On August 13, 2020 the American Hospital Association (AHA) along with the American College of Surgeons (ACS), American Society of Anesthesiologists (ASA) and Association of periOperative Registered Nurses (AORN) released a Joint Statement: Roadmap for Maintaining Essential Surgery During COVID-19 Pandemic. This new joint statement provides a list of principles and considerations to guide physicians, nurses, and hospitals and health systems as they provide essential care to their patients and communities. The joint statement builds on the Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic released by the AHA, ACS, ASA, and AORN on April 17, 2020.
Earlier today at the White House Task Force Press Briefing, the Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.
As more healthcare providers are increasingly being asked to assist with the COVID-19 response, it is critical that they consider whether non-essential surgeries and procedures can be delayed so they can preserve personal protective equipment (PPE), beds, and ventilators.
“The reality is clear and the stakes are high: we need to preserve personal protective equipment for those on the front lines of this fight,” said CMS Administrator Seema Verma.
This will not only preserve equipment but also free up our healthcare workforce to care for the patients who are most in need. Additionally, as states and the nation as a whole work towards limiting the spread of COVID-19, healthcare providers should encourage patients to remain home, unless there is an emergency, to protect others while also limiting their exposure to the virus. They should also urge patients to follow the President’s recently issued guidelines to help slow the spread of the virus.
The recommendations provide a framework for hospitals and clinicians to implement immediately during the COVID-19 response. The recommendations outline factors that should be considered for postponing elective surgeries, and non-essential medical, surgical, and dental procedures. Those factors include patient risk factors, availability of beds, staff and PPE, and the urgency of the procedure. This will help providers to focus on addressing more urgent cases and preserve resources needed for the COVID-19 response. The decision about proceeding with non-essential surgeries and procedures will be made at the local level by the clinician, patient, hospital, and state and local health departments.
The recommendations can be found here: https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures-recommendations.pdf
These recommendations, and earlier CMS guidance and actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov for further information. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.
CROWNWeb has announced that their next New User Training session will be held on December 11, 2018. Find details and register at http://mycrownweb.org/pcw_lems/dec-2018-crownweb-new-user-training/.
The December 2018 CROWNWeb Newsletter is also available, at http://mycrownweb.org/wp-content/uploads/2018/12/December_2018_Newsletter_V1.7-508.pdf. This issues includes articles on:
- The schedule for release of the PY2019 QIP reports and certificates:
- December 14, 2018 – PSRs and PSCs will be available to facility POCs on the ESRD QIP System at https://www.qualitynet.org/. PSCs must be prominently displayed in both English and Spanish within fifteen days of their availability and remain posted throughout the entire 2019 calendar year. Facilities without POCs are directed to call the QualityNet Help Desk at 866-288-8912.
- CMS expects to post the Performance Score Summary Report to DFC in January 2019, and to their Public Reporting & Certificates web page at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ESRDQIP/08_ReportandCert.html by December 29, 2018.
- Questions may be directed to the QualityNet ESRD QIP Q&A tool at https://cms-ocsq.custhelp.com/app/homeesrdqip/p/960.
- A summary of the November CROWNWeb Town Hall featuring the Kidney Community Emergency Response Coalition’s (KCER) role in emergency preparedness and disaster response coordination, and their coordination with EQRS and CROWNWeb. Slides of the meeting can be found at http://mycrownweb.org/wp-content/uploads/2018/11/November_Town_Hall_Version_2.3_508-Compliant.pdf. More information on KCER can be found at https://www.kcercoalition.com/.
- A Clinical FAQ on Post-Weight Dialysis Assessment date.
- Scheduled CROWNWeb Clinical Closure Dates; note that your Network may require earlier data entry in some situations.
Announcement of a December 20, 2018 CROWNWeb Town Hall on 2018: A Retrospective Review. See http://mycrownweb.org/pcw_community_events/crownweb-town-hall-2018-a-retrospective-review/ for details and registration.
The national Kidney Community Emergency Response Patient and Family Engagement Learning and Action Network (N-KPFE-LAN) is pleased to announce its new resource, Emergency Disconnect Procedure for In-Center Hemodialysis Patients. The one-page instruction sheet shows in-center hemodialysis patients how to disconnect from dialysis in three steps in an emergency situation. The resource can be downloaded and printed from the KCER website at: https://www.kcercoalition.com/contentassets/7202c26cb0ce40b9a098d3dbede5ccb9/emergencydisconnectdialysis508.pdf.
The International Association of Emergency Managers (IAEM) USA Healthcare Caucus has announced its second webinar in partnership with the Centers for Medicare & Medicaid Services (CMS) on the Emergency Preparedness Final Rule. The webinar will be held on Tuesday, April 24, 2018 from 1pm to 2pm, EST.
Please join Caecilia (Cece) Blondiaux with the Quality, Safety & Oversight Group (QSOG). Ms. Blondiaux will provide a recap and updates on the final rule. She will also highlight and discuss key areas in which CMS is seeing an increased number of deficiencies as related to the final rule. There will be approximately 20-25 minutes allotted for a question and answer session at the end of the webinar. For efficiency and to answer as many questions as possible, IAEM requests that questions be submitted in advance to email@example.com, no later than April 16, 2018.
Emergencies caused by severe weather or disasters can happen without warning. Transportation barriers, changes in water, loss of power, or access to supplies can critically impact dialysis treatment. Therefore, it is important to be prepared before an emergency occurs. In addition to routine review of disaster plans, resource management, drills, and updating contact numbers and medication records, dialysis facilities are encouraged complete the following action items to ensure continuity of care:
- Designate in CROWNWeb a Disaster/Emergency Coordinator for your facility. Be sure to include a cell phone number.
- Conduct a Hazards Vulnerability Assessment to determine how and when your facility might be at risk.
- Establish a Mutual Aid Agreement with a back-up dialysis provider that will accept your patients if your facility cannot provide access to care.
- Annually contact your local Office of Emergency Management (OEM) to communicate patient census and needs of ESRD patient care during an emergency.
Reporting Operational Status to the Network
In an emergency, the Network is required by CMS to work with Federal, State and local government agencies to assist with patient safety and ensure dialysis facilities are prioritized to be open for treatment. Networks are also tasked with tracking the status of facility operations and patient access to care during events. If your facility becomes inoperable or inaccessible due to an emergency, it must be communicated to the Network as soon as possible. This improves the ability of the Network to provide current information to assist patients, the renal community, and emergency management personnel.
For questions about facility emergency preparedness requirements, resource materials, or technical assistance, please contact the Network at 203-387-9332.
Are you confident that all members of your staff and your patients are aware of what to do in an emergency? Are you prepared to review your facility’s emergency planning with a state surveyor? Can you, your staff, and your patients:
Describe the facility’s emergency preparedness program?
- Staff and patients should be able to explain what they would do in an emergency, based upon what they have learned in training and drills.
Know where to find the facility’s emergency plan and documentation?
- Staff should know where the plan is, and who the leads are in an emergency.
- Patients should have, at least, an emergency contact sheet and a copy of their dialysis orders.
If you answered NO to either of these questions, find out who the emergency lead is at your facility, and work with them to ensure that you, your staff, and your patients are prepared.
For more information visit the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (HHS ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE)’s Tools and Templates webpage at https://asprtracie.hhs.gov/technical-resources/50/dialysis-centers/47#plans-tools-and-templates.
The New Emergency Preparedness Final Rule Requirements go into effect on November 17, 2017. As of that date, surveyors will start to survey and assess this Condition for Coverage (CfC) and can cite for noncompliance. There are many resources available to help staff at your facility ensure compliance to the Final Rule. To review these resources and ensure that your facility is in compliance, see the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, Information Exchange (TRACIE) webpage https://asprtracie.hhs.gov/technical-resources/50/dialysis-centers/47.
Resources for the New Emergency Preparedness Requirements:
- 2017 Surveyor Assessment Tool
- 2017 Emergency Preparedness Final Rule Presentation
- CMS Emergency Preparedness Rule – Resources at Your Fingertips: https://asprtracie.s3.amazonaws.com/documents/cms-ep-rule-resources-at-your-fingertips.pdf
KCER has revised the English version of the book Preparing for Emergencies: A Guide for People on Dialysis. Find the new edition at http://www.kcercoalition.com/contentassets/
People are exposed to many different types of emergencies. Weather related emergencies can include, but are not limited to, hurricanes, blizzards, earthquakes, and flooding. Additional emergencies can include terrorist attacks, illness pandemics, as well as many other scenarios. Emergency situations can lead to increased emergency department visits, hospitalizations, and even an increase in mortality rate. Medicare- & Medicaid-participating providers and suppliers are required to plan adequately for both natural and man-made disasters, and coordinate with federal, state, tribal, regional, and local emergency preparedness systems in order to meet the needs of patients. Dialysis facility leadership should ensure that all staff members have adequate training on the facility’s emergency response plan, and have a clear understanding of response functions and/or roles during an emergency. Staff should be able to identify gaps and lessons learned from previous disasters as a way to continuously improve their facility’s emergency response plan.
To read about lessons from Sandy and how healthcare systems can prepare for future disasters, click here.