National Nursing Home Training Series: Week 2 Recap

Implementation Strategies for COVID-19 Surveillance and Early Detection

How should nursing homes approach COVID-19 testing and surveillance for their residents, staff and others who visit their facilities? Through their work with hundreds of nursing homes, Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) are excellent resources for quality improvement expertise and crowd-sourced provider tips. And that’s what Marguerite McLaughlin, MA, senior program administrator, Healthcentric Advisors, and David Johnson, NHA, RAC-CT, senior quality improvement specialist, IPRO, both delivered as representatives of the IPRO QIN-QIO during their presentation on implementation strategies for COVID-19 surveillance and early detection in June 2020.

McLaughlin based her presentation around three simple goals for nursing home staff and administrators to keep top of mind during this period:

  1. Keep COVID-19 out
  2. Detect cases quickly
  3. Prevent transmission

Keeping COVID-19 Out

For infection preventionists, COVID-19 requires continual process improvement and visibility with staff, residents and vendors (read the recap of the May 28 event to learn how to adopt or refine your infection control plan). The IPRO QIN-QIO, which serves 12 New England states, along with the other QIN-QIOs serving every U.S. state and territory are ready to help (find your local QIN-QIO here). Daily listening, instruction and adjustments based on what’s going on with your residents and staff are to be expected.

Some preventive tactics that have worked well for nursing home providers include:

  • Delegate non-direct care staff to wellness checks for all who enter your facility
  • Use checklists and spreadsheets to document respiratory symptoms or loss of sense of smell
  • Check staff mid-shift (every four hours) and with self-assessments at shift end
  • Use the opportunity to offer reminders at the door about areas that need greater vigilance
  • Stagger shift start times to avoid traffic jams

Detect Cases Quickly 

Never have quality improvement practices like daily rounds and huddles been more important. Nursing home teams use their interdisciplinary meetings each morning to share information about every resident, including subtle signs of illness that a dietary aide, for example, might catch but a certified nursing assistant (CNA) could miss. 

Residents with dementia need special care. Some tips McLaughlin shared:

  • Watch for changes in behavior like increased agitation, confusion, sudden sadness or worsening dementia symptoms, which can indicate worsening stress and anxiety or infection
  • Any transfers can be traumatic and should be considered carefully. If a move is necessary, bring familiar items and brief caregivers on ways the resident prefers to receive comfort
  • Ensure care plans are up to date so unfamiliar staff members can provide continuity
  • Check out McLaughlin’s tips on the use of portable walls and ways to conduct temperature checks with dementia residents through the event recording

Prevent Transmission

Facilities have taken several approaches to testing, conducting tests on residents who develop symptoms, testing all residents at the same time or confining testing to new admissions or to those who are readmitted. Consult with experts who are familiar with your facility, review state or local regulations and consider calling on the quality improvement consultants at your local QIN-QIO to help choose your approach (Centers for Medicare & Medicaid Services has released a toolkit on state actions to mitigate COVID-19 in nursing homes). Facilities lacking personal protective equipment (PPE) or staffing should also file an individual 1135 waiver for flexibility with regulations that cannot be met due to these shortages.

Organize Your Reporting

Johnson introduced the IPRO QIN-QIO Infection and Antibiotic Tracking Tool that was recently updated for COVID-19 reporting through the National Healthcare Safety Network (NHSN). Track infections, antibiotic prescribing patterns, days of therapy, prophylaxis use, infection rates (facility-wide and location-specific) and more. One-time entries allow you to generate new data each month.

Download the IPRO QIN-QIO slides and resources from the National Nursing Home Training Series page and visit to connect with the QIN-QIO serving your state or territory. Sign up for updates about the National Nursing Home Training Series through July 2020.