providers who want to be considered as a “vaccinating site” for their eligible residents, clients, and direct care staff must register at www.calpanflu.org. If you are currently registered to dispense seasonal influenza vaccine as a VFC provider, this registration will be fairly quick as you will already be in the data system. If you are not currently a VFC provider and are not already registered at this site, you may still sign up but must:
* Set aside at least 20 minutes to register and order.
* Be an authorized representative of the applicant organization who is a prescribing medical care provider licensed to practice medicine in the State of California. You will need to complete the registration process by electronically signing the 2009 Influenza A (H1N1) Vaccine Provider Agreement.
* A working email address will also be required.
* After completing registration, you will be allowed to place your first H1N1 vaccine order.
Registration will remain open throughout flu season; however, early registration is recommended and will help minimize delays since your information will need to be authenticated before it can be processed. Registration does not guarantee you will be selected, but it does place you on the list that will be used to select vaccinators.
For the “Frequently Asked Question Fact Sheet” on H1N1 registrations go to
http://www.calpanflu.org/pdfs/H1N1FAQ.pdf. For a “one stop shop” of immunization training tools and other resources including calculations on refrigerator space, Medicare reimbursement fact sheet, and a training video for the administration of vaccinations among other resources go to http://eziz.org/resources/materials_h1n1.html.
Jocelyn Montgomery
H1N1 Respiratory Precautions
September 6, 2009
H1N1 RECOMMENDATIONS FOR CAREGIVERS
On Sept 3rd, the Institute of Medicine (IOM) released its recommendation that health-care workers who interact with patients suspected or confirmed to have novel H1N1 influenza A should wear N95 respirators. While many health care providers were thinking (hoping) that the IOM would downgrade their recommendation for the level of precautions for H1N1 from airborn to droplet spread, they instead restated their recommendations for N95s, not just for hospitals but also for non-hospital settings.
IOM emphasized several times throughout its “Letter Report—Respiratory Protection for Health care Workers in the Workplace against Novel H1N1 Influenza A” the importance of utilizing other infection-control strategies in addition to respiratory protection. IOM stated that it endorses the current guidelines from the Centers for disease Control and Prevention and recommends that these guidelines should be continued until or unless further evidence can be provided to the effect that other forms of protection or other guidelines are equally or more effective.
Employers should ensure that the use and fit-testing of N95 respirators be conducted in accordance with OSHA regulations, and health-care workers should use the equipment as required by regulations and employer policies.
The IOM was asked to evaluate personal protective equipment (PPE) designed to guard specifically against respiratory infection, the IOM committee focused solely on the efficacy of medical masks and respirators. IOM did not consider economic and logistical considerations, nor did it consider other variables, such as whether health-care workers are effectively immunized with the H1N1 vaccine.
IOM found a paucity of studies comparing the clinical effectiveness of respirators vs. medical masks in preventing the transmission of influenza viruses. Noting that the need for research is striking, IOM also recommended an increase in research on influenza transmission and personal respiratory protection.
ONLINE LINKS
To access the complete report, please go online to http://www.iom.edu/CMS/3740/71769/72967.aspx.
A two-page brief is available at http://www.iom.edu/CMS/3740/71769/72967/72970.aspx.
NEXT STEPS
In a briefing on the current H1N1 situation, CDC Director Thomas Frieden stated that his agency will be studying the IOM report over the next several days. He noted that IOM was not charged to look at economics or logistics.
The California Department of Public Health stated on its weekly stakeholder call that it will wait for CDC’s official guidance before making a decision regarding possible adjustment of California’s position.
Cal OSHA stated that they will be putting out more information on negative-pressure rooms, re-donning of respirators and respirator priority in the near future.
CAHF will provide updates on this issue as new guidance is released. Please visit www.cahf.org/public/H1N1/ for a list of H1N1 alerts and abudent resources for long term care providers including CAHF’s Model Respiratory Protection Program and Guide to N95 respirators.
REMINDER: H1N1 VACCINE FOR EMPLOYEES
CAHF member facilities are encouraged to provide seasonal and H1N1 vaccine to their residents and employees. Seasonal influenza vaccine is available now through the usual supply channels, and the CDPH recommends that residents and staff be vaccinatng for seasonal flu now. H1N1 vaccine will not be available until mid-October or early November.
At current projections, there should eventually be an ample supply of pandemic H1N1 vaccine to offer it to elderly residents of long-term care facilities as well as those who serve the populations. However, the initial supply of pandemic vaccine may very well be inadequate and so allocations will be limited to the following high-priority groups:
- Pregnant women
- Persons who live with or provide care for infants younger than 6 months
- Health-care and emergency-medical services personnel who have direct contact with patients or infectious material
- Children aged 6 months to 4 years
- Children and adolescents aged 5 to 18 years who have medical conditions that put them at higher risk for influenza-related complications
Long term care providers are encouraged to go to the new DPH flu Web site at www.calpanflu.org to register their staff and residents for H1N1 vaccine. This site allows providers to estimate their total anticipated vaccine need for each priority group and for the non-priority patients, as well as to place an initial order. Staff and residents should be included in these estimates.
The actual amount and timing of vaccine deliveries are subject to review by local and state health departments, and orders will be filled depending on availability.
NOTE: You will need to have a prescriber’s number to enter when ordering vaccine. Most facilities are utilizing their medical director’s number for this purpose.
Promoting Person Directed Care in California Nursing Homes
August 26, 2009
Person directed care in nursing homes means putting the humanity back into health care by focusing on the resident’s quality of life as well as quality of care. It means fostering a climate of respect for the people we serve and the workers who are providing their direct care. It means organizing the work schedules around the person’s preferences, and seeking opportunities to give them meaningful choices about how they spend their time. It means creating a comfortable and homelike environment that welcomes family and community members of all ages to enjoy time together.
How do you do it? Well, like most things worth doing, providing person directed care is not easy. One step that will help to convince you that it is worth the effort is to put yourself in the bed, literally, to experience what it’s like to live in your nursing home. Read about the experience of a New York geriatric specialist medical student who did just that. Follow this link for the New York Times article entitled “Experiencing Life, Briefly, Inside a Nursing Home “
http://www.nytimes.com/2009/08/24/health/24nursing.html?_r=1&emc=eta1
Another critical step is to seek education and support from providers who are engaged in promoting person directed care through the “culture change” movement. Beginning in September, nursing home providers who are based in Stockton, Sacramento, Palo Alto, Oakland or San Diego have a wonderful opportunity to join a California Culture Change Coalition’s Regional Collaborative. These Collaboratives offer quarterly learning sessions, monthly support, and expert facilitators to guide each home through their “Culture Change” journey toward person directed care. To learn more about the Collaboratives and access the brochure and registration form, just visit the Coalition website at www.calculturechange.org. Not only can you train up to 6 staff from your facility at these Collaboratives, but NHAP-P, BRN and CNA credits will be issued at each meeting, and payment plans are available.
Los Angeles and Orange county nursing home providers who are interested in person directed care will want to attend the “New Quality of Life Surveyor Guidelines” training offered by the California Culture Change Coalition on Oct 1 in Covina or Oct 2 in Stanton. This half day class taught by Barbara Frank and Cathy Brady will give providers an in-depth understanding of what CMS is trying to promote in terms of person directed care, and what surveyors will be looking for on your next survey. Register for these workshops at www.calculturechange.org.
The “Culture Change” movement is alive and well around the country and is gaining ground in California thanks to the devoted leadership of the Pioneer Network, the California Culture Change Coalition, and supporters of the movement, like the California Association of Health Facilities. Consumers and their families, as well as surveyors, are becoming aware of the differences between traditional and “culture change” facilities. What will they experience at your facility?
Jocelyn Montgomery, Director of Clinical Affairs, California Association of Health Facilities.
Disaster Preparedness for Long Term Care
August 24, 2009
| With the fourth anniversary of Hurricane Katrina approaching, and the impending threat of a pandemic this fall, long term care facilities have a strong motivation to review lessons learned and to update disaster plans to ensure that they are prepared for all kinds of disasters. Come to “Really Ready Too”, the CAHF disaster preparedness conference and get the latest information in disaster preparedness specifically geared for long term care. This important event held in Long Beach, California on Sept 29 and 30th, is the second state-wide conference that CAHF has held on disaster preparedness. The first “Really Ready” conference offered in 2007, was a sold out event that many said was the best conference on this topic that they had even attended.
Attendees to Really Ready Too will be the first to receive the recently completed Nursing Home Incident Command System (NHICs) manual. Also available are 3- hour participant workshops in NHICS, conducted by the training team from the HICS Institute on Education and Training for those interested in practicing this important planning and response tool. Really Ready Too attendees will be treated to a presentation from “Watered Down Truth” author Robert Abrams, on the murder indictments of nursing home owners in St. Bernard Parish. Keeping with the theme of long term care facilities in wide spread disasters, opening speaker Tim Graves, from the Texas Health Care Association, will speak on evacuation and receiving evacuees. There will be a viewing of the documentary film, “The Big Uneasy” by Barbara Frank and Cathy Brady, which chronicles the heroic nursing home staff who not only stuck by their residents through Katrina, but also through their facilities’ recovery. A session by Jocelyn Montgomery, Director of Clinical Affairs, California Association of Health Facilities, will provide realistic, all-hazards solutions for preparing for disasters, and Dr Ashby Wolfe, co-author of the “Pandemic Workbook for Long Term Care “will present on preparedness for the novel H1N1 influenza A pandemic. These and many more important presentations are available. Earn up to 14 BRN, NHAP, ARF, or NHA CEUs! Sept. 7 is the last day to take advantage of $125-per-night guest-room rate at the Renaissance Long Beach Hotel for Really Ready Too!, CAHF’s disaster-preparedness conference for long-term care, Sept. 29-30 in Long Beach. Phone the hotel at (562) 437-5900 and be sure to use the reservation reference: “California Association of Health Facilities.” The Renaissance Long Beach is located at 111 E. Ocean Blvd, Long Beach 90802, just east of Interstate 710. And don’t delay in registering for the conference itself. Until Sept. 22, advance registration for Really Ready Too! is only $249 per person. After that date, the cost goes up to $299 per person. To view the Really Ready Too conference brochure go to http://www.cahf.org/public/dpp/dpp_RR2.php. Registration for the conference itself is easy. Go online to https://marketplace.cahf.org/ and scroll down. If you are a CAHF member, you can register online. Non CAHF members can Fax, mail, or call in their registration. Information is on the brochure. |
