- Antibiotic Standards of Practice
- Beers Criteria
- CMS: Pocket Guides Tool KIt
- CMS: Critical Element (CE) Pathways
- CMS Resources and Updates
- COPD Assessment Tool Kit
- Covid-19 Tool Kit
- Delegation Tool Kit
- Dementia Tool Kit
- Diabetes Tool Kit
- Epilepsy Tool Kit
- Falls Tool Kit
- Geriatric Health
- Grief Resources Tool Kit
- Hepatic Encephalopathy (HE) In-Service Tool Kit
- Immunization Tool Kit
- Incontinence and Over Active Bladder (OAB)
- Infection Prevention in Long Term Care (LTC)
- IV Therapy Guide
- Mental Health
- Neuro Psychiatric Symptoms
- Opioid Standards of Practice
- Parkinson's Tool Kit
- Post-Acute and Long-Term Care Took Kit
- QAPI
- Sepsis
- Survey Tool Kit
- Tardive Dyskinesia and Drug-Induced Movement Disorders
- Trauma Informed Care
- Vaccinations
- Wound Toolkit
ANTIBIOTIC STANDARDS OF PRACTICE
The CDC recommends that all nursing homes take steps to implement antibiotic stewardship activities.
Improving the use of antibiotics in healthcare to protect patients and reduce the threat of antibiotic resistance is a national priority.1 Antibiotic stewardship refers to a set of commitments and actions designed to “optimize the treatment of infections while reducing the adverse events associated with antibiotic use.”2 The Centers for Disease Control and Prevention (CDC) recommends that all acute care hospitals implement an antibiotic stewardship program (ASP) and outlined the seven core elements which are necessary for implementing successful ASPs.2 CDC also recommends that all nursing homes take steps to improve antibiotic prescribing practices and reduce inappropriate use.
Beers Criteria
What medications are on the Beers Criteria list?
There are close to 100 medications or medication classes on the BeersCriteria list. The following table isn’t a comprehensive list of all of the medications listed.
Rather, it gives an example of a drug in each category and the reason why it’s harmful.
Beers Criteria Category | Drug or Drug Class Example | Concern |
Analgesics | Meperidine | Neurotoxicity, delirium. |
Antibiotics | Ciprofloxacin with warfarin | Increased bleeding. |
Antiseizure medications | Carbamazepine | Syndrome of inappropriate antidiuretic hormone secretion (SIADH). |
Antidepressants | Duloxetine | Nausea, diarrhea. |
Antigout | Bone marrow toxicity. | |
Antihistamines | Brompheniramine | Confusion, cognitive impairment, delirium. |
Antihypertensives | Alpha-blockers | Hypotension. |
Antiplatelets or anticoagulants | Edoxaban | Renal impairment. |
Antipsychotics | Any antipsychotics | Stroke, cognitive decline, delirium. |
Anxiolytics | Benzodiazepines | Impaired metabolism, cognitive impairment, unsteady gait. |
Cardiac medications | Disopyramide | Heart failure. |
Central nervous system agents | Dimenhydrinate | Confusion, cognitive impairment, delirium. |
Diabetes medications | Chlorpropamide | Hypoglycemia. |
Gastrointestinal medications | H2-blocker for delirium | Worsening delirium. |
Hormones | Estrogen | Breast cancer, endometrial cancer. |
Hypnotics | Barbiturates | Dependence, overdose. |
Musculoskeletal agents | Muscle relaxers | Confusion, dry mouth, constipation. |
NSAIDs | Aspirin (more than 325 mg/day) | Ulcer, gastrointestinal bleeding or perforation. |
Respiratory medications | Atropine | Confusion, cognitive impairment, delirium. |
Urinary medications | Desmopressin | Low sodium in blood (hyponatremia). |
Vasodilators | Ergoloid mesylates | Lack of intended results. |
NEW RESOURCES AVAILABLE
Quick Assessment Reference Pocket Guides/Badge Buddies for Coding
The Centers for Medicare & Medicaid Services (CMS) is offering Pocket Guides to assist providers in assessing and coding self-care and mobility, falls, and pressure ulcers/injuries. The pocket guides provide a quick reference for important terms and definitions that promote coding accuracy. These training assets are intended for providers in Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs), and Skilled Nursing Facilities (SNFs). The pocket guides are approximately 2 x 3.5 inches in size and are designed to be worn behind a provider identification badge. The pocket guides cover the following topics:
- Pocket Guide #1: Coding for Self-Care and Mobility Items.
- Pocket Guide #2: Definitions for Coding Section J Fall Items.
- Pocket Guide #3: Pressure Ulcers/Injuries Stages and Definitions.
The pocket guides are available under the Downloads section of the Quality Reporting Program (QRP) Training page for each setting:
- Home Health QRP Training
- Inpatient Rehabilitation Facility QRP Training
- Long-Term Care Hospital QRP Training
- Skilled Nursing Facility QRP Training
If you have questions about accessing the resources or feedback regarding the trainings, please email the PAC Training Mailbox (PACTraining@EconometricaInc.com). Content-related questions should be submitted to the setting specific help desk:
Stay current and visit this page for updated information.
Revised Long-Term Care Surveyor Guidance
- Revised Surveyor Guidance: CMS is releasing the following guidance and associated training for nursing home surveyors: Phase 2 and 3 Requirements: Clarifications and technical corrections of Phase 2 guidance issued in 2017, and new guidance for Phase 3requirements which went into effect in November 28, 2019. Arbitration Requirements: Guidance on the new requirements which became effective September 16, 2019.
- Effective Date: Surveyors will begin using this guidance to identify noncompliance on October 24, 2022. This will allow for ample time for surveyors and facilities to be trained on this new information.
- Training Resources: Training on guidance for surveyors and providers will be available upon release of this memorandum.
- Complaint and Facility Reported Incidents (FRIs): CMS revised the guidance in Chapter 5 and related exhibits of the State Operations Manual (SOM) to strengthen the oversight of nursing home complaints and FRIs. CMS also revised its guidance for all Medicare-certified provider/supplier types to improve consistency across the State agencies in their communication to complainants.
- Psychosocial Outcome Severity Guide: CMS revised guidance to clarify the reasonable person concept and examples across the different severity levels.
Nursing Homes
Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities
Nursing home surveys are conducted in accordance with survey protocols and Federal requirements to determine whether a citation of non-compliance appropriate. Consolidated Medicare and Medicaid requirements for participation (requirements) for Long Term Care (LTC) facilities (42 CFR part 483, subpart B) were first published in the Federal Register on February 2, 1989 (54 FR 5316). The requirements for participation were recently revised to reflect the substantial advances that have been made over the past several years in the theory and practice of service delivery and safety. The revisions were published in a final rule that became effective on November 28, 2016.
The survey protocols and interpretive guidelines serve to clarify and/or explain the intent of the regulations. All surveyors are required to use them in assessing compliance with Federal requirements. Deficiencies are based on violations of the regulations, which are to be based on observations of the nursing home’s performance or practices.
The sections below provide additional information about the background and overview of the final rule, frequently asked questions, and other related resources.
PharMerica CMS 5 Part Series
COVID-19 QUICK REFERENCE RESOURCES
Delegation Tool Kit ©
This Delegation Tool Kit is designed to help you determine when it is appropriate to delegate, the types of tasks that can be delegated, and to whom delegation tasks can be assigned. The purpose of delegation is twofold. First, well thought out delegation relieves the nurse leader of workload components and tasks that can safely be assigned to other staff members. Second, appropriate delegation develops the skills and confidence of the individual team member to whom the tasks may be assigned.
View and download PDF
Front Line Forces: Behavioral Interventions for People with Dementia
Information for Supervisors
- Staff watch a short training video.
- This module includes a test your knowledge quiz
- The quiz taker provides some basic information including an email address
- After completing the quiz, staff click the submit button, the page displays the quiz score and a list of questions they got incorrect along with the correct answers
- A score of 80% or better indicates understanding of the module content
- An email indicating completion of the knowledge quiz will be sent to the email provided, this email indicates the module name and score received.
- Please note: Superior Health Quality Alliance does not offer continuing education credits for completion.
PharMerica Follow-Up for Insulin Management Webinar
PharMerica Appropriate Use of Prefilled Insulin Pen Devices
Insulin pens include a number of manufacturer-unique administrative devices designed for accurate and simple insulin administration. These benefits are only realized if prefilled insulin pen devices are used appropriately.
PharMerica Insulin Drug Chart
Front Line Forces: Pressure Injury and Prevention
- Staff watch a short training video
- This module includes a test your knowledge quiz
- The quiz taker provides some basic information including an email address
- After completing the quiz, staff click the submit button, the page displays the quiz score and a list of questions they got incorrect along with the correct answers
- A score of 80% or better indicates understanding of the module content. If this is not achieved it is recommended the staff watch the training video again or seek additional training from their supervisor
- An email indicating completion of the knowledge quiz will be sent to the email provided, this email indicates the module name and score received
- Please note: Superior Health Quality Alliance (Superior Health) does not offer continuing education credits for completion
Seizure Disorder Resource Guide
The International League Against Epilepsy (ILAE) created a seizure classification system in 1981, which was revised in 2010.4,5 The seizure classification system worked well for over 35 years, but did not capture many types of seizures.
Learn More View and download PDF
Epilepsy Management Assessment Form
Assessment form to download and complete using information from resident and medical record.
View and download PDF
Epilepsy Allies Demo Video
Epilepsy Allies is an educational program intended to advance the knowledge of caregivers for individuals with developmental disability or elderly in long term care settings who are at risk of having a seizure
Learn More Watch the video
Epilepsy Allies Overview Leave-Behind Brochure
Epilepsy Allies is housed in EdApp, an engaging and effective learning platform that can be downloaded directly to your phone
Learn More View and Download the PDF
Epilepsy Allies Refresher LTC
A seizure is a sudden, uncontrolled electrical disturbance in the brain, which can cause changes in your behavior, movements or feelings, and levels of consciousness
Learn More View and Download the PDF
Epilepsy Allies Refresher IDD
The following information applies to all people with epilepsy and is not specific to the IDD population
Learn More View and Download the PDF
Front Line Forces: Change in Condition
Information for Supervisors
- Staff watch a short training video
- This module includes a test your knowledge quiz
- The quiz taker provides some basic information including an email address
- After completing the quiz, staff click the submit button, the page displays the quiz score and a list of questions they got incorrect along with the correct answers
- A score of 80% or better indicates understanding of the module content. If this is not achieved it is recommended the staff watch the training video again or seek additional training from their supervisor
- An email indicating completion of the knowledge quiz will be sent to the email provided, this email indicates the module name and score received
- Please note: Superior Health Quality Alliance does not offer continuing education credits for completion
Front Line Forces: Proper Technique for Blood Pressure Measurement
- Staff watch a short training video
- This module includes a test your knowledge quiz
- The quiz taker provides some basic information including an email address
- After completing the quiz, staff click the submit button, the page displays the quiz score and a list of questions they got incorrect along with the correct answers
- A score of 80% or better indicates understanding of the module content. If this is not achieved it is recommended the staff watch the training video again or seek additional training from their supervisor
- An email indicating completion of the knowledge quiz will be sent to the email provided, this email indicates the module name and score received
- Please note: Superior Health Quality Alliance (Superior Health) does not offer continuing education credits for completion
Front Line Forces: Sepsis
- Staff watch a short training video
- This module includes a test your knowledge quiz
- The quiz taker provides some basic information including an email address
- After completing the quiz, staff click the submit button, the page displays the quiz score and a list of questions they got incorrect along with the correct answers
- A score of 80% or better indicates understanding of the module content. If this is not achieved it is recommended the staff watch the training video again or seek additional training from their supervisor
- An email indicating completion of the knowledge quiz will be sent to the email provided, this email indicates the module name and score received
- Please note: Superior Health Quality Alliance (Superior Health) does not offer continuing education credits for completion
Front Line Forces: Smoking Cessation
- Staff watch a short training video
- This module includes a test your knowledge quiz
- The quiz taker provides some basic information including an email address
- After completing the quiz, staff click the submit button, the page displays the quiz score and a list of questions they got incorrect along with the correct answers
- A score of 80% or better indicates understanding of the module content. If this is not achieved it is recommended the staff watch the training video again or seek additional training from their supervisor
- An email indicating completion of the knowledge quiz will be sent to the email provided, this email indicates the module name and score received
- Please note: Superior Health Quality Alliance (Superior Health) does not offer continuing education credits for completion
Premier Geriatric Solutions (PACNEP) educational series
Episode 1, Know Before You Call
Episode 2, Water Depletion
Episode 3, Hand Washing
Episode 4, Personal Protective Equipment
Episode 5, Personal Protective Equipment (continued)
Episode 6, The Water Tool
Episode 7, Medically Necessary Visits
Episode 8, Delirium
Episode 9, Best Practice Urinalysis Guidelines
Episode 10, Pneumonia
Episode 11, Sepsis
Episode 12 Heart Failure:
POLARIS Cumulative Grief Resource Guide
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POLARIS Four Things Resource Guide
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POLARIS Processing Grief Resource Guide
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POLARIS Support Grief Resource Guide
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POLARIS Team Grief Resource Guide
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Hepatic Encephalopathy (HE)
Thank you for your interest in the Hepatic Encephalopathy (HE) In-service Toolkit. The materials in the kit are for your utilization in your facilities or other LTC treatment settings that you work to provide education to your staff on (HE).
The kit includes two (HE) in-service decks that you can use to deliver two separate in-service presentations approximately 15-20 minutes In length. There is also a version of each in-service presentation with facilitator notes to help you prepare for your in-service presentations.
We have also included two links to recorded versions of each in-service presentation for easy on-demand utilization or for you to send out to your staff as you see fit to support their education and development.
We hope you find these materials helpful and we thank you for the support you provide to your staff and the care you provide to your residents.
PART 1: Change in Mental Status Hepatic Encephalopathy (HE) Management Overview
PART 2: Change in Mental Status Hepatic Encephalopathy (HE) Treatment & IDT Process
In-service Decks (For live presentation)
In-service Deck Part 1: Change in Mental Status Hepatic Encephalopathy (HE) Management Overview
Part 1: Change in Mental Status Hepatic Encephalopathy (HE) Management Overview – Facilitator Notes
Part 2: Change in Mental Status Hepatic Encephalopathy (HE) Treatment & IDT Process
Part 2: Change in Mental Status Hepatic Encephalopathy (HE) – Facilitator Notes
In-service recordings (Same as the decks but video with voice-over for plug and play or digital dissemination)
Recorded In-service Part 1: Change in Mental Status Hepatic Encephalopathy (HE) Management Overview
In-service Material – Additional Supportive
The LTC Patient: Don’t Forget the Liver in this COVID World and Beyond View Recording
The LTC Patient: Don’t Forget the Liver in this COVID World and Beyond Handout
A Diagnostic Code for Hepatic Encephalopathy
A Diagnostic Code for Hepatic Encephalopathy: Effective October 1, 2022
Front Line Forces: Urinary Tract Infections (UTIs)
- Staff watch a short training video
- This module includes a test your knowledge quiz
- The quiz taker provides some basic information including an email address
- After completing the quiz, staff click the submit button, the page displays the quiz score and a list of questions they got incorrect along with the correct answers
- A score of 80% or better indicates understanding of the module content. If this is not achieved it is recommended the staff watch the training video again or seek additional training from their supervisor
- An email indicating completion of the knowledge quiz will be sent to the email provided, this email indicates the module name and score received
- Please note: Superior Health Quality Alliance (Superior Health) does not offer continuing education credits for completion
Overactive Bladder (OAB) in LTC Fact Sheet
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LTC Unbranded Nurse Care Plan
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PharMerica CMS 5 Part Series
Library of Additional Resources
The Toolkit contains resources to help staff in senior living communities promote nonpharmacologic behavioral health strategies to address behavioral and psychological symptoms of distress (BPSD) that frequently occur in long-term care residential settings, especially among residents with dementia.
Urgent or Unresolved Behaviors
Practice-based suggestions for how to initially respond to behavioral and psychological symptoms of distress (BPSD). For example, apathy, aggressiveness and resistance to care.
Interdisciplinary Team Members
Description of the educational preparation and unique contributions to behavioral health that are provided by the different members of the healthcare team. How nursing homes can gain access to their services is also included.
Additional Resources
Additional training and clinical care tools, websites of interest, and literature about behavioral and psychological symptoms of distress.
Front Line Forces: Well-Being
The demands of caring for others can lead to high levels of stress in even the best of times. We all face our own set of stressors, related to work or life outside of work. All of these stressors impact our wellness and capacity as caregivers. Regulation activities can help us shift from a state of fear and overwhelm to a state of calm and focus.
Front Line Forces: Substance Use Disorder
Stigma continues to be one of the strongest negative influences on how we see and treat people with addiction. This four-part series, each approximately four to nine minutes in length, describes addiction as a chronic medical condition, offers strategies for combatting stigma, describes resources for treatment and discusses prevention strategies. While the intended audience is nursing assistants and caregivers for patients and residents in nursing homes, the material is relevant to everyone.
Dementia
Assessment and Interview Tools
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Behavior Assessment IDT Tools
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Behavior Interventions
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Care Giver Fact Sheet
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Documentation of Neuropsychiatric Symptoms Related to Dementia
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Evaluation of Behaviors
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Tardive Dyskinesia (TD)
Tardive Dyskinesia (TD)
TD Awareness Week 2023 TD Fact Sheet Patient Color: About Tardive Dyskinesia
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TD Awareness Week Infographic: Tardive Dyskinesia Awareness Week
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HCP TD vs EPS: Is it Time to Take a Different Treatment Approach to TD?
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Population Health TD Resource Overview Flashcard: Population Health Resources to Help Individuals with Drug-Induced Movement Disorders
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TD AIMS Instructional Booklet: The Abnormal Involuntary Movement Scale (AIMS): What, Why, When, and How
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TD AIMS Scorecard and Instructions: Abnormal Involuntary Movement Scale (AIMS)
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Unbranded TD Toolkit – Interactive Abnormal Movements Questionnaire: Abnormal Movements Questionnaire
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OPIOID STANDARDS OF PRACTICE
Timeline 2019-2020
- Opioid death rates Increase by 38%
- Rx opioid-involved death rates increase by 17%
- Heroin-involved death rates increase by 7%
- Synthetic opioid-involved death rates increased by 56%
Front Line Forces: Preventing Falls and Injury from Falls
- Staff watch a short training video
- This module includes a test your knowledge quiz
- The quiz taker provides some basic information including an email address
- After completing the quiz, staff click the submit button, the page displays the quiz score and a list of questions they got incorrect along with the correct answers
- A score of 80% or better indicates understanding of the module content. If this is not achieved it is recommended the staff watch the training video again or seek additional training from their supervisor
- An email indicating completion of the knowledge quiz will be sent to the email provided, this email indicates the module name and score received
- Please note: Superior Health Quality Alliance (Superior Health) does not offer continuing education credits for completion
Do You See What I See? Parkinson’s Training
Cindy Fronning RN-BC, RAC-Ct, CDONA, FAC-DONA, IP-BC, AS-BC Director of Education NADONA © 2019 NADONA LTC
Behavior Interventions
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Behavior Tracking Form (Handout)
Download Excel Form
Diseases and Behaviors (Handout)
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PDP Care Plan
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PDP-0765-v2 Professional – Caregiver Fact Sheet
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PDP Screening Documentation Tool
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PDP 0456 CMS Tool Digital
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72533 – Acadia Universal Form
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Implementing Change in Long-Term Care Toolkit
This toolkit was designed to assist organizations, and the staff who work there, to implement changes that will improve care quality and to sustain them. Whether you are contemplating a comprehensive, organization-wide culture change, or implementing a best-practice protocol in a single clinical area, knowing something about how to implement and manage change will help you achieve your goal. You will find suggestions about preparing your organization for change, assisting your staff to gain a sense of ownership over the changes, and sustaining the changes over time. Not all sections of this toolkit will be useful to everyone. Look for what you think is the most useful, and start there.
Who should use this toolkit?
This toolkit is intended for managers and staff development departments in long term care organizations. It is intended to stimulate discussions and engage a wide range of staff, to foster sustainable change.
What does the toolkit contain?
In this toolkit you will find case studies, exercises, worksheets and tools. Topics covered include:
- Person-centered care
- Leadership
- Developing teams
- Staff education and development
- Preparing for the change
- Conducting organizational assessments
- Sustaining proactive change and developing accountability systems
The toolkit also includes system-level questions, reading guides and case studies in five clinical practice areas that are often the focus of culture change efforts: elimination, skin, falls, nutrition and psychosocial well-being.
Continue reading go to website
PROTECT YOUR RESIDENTS FROM SEPSIS.
Sepsis is a medical emergency.
You play a critical role. Protect your residents by ACTING FAST. Infections put your residents at risk for sepsis. Anyone can get an infection, and almost any infection, including COVID-19, can lead to sepsis. With your fast recognition and treatment, most residents survive.
To learn more about sepsis and how to prevent infections, visit www.cdc.gov/sepsis
SURVEY
Surveys are conducted to ensure long term care facility (LTC) facility is meeting state and federal standards. These tools help with your survey needs.
Tardive Dyskinesia (TD)
Tardive Dyskinesia (TD)
Recognizing and treating tardive dyskinesia (TD)Long-term care facilities
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HCP TD vs EPS: Is it Time to Take a Different Treatment Approach to TD?
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Population Health TD Resource Overview Flashcard: Population Health Resources to Help Individuals with Drug-Induced Movement Disorders
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TD AIMS Instructional Booklet: The Abnormal Involuntary Movement Scale (AIMS): What, Why, When, and How
View and Download PDF
TD AIMS Scorecard and Instructions: Abnormal Involuntary Movement Scale (AIMS)
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Abnormal Movement Questionnaire
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NEWSLETTER: How does tardive dyskinesia (TD) impact residents at your long-term care facility?
Uncover the impact and importance of managing TD
©2023 Neurocrine Biosciences, Inc. All Rights Reserved. CP-TD-US-1285 03/2023
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NEWSLETTER: 360-Degree Impact of Tardive Dyskinesia: Functional, Emotional, and Social Impact
©2022 Neurocrine Biosciences, Inc. All Rights Reserved. MED-MSL-TD-US-0237 v2 CP-TD-US-0691 v5 09/2022
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Trauma Informed Care
Exposure to adverse and potentially traumatic experiences is common and may influence the health of millions of individuals. Trauma exposure has been associated with negative mental and physical health outcomes across the life span.1-7 Additionally, trauma exposure can result in greater need for services from healthcare clinicians and social service providers. Organizations and systems, including healthcare systems, recognize the potential consequences of trauma exposure and/or experiences. In response, providers, systems, and organizations are working to both improve care and prevent trauma exposure and its consequences through approaches called Trauma Informed Care (TIC).
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VACCINE QUICK REFERENCE RESOURCES
Ways to use WoundSource.
WoundSource is an annual wound care product reference guide that was first published in 1998. WoundSource currently includes over 1,700 products manufactured by over 200 wound care companies.
To learn more about wounds and how to products available, visit WoundSource.com