A Discussion with Real Time’s Business Analyst, Debbie Martin, RN, RAC-CT
Since 2016, when the Centers for Medicare & Medicaid Services (CMS) first issued mandates for infection prevention and control (IPC), skilled nursing facilities (SNFs) have been hard at work developing strong programs to protect their vulnerable populations. Most recently, in November 2019 when Phase 3 was announced, SNFs once again were required to expand their programs – this time redefining the role of the infection preventionists (IPs). SNFs were also tasked with creating and enforcing Antibiotic Stewardship procedures/processes, increasing surveillance of infectious disease, and offering recommendations for the prevention and control of influenza.
But then in March, COVID-19 hit the U.S. and overwhelmed the healthcare system – giving nursing facilities limited time to begin complying with Phase 3 requirements. Cases and mortality rates soared across the nation with SNFs being hit the hardest. While all of the focus was on PPE, hygiene, quarantine, and preventing the spread of the virus, COVID-19 also brought to light how patients in these facilities were significantly affected by communicable diseases. The essential need for the implementation of a comprehensive IPC program became abundantly evident. Although CMS and SNFs were in the midst of working to close gaps, COVID-19 left them ill-prepared for what would lie ahead.
Now, more than six months later, COVID-19 rates are still spiking in most parts of the country, flu season has begun, and CMS is on track to resume onsite surveys. It is imperative that SNFs begin to prepare for increased oversight by ensuring they are tracking, trending, and complying with the entire IPC program guidelines – inclusive of Antibiotic Stewardship surveillance.
We recently spoke with Debra Martin, RN, RAC-CT, Business Analyst for Real Time, to get her thoughts on where SNFs are headed, what they need to know now, why Antibiotic Stewardship is relevant in the wake of COVID-19, and why Real Time recently launched a new solution to help IPs and facilities with their IPC efforts.
Real Time: COVID-19 is a virus, so why were patients who were hospitalized for it prescribed antibiotics?
Debbie Martin: In the early days of COVID-19, antibiotics were prescribed to treat their symptoms when clinicians were unsure of the diagnosis or were waiting for test results to come back. They were also overwhelmed by a lot of critically ill patients and there was a lack of any other proven treatment. So, although antibiotics were not indicated, they were still seen as the first line of defense.
At the same time, there were patients who tested positive for COVID-19 and developed secondary infections such as pneumonia, so prescribing antibiotics was necessary.
Before COVID-19 was even a threat however, patients looking for relief from their symptoms were also responsible for driving antibiotic use.
Real Time: How has COVID-19 highlighted the need for improved infection prevention and control in SNFs?
Debbie Martin: Three years ago, when CMS mandates were rolled out, SNFs had already started to implement their programs and systems, yet when COVID-19 first hit the United States, it re-emphasized the fact that vulnerable populations have a significantly high risk for communicable diseases. Particularly in the early days of the pandemic when there were nationwide testing shortages. Identifying those patients who were infected, or presumed to be infected, with the virus was delayed.
COVID-19 has pulled back the curtain on how SNFs handle infection prevention and control within their facilities. Forty-two percent of COVID-19 deaths in the U.S. have occurred in SNFs and assisted living facilities.
It should come as no surprise that CMS has been increasing their oversight of SNFs. In August, CMS announced that it had imposed more than $15 million in fines to more than 3,400 SNFs during the COVID-19 pandemic for non-compliance with infection control requirements.
In the coming months, we expect that infection prevention and control processes and procedures will be monitored even more closely.
Real Time: At the same time, COVID-19 has actually made antibiotic stewardship more relevant—why?
Debbie Martin: While SNFs are still very focused on COVID-19, CMS mandates that they have a full infection prevention and control program in place – this includes antibiotic stewardship surveillance.
Since patients have a higher risk for infection and more complex health needs, the facilities must have access to evidenced-based data and insights that will support their efforts to properly care for, and treat, their patient populations.
We know that up to 70% of nursing home residents are prescribed one or more courses of antibiotics every year, and 40% to 75% may be unnecessary or inappropriate.
As patients are prescribed antibiotics, whether they have symptoms of COVID-19, secondary infections, or another type of bacterial infection, these decisions must be made based on data found in the patient’s medical history, so they do not become resistant to antibiotics they may need down the line.
Real Time: What should infection preventionists and clinicians know about infection prevention and control, as well as antibiotic stewardship throughout COVID-19 and beyond?
Debbie Martin: With COVID-19 rates still spiking and the start of the flu season underway, SNFs must be proactive. They need the right data and insights at their fingertips so they can track their patients, know the early warning signs, look at trends, make the right diagnoses, know the antibiotic history of patients, and prescribe antibiotics only when necessary.
Also, expect the role of infection preventionist to evolve. They will be responsible for driving antibiotic use in facilities, and all things related to the QAPI program, and will likely be consulted by staff providers and pharmacists regularly.
Real Time: Please describe Real Time’s new solution and why it’s relevant for SNFs today.
Debbie Martin: Using EHRs to track and trend IPC program data has traditionally been an arduous, manual, and extremely time-consuming process. While EHRs have always been a resource for storing data, many lack the sophistication of analyzing that data and bringing clinical insights to the forefront for clinicians to review. Many times, the process also requires duplicate data entry.
Our new Infection Control and Antibiotic Stewardship Surveillance solution, however, allows IPs to have centralized and automated tools in place to easily identify, monitor, track, trend, and report toward the IPC Program requirements outlined in the CMS Requirements of Participation (RoPs). Our solution extracts live, relevant data from the EHR to enable clinicians to immediately identify emerging infections before an outbreak, reduce overall antibiotic-resistance cases, and proactively monitor for all infectious diseases including COVID-19 and influenza within, and across, all facilities without any additional work from the staff.
The dashboard, which was developed using the CDC’s Core Elements for Antibiotic Stewardship in Skilled nursing facilities, includes a large data pool of symptoms, infection logs, labs, and every order that’s written for antibiotics sorted by physician, class, indication, duration, location of the patient population, and the percentage of the patient population that is currently taking antibiotics.
Live analytics of the data gives clinicians insight into how antibiotics are utilized, why there is a spike in usage, the conditions they are being prescribed for, and which antibiotics are effective for the types of infections that occur in the facility. The dashboard also monitors prescribing patterns to help improve utilization and prevent misuse and over-utilization. With that data, clinicians can take immediate action, treat patients appropriately, and set up a plan to remedy the problem in their facilities. IPs can pull their automated analysis based on current and previous months, quarters, and years. Our new solution also enables improved communication and reporting between partnering pharmacist and physician care teams to reduce antibiotic-resistance cases, while still staying compliant with the components of CMS’ RoPs.
Instead of spending hours each day pulling data, making calculations, and looking for insights, our solution allows IPs to get everything they need within seconds, saving them valuable time and energy to care for their patients. We have found that depending on the size of their facilities, using our solution IPs spend only about 30-minutes each day on their surveillance work.
Real Time: In what ways will Real Time’s solution help SNFs improve care coordination efforts with their partnering hospitals?
Debbie Martin: Our solution allows hospitals and SNF’s to share data in real-time, allowing them to truly collaborate for optimized care. With clinical line-of-sight into the SNF EHR, including infection control and Antibiotic Surveillance data, care teams are given the ability to follow their patients, look for trends based on their vital signs or orders that are placed, and address them immediately so patients are not re-admitted into the hospital.
Real Time’s analytics of the EHR data also helps hospitals and SNFs identify if an infection is healthcare-acquired (HAI) or community-acquired (CAI), once again automating the required surveillance and intervention, as well as prepare them for potential new quality measures that may be required by CMS in the near future.
To learn more about our Infection Control and Antibiotic Stewardship Surveillance solution, contact us today.