LONG-TERM CARE FACILITY (LTCF) Facility Guide to Using the COVID-19 Module

June 2020

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Description

As part of CDC’s ongoing COVID-19 response, the COVID-19 Module for Long-term Care Facilities (LTCF) has been created in NHSN to help LTCFs track and monitor the number of residents with suspected and laboratory positive COVID-19, staff and facility personnel impact, and supply availability. LTCFs eligible to report data into the Module include skilled nursing facilities (SNF) / nursing homes (NH), long-term care for the developmentally disabled, and assisted living facilities. Enrolled NHSN LTCFs will see the new COVID-19 Module in the left navigation menu. LTCFs that are not currently enrolled in NHSN will need to complete enrollment before reporting into the Module will be available. Please visit the Enrollment section of the LTCF COVID- 19 webpage: https://www.cdc.gov/nhsn/ltc/covid19/index.html. LTCF COVID-19 Module Enrollment Refresher slides are also available on the website, as well as the recorded webinar.

The Module is organized by specific focus, referred to as Pathways.

There are 4 individual reporting pathways, including:

1) Resident Impact and Facility Capacity

2) Staff and Personnel Impact

3) Supplies and Personal Protective Equipment

4) Ventilator Capacity and Supplies

Module questions include the reporting of counts and simple responses (for example, yes or no type responses). Users can opt to navigate to each pathway during one session to answer questions or in different sessions by selecting SAVE after questions in each pathway are answered. The Module is designed to allow users the ability to SAVE incomplete data in one or all pathways, which means users do not have to complete data entry in one session, unless otherwise stated in the instructions. Neither resident nor staff level information are collected. The Module may be accessed, and data entered at any time during the week or weekends.

Training:

COVID-19 Module Training slides and a recorded webinar are available on the LTCF COVID- 19 webpage

Reporting Frequency:

It is expected that LTCF users will consistently collect and enter data into the NHSN LTCF COVID-19 Module. While daily reporting will provide the timeliest data to assist with COVID-19 emergency response efforts, retrospective reporting of new counts for prior day(s) is encouraged

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if daily reporting is not feasible. At a minimum, facilities should collect new count data at the same time each day, including weekdays and weekends and respond to Module questions at least once per week (specifically, every 7 days). If reporting in the Module only once per week, users are encouraged to report on the same day every week, if possible.

• Daily reporting. If reporting daily, the selected calendar date must reflect the date in which the responses and counts are collected and entered in the Module.

• Non-daily reporting. The selected calendar date must reflect the date in which data are being reported. Unless otherwise stated in the table of instructions for a pathway, responses to the COVID-19 questions requiring counts must only include the total number of new counts since the last time data were entered in the Module. The goal for each reporting date is to collect incidence only. Answers to the yes or no questions must be based on responses on the date of data entry.

• Weekly reporting. Users are strongly encouraged to report on the same day of the week every week (for example, every Friday), if possible. The selected calendar date must reflect the date in which responses are being reported. Unless otherwise stated in the table of instructions for the pathway, responses to the COVID-19 questions requiring counts must only include the total number of new counts since the last time data were entered in the Module. The goal for each reporting date is to collect incidence only. Answers to the yes or no questions must be based on responses on the date of data entry.

Data Collection Forms and Instructions:

For each pathway, an accompanying data collection form and form instructions (referred to as Table of Instructions or TOI) is available. It is Important for users to apply the accompanying instructions when entering responses in the COVID-19 Module to ensure accuracy in the application of case definitions and criteria.

Data Submission Options:

Users have the option of entering data manually or uploading data using CSV file(s) for individual facilities or facilities within a group. To upload data, the CSV option is available. After entering data manually for a LTCF, click in the SAVE button and no further action is required for data to be available for group use (if applicable) or CMS submission (specifically, for CMS certified facilities). It is important to note that manually entered data will automatically over-ride imported data if the submission dates are the same. Additionally, saved data can be exported for additional analysis outside the application. The data collected within this Module will be informative and provide situational awareness at both state and national levels.

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How to Access and Enter COVID-19 Responses and Counts for Enrolled Facilities STEP 1: Select the COVID-19 tab on the left navigation menu. Note: The NHSN home page may look different depending on facility participation in NHSN. However, the functionality for the COVID-19 Module is the same for all LTCFs.

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After clicking on the COVID-19 Module tab, a calendar defaulting to the current month will appear, as shown in the screenshot below. The arrow back button may be used to enter retrospective counts from January 1, 2020 up until April 30, 2020 (optional). Data may be entered up to the present date. Again, users may enter data manually or by uploading dating using a CSV file. Visit the LTCF COVID- 19 webpage under the Resources tab for templates and guidance documents for. https://www.cdc.gov/nhsn/ltc/covid19/index.html.

Import and Export Options:

As shown at the bottom of the calendar, the Module provides options to import and export facility level and/or group level data. Users may choose to import data instead of manually entering the data.

A. Data can be uploaded using a CSV file. See the “Upload CSV” option. B. The “Download CSV Template” option is available for users to download sample CSV files,

which can then be accessed to upload facility COVID-19 data. • The headers in the CSV file represent the data fields on the ‘Add’ screen.

C. Users also have the option to export data in a table format using the “Export CSV”

See LTCF COVID-19 webpage for templates and guidance documents for facilities and groups.

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Complete and Incomplete Records:

Each SAVED pathway will be highlighted as COMPLETE or INCOMPLETE on the calendar view page.

• Record Complete: Pathway saved, and all questions have been answered

• Record Incomplete: Pathway saved with one or more unanswered questions

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STEP 2: To begin manual data entry for a LTCF, click on the date for which the data will be entered.

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After clicking on the date from the calendar view, a separate window will appear with four (4) tabs representing each reporting pathway. While the default is the “Resident Impact and Facility Capacity” pathway, users may navigate to and from each pathway during one session to enter data.

Users have the option to “SAVE” entered data or “CANCEL” data entered in individual pathways. If “CANCEL” is selected for a pathway, data will not be saved for that pathway and the user will be returned to the calendar view page.

“Date for which responses are reported” will auto-populate for each pathway unless a pathway is cancelled. Additionally, entered data will save when navigating between pathways during the same session; however, users must click SAVE prior to exiting the pathway screen. A user may edit or add additional data anytime by clicking on the date in the calendar and selecting the applicable pathway.

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STEP 2a: Enter Data for Resident Impact and Facility Capacity Pathway

This pathway focuses on the impact of COVID-19 on residents, facility capacity, and availability of COVID-19 testing for residents. The pathway has a total of nine questions that are divided into two sections: Resident Impact and Facility Capacity and Laboratory Testing. It is Important for users to apply the accompanying Table of Instructions when entering responses for this pathway to ensure accuracy in the application of case definitions and criteria. The COVID-19 Module Long Term Care Facility: Resident Impact and Facility Capacity (CDC 57.144) data collection form can be used to document daily new cases, which may be helpful if entering data into the Module on a weekly basis. One form should be used for each day of the week.

“Date for which responses are reported” will auto-populate based on the date selected from the calendar view page. The only required question that must be answered before being able to save responses is “Testing.” After providing a response for “Testing,” and “All Beds,” future dates will auto-populate; however, users are able to edit the auto-populated responses.

Important Notes:

• Answer 0 if the facility had zero new counts for the reporting period. Do not leave any field blank because an empty field is equivalent to incomplete data.

• When entering counts for resident impact questions, include only the new counts collected since the last time the counts were entered in the Module or the previous 7 days if it’s the first time these counts are being entered. Remember, the goal is report incidence only.

• “All Beds” includes licensed beds in the facility, regardless of the payer type.

• “Total Deaths” must include ALL deaths, including residents reported in the “COVID-19 Deaths” count. The “COVID-19” Death count must not be higher than “Total Deaths”.

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Once the pathway is SAVED, a pop-up message will appear to confirm the record was successfully saved. Additionally, a complete record, meaning a response was given for every data element in this pathway, will be highlighted green on the calendar page. An incomplete record will be highlighted tan.

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STEP 2B: Enter Data for Staff and Personnel Impact Pathway

This pathway focuses on the impact of COVID-19 on staff and facility personnel, including confirmed and suspected COVID-19 cases and staffing shortages. There are 7 questions, including three count and four “yes” or “no” questions. Staff and facility personnel are defined as anyone working or volunteering in the facility, including, but not limited to full-time, part-time, and as needed staff (prn), contractors, temporary staff, shared staff between other areas of the facility, personal resident care givers, etc.

It is Important for users to apply the accompanying Table of Instructions when entering responses for this pathway to ensure accuracy in the application of case definitions and criteria. The COVID-19 Module Long Term Care Facility: Staff and Personnel Impact (CDC 57.145) data collection form can be used to document daily new cases, which may be helpful if entering data into the Module on a weekly basis. One form should be used for each day of the week.

To enter data manually, from the calendar view page, click on the date in which data will be entered. “Date for which responses are reported” will auto-populate based on the date selected from the calendar view page. Note: if users are already in another pathway, they may switch to the next pathway during the open instead of clicking SAVE for each individual pathway. Click “Staff and Personnel Impact” tab.

Important Notes:

• When entering counts for “Confirmed,” “Suspected,” and “COVID-19 Deaths,” include only new counts collected since the last time the counts were entered in the Module. Remember, the goal is report incidence only.

• Answer 0 if the facility had zero new counts for the reporting period. Do not leave any field blank because an empty field is equivalent to incomplete.

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• Staffing Shortage responses are based on shortages occurring on the date responses are being reported in the Module. Staffing shortages are defined based on the LTCF staffing needs based on resident ratio and staffing policy. Shortages must be considered, even if the facility has a history of staffing shortages before COVID-19.

Once the pathway is SAVED, a pop-up message will appear to confirm the record was saved. Additionally, a complete record, meaning a response was given for every data element in this pathway, will be highlighted green on the calendar page. An incomplete record will be highlighted tan.

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Step 2C: Enter Data for Supplies and Personal Protective Equipment Pathway

This pathway is used to assess the availability of personal protective equipment (PPE) and hand hygiene supplies in a facility. There are two columns for each of the 6 supply items listed. Each response is either a “Yes” or “NO” based on the availability of supplies on the date responses are being entered and the availability for one week (the next 7 days). This pathway does not require count data. It is Important for users to apply the accompanying Table of Instructions when entering responses for this pathway to ensure accuracy in the application of case definitions and criteria.

To enter data manually to this pathway, click on the pathway while in an open session or select the date on the calendar for which the responses are being reported and then click the “Supplies and Personal Protective Equipment” tab. “Date for which responses are reported” will auto-populate based on the date selected from the calendar view page. Complete this form by using the drop-down menu to answer “YES” or “NO” for each row of the supply item. Responses must be based on availability and expected availability on the date the responses are being reported in the Module.

Important Notes:

• Responses to the questions must be based on PPE and supply status on the date the responses are being entered in the Module.

• Implementation of crisis level strategies for a PPE item is considered as a shortage for that item since these strategies do not commensurate with U.S. standards of care.

• For information in relation to CDC’s optimization strategies for PPE (standard, conventional, and crisis), please refer to Optimize PPE Supply website: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html

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Once a pathway is SAVED, a pop-up message will appear to confirm the record was saved. Additionally, a complete record, meaning a response was given for every data element in this pathway, will be highlighted green on the calendar page. An incomplete record will be highlighted tan.

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Step 2D: Enter Data for Ventilator Capacity and Supplies Pathway

This pathway is specific to LTCFs that have ventilator dependent unit(s) and/or beds accesses ventilator capacity and supplies. Completion of this form is conditional.

To enter data manually in this pathway, click on the pathway while in an open session or select the date on the calendar for which the responses are being reported and then click the “Ventilator Capacity and Supplies” tab. “Date for which responses are reported” will auto-populate based on the date selected from the calendar view page.

Answer the first question, “Do you have ventilator units and/or beds in your facility.” If “No” is selected and saved, the pathway is considered as complete. If “Yes” is selected, the remainder of the form will populate with additional questions that must be answered. The responses to this pathway are based on counts and responses on the date the data are being entered in the Module.

It is Important for users to apply the accompanying Table of Instructions when entering responses for this pathway to ensure accuracy in the application of case definitions and criteria.

Important Notes:

• Responses to the count questions must be based on total number of ventilators in the facility and the number of ventilators being used for residents suspected or with laboratory positive COVID-19 on the date counts are being entered in the Module.

• For the next section, use the drop-down menu to answer “YES” or “NO” to describe the current availability of ventilator supplies and expected supply availability for the next week (7 days). Responses must be based on current availability and expected availability on the date the responses are being entered in the Module.

• Answer 0 if you have zero new counts for the reporting period. Do not leave any field blank because an empty field is equivalent to incomplete.

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Once a pathway is SAVED, a pop-up message will appear to confirm the record was saved. Additionally, a complete record, meaning a response was given for every question in this pathway, will be highlighted green on the calendar page. An incomplete record will be highlighted tan.

Complete and Incomplete Data:

The below calendar is an example of what the calendar will look like once data are saved in one or more of the pathways. Green indicates “Record Complete” and tan/yellow indicates “Record Incomplete.” Dates with white spaces means there were no data saved in any pathway for that day.

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To View or Edit Data: Once responses and counts have been entered and saved, users may click on a date in the calendar view to view and make edits. For example, if a record shows as incomplete on the pathway, users may open the record, enter the missing data, and click save.

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Uploading Data using the Upload CSV Option: Please find instructions on how to Upload COVID-19 Module data via .csv files here: https://www.cdc.gov/nhsn/pdfs/covid19/ltcf/fac-import-csv-508.pdf Exporting data using the Export CSV Tab:

Once data have been entered or uploaded, facility users can export their data in table form to view or to perform additional analysis outside the application. First select Export CSV on the calendar. A dialogue box will appear with options to select which pathway files to download. Select preference and Export to open or save data. A sample of the Resident Impact and Facility Capacity pathway exported table is displayed below in table 1.

Table 1. COVID-19 Summary Data Export

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Additional Resources: 1. CDC’s Coronavirus (COVID-19) website: https://www.cdc.gov/coronavirus/2019-nCoV/index.html

2. NHSN COVID-19 Webpage for Long-term Care Facilities: https://www.cdc.gov/nhsn/ltc/covid19/index.html

3. CDC’s National Healthcare Safety Network (NHSN) Home Page: https://www.cdc.gov/nhsn/index.html

4. Guidance for Retirement Communities and Independent Living: https://www.cdc.gov/coronavirus/2019-ncov/community/retirement/index.html

5. Preparedness Checklist for Nursing Homes and Other Long-Term Care Settings: https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care-checklist.html

6. Guidance for U.S. Healthcare Facilities about Coronavirus (COVID-19): https://www.cdc.gov/coronavirus/2019-ncov/hcp/us-healthcare-facilities.html

7. Preparing for COVID-19: Long-term Care Facilities, Nursing Homes: https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html