April DOH/Providers Meeting Summary

Lisa Volk and Nancy Leveille in Clinical & Quality

The primary topics discussed: 

  1. Change in Western and Rochester Regional Office
  2. Nursing Home Antibiotic Stewardship Collaborative Project, Candida Auris update
  3. Update on new survey process
  4. E-prescribe
  5. Provider association/State Agency/Consumer education
  6. CMP project ideas

See below for full information. We have contact information and attachments included in the summary related to these topics for access to resources.

NYSDOH and Provider Meeting
Meeting Summary- April 13, 2017

The following topics were discussed at this month’s meeting: 

1.    Change in Regional Office: Joseph Egnaczak, Director for the Rochester and Western Regional Office has retired. Currently, Gail Ajavon will cover as interim in the Rochester region and Gloria Duffy will serve as interim in the Western region. NYSDOH is currently recruiting to hire for this Regional Office position.

2a.  Collaboration to Launch Antibiotic Stewardship Programs (CLASP): Monica Quinn RN, MS, CIC Nurse Epidemiologist Bureau of Healthcare Associated Infections, Division of Epidemiology Infections NYSDOH presented information about this program. (See slides and DOH Informational Memo). The goal is to support LTCF implement an antibiotic stewardship program (ASP), for facilities interested in the project this is a one year commitment. NYSDOH offers educational webinars and provides the facility survey data (ASP) at intervals during the project, new participates are still being accepted into this program. Any facilities interested, please contact NYSDOH project leaders Coralie Bucher or Monica Quinn at 518-474-1142 or by email at: prevent.hai@health.ny.gov.

2b.  Candida auris Globally and New York State - A Call to Action:

Emily Lutterloh MD, MPH, Director, Bureau of HealthCare Associated Infections NYSDOH presented information on candida auris including background, emergence and presence in the United States and NYS. See attached (slides and advisory). Concerns associated with this are the challenges related to identification of the organisms, are often multi-drug resistant, high mortality rates and have been transmitted in healthcare facilities.

  • The following infection control recommendations were given specific to long term care:
  • Single room when available
  • Standard and Contact Precautions

–       Residents not restricted to room → discuss with DOH

  • Modified Contact Precautions for low-risk residents → discuss with DOH

–       High functioning, no wounds or indwelling devices
–       Gowns/gloves for tasks that might result in contamination of hands or clothing
–       Clean and disinfect shared items
–       Persistent colonization
–       No data and no recommendations for decolonization
–       May attempt to “clear” resident → discuss with DOH
–       Clinical infection resolved
–       Not on antifungals
–       Need at least 2 rounds of negative surveillance cultures (not on antifungals) at least 1 week apart before a person can be considered “cleared”
–       Follow-up surveillance cultures every 1-3 months
–       Standard and Contact Precautions indefinitely unless cleared
–       Notify DOH that transfer will occur
–       Notify receiving facility of C. auris
–       Persistence in healthcare environments|
–       Thorough daily and terminal cleaning and disinfection of patient rooms using EPA-registered hospital grade disinfectant with a claim for C. difficile

Further information can be found at the link below: 

https://www.cdc.gov/fungal/diseases/candidiasis/recommendations.html
Any further questions regarding candida auris can be directed to icp@health.ny.gov 

3.   Update on new survey process:

Each state has identified 7 trainers that will be sent to Baltimore between July 31st - August 3rd to be trained on the new survey process. These trainers will assist as a resource for surveyors learning the new process, they will also take part in CMS conference calls.

All surveyors will have training via the Webinar August 14th - 18th. The release of this training for providers is anticipated in July 2017. There will be a make-up session for surveyors in October.

Discussion that the interpretive guidelines are currently in draft form and will be released in May 2017.

NYSHFA has advocated for education with providers as it should be a transparent process

4.   E-prescribe: a provider question was raised regarding residents being discharged from the nursing home to the community, does the script need to be done in
      the e-prescribe fashion (yes). The blanket waiver does not apply to a written script in the community.

More information on the legislative change will be forthcoming. Providers need to continue to prepare for full implementation by October 31, 2017.

5.   Provider Association/State Agency/Consumer Education: Discussion held regarding NYSDOH partnering with associations to assist with ROP survey training, Emergency Preparedness, Life Safety and highlights of phase one. Also discussed breaking each of those areas out separately when educating.

Provider association advocated working through each area utilizing multiple training methods for adult learners.

6.   CMP Project ideas:  Further brain storming session held regarding suggestions of how CMP dollars can be used to directly benefit the residents by improving care. Topics under consideration include:

  1. Behavioral Health
  2. QAPI
  3. Infection Control and Antibiotic Stewardship
  4. Customer Satisfaction
  5. Advance Directives
  6. Palliative Care


NYSHFA/NYSCAL CONTACTS:

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15

Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20