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Training Manual and Users` Guide Using the Pennsylvania Patient

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1. RR 9 U RARI 9 NT RII KK ueeEE M 9 5 Users VOUS M EIE MM I M EM S M 10 Advanced iser admina BID 10 Oa DICH 11 13 LIST OF REPORTABLE 15 REPERE SE cv sete incon i da e up seed ce vot sae haud nV ED Ibn Ne E ges conde qud UE 15 A SYMP Fara eR urinary tract MCC UO m 15 1 Resident with indwelling urinary catheter oai sibs og io aca auedbacheusacnenavidacdeeseeadeiuodiaeieeceaceie 15 2 Resident without urinary catheter aeuo dederat nera tite iio ue soci as E ISO M dariniai nianiar ebstasdadeloneddstetecdubes cudceteens 15 DR a e E 16 1 Lower respiratory tract infection pneumonia bronchitis tracheobronchitis 16 2 AMMO EUS ko kta A E eM LE EAE iM RM 16 C Skin and OD LENS CUTS IUE INC DRM RENNES 17 1 Vascular or diabetic ulcer chronic non healing
2. a i om un Li FF un These are the numbers to enter Into PA PSAS at the amd of each month Th se totals must be separately for each unit care area your facility las set up in PA PSRS l PSRS Pirayan a Cel y Pega piam VERSION 2 0 104 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM This page was left blank intentionally VERSION 2 0 105 MAY 2009
3. cccscscsscecessessesscsscsscsscsscssessecsecsecsscesssssssessessessecsecsecsessassssessssesseeeessesessessesecseseeeaseaseaseas 17 2 Decubitus ulcer Messire Te Ie d NNI cee eene EEEE KT 17 ONE PUNAS OE e E Tv 17 a E e T E NEE EE EEA ANE N A A EA AAE EAEE 17 ME SN E A E E E EENET es vo EN EIEI E O AAIE 17 NB EIS I EA AAA EAE A A A AN AAI A EE AAAA IA AEN EA eee N 17 DB Co is aaae Re e E EEE AE 18 e 18 1 Intra abdominal infection Peritonitis deep ABSCESS 18 25 18 p cea eese UEM E eg ce E ects eee 19 SM Ieri ee ee ee ne er ne ee re ee eee eee er re See eee eee ener 20 3 Primary bloodstream MNS CU ON m 20 FREQUENTLY JASKEDOUESTIONS 26 catsscausunaestedadeieunsstraiaiodeeatsancwataasstodatnesassalesaintaawlawsnoaioassdajednlawaneawansntslaisaaatentansnsaatusnciisassuteanetedangsanartudansGiacusaads Zl T ZI A172 7211 NC E 23 Vien Nonce serious E velt Lenor asradi E E ue t e Dd 27 Of 28 REPORTING INFECTIONS 31 REPORTING INFECTION EVENTS 31 Tecno KEPO SUDNI OT isir E stu tou enD UM NIE bm edP M RERUMS Em MUERE MM
4. 9 Resident admitted as select one Required Long term care Shortterm skilled Rehabilitation and or medical care Infection confirmation date i e date of determining that infection met crieteria Required Date mm dd ewwy 11 What care area is this resident assigned to Required Select Care Area v Next Page TopofPage Cancel Return to Questions 1 2 Information contained in this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authonty Al rights reserved Helpful Tip Note that you can abort a report submission by hitting Cancel Also if you close your browser at any point before reaching the last screen or before clicking on Submit Report this will also cancel your report submission Screen 4 Questions 12 through 17 See Layout 1 below e This screen captures information about any laboratory testing the facility s response to the infection whether or not the resident has died and any additional comments the user may wish to add The screen displays intake report questions 12 15 See Layout 2 below e If the type of infection is a Symptomatic urinary tract infection and the Sub Category level 2 selection is resident with indwelling urinary catheter there will be two additional questions on this page The screen displays i
5. NNNM PN UM aU UD oe 31 Mando me EPOPS eroe e 39 VERSION 2 0 l MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING TABLE OF CONTENTS o PITT ted dee esta R E 40 LB SA TON 4 eco m T eaeeeceee 42 Reels at ec 42 METER 43 VIEWNGAND PRINTINGREPORTS 44 EEPOPTEUSTORY o E MI M MEE ME 45 FORMS coude ME MM ME E ME 45 45 FREOUENILY An ED OUES TIONG 46 TP e GHONS 46 a A E S 46 47 47 50 Hsu CS PE ed NRI NER ERROR E 50 ACCESSING AVAILABLE POR RS 51 TYPES OF ANALYTICAL REPORTS aus tek oa est DR EM 53 SAVING FTE YT AL IEDCD ae cece i ries RM tec EE MEI 62 SBAPCHPBG RETOR E iaceat fedi DM MU LP MM UM 62 STAND TD DATAE M ML MEME LE T Ei 63 SILET ATION 64 64 PATIENT 64 PATIENT SAFETY RECOMMENDATION Sepiii a 64 PROGRAM ANNOUNCEMENTS AND SYSTEM ADMINISTRATION sscisscidsceansescnvesosdenseteseasuanctdecicaneusscuubedaovadesuedeenaddanvandooe
6. SPEC Commonwealth of Pennsyivania E E BLUR Patient Safety Authorit SAFETY y y i UE AUTHORITY Fax 610 567 1114 Training Manual and Users Guide Using the Pennsylvania Patient Safety Reporting System PA PSRS Nursing Home Event Reporting P PSRS Pennsylvania Patient Safety Reporting System Version 2 0 May 1 2009 This page was left intentionally blank VERSION 2 0 l MAY 2009 Table of Contents MN ON e COS 1 PORTO cNENETT 1 MEOS 2 P COPE OF E ah costae gees ccm 3 SYSTEM CONFIDENTIALITY AND DATA ACCESSIBILITY EEE 3 IMPACT OF PA PSRS ON REPORTING TO OTHER ORGANIZATIONS ccssccessscesssccsssecesseccsssecessecesseccesecessecesseecsssecesseecsssecessecesseecesecesseecsseees PTI VEG WAIN E T T Tm ING EC r 1 Ve IN ONS 1 T 8 1 TG GON 3 TANG AOI MPH H H 4 EE EEIE a OID E E O E E EA O E E E EAE A EEA 7 FACILITY MANAGEMEN e H 9 MP 1 SM
7. is suggested that copies of all forms letters worksheets relating to HAls be kept as part of the resident s record but ultimately it is up to the discretion of the individual facility as to whether they choose to keep copies and where they are placed Does the letter have to be mailed The MCARE statute does not specify what methods to use when providing written notification Department of Health VERSION 2 0 Why do we have to continue to report Communicable Diseases to DOH Reporting is mandated by different regulations laws and every nursing home must report these infections to PA PSRS if meets the nursing home criteria AND to DOH if it is required for reporting as a communicable disease Will DOH use the HAI data rates as part of the survey process DAAC and DNCF surveyors will not receive the infection data HAIP staff will receive and review HAI data Surveyors will continue to survey for care and service issues and determine if it is related to failure to implement the infection control plan HAI data and rates will be used by HAIP staff to help facilities identify problems and formulate solutions for infection reduction What should facilities do with updates to their prevention plans submitted to DOH Hold onto updates until you receive a call from DOH Nursing homes will need to submit all updates in duplicate the same as the original The nursing homes should use this process for all updates How are corporate IC plans
8. Streptococcus species non S pneumoniae Streptococcus pneumoniae pneumococcus Acinetobacter speices Clostridium difficile C diff Legionella species Mycoplasma pneumoniae Chlamydophila pneumoniae OOOOORO000 Influenza virus 13 Facility response to this infection for the resident select one Required Notreatment Treatment in the nursing home Transferred to another facility for treatment of this infection or its consequences 14 Has the resident died select Required O Yes No Unknown 15 Did the resident receive dialysis treatment within 7 days ofthe onset of signs and symptoms ofthis infection Required Yes a Ifyes what type of dialysis was received Hemodialysis Peritoneal Dialysis 16 Please enter any additional comments you would like us to review regarding this resident s infection Submit Report Top of Page Cancel Return to Questions 1 2 3 11 Information contained in this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authority Al rights reserved ei gt VERSION 2 0 88 MAY 2009 This page was left intentionally blank VERSION 2 0 89 MAY 2009 Appendix Event Type Taxonomy Infection Types VERSION 2 0 A Symptomatic urinary tract infection iP 2 Resident with indwelling
9. The Pennsylvania Patient Safety Reporting System PA PSRS is a mandatory confidential statewide information system for reporting of events occurrences or situations that have or could have resulted in unanticipated injury to a patient in an Act 13 covered medical facility Covered facilities include acute care hospitals ambulatory surgical centers behavioral health centers birthing centers abortion facilities and with Act 52 nursing homes PA PSRS collects only reports of healthcare associated infections from nursing homes Important Note As used in this manual or in the PA PSRS software application the word event is a generic term to describe any actual or potential patient safety related occurrence In this context the word event is not to be confused with the Act 13 defined term serious event which is defined much more narrowly In developing PA PSRS the Patient Safety Authority established several underlying principles e PA PSRS must be comprehensive understandable and easy to use e PA PSRS must be user friendly and respectful of the limited resources available to reporting facilities e Once established PA PSRS should not be redundant duplicative or burdensome to reporting facilities e PA PSRS must support two way communications The PA PSRS program not only receives reports from reporting facilities but also provides feedback to facilities that they can use in their own patient safety and quality impr
10. 9 00 a m VERSION 2 0 101 MAY 2009 Utilization Data Collection Form Sample Printable form for use in daily rounds tracking resident days and catheter days The following pages are a blank sample of a Utilization Data Collection Form and an example of that form filled out VERSION 2 0 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM UTILIZATION DATA COLLECTION FORM Month Year Unit Use this form to collect resident days and catheter days for each unit your facility has defined in PA PSRS Use a different form for each unit Conduct a house wide census each day to collect resident days and catheter days The daily census and collection of catheter days should be performed at the same time every day Resident days specifications e Record the number of occupied beds on the unit In your count INCLUDE all occupied beds and hospitalized residents Catheter days specifications e Record the number of residents with indwelling foley catheters on the unit Reporting utilization data to PA PSRS At the end of each month for each unit add all the daily numbers to get the total numbers of resident days and catheter days for that unit for that month Each unit s monthly catheter days will be reported separately in PA PSRS These are the numbers to e
11. Date rmmiddsyyyy 6 Age of Resident years 7 Gender of Resident select one Required O Male O Female 8 Date of most recent admission re admission Required Date rimiddiyyyy 9 Resident admitted as select one Required O Long term care Shortterm skilled Rehabilitation and or medical care 10 Infection confirmation date i e date of determining that infection met crieteria Required Date mmiddyy 88 11 What care area is this resident assigned to Required Select Care Area v NextPage Top of Page Cancel Return to Questions 1 2 Information contained in this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0162004 Pennsylvania Patient Safety Authority Al rights reserved VERSION 2 0 75 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING EVENT TYPE TAXONOMY PA Pennsylvania Patient Safety PSRS Reporting System Monday April 13 2009 Time remaining 14 39 Reset Timer Help Event Report Organization Manor Care 12 12 vas laboratory testing done Required O Yes No a Ifyes were any ofthe following organisms identified check all that apply MRSA methicillin resistant staphylococcus aureus VRE vancomvycin resistant enterococcus ESBL extended spectrum B lact
12. In dwelling drain site 9 Oo p Other please specify 5 Cellulitis 6 Other Criteria e Purulent drainage pustules or vesicles at wound skin or soft tissue site or FOUR or more of the following signs and symptoms e Fever with no other recognized cause e Heat e Redness e Swelling e Pain or tenderness Serous drainage Note Presence of an ulcer in the absence of criteria is not indicative of an infection VERSION 2 0 17 MAY 2009 D Gastrointestinal tract infection Criteria Symptoms for Viral and Bacterial Infections to include ONE or more of the following signs and symptoms e Two or more loose or watery stools above what is normal for the resident in a 24 hour period e wo or more episodes of vomiting within a 24 hour period e Laboratory confirmed enteric pathogen from stool WITH a compatible clinical syndrome e Stool toxin assay C difficile e Single IgM or fourfold increase in IgG for pathogen in paired sera Note These criteria must include NO evidence of a non infectious cause e g DIARRHEA laxatives change in tube feeding or medication VOMITING change in medication other G I diseases such as peptic ulcer disease The Centers for Disease Control CDC defines a C difficile laboratory confirmed infection as health care acquired if it presents more than 3 days after admission i e on or after day 4 E Other Infection 1 Intra abdominal infection Peritonitis deep abscess Criteria TWO or
13. These reports represent those which may be amended Once the reports have passed the 45 day threshold they drop off the list and may no longer be amended however the reports are still retrievable by report ID number The list is sorted by the submit date and time and will only display 20 items per page Prev and Next buttons allow the user to page through the complete list of reports PA 3 Pennsylvania Patient Safety PSRS Reporting System Thursday December 4 2008 Help Event Report Utilization Data View Print Analytical Data Tools Date Range 10 21 2008 to 12 04 2008 new date range Showing Selected Report ID Days Remaining infection Confirmation Date amp Time Report Omen to Amend Date Report Submitted 10410617 North Wing B Respiratory tract infection 31 11 20 2008 11 20 2008 16 14H 10410590 South Wing D Gastrointestinal tract infection 23 11 12 2008 11 12 2008 08 44H 10410572 South Wing C Skin and soft tissue infection 16 11 05 2008 11 06 2008 14 13H 10410563 East Wing E Other 12 11 01 2008 11 01 2008 03 53H Prev Next Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0182004 Pennsylvania Patient Safety Authority All rights reserved The user also has the option of changing the Date Range displayed by clicking new date ran
14. which can be made available to them only through institutional facilities Dementia Unit A nursing unit to assist specific needs of residents with dementia and related conditions Ventilator Dependent Unit A distinct part of an institution which is primarily engaged in providing nursing care and related services for residents who require mechanical ventilation Mixed Unit If fewer than 80 of the residents are of the same type acuity as described in the unit definitions above designate the care area as mixed To establish your facility s care areas follow these steps 1 While logged in as the Facility System Manager click on Care Areas in the Navigation Bar 2 Click on Add Care Area in the pop up menu 3 Inthe first dialog box see screen on next page enter the first location you wish to identify in your facility e g 3 West 4 nthe second dialog box select the location type for that care area from the drop down menu e g Skilled Nursing Short Term Rehabilitation unit 5 Click Save PA 3 Pennsylvania Patient Safety gt S Reportin System Monday April 13 2009 Help Add Care Area Care Area Name Required Care Area Type Required D View Print Skilled Nursing Shor Term Rehabilitation Unit Nursing Unit Dementia Unit Ventilator Dependent Unit Mixed Unit Repeat these steps for each care area you wish to define in your facility While this may
15. Admitted To B4 M ele 8 8 2008 8 11 2008 a Lower respirator ji hospital unit tract 2 Respiratory tract Treatment Lower respiratory 83 F Mixed unit 8 13 2008 8 13 2008 nursing home tract 2 Respiratory tract P T Admitted to Lower respiratory 79 F Mixed unit 8 13 2008 8 14 2008 hospital tract 5 Other Treatment i m 82 M umen 8 15 2008 8 15 2008 d Osteomyelitis nursing home unit 3 Skin and Soft Tissue Treatment Mursing d Device associated ime 89 M 8 15 2008 8 17 2008 nursing home unit i Tracheostomy site 1 Catheter related f i Admitted to Nursing urinary tract infection 75 i 8 16 2008 8 17 2008 hospital unit 3 Skin and Soft Tissue Treatment Ventilator b Decubitis ulcer 94 8 21 2008 8 22 2008 nursing home dependent unit 2 Respiratory tract Treatment Ventilator LI b Influenza like i 86 M 8 25 2008 8 25 2008 nursing home dependent unit illness 3 Skin and Soft Tissue d Device associated Ventilator zt Death 89 F 8 26 2008 8 27 2008 ii Peripheral central dependent unit IV site 3 Skin and Soft Tissue d Device associated Admitted to Nursing 8 29 2008 9 29 2008 v In dwelling drain hospital unit site 61 MAY 2009 Saving Analytical Reports PA PSRS supports saving the graphs or tables from any report you generate using the system You can then paste these graphs and tables into word processing documents use them in r
16. First MI 4 Social Security Number Required 5 Resident date of birth Required Date rmiddivyyy 6 Age of Resident years 7 Gender of Resident select one Required O Male O Female 8 Date of most recent admission re admission Required Date rmiddiyyyy 9 Resident admitted as select one Required O Long term care Short term skilled Rehabilitation and or medical care 10 Infection confirmation date i e date of determining that infection met crieteria Required Date frmiddiyyyy 11 What area is this resident assigned to Required Select Care Area v NextPage Top of Page Cancel Return to Questions 1 2 Information contained in this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authority Al rights reserved VERSION 2 0 67 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING BLANK FORM PA Pennsylvania Patient Safety Monday December 8 2008 PSRS Reporting System Time remaining BEE Reset Timer Help Event Report Organization EDS Administrators 12 Vas laboratory testing done Required O Yes O No a Ifyes were any ofthe following organisms identified check all that apply MRSA methicillin resistant staphylococcu
17. Infection Primary Bloodstream Infection P Pennsylvania Patient Safety Wednesday December 3 2008 PSRS Reportin system Time remaining EINE Reset Timer Help Event Report Organization Manor Care Infection Criteria questions Other Primary Bloodstream Infection 2 Which ofthe following criteria does the resident meet TWO ormore blood cultures drawn on separate occasions from separate sites documented with a common skin contaminant e g diphtheroids Bacillus sp Propionibacterium sp coagulase negative staphylococci or Organisim in blood culture is not related to infection at another site secondary bacteremia o A single blood culture documented with a pathogenic organism non contaminant Organism in blood culture is not related to infection at another site secondary bacteremia and Check ONE of the following 1 Fever or new hypothermia N o Drop in systolic blood pressure of gt 30 mm Hg over baseline Change in mental or functional status Next Page Top of Page Cancel Return to Question 1 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws lt PA 3 Pennsylvania Patient Safety PSRS Reporting System Monday April 13 2009 Time remaining 14 48 Reset Timer Help Event Report Organization Manor Care 12 3 Resident Nam
18. Navigation bar then select which resource you want to access from the pop up menu 45 MAY 2009 PA Pennsylvania Patient Safety PSRS Reporting System Thursday December 4 2008 Help Event Report Utilization Data View Print Blank Forms Analytical Data Tools Date Range 10 21 2008 to 12 04 2008 new date range Nursing Home User Showing Manual t ID Days Remaining Infect Nursing Home Training Date amp Time decades to Amend slides Report Submitted Program Memorandum 10410617 North Wing B Respiratory tract infection 31 11 20 2008 11 20 2008 16 14H 10410590 South Wing D Gastrointestinal tract infection 23 1112 2008 11 12 2008 08 44H 10410572 South Wing C Skin and soft tissue infection 16 11 05 2008 11 06 2008 14 13H 10410553 East Wing E Other 12 11 01 2008 11 01 2008 03 53H Prev Next Frequently Asked Questions Reportable Infections What infections do we report through PA PSRS The PA PSRS Program is designed to collect infection reports from nursing homes to the Patient Safety Authority the Authority and the Department of Health DOH as prescribed by Act 52 of 2007 the Health Care Associated Infection Prevention and Control Act Those infections deemed to be reportable were listed in the public notice printed in the Pennsylvania Bulletin on September 20 2008 see Appendix C for a reprint of the public notice The system was designed to walk the user through
19. be imported to Microsoft Excel or another spreadsheet program To use this feature take the following steps 1 Select Analytical Data Tools from menu bar main screen then select Export Data Enter a date range for the reports you wish to download Note Date ranges may be no larger than one month for each file you create with this feature To create spreadsheets with longer date ranges you will need to perform multiple downloads Press the Export button You will be presented with a choice to save the download file to your computer or to open the file see below To save the file press Save and select a location and filename using the dialog boxes presented To open the file press Open For the file to open properly you must have a spreadsheet program such as Microsoft Excel already on your computer File Download 9 Some files can harm your computer If the file information below P looks suspicious or you do not fully trust the source do not open or save this file File name PSA ExportFile csv File type Microsoft Excel Worksheet From edsegov0l A This type of file could harm your computer if it contains malicious code Would you like to open the file or save it to your computer Open Cancel More Info Always ask before opening this type of file 63 MAY 2009 Chapter f Communications Report Follow up A member of the PA PSRS Program and or Department
20. e Newor increased cough Newor increased sputum production e Pleuritic chest pain Rhonchi rales wheezes and or bronchial breathing e New and or increased shortness of breath achypnea normal respiratory rate 16 25 breaths min e Change in mental and or functional status from baseline in the presence of symptoms Note Congestive heart failure and other non infectious causes of similar signs and symptoms should be ruled out A chest x ray is NOT required for purposes of determining whether the resident has a reportable pneumonia However a chest x ray may be used to determine whether a pneumonia was present on admission If a chest x ray is obtained prior to admission and a physician or radiologist s report confirms the presence of pneumonia IN the presence of defined signs and symptoms this indicates that the pneumonia was present on admission and is therefore not reportable by the nursing home 2 Influenza like illness Criteria e Fever and e THREE or more of the following during Influenza season October 1 to April 30 e Chills e Headache or eye pain VERSION 2 0 16 MAY 2009 e Malaise or loss of appetite e Sore throat e Dry cough e Myalgia C Skin and soft tissue infection 1 Vascular or diabetic ulcer chronic non healing 2 Decubitus ulcer pressure related 3 Burn associated 4 Device associated a Tracheostomy site b Peripheral central IV catheter site G tube site Supra public catheter site
21. facility The default setting for most analytical reports will be to display data for the entire facility Most reports will allow you to drill down to the unit level provided you have set up your care areas according to unit How can access each individual facility or corporate analytical reports as oversee 6 facilities Facility accounts follow the licensure so that three locations licensed separately will have three facility accounts An individual at the corporate level overseeing all three facilities would have to have a user account at each of the three facilities in this case In response to suggestions made by individuals attending the first several nursing home training sessions the Authority will investigate the feasibility of adding a new user type that would allow corporate users to see data from multiple facilities with one user account but this will not be in place when mandatory reporting begins in June 2009 In the future will reports be available by searching other identifiers versus the incident ID number For example the SSN Yes one analytical report we have planned will allow you to pull up a resident s infection history using the Social Security Number Should we report data from June 1 when this program of reporting is to start on June 15 22 Start reporting infections and collecting utilization data on June15 and June 22 even though utilization data will only be for 15 16 days or 9 10 days I
22. how many days remain to amend a report from the Main Page refer to the column Days Remaining to Amend After a period of 45 days from original submission each report is locked down in the system and may no longer be amended Such reports may still be viewed and printed To amend a submitted report follow these steps 1 From the Main Page enter the Report ID in the dialog box in the upper right of your screen labeled Selected Report ID Rather than type in the Report ID clicking on an ID number in the first column will enter it for you 2 Click on Event Report in the Navigation Bar Pennsylvania Patient Safety PSRS Reporting System Thursday December 4 2008 Help Ww Event Report Utilization Data Blank Forms Analytical Data Tools Date Range 10 2 Create New Event iw date range Showing Report Selected Report ID Amend Event Report Days Remaining Infection Confirmation Date amp Time orum Retrieve Event Report By to Amend ume HD bea Report ID 10410617 North Wing B Respiratory tract infection 31 11 20 2008 11 20 2008 16 14H 10410590 South Wing D Gastrointestinal tract infection 23 11 12 2008 11 12 2008 08 44H 10410572 South Wing C Skin and softtissue infection 16 11 05 2008 11 06 2008 14 13H 10410563 East Wing E Other 12 11 01 2008 11 01 2008 03 53H Prev Next VERSION 2 0 40 MAY 2009 3 Click on Amend Event Report in the pop up menu 4 M
23. in the Pennsylvania Bulletin This notice may include updates or changes based on public comments to the reporting requirements Persons with a disability who require an alternative format of this notice for example large print audio tape or Braille should contact the PA PSRS help desk at 866 316 1070 Exhibit A List of Reportable HAls 1 Symptomatic Urinary Tract Infection 1 1 Indwelling urinary catheter related 1 2 Nonurinary catheter related 2 Respiratory Tract Infection 2 1 Lower Respiratory Tract Infection Pneumonia Bronchitis tracheobronchitis 2 2 Influenza like illness ILI 3 Skin and Soft Tissue Infection 3 1 Cellulitis 3 2 Burns 3 3 Vascular and diabetic ulcer chronic non healing 3 4 Device associated soft tissue wound infection for example e Tracheostomy site e Peripheral Central IV catheter site e G tube site e Supra pubic catheter site e In dwelling drain e In dwelling vascular catheters dialysis 3 5 Decubitus ulcer pressure related Infection 4 Gastrointestinal Tract Infection VERSION 2 0 96 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM PUBLIC NOTICE OF NURSING HOME REPORTING REQUIREMENTS 5 Other infections 5 1 Intra abdominal infection Peritonitis deep abscess 5 2 Meningitis 5 3 Viral Hepatitis 5 4 Osteomyelitis 5 5 Primary Bloodstream Infection Exhibit B Criteria for Defining HAls in Long Term Care The Centers for Disease Control and Prevention CDC definitions for health ca
24. into consideration that the nursing home population presents differently from acute care patients No changes have been made in response to these comments Duplicate Reporting of HAls to the Department We received 11 comments regarding the list containing infections that are currently being reported to the Department as a reportable disease and or infection as per 28 Pa Code S 211 1 Reportable Diseases The comments requested that those infections that overlap with reportable diseases be eliminated from the list of infections Response The reporting requirements for 28 Pa Code S 211 1 and Act 52 are separate requirements and nursing homes are mandated by separate laws to report to both No changes have been made in response to these comments Limited In house Physician Consultation We received 11 comments regarding limited physician resources The comments noted that nursing homes are different clinical settings than hospitals in that many nursing homes have limited in house consultation from medical specialists VERSION 2 0 95 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM PUBLIC NOTICE OF NURSING HOME REPORTING REQUIREMENTS resulting in an increased need for telephone and remote monitoring The limited presence of physicians can adversely affect the diagnosis and management of infections Response HAI criteria and definitions will be included in the educational training programs for reporting requirements Act 52 re
25. more loose or watery stools above what is normal for the resident in a 24 hour period e wo or more episodes of vomiting within a 24 hour period e Laboratory confirmed enteric pathogen from stool WITH a compatible clinical syndrome e Stool toxin assay C difficile e Single IgM or fourfold increase in IgG for pathogen in paired sera Note These criteria must include NO evidence of a noninfectious cause e g DIARRHEA laxatives change in tube feeding or medication VOMITING change in medication other diseases such as peptic ulcer disease CDC defines a C difficile laboratory confirmed infection as health care acquired if it presents gt 3 days after admission that is on or after day 4 Other Infections Intra abdominal Infection Peritonitis Deep Abscess Two or more of the following with no other recognized cause e Fever e Nausea e Vomiting e Abdominal pain e Jaundice VERSION 2 0 99 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM PUBLIC NOTICE OF NURSING HOME REPORTING REQUIREMENTS and One of the following e Physician diagnosis of an intra abdominal infection e Radiographic evidence of infection e Organism s cultured from drainage from surgically placed drain or tube Meningitis Physician diagnosis of Meningitis and Three or more of the following with no other recognized cause e Fever e Headache e Stiff neck e Meningeal signs as determined by a physician e Cranial nerve signs as determine
26. notice HAls reported to the Authority are subject to the same patient notification requirements set forth by Act 13 for all Serious Events Under Act 13 all Serious Events require that the healthcare facility notify the patient or their legal representative in writing that a Serious Event has occurred This written notification must occur within 7 calendar days For purposes of meeting the 24 hour reporting requirement for Serious Events set forth by Act 13 nursing homes must submit reports of HAls to the Authority within 24 hours of their confirmation surveillance completed and HAI confirmed according to the criteria by a staff member responsible for infection control If confirmation of an HAI occurs over a weekend or State government holiday reports must be submitted by 5 p m on the next workday Summary of Public Comments and Responses Note For a copy of the original Public Notice see on the internet htto www pabulletin com secure data vol38 38 22 1036 html Following are the categories of comments the Authority received during the public comment period along with the Authority s responses Burden on Financial and Human Resources We received 56 comments regarding the reporting requirements potentially creating an economic and human resource burden for the nursing homes The comments noted that unrealistic and onerous reporting requirements would not result in quality improvement or a positive effect on resident outcomes Act 5
27. tenderness self described or identified upon examination e Gross hematuria or change in character of urine e Change in mental and or functional including incontinence status from daily baseline Note Asymptomatic Bacteriuria ASB is NOT reportable to PA PSRS Urinalysis is NOT used to determine if a resident has a nursing home reportable UTI It may be used to determine whether a resident had a UTI that was present on admission If a urinalysis is obtained prior to admission and one or more of the following is positive IN the presence of defined signs and symptoms the UTI was present on admission and is not reportable by the nursing home VERSION 2 0 15 MAY 2009 gt Positive leukocyte esterase and or nitrate gt Pyuria greater or equal to10 white blood cells Similarly a urine culture is not used to determine if a resident has a reportable UTI It may be used to determine whether a resident had a UTI that was present on admission If a urine culture is obtained prior to admission and greater or equal to 100 000 microorganisms per cc of urine with no more than 2 species of microorganisms are identified IN the presence of defined signs and symptoms the UTI was present on admission and is not reportable by the nursing home B Respiratory tract infection 1 Lower respiratory tract infection pneumonia bronchitis tracheobronchitis Criteria THREE or more of the following one from each category line e Fever with no other cause
28. the logical process of assuring that the event matches up with the specific criteria for each reportable infection Refer to Chapter 4 for the list of reportable infections and the criteria for each Specific Questions What admission date do we use as the most recent admission If a resident is formally discharged from the facility and returns to the facility as a new admission in the nursing home records that date will be the most recent one If however a bed is held for a transfer and the resident is NOT formally discharged and admitted again then the original admission will be the most recent one Is it mandated that a report be amended to answer the laboratory and death related questions Yes it is required that a report be amended if additional information becomes available to the nursing home such as laboratory results pertinent to the infection or if death occurs within the 45 day period of original submission of the report The comment section should be used to provide additional information if available Do we amend a report for a subsequent death only if the death occurred at the facility A death regardless of where it occurred or the possible cause if identified after the report was submitted must be reported to PSRS for up to 45 days after the initial report by using the amend VERSION 2 0 46 MAY 2009 report function The death does not have to take place at the facility The comment section should be used to provide ad
29. to enter ten utilization figures each month a resident days total and a catheter days total for each unit Refer to Appendix D for a sample Utilization Data Collection Form You are encouraged to use this form or a similar one to reliably collect utilization data on each unit The Appendix includes a blank form that you could copy and hand out to managers or staff in each care area as well as an example of a completed form for a hypothetical unit The IPD at your facility will be prompted monthly via e mail on the first day of the month to enter your utilization data for the previous month You will have until the end of the current month to enter the utilization data for the previous month On the 15 day of each month a reminder email will be sent to the IPD at any facility that has not entered their utilization data for the previous month In addition starting on the 15 day of the month a pop up message will appear every time a facility logs in that has yet to enter their utilization data for the previous month Once the facility enters their utilization data for the previous month the pop up message will no longer appear On the 30 day of each month a report will be generated listing any facility that has not entered their utilization data for the previous month This report will be sent to the Authority and to the DOH HAI section Another report will be generated for any facility whose utilization data is more than 10 of the previo
30. utilized to determine a fever Symptomatic urinary tract infection Resident with Urinary Catheter Two or more of the following with no other recognized cause e Fever and or chills with no other source e Flank or suprapubic pain or tenderness self described or identified upon examination e Gross hematuria or change in character of urine e Change in mental and or functional status from daily baseline Resident without Urinary Catheter Three or more of the following e Fever and or chills VERSION 2 0 97 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM PUBLIC NOTICE OF NURSING HOME REPORTING REQUIREMENTS e New burning pain on urinating dysuria frequency or urgency e Flank or suprapubic pain or tenderness self described or identified upon examination e Gross hematuria or change in character of urine e Change in mental and or functional including incontinence status from daily baseline Note a Ifa urinalysis is obtained one or more of the following must be positive IN the presence of defined signs and symptoms gt Positive leukocyte esterase and or nitrate gt Pyuria gt 10 white blood cells b Ifa urine culture is obtained gt 100 000 microorganisms per cc of urine with no more than 2 species of microorganisms must be present together WITH defined signs and symptoms Respiratory Tract Infection Lower Respiratory Tract Infection Three or more of the following e Fever with no other cause e New or i
31. wcramer state pa us Website http www dsf health state pa us health cwp browse asp a 188 amp C 738963 amp BM VERSION 2 0 65 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING BLANK FORM Appendix Blank Forms The following pages can be printed out as hardcopy which may be useful in coding infection reports or for training purposes within your facility PA 3 Pennsylvania Patient Safety PSRS Reporting System Monday January 12 2009 Help Main Page Event Report Utilization Data View Print Blank Forms Analytical Data Tools Resources Date Range to new date range Event Type List Showing Reportable Infection Selected Report ID m SEPA Criteria Days Remaining Infection Confirmation Date amp Time ssid S hia Event Report to Amend Date Report Submitted Event Details 10410617 North Wing B Respiratory tract infection M 31 11 20 2008 11 20 2008 16 14H 10410590 South Wing D Gastrointestinal tract infectio iator Data 23 11 12 2008 11 12 2008 08 44H 10410572 South Wing C Skin and softtissue infection 16 11 05 2008 11 06 2008 14 13H 10410563 East Wing E Other Download Adobe 12 11 01 2008 11 01 2008 03 53H Acrobat Reader Prev Next When printing these forms take care in selecting only the pages you would like to print out The easiest way to limit the pages to print is to select the Cur
32. were given and on day 2 the resident has cloudy urine and flank pain but is no longer confused It needs to be a snap shot with all of the symptoms present at once while doing the chart surveillance If a resident is transferred to a hospital with symptoms of an infection but the criteria are not met while in the nursing home is this considered a nursing home HAI if the resident develops subsequent symptoms in the hospital The nursing home must conduct surveillance using the resident s in house records after transfer to the hospital and determine if the signs and symptoms prior to transfer meet the criteria If the criteria are NOT met for nursing home HAls then regardless of the diagnosis in the hospital the nursing home will not report the infection A resident is transferred to hospital for change in mental status and has a skin tear when transferred He stays 24 hours and returns 24 hours later The resident develops a cellulitis at the skin tear site within 48 hours of readmission Is this infection considered hospital acquired 23 MAY 2009 VERSION 2 0 If the resident upon return to the nursing home meets the criteria for a skin and soft tissue infection this infection will be counted as a nursing home related infection as it occurred within 48 hours of RE ADMISSION and does not involve insertion of an invasive device while in the hospital It is considered incubating at the time of transfer to the hospital for the mental s
33. 0 8 660 8 640 620 SA 600 TN au a i OMEN zii n L WEFT odi 540 es at 520 0 Catheter Days Numberof CALTIS and Rate CAUTIs per 1000 Catheter Days lan Feb Mar Apr May Jun Jul Aug Days E CAUTI CAUTI Rate VERSION 2 0 53 MAY 2009 Catheter Utilization Line graph showing for each month x axis the number of catheter days divided by the number of resident days A tabular version is available User can drill down to unit level Urinary Catheter Utilization Facility amp 8 gt 5 E Cath Days Utilization Rate Lower Respiratory Tract Infection Rate Line graph showing for each month x axis the number of lower respiratory tract infections divided by the number of resident days multiplied by 1 000 A tabular version is available User can drill down to unit level Lower Respiratory Tract Infection Rates for Facility l Facility LATI Rate Influenza Like Illness Infection Rate Line graph showing for each month x axis the number of influenza like illness reports divided by the number of resident days multiplied by 1 000 User can isolate one series at a time A tabular version is available User can drill down to unit level VERSION 2 0 54 MAY 2009 Influenza Like Illness Rates for Facility lll Facility ILI Rate Respiratory Tract Infections Proportions Vaccinated Two charts one for LRTI and one for ILI A tabular ve
34. 2 0 mainframe data center help desk and desktop services application maintenance and development and business process outsourcing and transformation services to more than 35 000 business and government clients around the world The Institute for Safe Medication Practices ISMP based in Horsham Montgomery County is providing analytical support and technical assistance to the PA PSRS program ISMP is a non profit organization that works closely with healthcare practitioners and institutions regulatory agencies professional organizations and the pharmaceutical industry to provide education about adverse drug events and their prevention The Institute provides an independent review of medication errors that have been voluntarily submitted by practitioners to a national Medication Errors Reporting Program MERP operated by the United States Pharmacopoeia USP in the USA Infection Control Consulting Services ICCS LLC based in Blue Bell Montgomery County is providing infection control services to the PA PSRS program ICCS provides services to various healthcare related industries with a strong emphasis on Long Term Care Facilities including LTACH In addition ICCS provides services to Acute Care hospitals Rehab Facilities Home Care Services Personal Care Homes Skilled Nursing Facilities Behavioral Health Facilities private medical and dental practices free standing dialysis centers and ambulatory surgi centers The PA PSRS so
35. 2 mandates that nursing homes electronically report HAI data to the Department and the Authority Act 52 provides no discretion in this requirement No changes have been made in response to these comments Infection List Too Long We received 40 comments regarding the infection list with requests for 14 infections to be eliminated The comments noted that while nursing homes take HAI reporting seriously they believe that there are a number of reportable HAls on the list contained in Exhibit A of the notice that are vague hard to define in the NH setting will lead to misdiagnosis and most importantly have no clinical or scientific basis to support improvement in resident outcomes gt Conjunctivitis We received 38 comments requesting that conjunctivitis be eliminated as there are many non infectious conditions that have an identical presentation This will result in an over estimate of the actual number of cases In addition this group of infections has not been identified as a marker of significant morbidity and or mortality in the nursing home population gt Sinusitis We received 35 comments requesting that sinusitis be eliminated due to the difficulty in diagnosing a true infection versus allergic rhinitis and residual rhinitis from a viral syndrome without invasive intervention In addition this group of infections has not been identified as a marker for significant morbidity and or mortality in the nursing home population gt Mout
36. 2008 Help Date Range 10 21 2008 to 12 04 2008 new date range Showing Selected Report ID D Days Remaining Infection Confirmation Date amp Time Hapori oia Even pa to Amend Date Report Submitted TL TL 10410617 North Wing B Respiratory tract infection 31 11 20 2008 11 20 2008 16 14H 10410590 South Ving D Gastrointestinal tract infection 23 11 12 2008 11 12 2008 08 44H 10410572 South Wing C Skin and soft tissue infection 16 11 05 2008 11 06 2008 14 13H 10410563 East Wing E Other 12 11 01 2008 11 01 2008 03 53H Prev Next Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0162004 Pennsylvania Patient Safety Authority All rights reserved From this page you can sort your reports by several criteria simply by clicking on the blue up and down arrows beneath the column headings For instance e want to group your reports from a particular location click on the down arrow beneath the column heading Care Area e want to order your reports by the type of infection click the up arrow under the column heading Event Type If you want to view your most recent reports clicking on the down arrow in the column labeled Date amp Time Report Submitted will sort your reports in reverse chronological order On each screen 20 reports are shown T
37. 6 Exhibit D Criteria tor BAIS im Long Term Cae uo ood eo E cb ep EE HB reete eti tes beni icu ce e LO Dade 97 Key Points in Defining Infections in the E LOIS NP 97 Symptomatic urinary tract infection NIIT m 97 Tract M CUO isee E 98 Sia oo Tissue Mieco eeii EE EE S ELM ICE cM IM c MD dU 99 Gastrointestinal Tract MANS ed REPRE 99 alee NoNe aee atu eiim Hoe REM ED EINIGE LI MEDI cadaes R RA 99 UTILIZATION DATA COLLECTION FORM SAMPLE i iscssesenencatusna t es ebuskavasxvauus ubsvakdVa v2 Va Yu TRE vu S ETE Vra a CR FRE YER REPE 102 PRINTABLE FORM FOR USE IN DAILY ROUNDS TRACKING RESIDENT DAYS AND CATHETER 102 VERSION 2 0 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING TABLE OF CONTENTS This page was left intentionally blank VERSION 2 0 IV MAY 2009 Chapter 1 Introduction Using the PA Patient Safety Reporting System to improve healthcare safety and quality Purpose VERSION 2 0 The purpose of this Training Manual and Users Guide is to help Pennsylvania nursing homes to improve the safety and quality of the care they provide to residents The Medical Care Availability and Reduction of Error Act of 2002 also known as Mcare or Act 13 estab
38. 8 Help Event Report Utilization Data View Print Blank Forms Data Tools Date Range 10 21 2008 to 12 04 2008 new date range Search Submitted Evert Showing Reports Selected Report ID pa Event Report Data ion Confirmation Date amp Time Report ID CareArea Event Type Analysis Date Report Submitted Td TL Td Data Export Td 10410617 North Wing B Respiratory tract infection 31 11 20 2008 11 20 2008 16 14H 10410590 South Wing D Gastrointestinal tract infection 23 11 12 2008 11 12 2008 08 44H 10410572 South Wing C Skin and soft tissue infection 15 11 05 2008 11 06 2008 14 13H 10410563 East Wing E Other 12 11 01 2008 11 01 2008 03 53H Prev Mext VERSION 2 0 Search criteria can include o Date confirmation date submission date admission date o Resident Name o Resident Social Security Number 62 MAY 2009 VERSION 2 0 o Resident gender o Resident age o Care area unit o Infection type all levels After selecting the criteria for the reports you wish to retrieve click on Generate Report in the lower right hand corner of the page The resulting data set will be displayed in a format similar to that used in managing your current reports see Chapter 4 Standard Data Export You can download data elements from reports you have submitted to PA PSRS using the Export Data function The Export Data function will create a comma delimited file containing key report elements which can then
39. D USERS GUIDE FOR NURSING HOME REPORTING BLANK FORM Infection Report Form Respiratory Tract Infection Lower respiratory tract infection pneumonia bronchitis tracheobronchitis P Pennsylvania Patient safety Wednesday December 3 2008 PSRS Reporting System Time remaining 8 Reset Timer Help Event Report Organization Manor Care Infection Criteria questions Respiratory Tract Infection Lower Respiratory Tract Infection pneumonia bronchitis tracheobronchitis 2 Which ofthe following criteria does the resident meet Check THREE or more ofthe following Fever with no other casue New or increased cough New or increased sputum production Pleuritic chest pain Rhonchi rales wheezes and or bronchial breathing New and or increased shortness of breath Tachypnea normal respiratory rate 16 25 breaths min Change in mental and or functional status from baseline in the presence of symptoms bpe ghghgh gepi Next Page Top of Page Cancel Return to Question 1 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0162004 Pennsylvania Patient Safety Authority All rights reserved PA 3 Pennsylvania Patient Safety PSRS Reporting System Monday April 13 2009 Time remaining 14 48 Reset Timer Help Event Report Organization Manor Care 12 3 Resident Name Required
40. FORMS PA Pennsylvania Patient Safety Monday December 8 2008 PSRS Reporting System Time remaining 8 Reset Timer Help Event Report Organization EDS Administrators 12 as laboratory testing done Required O Yes O No a lIfyes were any ofthe following organisms identified check all that apply MRSA methicillin resistant staphylococcus aureus VRE vancomycin resistant enterococcus ESBL extended spectrum p lactamase Streptococcus species non S pneumoniae Streptococcus pneumoniae pneumococcus Acinetobacter species Clostridium difficile C diff Legionella species Mycoplasma pneumoniae Chlamydophila pneumoniae Influenza virus OO OOOOOOOO0O 13 Facility response to this infection for the resident check one Required No treatment Treatment in the nursing home Transferred to another facility for treatment of this infection or its consequences 14 Has the resident died check one Required O Yes O No O Unknown 15 Please enter any additional comments you would like us to review regarding this resident s infection Submit Report Top of Page Cancel Return to Questions 1 2 3 11 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0162004 Pennsylvania Patient Safety Authority All rights reserved VERSION 2 0 86 MAY 2009 Infection Report Form Other
41. Last First MI 4 Social Security Number Required 5 Resident date of birth Required Date mrniddiyyyy 6 Age of Resident years 7 Gender of Resident select one Required O Male O Female 8 Date of mostrecent admission re admission Required Date 9 Resident admitted as select one Required Long term care Shortterm skilled Rehabilitation and or medical care 10 Infection confirmation date i e date of determining that infection met crieteria Required Date mimiddiyyyy Ys Te 11 What care area is this resident assigned to Required Select Care Area v Next Page Top of Page Cancel Return to Questions 1 2 Information contained in this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authority rights reserved VERSION 2 0 71 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING BLANK FORM PA Pennsylvania Patient Safety Monday December 8 2008 PSRS Reporting System Time remaining BERA Reset Timer Help Event Report Organization EDS Administrators1 12 Vas laboratory testing done Required O Yes O No a lfyes were any ofthe following organisms identified check all that apply MRSA methicillin resistant sta
42. OOO000 MRSA methicillin resistant staphylococcus aureus VRE vancomwycin resistant enterococcus ESBL extended spectrum B lactamase Streptococcus species non S pneumoniae Streptococcus pneumoniae pneumococcus Acinetobacter species Clostridium difficile C diff Legionella species Mycoplasma pneumoniae Chlamydophila pneumoniae Influenza virus 13 Facility response to this infection for the resident check one Required O No treatment Treatment in the nursing home Transferred to another facility for treatment of this infection or its consequences 14 Has the resident died check one Required O Yes O No O Unknown 15 Date of catheter insertion Required Date mmidaiyyy E Or L Resident admitted with catheter 16 hat is the current medical justification for this resident s indwelling urinary catheter check all that apply Required d Urinary retention that cannot be treated or corrected medically or surgically for which alternative therapy is not feasible Contamination of Stage Ill or IV pressure ulcers with urine which has impeded healing despite appropriate personal care for the incontinence Terminal illness or severe impairment which makes positioning or clothing changes uncomfortable or which is associated with intractable pain Other Please specify OG Unknown 17 Please enter any additional comments you would like us to review regarding this resi
43. ach infection individually and consider 48 to 72 hours as a general guide depending on the infection If a resident is able to be educated about infections is written documentation of education of the resident required There is no state mandate for documentation of resident education How do nursing homes report infections related to surgical procedures If a resident has surgery and is transferred back to the nursing home and subsequently develops an infection as a result of the surgery e g intra abdominal abscess peritonitis the nursing home should contact the Infection Preventionist at the hospital or ambulatory surgical facility ASF that performed the procedure to discuss whether this is an HAI related to the surgery In the case of surgery not involving implantable see definition below e If the infection occurs within 30 days of the surgery the infection is attributable to the hospital or ASF The nursing home does not report it e If the infection occurs beyond 30 days of the surgery and the resident has been back in the nursing home for more than 72 hours the nursing home should report the infection In the case of surgery that does involve implantable 26 MAY 2009 If the infection occurs within one year of surgery the infection is attributable to the hospital or ASF The nursing home does not report it If the infection occurs beyond one year of surgery the nursing home should report the infection De
44. ain or tube Next Page Top of Page Cancel Return to Question 1 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0182004 Pennsylvania Patient Safety Authority All rights reserved PA 3 Pennsylvania Patient Safety PSRS Reporting System Monday April 13 2009 Time remaining 14 48 Reset Timer Help Event Report Organization Manor Care 12 3 Resident Name Required Last First E 4 Social Security Number Required 5 Resident date of birth Required Date immidd 6 Age of Resident years 7 Gender of Resident select Required O Male O Female 8 Date of most recent admission re admission Required Date rimiddiyyyy 9 Resident admitted as select one Required O Long term care Short term skilled Rehabilitation and or medical 10 Infection confirmation date i e date of determining that infection met crieteria Required Date rimiddiyyyy 1 11 What care area is this resident assigned to Required Select Care Area v Next Page TopofPage Cancel Return to Questions 1 2 Information contained in this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Pat
45. al care 10 Infection confirmation date i e date of determining that infection met crieteria Required Date 11 What care area is this resident assigned to Required Select Care Area v Next Page Top of Page Cancel Return to Questions 1 2 Information contained in this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authority Al rights reserved VERSION 2 0 83 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING EVENT TYPE TAXONOMY PA Pennsylvania Patient Safety Monday December 8 2008 PSRS Reporting System Time remaining EBEN Reset Timer Help Event Report Organization EDS Administrators 12 as laboratory testing done Required O Yes O No a lfyes were any ofthe following organisms identified check all that apply MRSA methicillin resistant staphylococcus aureus VRE vancomycin resistant enterococcus ESBL extended spectrum B lactamase Streptococcus species non S pneumoniae Streptococcus pneumoniae pneumococcus Acinetobacter species Clostridium difficile C diff Legionella species Mycoplasma pneumoniae Chlamydophila pneumoniae Influenza virus OO L1 DJ DJ DJ DJ D D DJ D 13 Facility response to this infection for the resident check one Req
46. amase Streptococcus species non S pneumoniae Streptococcus pneumoniae pneumococcus Acinetobacter speices Clostridium difficile C diff Legionella species Mycoplasma pneumoniae Chlamydophila pneumoniae Influenza virus 13 Facility response to this infection for the resident select one Required No treatment Treatment in the nursing home Transferred to another facility for treatment of this infection or its consequences 14 Has the resident died select one Required Yes Unknown 15 Did the resident receive dialysis treatment within 7 days ofthe onset of signs and symptoms ofthis infection Required Yes No a If yes what type of dialysis was received Hemodialysis Peritoneal Dialysis 16 Please enter any additional comments you would like us to review regarding this resident s infection Submit Report Top of Page Cancel Return to Questions 1 2 3 11 Information contained in this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authority All rights reserved lt TIT gt VERSION 2 0 76 MAY 2009 Infection Report Form Gastrointestinal Tract Infection P u Pennsylvania Patient safety Wednesday December 3 2008 PSRS Reportin System Time remaining EINE Reset Timer Help Event R
47. and its contractors will have access to all reports of HAls While the Authority will produce analytical reports based on submitted data these reports will include only aggregate de identified data representing multiple institutions Under no circumstances will the Authority release the details of specific event reports in a manner that allows a reporting facility to be identified The Department of Health will have access to all reports of HAls Submitted reports will identify specific facilities and residents e Each facility that submits reports to PA PSRS will have complete access to all of its own reports Each facility will also have access to aggregate data gathered from reports submitted by other facilities which will be useful for comparative purposes However no individual facility will be identifiable through the aggregate data reports Act 13 specifically protects from disclosure reports submitted to the Authority through PA PSRS Section 311 a of the Act states that any documents materials or information solely prepared or created for the purpose of complying with the Act s patient safety reporting requirements are confidential and shall not be discoverable or admissible as evidence in any civil or administrative action or proceeding Impact of PA PSRS on Reporting to Other Organizations PA PSRS is an easy to use point and click internet application that standardizes a statewide reporting mechanism in which reporting
48. ates of reports of a certain type of infection Is one care area really safer than the other do the resident populations differ or is staff on one floor more compliant about reporting events In order to help you identify the locations of events in your facility PA PSRS allows you to establish care areas for your facility Establishing care areas simply involves e Developing a list of locations in your facility e g Third Floor West Wing or 3 West e Coding each care area for the area type e g Skilled Nursing Short term rehabilitation unit Nursing Unit etc There are five types of care areas available e Skilled nursing Short Term Rehabilitation Unit e Nursing unit e Dementia unit Ventilator dependent unit e Mixed unit Care Area Definitions Skilled Nursing Short Term Rehabilitation Unit A distinct part of an institution which is primarily engaged in providing skilled nursing care and related services generally short term for residents who require medical nursing and or rehabilitation services for the rehabilitation of injured disabled or sick persons Nursing Unit A distinct part of an institution which is primarily engaged in providing skilled nursing care and related services for residents who require medical or nursing care rehabilitation of injured disabled or sick persons or on a regular basis health related care and services above 11 MAY 2009 VERSION 2 0 the level of room and board
49. buttons Use the hyperlinks to move between sections of the reporting form If you accidentally use your browser s buttons to navigate you will need to hit the refresh button to continue Screen 3 Questions 3 through 11 e Answer each question by selecting the appropriate check boxes or entering the information requested into the dialog boxes For questions 8 and 10 click on the calendar icon 29 to get a pop up calendar that can help you answer these questions e Click Next Page when finished to proceed to the next screen e Note the Time remaining box that appears in the upper right hand corner of the screen You have 15 minutes to fill out the page the timer resets for each page If you allow the system to time out the program will automatically close the session and your report will be lost Click on Reset Timer at any time to reset the timer to 15 minutes VERSION 2 0 33 MAY 2009 PA 3 Pennsylvania Patient Safety PSRS Reporting System Monday April 13 2009 Time remaining 14 48 Reset Timer Help Event Report Organization Manor Care 12 3 Resident Name Required Last First MI 4 Social Security Number Required 5 Resident date of birth Required Date mimiddiyyyy 6 Age of Resident years 7 Gender of Resident select one Required O Male O Female 8 Date of most recent admission re admission Required Date immidd m
50. ceived 12 comments requesting that UTIs be eliminated Seven of the comments suggested that non catheter associated UTIs be eliminated due to the inability to prevent these infections The comment states that typically non catheter related UTIs do not occur as a result of poor practices in the elderly Five comments noted that the entire category should be eliminated as UTIs are endemic and closely monitored gt Bronchitis We received 11 comments requesting that bronchitis be eliminated as it is endemic in the nursing home population particularly during the winter months when visitors and staff members who are carrying the cold virus infect residents gt All Respiratory Infections We received 10 comments requesting that all respiratory infections be eliminated as they are endemic at certain times of the year and are closely monitored Reporting these infections will increase the surveillance burden gt Viral Hepatitis We received 5 comments requesting that viral hepatitis be eliminated as these infections are reported to the Department as a communicable disease gt Gastrointestinal skin and soft tissue infections and influenza like illness We received 5 comments for each of these infections requesting that they be eliminated as they are endemic and closely monitored Response we eliminated the following infections Conjunctivitis Sinusitis Mouth and perioral infections Response we combined the category of decubitus ul
51. cer infection with skin and soft tissue SST infection per the McGeer criteria Duplicate Notification of Change in Condition We received 35 comments regarding Act 52 Serious Event notification The comments noted that duplicate notification would occur as CMS F Tag 157 together with the State mandates immediate notification of a significant change in condition of a resident to the legal representative s This creates an additional workload Response Act 52 requires that healthcare facilities provide written notification of a serious event within seven calendar days of identifying the HAI The Act provides no discretion in this requirement and does not affect additional federal or state mandated reporting requirements No changes have been made in response to these comments Misinterpretation of MCARE Act 13 Serious Event Reporting We received 24 comments regarding the applicability of the Act 13 provisions requiring written notification of a Serious Event to the resident or legal representative The comments noted that Act 13 defines Serious Events as an event occurring within a medical facility while under the Act 13 definition nursing facilities VERSION 2 0 94 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM PUBLIC NOTICE OF NURSING HOME REPORTING REQUIREMENTS are not defined as a medical facility but rather as a health care provider They contend that Act 13 therefore does not require nursing facilities to provide w
52. cscscssssseccesccsssssacessccssssceeseessssssaceseseeseees 83 INFECTION REPORT FORM OTHER INFECTION OSTEOMYELITIS ccccccsssssssccsccssssssscccscccssssssccescccsssssecesscccssssacesscsesssscesscesssssescessesessees 85 INFECTION REPORT FORM OTHER INFECTION PRIMARY BLOODSTREAM INFECTION cccsssscccscssssssscccesccssssssccccscesssssecesssesssssaceeseees 87 TAXONOMY 2 90 OO 90 PUBLIC NOTICE OF NURSING HOME REPORTING REQUIREMENT cccssssssssssssscccssscccssscccssscccsssssccssscccsesssscessssesseses 92 REPORTING REQUIREMENTS FOR NURSING HOMES UNDER CHAPTER 4 OF THE MEDICAL CARE AVAILABILITY AND REDUCTION OF ERROR MCARE ACT E34 98238950 c MH 92 TUE OOS 92 Of TE IN OCC 92 Repor IES NUS IO 92 Serious Eveni Repor ME eder iniu ede en additi iode uA AMD MEN ELM E UI NE UU DCN SEEMS 93 Summary Ol Public Commens antl RESPONSES science trees Gets e tto duoc ete coe utat Lora UE ea esM EN UE 93 VERSION 2 0 ii MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING TABLE OF CONTENTS c deu 9 ES 0 018 02 6 Com ene On 9
53. d by a physician e Irritability Viral Hepatitis Positive antigen or antibody test for Hepatitis A B C or delta antigen and Two or more of the following with no other recognized cause e Fever e Anorexia e Nausea e Vomiting e Abdominal pain e Jaundice e History of transfusion within the previous 3 months Osteomyelitis Physician diagnosis of Osteomyelitis and Two or more of the following with no other recognized cause e Fever e Localized swelling e Tenderness at suspected site of bone infection e Heat at suspected site of bone infection VERSION 2 0 100 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM PUBLIC NOTICE OF NURSING HOME REPORTING REQUIREMENTS e Drainage at suspected site of bone infection Primary Bloodstream Infection Two or more blood cultures drawn on separate occasions documented with a common skin contaminant such as diphtheroids Bacillus sp Propionibacterium sp coagulase negative staphylococci or micrococci or A single blood culture documented with a pathogenic organism non contaminant and One of the following e Fever or new hypothermia e Drop in systolic blood pressure of gt 30 mm Hg over baseline e Change in mental or functional status Note Organism in blood culture is not related to infection at another site secondary bacteremia MICHAEL C DOERING Executive Director Patient Safety Authority Pa B Doc No 08 1740 Filed for public inspection September 19 2008
54. dent s infection Submit Report Top of Page Cancel Return to Questions 1 2 3 11 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authority All rights reserved VERSION 2 0 36 MAY 2009 VERSION 2 0 Helpful Tip When filling out an event report you can move back and forth through the screens by using the hyperlinks at the bottom right hand corner of the screen For example after filling out the questions on the screen above you can go back to previously completed parts of the form by clicking on the question numbers to which you want to return When you click Submit Report you will see the screen below which asks you to attest that the information in the report is accurate and complete and to confirm that you are ready to submit the report Press OK to submit the report Microsoft Internet Explorer This infection will be reported to the Patient Safety Authority and the Department of Health By submitting this report you attest that the information provided is accurate and complete to Ehe best of your knowledge Do you wish Ea submit this report at this time Once the report is submitted it goes to the Patient Safety Authority and the Department of Health If you fail to click Submit Report from this screen or if you stop entering in
55. ditional information if available Utilization Data How do you calculate catheter days Collect and record the number of residents with indwelling Foley catheters on each unit care area on a DAILY basis Catheter days should be collected at the same time each day at a time decided by the facility PA PSRS does not prescribe a specific time of day At the end of each month for each unit add all the daily numbers of catheterized residents to get the total number of catheter days for that unit for that month Only the monthly total for each unit is reported to PA PSRS For example Consider a unit with 20 residents 5 of whom have an indwelling Foley catheter If the same residents are on the unit throughout a 30 day month and the 5 residents with catheters remain catheterized throughout the month the number of catheter days reported at the end of the month would be 5 residents x 30 days 150 catheter days Do we count the day the catheter was inserted or removed Do you count the day the resident was admitted with a catheter in Because facilities are asked to count resident and catheter days at the same time each day for example at midnight the time of day will be the determinant as to whether to count the insertion or removal day If the catheter was inserted at 9 00 p m and the catheter count occurs at midnight that day it counts as a catheter day If the catheter was removed at 9 00 p m and the catheter count occurs at midnig
56. down or you have a power failure that prevents timely reporting Use the comment box to note the issue however if a pattern develops DOH will investigate for validity of ongoing issues Will this legislation extend to AL and IL Will electronic surveillance be required eventually Currently Act 52 legislation involves hospitals and nursing homes only Legislation for AL and IL will require separate legislation of which there is none to date What documentation will the DOH surveyors look for PSA plans to work with the DOH HAI prevention section to educate field offices and surveyors with respect to the mandatory reporting requirements It is suggested by DOH that all relevant information be documented such as communication with transferring facilities and written proof of sending serious event notices etc If the hospital cites HIPAA as a reason to refuse to send clinical notes how should this be handled Contact the Department of Health if this situation arises Are hospitals only required to communicate positive MRSA lab results If so how can the nursing home be assured that MRSA screening was actually done If the hospital isn t doing MRSA screening what should the nursing home do Contact DOH as they are the enforcement agency Which infections have to be reported to the Department of Health separately from PA PSRS All HAls reported through PA PSRS are available both to the Patient Safety Authority and the Infectio
57. dsansatensaeueneldaceanseeiouals 64 J Mm 65 DLANK TORN a cerca access inae uis sce ase eon date in iO e E MI E Md MC EE 66 INFECTION REPORT FORM SYMPTOMATIC URINARY TRACT INFECTION RESIDENT WITH INDWELLING URINARY CATHETER 67 INFECTION REPORT FORM SYMPTOMATIC URINARY TRACT INFECTION RESIDENT WITHOUT URINARY 69 INFECTION REPORT FORM RESPIRATORY TRACT INFECTION LOWER RESPIRATORY TRACT INFECTION PNEUMONIA BRONCHITIS TRA TE ORRON 1 RIS eee anne oan een ee 71 INFECTION REPORT FORM RESPIRATORY TRACT INFECTION INFLUENZA LIKE ILLNESS 73 INFECTION REPORT FORM SKIN AND SOFT TISSUE INFECTION ccccccccccssssssscccsccsssssssccescecssssssccsscccsssssscesscessssssscessccssssscesseeessssseeeseeessees ys INFECTION REPORT FORM GASTROINTESTINAL TRACT INFECTION ccccssscccsccssssssscccscccsssssscccscccsssssecesscccssssaccesccsssssssesccessssaceesseessaes T INFECTION REPORT FORM OTHER INFECTION INTRA ABDOMINAL INFECTION PERITONITIS DEEP 88 79 INFECTION REPORT FORM OTHER INFECTION MENINGITIS cssssscccsscssssssscccscscssssscccessccsssscecessccsssssscessscesssseacescesssssscessecsssssasessseessees 81 INFECTION REPORT FORM OTHER INFECTION VIRAL HEPATITIS cccsssssscscsccssssscccccscccsssscce
58. e Required Last First MI 4 Social Security Number Required 5 Resident date of birth Required Date mimniddiyyyy 6 Age of Resident years 7 Gender of Resident select one Required O Male Female 8 Date of mostrecent admission re admission Required Date mmddyy 88 9 Resident admitted as select one Required Long term care Shortterm skilled Rehabilitation and or medical care 10 Infection confirmation date i e date of determining that infection met crieteria Required Date mmo 1 283 11 What care area is this resident assigned to Required Select Care Area v Next Page Top of Page Cancel Return to Questions 1 2 Information contained in this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authority rights reserved VERSION 2 0 87 MAY 2009 PA 3 Pennsylvania Patient Safety P SRS Reporting System Monday April 13 2009 Time remaining Reset Timer Help Event Report Organization Manor Care 12 12 Vas laboratory testing done Required Yes No a Ifyes were any ofthe following organisms identified check all that apply MRSA methicillin resistant staphylococcus aureus VRE vancomycin resistant enterococcus ESBL fextended spectrum p lactamase
59. e 10 21 2008 to 12 04 2008 new date range View HM Showing Taaa nd Selected Report ID Print Amendments to Event Jays Remaining Infection Confirmation Date amp Time RERO M CARACOS 2 17 to Amend Date Report Submitted TL TL TL TL 10410617 North Wing B Respiratory tract infection 31 11 20 2008 11 20 2008 16 14H 10410590 South Wing D Gastrointestinal tract infection 23 11 12 2008 11 12 2008 08 44H 10410572 South Wing C Skin and soft tissue infection 18 11 05 2008 11 06 2008 14 13H 10410563 East Wing E Other 12 11 01 2008 11 01 2008 03 53H Prev Next Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laus 0162004 Pennsylvania Patient Safety Authority All rights reserved To view or print a report e From the Main Page enter the Report ID in the dialog box in the upper right of your screen labeled Selected Report ID Rather than type in the Report ID clicking on a Report ID number in the left column will enter it for you e Click on View Print in the Navigation Bar e Click on either view or print in the pop up menu e By default the system will present a summary version of the report for viewing or printing In a summary view only items that were entered or checked will be shown e Alternately clicking Full View will present the entire report includ
60. e IPDs to submit reports to the system the IPD must ultimately be responsible for the integrity of submitted reports 9 MAY 2009 If the IPD wishes to authorize other individuals only to view and analyze reports on his or her behalf you may add read only users by following these steps Click User Administration on the Navigation Bar Click Add New User in the pop up menu Enter the information requested on the screen below and select No to the question Can this user enter and amend PA PSRS reports Click Save when done PAG B Pennsylvania Patient Safety PSRS Reporting System Monday April 20 2009 Help User Information User ID FSM 123 First Name MI Required Last Name Required Smith Title Address Line 1 Required 123 Blvd Address Line 2 City State Zip Required Iwland PA 112345 Phone Required 71 123 456 Ext Fax Email Required msmith 123 com Active In PA PSRS you can create two types of users e Those who can enter amend and read reports e Those who can only read reports Can this user enter and amend PA PSRS reports ves ONo Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0182004 Pennsylvania Patient Safety Authority All righ
61. e both infections reported A bloodstream infection occurring together with an infection at another site is considered a SECONDARY bloodstream infection and must not be reported Only the primary infection UTI or LRTI must be reported How do we use the results of urinalysis and urine cultures Urinalysis and urine cultures are not used as criteria when determining whether a resident has a nursing home reportable HAI They may be used to determine whether a resident had a pre existing HAI upon admission to the nursing home If a resident is transferred to a nursing home with positive laboratory results this indicates that the urinary tract infection was incubating or present on admission and it is therefore not reportable by the nursing home 21 MAY 2009 VERSION 2 0 Positive laboratory results include For URINALYSIS one or more of the following must be positive IN the presence of defined signs and symptoms gt Positive leukocyte esterase and or nitrate gt Pyuria greater or equal to10 white blood cells e Foraurine CULTURE greater or equal to 100 000 microorganisms per cc of urine with no more than 2 species of microorganisms must be present together WITH defined signs and symptoms A positive urinalysis CANNOT be used as a sign of change of character of urine There needs to be a visible change in the character when looking at the urine with the naked eye If a resident develops a UTI after removal of a catheter w
62. e facility s utilization data Options are available under this menu item to enter new data or edit existing data PA 3 Pennsylvania Patient Safety PSRS Reporting System Thursday December 4 2008 Help Event Report Wwutilization Data View Print Blank Forms Analytical Data Tools Date Range 10 21 2008 to 12 04 2008 Enter New Utilization Showing Data Selected Report ID Edit Utilization Data Days Remaining Infection Confirmation Date amp Time a CNN to Amend Date Report Submitted 10410617 North Wing B Respiratory tract infection 31 11 20 2008 11 20 2008 16 14H 10410590 South Wing D Gastrointestinal tract infection 23 11 12 2008 11 12 2008 08 44H 10410572 South vying C Skin and soft tissue infection 16 11 05 2008 11 06 2008 14 13H 10410563 East Wing E Other 12 11 01 2008 11 01 2008 03 53H Prev Next Starting on the first of the month the user will be able to enter utilization data for the previous month VERSION 2 0 42 MAY 2009 Enter Utilization Data for March 2009 Unit Skilled Nursing Rehabilitation Unt Nursing Unit Dementia Unt Ventilator Dependent Unit Editing Utilization Data Care Area Type Care Area Central Wing East Wing North Wing south Wing West Wing Resident Days 250 003 090 Definitions Catheter Days The system allows editing of utilization data for
63. each facility It is suggested that a surveillance worksheet be developed by each facility for the purpose of maintaining a working record DOH surveyors may ask to see worksheets and other documentation of the onset of symptoms and confirmation of infection i e once surveillance is completed the infection is confirmed and therefore untimely surveillance may result in a citation Surveillance for the benefit of confirmation or rule out of infection must not affect daily ongoing communication between staff members residents and families with respect to standards of care Walking rounds and chart cardex reviews are essential to identify immediate and day to day issues and potential action taken to rectify the problems or prevent outbreaks of infection Surveillance must not interfere with any medical treatment rendered by Physicians How does a Nursing Home manage Surveillance and reporting when the sole IPD is absent from work It is encouraged that every nursing home designate a back up or back ups for the IPD in the event of a work absence The Department of Health will not accept that no one was available at the NH to do surveillance Do all of the signs and symptoms need to present on the same day For example if a resident is confused on day 1 and extra fluids were given and on day 2 the resident has cloudy urine and flank pain but is no longer confused It needs to be a snap shot with all of the symptoms present at once while d
64. ection GI Rate Bar chart showing for each month x axis the number of GI infections divided by the number of resident days multiplied by 1 000 Each bar consists of two series Gl infections that are or are not identified as C Diff A tabular version is available User can drill down to unit level Monthly Gastrointestinal Rate Percentage of C Diff cases Apr May E C Diff E non C Diff VERSION 2 0 Unit Infection Rates A tabular report listing unit specific infection rates for the following infections CAUTI LRTI ILI SST GI User can choose to group data by unit or by infection type Data are sorted by default with the highest rates at the top whether grouped by unit or infection type Default timeframe is one month but this is modifiable by the user No graphical view available 58 MAY 2009 VERSION 2 0 Drilldown 55715 by Unit Jan Jun 2008 UnitA UnitB 5511 Resident Days 8 882 26 723 SSTI Rate Vascular or diabetic ulcer Decubitus ulcer Burn Device associated Cellulitis Other Multi Drug Resistant Organisms MDROs Bar charts showing by month the numbers rates and proportions of reported infections identified as MDROs Numbers will show the raw number of infections per period Rate will show the number of MDROs per 1 000 resident days Proportions will be calculated as the number of MDRO infections MRSA VRE and ESBL divided by the number of all infections in each period U
65. elete Care Area Care Area Name Required East Wing Care Area Type Required Skilled Nursing Short Term Rehabilitation Unit iew Print Note You cannot add or edit utilization data for deleted care areas Be sure that all utilization data is current before deleting a care area 13 MAY 2009 This page was left blank intentionally VERSION 2 0 14 MAY 2009 Chapter 4 List of Reportable Infections Infections to be reported through PA PSRS Reportable Infections A Symptomatic urinary tract infection 1 Resident with indwelling urinary catheter defined as an indwelling device inserted into the bladder through the urethra left in place and connected to a closed collection system Indwelling catheters do NOT include straight in and out catheters or other catheters that are not placed in the urethra such as suprapubic catheters Criteria TWO or more of the following one from each category line with no other recognized cause e Fever and or chills with no other source e Flank or suprapubic pain or tenderness self described or identified upon examination e Gross hematuria or change in character of urine e Change in mental and or functional status from daily baseline 2 Resident without urinary catheter Criteria THREE or more of the following one from each category line e Fever and or chills e New burning pain on urinating dysuria frequency or urgency e Flank or suprapubic pain or
66. end Event Report Not seen by Read only User Retrieve Event Report By Report ID Utilization Data Not seen by Read only User Enter New Utilization Data Not seen by Read only User Edit Utilization Data Not seen by Read only User View Print View Completed Report Amendments to Report VERSION 2 0 5 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING INTRODUCTION Print Completed Report Amendments to Report Blank Forms Event Type List Reportable Infection Criteria Event Report Utilization Data Collection Form Download Adobe Acrobat Reader Analytical Data Tools Search Submitted Event Reports Event Report Data Analysis Data Export Resources Nursing Home Training Manual Nursing Home Training Slides Program Memoranda Nursing Homes Logoff If you logged in as the Facility System Manager your Navigation Bar will appear as shown below A IAN As the Facility System Manager the selections available from your Navigation Bar are Main Page User Administration Add New User View Edit User Care Areas Add Care Area Edit Delete Care Area Nursing Home User Manual Training Slides Program Memoranda VERSION 2 0 6 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING INTRODUCTION Log Off We discuss Facility Management tasks in the next section Changing Passwords All
67. eport Organization Manor Care Infection Criteria questions Gastrointestinal Tract Infection 2 Which ofthe following criteria does the resident meet Check ONE or more ofthe following signs and symptoms Twoormore loose watery stools above what is normal for the resident in a 24 hour period Twoormore episodes of vomiting within a 24 hour period L Laboratory confirmed enteric pathogen from stool WITH a compatible clinical syndrome Stool toxin assay C difficile Single IgM or four fold increase in IgG for pathogen in paired sera Next Page Top of Page Cancel Return to Question 1 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0182004 Pennsylvania Patient Safety Authority All rights reserved PA Pennsylvania Patient Safety PSRS Reporting System Monday April 13 2009 Time remaining 14 48 Reset Timer Help Event Report Organization Manor Care 12 3 Resident Name Required Last First MI 4 Social Security Number Required 5 Resident date of birth Required Date 6 of Resident years 7 Gender of Resident select one Required O Male O Female 8 Date of mostrecent admission re admission Required Date immidd 9 Resident admitted as select one Required O Long term care Short term
68. eports you make to your facility s Patient Safety Committee or to support your own analyses To save a graph or chart select File in the gray toolbar at the top of the image you want to save and then select Save Chart This will open a Save as dialog box where you must select a filename and file type To save files for use in word processing applications we recommend saving the chart as a Windows metafile To do this from the Save as dialog box click on Save as type then choose metafile from the menu This will save the document in a form that can be read by most Windows applications To save data tables use your mouse to highlight all the rows and columns of the table you want to save When the area you wish to capture is highlighted press CTRL C on your keyboard to copy Next open a new blank file in your word processing or spreadsheet program and pres CTRL V on your keyboard to paste Searching Reports PAS PA PSRS includes a search utility that allows you to identify all submitted reports matching a variety of criteria you may set and modify Users may search for infection reports from their own facility To access the search screen while logged in as a PA PSRS User or Read only PA PSRS User select Analytical Data Tools from the main screen menu bar then select Search Submitted Event Reports Pennsylvania Patient Safety PS RS Reporting System Thursday December 4 200
69. er of Resident select one Required O Male O Female 8 Date of most recent admission re a Date mm ddhah 9 Resident admitted as select one Required 10 Infection confirmation date i e date of determining that infection met crieteria Required Date mmiddAyy dmission Required m mm 11 hat care area is this resident assigned to Required Select Care Area Information contained in this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authority VERSION 2 0 Next Page All rights reserved Top of Page Return to Questions MI Long term care O Short term skilled Rehabilitation and or medical care Cancel 112 Time remaining 14 48 Reset Timer Help Organization Manor Care 12 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING BLANK FORMS PA Pennsylvania Patient Safety Nuria Decombera S008 PSRS Reporting System Time remaining Reset Timer Help Event Report Organization EDS Administrators 12 Vas laboratory testing done Required O Yes No a were any ofthe following organisms identified check all that apply MRSA methicillin resistant staphylococcus aureus VRE vancomycin resistant en
70. f we create a report and subsequently a non infectious diagnosis is made e g pleural effusion that mimics a LRTI how do we amend the report to exclude the original report of an HAI Once a report has been entered into PA PSRS it cannot be deleted It is suggested that an amended report which will have to have the same criteria a report cannot be entered if it does not meet the criteria be entered with comments relating to the final non infectious diagnosis The amended report and comments will be taken into consideration Our corporation requires that we monitor other infections not required under Act 52 Can use PA PSRS to monitor these other infections PA PSRS is designed to collect only those infections determined by the Authority and DOH to be reportable However infections that are not in the reportable list can be collected internally for the 48 MAY 2009 nursing home database of infections such as conjunctivitis mouth and peri oral infections and others nursing home is part of a hospital will the nursing home use hospital s existing PA PSRS system Nursing homes will receive their own PSRS system and will not share with the hospital What is the procedure to update PA PSRS with changes in personnel who are responsible for reporting To do so go to the Authority s Web site which is accessible via a button on the left side of the PA PSRS sign on screen Click on the PA PSRS link then Facility Re
71. facilities can submit their reports to the Authority using a series of question and answer screens Through PA PSRS the Authority will receive reports of HAls In addition all reports of HAls will be provided electronically to the Department of Health DOH Reporting through PA PSRS does not relieve a healthcare facility of any obligations it may have to report to other federal state or local government agencies independent accrediting organizations or licensing boards Acknowledgements leading international information technology firm with 138 000 employees providing VERSION 2 0 PA PSRS was developed by ECRI Institute under contract to the Pennsylvania Patient Safety Authority ECRI Institute is a Pennsylvania based independent non profit health services research agency headquartered in Plymouth Meeting Montgomery County Its focus is healthcare technology healthcare risk and quality management and healthcare environmental management ECRI Institute is a Collaborating Center of the World Health Organization and is designated an Evidence based Practice Center EPC by the U S Agency for Healthcare Research and Quality AHRQ Electronic Data Systems Corporation EDS an HP company based in Plano Texas is providing IT programming and support services to the PA PSRS program EDS is a 4 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING INTRODUCTION VERSION
72. fety Monday December 8 2008 PSRS Reporting System Time remaining QQ Reset Timer Help Event Report Organization EDS Administrators 12 as laboratory testing done Required O Yes O No a lfyes were any ofthe following organisms identified check all that apply MRSA methicillin resistant staphylococcus aureus VRE vancomycin resistant enterococcus ESBL extended spectrum B lactamase Streptococcus species non S pneumoniae Streptococcus pneumoniae pneumococcus Acinetobacter species Clostridium difficile C diff Legionella species Mycoplasma pneumoniae Chlamydophila pneumoniae Influenza virus OO OOOOOOOO0 13 Facility response to this infection for the resident check one Required No treatment Treatment in the nursing home O Transferred to another facility for treatment of this infection or its consequences 14 Has the resident died check one Required O Yes O No O Unknown 15 Please enter any additional comments you would like us to review regarding this resident s infection Submit Report Top of Page Cancel Return to Questions 1 2 3 11 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0192004 Pennsylvania Patient Safety Authority All rights reserved VERSION 2 0 70 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AN
73. finition of implantable taken from CDC s NHSN reporting system A nonhuman derived object material or tissue e g prosthetic heart valve nonhuman vascular graft mechanical heart or hip prosthesis that is permanently placed in a patient during an operative procedure and is not routinely manipulated for diagnostic or therapeutic purposes Solid organ transplant surgery is not considered an implantable surgery unless a nonhuman derived object was inserted into the patient during the transplantation If an infection develops after transplantation the 30 day look back rule applies What is the nursing home s obligation regarding infections attributable to hospitals or ASFs If a nursing home identifies an infection attributable to a hospital or ASF the nursing home s obligation is to contact the other facility s Infection Preventionist or designee Depending on the circumstances the other facility may be required to report it The nursing home s obligation if the infection is not reportable by the nursing home is to communicate the information it has relevant to the patient resident s infection to the other facility Document your communication with the transferring facility How should document communication to the hospital that a resident was transferred back to the nursing home with a probable or confirmed hospital acquired HAI The State agencies do not make any recommendations for documentation of communication however t
74. formation at any point before reaching this screen the report will not be submitted and your data will not be stored in PA PSRS Once you submit your report you will see the following screen which confirms that your report has been received The report will be assigned a unique Report Number which you can record You will also have the option to print out a summary of the report you just submitted or to immediately begin to enter a new report 37 MAY 2009 PA 3 Pennsylvania Patient Safety PSRS Reporting System Wednesday December 3 2008 Help Event Report The submission process has been successfully completed This report has been submitted to the Patient Safety Authority In addition a copy will also be sentto the PA Department of Health For your records the Report Identifier associated with this submission is 49511 Thank you What would you like to do next Print This Report Add another Event Report Return to Main Page Logoff Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2 2004 Pennsylvania Patient Safety Authority All rights reserved VERSION 2 0 38 MAY 2009 Managing Submitted Reports You can manage your reports from the main page the first page you see when you log on as a PA PSRS User PA 3 Pennsylvania Patient Safety S R S Reportin System Thursday December 4
75. ftware program was developed in part based on Patient Safety Net a proprietary patient safety reporting application developed and maintained by the University HealthSystem Consortium UHC UHC based in Chicago Illinois is a non profit alliance of the clinical enterprises of 87 academic health centers Diversified Data Systems DDS based in Mechanicsburg PA provided assistance in developing the PA PSRS training program and this manual The Authority and ECRI Institute also wish to thank the Pennsylvania healthcare organizations who participated in pilot testing PA PSRS Their feedback and suggestions have helped to improve the usefulness of the system and their ideas will continue to influence future enhancements We appreciate their leadership and commitment to patient safety 5 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING INTRODUCTION This page was left intentionally blank VERSION 2 0 6 MAY 2009 Chapter 2 Getting Started Key system functions and startup Key System Functions The system is designed around the following key functions in nursing homes 1 System administration 2 Submitting reports of infections 3 Amending submitted reports 4 Data analysis of submitted reports User Roles Each facility will have three system roles e Facility System Manager PA PSRS User e Read Only PA PSRS User Each role has unique respon
76. ge located under the navigation bar The maximum difference between Start Date and End Date is 45 days A user cannot bring back data greater than a 45 day span 4 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING INTRODUCTION Note the blue horizontal Navigation Bar on your screen that looks like the one shown below Mainpage TT IIT 0900 This Navigation Bar s buttons or selections are used to move between the different system functions You use the Navigation Bar by positioning your cursor over your selection This will initiate a pop up menu of possible selections under that heading If you are a PA PSRS User positioning your mouse over Event Report in the Navigation Bar brings up a menu with three selections Create New Event Report Amend Event Report or Retrieve Event Report By Report ID To perform these functions simply click on your selection If you are a Read only user positioning your mouse over Event Report in the Navigation Bar brings up a menu with only one selection Retrieve Event Report By Report ID To perform this function simply click on your selection This manual addresses the specifics of performing these tasks in later chapters For now familiarize yourself with the Navigation Bar and the available selections Main Page Event Report Create New Event Report Not seen by Read only User Am
77. gist s report confirms the presence of a pneumonia IN the presence of defined signs and symptoms this indicates that the pneumonia was present on admission and is therefore not reportable by the nursing home What are the criteria to determine how long to wait until MRSA clears Some patients will always test positive How long do you wait to determine if an infected ulcer has cleared to determine if you need to report the infection again MRSA colonization is not reportable Criteria to determine an infection must be met in order to report regardless of the organism For determination of a re infection refer to the question above If the resident has an access device for dialysis and becomes infected is this reportable The resident goes out for the dialysis and the nursing home staff doesn t touch the site If the resident is residing in the nursing home and meets the criteria for a skin and soft tissue infection at the device site the infection must be reported as an HAI even though the site is not touched by the nursing home staff In the event that a resident receiving dialysis develops a PRIMARY bloodstream infection with no signs and symptoms of a skin and soft tissue infection or other infection the bloodstream infection will be reportable as an HAI as it is presumed to be related to an indwelling device Do all of the signs and symptoms need to present on the same day For example if a resident is confused on day 1 and extra fluids
78. going to be approved DOH will still contact each facility to confirm contacts What are the ramifications for the nursing homes if they miss a report DOH has the authority to fine up to 1000 a day for failure to report This is only likely to occur if sufficient evidence exists to support that the facility purposely attempted to misrepresent themselves by not reporting If it is a legitimate error DOH will work consultatively with facilities to help them do better If it appears that there is refusal to report fines will ensue What is the DOH going to do with the event reports Will DOH look at the data Initially DOH will look at event reports for data validation Eventually risk adjusted benchmarking for certain infections adjusted for differences in nursing homes will take place At the time of manual development timelines have not been put in place yet Will infection rates be published to the public Nursing Home benchmarking with subsequent rate reporting will be established in the future What if the facility is late on reporting infections after confirmation 28 MAY 2009 VERSION 2 0 Nursing homes should do their best to report within 24 hours of confirmation If patterns develop DOH may have to call to determine the cause All nursing homes should have at least one back up staff member to cover for vacations sick time and other situations whereby the key staff member is absent from work What happens if the system goes
79. h and Perioral Infections We received 34 comments requesting that mouth and perioral infections be eliminated due to the potential for numerous misdiagnosed cases Many non infectious causes mimic these infections and criteria are too broad to be meaningful In VERSION 2 0 93 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM PUBLIC NOTICE OF NURSING HOME REPORTING REQUIREMENTS addition this group of infections has not been identified as a marker for significant morbidity and or mortality in the nursing home population gt Intra abdominal infection peritonitis deep abscess Osteomyelitis and Blood Stream Infections We received 21 comments for each of these infections The comments noted that these infections are extremely uncommon in the nursing home setting and that resources would be better utilized in identifying the more common and costly infections for the purpose of improving quality and resultant positive outcomes gt Decubitus ulcer infections We received a total of 19 comments requesting that decubitus ulcer infections be eliminated The comments noted that in order to diagnose a true decubitus ulcer infection it is necessary to do a culture of properly collected fluid or tissue The vast majority of facilities are not equipped to do needle aspiration culture or tissue biopsy culture which will result in unreliable data that will substantially under estimate the actual number of cases gt Urinary Tract Infections We re
80. hapter 4 of the Medical Care Availability and Reduction of Error Act relating to Health Care Associated Infections Act 52 of 2007 The reporting requirements presented in this notice were developed in consultation with the Department and the Authority s Health Care Associated Infection Advisory Panel Background of Final Notice Under 40 P S S 1203 405 an initial notice was published at 38 Pa B 2542 May 31 2008 Public comment was solicited for a period of 30 days after publication of the notice which resulted in the Authority receiving 61 public comments addressing 10 main categories A summary of the comments and responses is detailed in this notice The Authority has revised the reporting requirements in response to those comments as reflected in this document Reporting Requirements for Nursing Homes In addition to reporting under the Health Care Facilities Act 35 P S S 3448 101 et seq Act 52 requires that nursing homes electronically report patient specific health care associated infections HAI to the Authority and the Department using nationally recognized standards based on Centers for Disease Control and Prevention CDC definitions Nursing homes will begin mandatory reporting on April 1 2009 The list of reportable HAI infections is presented at the end of this notice as Exhibit A The criteria for determining HAls were developed utilizing the McGeer Criteria together with CDC definitions which were adapted to the long
81. hat is the allowable time frame from removal of the catheter to development of a symptomatic UTI to consider it a catheter associated UTI CAUTI Nursing homes are to follow the latest UTI module from CDC NHSN CDC considers a symptomatic UTI as catheter related IF the catheter was removed within 48 hours of the onset of signs and symptoms Therefore if the resident develops signs and symptoms within 48 hours of catheter removal the criteria for a catheter associated CAUTI will need to be met and entered into PA PSRS If a resident has a suprapubic catheter and develops a UTI how is it reported A UTI that develops in a patient with a suprapubic catheter is reported as a UTI in a resident WITHOUT a urinary catheter Is pyelonephritis reportable Unless the condition fits the definition and criteria of a UTI other genito urinary infections are not reportable as per Act 52 If a resident only has 1 qualifying urinary tract symptom but their urine culture is positive for a multi drug resistant organism is this reportable Urinary tract infections rely strictly on signs and symptoms and a urine culture which will reveal the MDRO and urinalysis do NOT play a role in the confirmation or rule out of an infection One sign and symptom will not meet the criteria for a UTI IF a resident is severely impaired and cannot verbalize burning pain frequency flank or supra pubic pain or tenderness but has only one symptom being a change in me
82. he facilities are obligated to communicate with each other and it is suggested that facilities document in the resident s record that they have had communication with the hospital It is up to the discretion of the nursing home as to where they document this Records should be accessible at all times Written Notice Serious Event Letter VERSION 2 0 Act 52 requires that nursing homes provide written notice of the occurrence of a Serious Event Do we send notification to the residents and their families or POA If the resident is considered competent the written notice should be given to the resident If the resident is not considered competent the written notice should be given to the responsible party What information should the written notification letter contain The State agencies do not make recommendations for content of serious event notification letters Itis up to the individual facilities to make that determination When notifying family resident of a serious event does the term serious event need to appear in the notice MCARE Section 308 b states the following A medical facility through an appropriate designee shall provide written notification to a patient affected by a serious event or with the consent of the patient to an available family member or designee The MCARE statute does not provide specific verbiage for the written notice 27 MAY 2009 Should a copy of the letter be kept in the resident s chart
83. ht that day it does not count as a catheter day Do we count suprapubic catheters in the catheter days collection NO you do NOT count suprapubic catheters as an in dwelling catheter See slide 36 for the definition of an indwelling catheter If a resident stays overnight in the ED for observation and isn t admitted does this count as a resident day If a bed is held for a resident this bed is not counted as a resident day Only physically OCCUPIED beds are considered for the daily count Reporting System VERSION 2 0 Does the timer at the top of the page on the Infection entry reports allow 15 minutes per page Does one lose all the data if one is timed out The timer allows 15 minutes per page can be reset if you are running out of time and ALL data will be lost if you are timed out Who will receive the ID Password for PA PSRS reporting An e mail will be sent to the Infection Prevention Designee IPD if one has been assigned If there is no assigned IPD the e mail will go to the Administrator 47 MAY 2009 VERSION 2 0 At any time prior to submitting the report can you cancel if you make a mistake Yes unless you click on the submit report button you can shut down and start again How long is data stored in PA PSRS The data is stored indefinitely We may reach a point after several years where we begin archiving data but there are no set plans to do so at this time Can data reports be divided by unit instead of
84. ient Safety Authority Al rights reserved VERSION 2 0 79 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING EVENT TYPE TAXONOMY PA Pennsylvania Patient Safety PSRS Reporting System Monday April 13 2009 Time remaining 14 39 Reset Timer Help Event Report Organization Manor Care 12 12 vas laboratory testing done Required O Yes No a Ifyes were any ofthe following organisms identified check all that apply MRSA methicillin resistant staphylococcus aureus VRE vancomvycin resistant enterococcus ESBL extended spectrum B lactamase Streptococcus species non S pneumoniae Streptococcus pneumoniae pneumococcus Acinetobacter speices Clostridium difficile C diff Legionella species Mycoplasma pneumoniae Chlamydophila pneumoniae Influenza virus 13 Facility response to this infection for the resident select one Required No treatment Treatment in the nursing home Transferred to another facility for treatment of this infection or its consequences 14 Has the resident died select one Required Yes Unknown 15 Did the resident receive dialysis treatment within 7 days ofthe onset of signs and symptoms ofthis infection Required Yes No a If yes what type of dialysis was received Hemodialysis Peritoneal Dialysis 16 Please enter any additional c
85. imer Help Event Report Organization EDS Administrators 12 vas laboratory testing done Required O Yes O No a lIfyes were any ofthe following organisms identified check all that apply MRSA methicillin resistant staphylococcus aureus VRE Wwancomycin resistant enterococcus ESBL extended spectrum p lactamase Streptococcus species non S pneumoniae Streptococcus pneumoniae pneumocaccus Acinetobacter species Clostridium difficile C diff Legionella species Mycoplasma pneumoniae Chlamydophila pneumoniae Influenza virus 9 99 99 99 99 99 99 9 N 13 Facility response to this infection for the resident check one Required No treatment Treatment in the nursing home O Transferred to another facility for treatment of this infection or its consequences 14 Has the resident died check one Required O Yes O No O Unknown 15 Please enter any additional comments you would like us to review regarding this resident s infection Submit Report Top of Page Cancel Return to Questions 1 2 3 11 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2 2004 Pennsylvania Patient Safety Authority All rights reserved VERSION 2 0 82 MAY 2009 Infection Report Form Other Infection Viral Hepatitis PA Pennsylvania Patient Safety Wedneaday Deceniba
86. infections as well as other county State Norovirus reporting requirements If you admit a neutropenic resident to a unit and they develop an infection is that an HAI All residents exhibiting signs and symptoms of a possible infection regardless of their admission diagnosis must undergo surveillance procedures to rule out or confirm an infection If the neutropenic resident fits the criteria for an HAI this must be reported to PA PSRS If a resident develops an infection after being discharged to home and the nursing home finds out this information is this required to be reported The nursing home should do retrospective surveillance if the resident was recently discharged As there is no specific rule as to how long after discharge an infection would be considered an HAI it is suggested that the IPD assess each infection individually and consider 48 to 72 hours as a general guide depending on the infection If a resident is able to be educated about infections is written documentation of education of the resident required 24 MAY 2009 There is no state mandate for documentation of resident education Surveillance VERSION 2 0 How often should surveillance for the purpose of identification of HAls be conducted Act 52 does not stipulate timelines for confirming an infection Industry standards suggest timely surveillance Please note however that it is essential to conduct surveillance in a timely manner determined by
87. ing all the items and check boxes that were not used in the report When viewing or printing a report the information displayed includes the Report ID current amendment number where applicable the original submission date and time the User ID of the individual who submitted the original report date and time of last update where applicable and the User ID of the individual who made the latest amendment 44 MAY 2009 Report History You can also use PA PSRS to generate a report history A report history is essentially a report that shows you what changes have been made to an event report since it was originally submitted as well as who made each change This feature will be more significant for facilities where the IPD has authorized multiple individuals to submit reports to PA PSRS You will know if a report has been amended by looking at the Report ID number see screen below If a Report ID ends in a hyphen followed by a two digit suffix e g 0123456 01 this indicates that the report has been amended since its original submission The two digit suffix indicates the number of times the initial report has been revised e g 0123456 01 indicates that there has been one amendment to the original report 0123456 02 indicates that there have been two amendments 0123456 05 indicates that there have been five amendments etc To see a report history for a particular event report follow these steps 1 From the Main Page en
88. ist of infections What timeframe applies to Clostridium difficile and is it reportable by the NH if the resident was antibiotic therapy CDC defines a C difficile laboratory confirmed infection as health care acquired if it presents greater than gt days after admission i e on or after day 4 If a resident is admitted on Monday and on Thursday he she has a positive stool toxin assay for C difficile the nursing home would report this as a Gastrointestinal Tract infection If the infection meets the criteria then it is reported as an HAI regardless of antibiotic therapy How do we determine if a C difficile infection is recurring or a newly acquired one If a C diff infection has been treated or resolves spontaneously absence of diarrhea is considered resolved and signs and symptoms occur again after the cessation of previous symptoms a new infection should be reported Primary bloodstream infection BSI requires a blood culture result If a resident is transferred to an ER with signs and symptoms that meet the NH criteria for a BSI how do we obtain the information about a blood culture The NH should contact the hospital either the laboratory directly or the infection preventionist and request the blood culture results in order to confirm the infection If a resident exhibits signs and symptoms of an infection that meet criteria for a UTI or lower respiratory tract infection AND a bloodstream infection at the same time ar
89. itions Reports of HAls from nursing homes are submitted simultaneously to the Authority and the DOH using PA PSRS a web based reporting system PA PSRS also collects utilization data from nursing homes such as resident days and catheter days The occurrence of an HAI is deemed to constitute a Serious Event as defined by the MCARE Act Act 13 If an infection meets the criteria for reporting that infection shall be reported to the Authority as a Serious Event required by Act 13 and Act 52 Reports of 4 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING INTRODUCTION VERSION 2 0 Serious Events are seen BOTH by the Authority and by the DOH and are used by each organization for different purposes The Authority focuses on trending and best practices while the DOH focuses on regulatory responsibilities and calculates facility infection rates for public disclosure The Manual is organized into the following chapters and appendices Chapter 1 Introduction explains the purpose of the Training Manual and Users Guide presents an annotated outline of the manual and discusses the scope of PA PSRS Chapter 2 Getting Started briefly outlines the major functions of the system and teaches you how to log on and navigate PA PSRS Chapter 3 Facility Management provides instructions for the Facility System Manager to perform their required activities Chapter 4 List of Rep
90. lished the Patient Safety Authority the Authority as an independent agency of the Commonwealth The Authority is charged with taking steps to reduce medical errors by identifying problems and recommending solutions that promote patient safety in Pennsylvania healthcare facilities Act 13 required Pennsylvania hospitals ambulatory surgery centers behavioral health centers and birthing centers to report to the Authority on the occurrence of serious events and incidents Act 13 also requires facilities to report serious events and infrastructure failures to the Department of Health DOH The Authority developed the Pennsylvania Patient Safety Reporting System PA PSRS to e Collect serious event and incident reports from Act 13 covered facilities e Facilitate internal analysis and reporting of patient safety related data within each facility e Facilitate aggregate data analysis across facilities and development of preventive recommendations to improve patient safety e as an educational resource and quality improvement tool for healthcare provider organizations and their Patient Safety Committees The Health Care Associated Infection Prevention and Control Act of 2007 or Act 52 requires that nursing homes electronically report patient specific health care associated infections HAI to the Authority and the Department using nationally recognized standards based on Centers for Disease Control and Prevention CDC defin
91. ll refer to this individual as the Infection Prevention Designee IPD The IPD is ultimately responsible for all reports submitted to the system Therefore exercise good judgment when granting rights to additional individuals to serve as additional PA PSRS Users We recommend that each facility designate at least one other individual with patient safety or quality management responsibilities to serve as a PA PSRS User particularly as a point of contact during periods when the primary IPD is unavailable Each IPD and each delegate they establish will receive a unique ID and password for accessing the system Each facility must notify the Authority of any changes in its IPD To do so go to the Authority s Web site which is accessible via a button on the left side of the PA PSRS sign on screen Click on the PA PSRS link then Facility Reporting Information from the left hand menu There you will find the Contact Information Form for updating the name and contact information for your facility s IPD The third role is that of the Read only PA PSRS User Users who are assigned the Read only user role are restricted from submitting or amending reports This user role has access to the system for the following purposes e Viewing and printing reports e Analyzing data from the system The three types of User Roles are summarized below Note One PA PSRS User must Enter edit infection al eed reports Infection Enter edit utili
92. more of the following with no other recognized cause e Fever e Nausea e Vomiting e Abdominal pain e Jaundice and ONE of the following e Physician diagnosis of an intra abdominal infection e Radiographic evidence of infection e Organism s cultured from drainage from surgically placed drain or tube 2 Meningitis Criteria e Physician diagnosis of Meningitis and The National Healthcare Safety Network NHSN Manual Patient Safety Component Protocol Multidrug resistant Organism MDRO and Clostridium difficile Associated Disease CDAD Module Page 21 April 2008 VERSION 2 0 18 MAY 2009 THREE or more of the following with no other recognized cause e Fever e Headache e Stiff neck e Meningeal signs as determined by a physician e Cranial nerve signs as determined by a physician e Irritability 3 Viral hepatitis Needs to be reported to DOH Chapter 211 1 in addition to PA PSRS Criteria e Positive antigen or antibody test for Hepatitis A B C or delta antigen and TWO or more of the following with no other recognized cause e Fever e Anorexia e Nausea e Vomiting e Abdominal pain e Jaundice e History of transfusion within the previous 3 months VERSION 2 0 19 MAY 2009 4 Osteomyelitis Criteria e Physician diagnosis of Osteomyelitis and TWO or more of the following with no other recognized cause e Fever e Localized swelling e Tenderness at suspected site of bone infection e Heat at suspected si
93. n Prevention Section of the Department of Health PA PSRS handles all of the reporting requirements for both agencies under Act 52 of 2007 or Chapter 4 of MCARE Nursing homes must continue to report communicable diseases to the Department of Health under the nursing home regulations Chapter 211 1 Types of infections that are required under both reporting statutes include e Viral hepatitis e Meningitis Specific G I related bacterial infections for complete list see Chapter 211 1 communicable disease list Will DOH accept a physician s diagnosis of a healthcare associated UTI if it does not meet the criteria 29 MAY 2009 The DOH assisted with the development of HAI criteria for nursing homes and will not accept a physician s diagnosis of UTI if the criteria for signs and symptoms are not met Do we need to report HAls to other agencies such as the Area on Aging Act 52 requires that nursing homes report HAls to the Department of Health and Patient Safety Authority This process will take place through a single web based system known as PA PSRS Act 52 does not require reporting to other agencies however nursing homes must follow other reporting requirements that are separate from Act 52 VERSION 2 0 30 MAY 2009 Chapter 9 Reporting Infections oubmitting new reports and utilization information searching and amending submitted reports Reporting Infection Events Infection Report Submission To submit a new rep
94. n modified to reflect physician diagnosis as acceptable for determining that would have otherwise necessitated laboratory and or radiology confirmation with the exception of primary bloodstream infection Clarification of HAI definition incubation period We received 18 comments regarding the lack of a defined incubation period as part of the HAI definition and the request to provide nursing homes with direction relating to accurately determining the incubation period Response Neither CDC nor McGeer define the incubation period of a HAI CDC defines an HAI as an infection that is not present or incubating at the time of admission McGeer applies seven important conditions to all definitions which are listed under Key Points in Defining Infections in the Elderly in this notice Overlapping of Signs and Symptoms Vague Criteria atypical presentation in the elderly We received 15 comments regarding overlapping of signs and symptoms and atypical presentation of infections in the elderly The comments noted that residents are often too clinically complex to be diagnosed and assessed accurately by the proposed criteria The overlap of non specific symptoms in the elderly patient is too broad to provide accurate data Response The criteria were developed utilizing the McGeer criteria which were developed in 1991 specifically to address these issues In addition CDC criteria that were applicable to long term care were utilized taking
95. nals have chosen a 48 72 hour rule of their own but assess each infection separately as the incubation period can be different for different Infections How do we know whether to report infections related to invasive devices shortly after admission See slides 27 and 28 of the power point presentation provided during training Appendix A in training manual Are the hospitals required under Act 52 to report positive MRSA or other MDROs including VRE to the nursing homes f so does the report need to be in writing or can it be given verbally Under Act 52 hospitals have a legal requirement to screen all nursing home residents admitted to the hospital for MRSA In addition Act 52 requires that hospitals communicate all cases of positive MDROs including MRSA to receiving facilities There are no legal requirements or rules as to how the communication should occur However it is suggested that documentation of communication between facilities be maintained Act 52 also requires that nursing homes communicate known MDRO information to receiving facilities If a resident develops an infection after being discharged to home and the nursing home finds out this information is this required to be reported The nursing home should do retrospective surveillance if the resident was recently discharged As there is no specific rule as to how long after discharge an infection would be considered an HAI it is suggested that the IPD assess e
96. ncreased cough e New or increased sputum production e Pleuritic chest pain Rhonchi rales wheezes and or bronchial breathing e New and or increased shortness of breath achypnea normal respiratory rate 16 25 breaths min e Change in mental and or functional status from baseline the presence of symptoms Note a Congestive heart failure and other non infectious causes of similar signs and symptoms should be ruled out b Ifa chest x ray is obtained the presence of a pneumonia must be confirmed by a physician radiologist IN the presence of defined signs and symptoms Influenza Like Illness ILI Fever and Three or more of the following during Influenza season October 1 to April 30 e Chills e Headache or eye pain e Malaise or loss of appetite e Sore throat VERSION 2 0 98 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM PUBLIC NOTICE OF NURSING HOME REPORTING REQUIREMENTS e Dry cough e Myalgias okin and Soft Tissue Infection Cellulitis IV Site Burns Vascular diabetic Ulcer device associated decubitus ulcer Purulent drainage pustules or vesicles at wound skin or soft tissue site Or Four or more of the following signs and symptoms e Fever with no other recognized cause e e Redness e Swelling e Pain or tenderness e Serous drainage Gastrointestinal Tract Infection Symptoms for Viral and Bacterial Infections to include One or more of the following signs and symptoms e wo or
97. ndividual to maintain both roles under separate log in IDs Recognizing that some organizations prefer to have different individuals handle these functions we have defined a unique role for the Facility System Manager to offer this option There are separate User ID and password combinations for the Facility System Manager and the PA PSRS User Even if the same individual serves both roles they will need to use the Facility System Manager login to perform administrative functions and the PA PSRS User login to work with event reports and perform data analyses We recommend that the PA PSRS User and the Facility System Manager review the material in this chapter together Each facility should decide e Who will be granted access to the system within the organization and e What care areas are relevant to their facility Ideally this should be done before you submit your first report to PA PSRS User Administration Add users VERSION 2 0 From the Main Page when logged in as the Facility System Manager click on User Administration to add a new user or to view edit an existing user s profile The first thing to do is to edit the profiles of these users to ensure that contact information and other details are correct Next decide whether your facility wants more than one person to have the ability to submit reports to PA PSRS If you choose to allow anyone other than the IPD i e other PA PSRS Users who will serve as Associat
98. nly be used or disclosed in accordance with those same laws 016 2004 Pennsylvania Patient Safety Authority All rights reserved PA 3 Pennsylvania Patient Safety PSRS Reporting System Monday April 13 2009 Time remaining 14 48 Reset Timer Help Event Report Organization Manor Care 12 3 Resident Name Required Last First MI 4 Social Security Number Required 5 Resident date of birth Required Date rmiddiyyyy 6 Age of Resident years 7 Gender of Resident select one Required O Male O Female 8 Date of mostrecent admission re admission Required Date O Long term care O Short term skilled Rehabilitation and or medical care 9 Residentadmitted as select one Required 10 Infection confirmation date i e date of determining that infection met crieteria Required Date mmo 1 283 11 What care area is this resident assigned to Required Select Care Area v Next Page Top of Page Cancel Return to Questions 1 2 Information contained in this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authority rights reserved VERSION 2 0 85 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING BLANK
99. ntake report questions 12 17 See Layout 3 below e f the type of infection is a Respiratory tract infection there will be two additional questions on this page The screen displays intake report questions 12 17 VERSION 2 0 34 MAY 2009 See Layout 4 below This screen captures information about any laboratory testing the facilitys response to the infection whether or not the resident has died whether the resident is undergoing dialysis treatment and any additional comments the user may wish to add The screen displays intake report questions 12 16 the type of infection is Skin and Soft Tissue infection there will be one additional question on this page The Screen displays intake report questions 12 16 f the type of infection is Other Intra abdominal Infection there will be one additional question on this page The Screen displays intake report questions 12 16 e the type of infection is Other Primary Bloodstream Infection there will be one additional question on this page The Screen displays intake report questions 12 16 VERSION 2 0 35 MAY 2009 Pennsylvania Patient Safety Monday December 8 2008 PSRS Reportin System Time remaining Reset Timer Help Event Report Organization EDS Administrators 12 Was laboratory testing done Required O Yes O No a Ifyes were any of the following organisms identified check all that apply OO OOOO
100. ntal status is that a reportable HAI If the resident does not meet the criteria for a UTI regardless of their overall status it must not be reported as such How do we report residents who suffer with chronic infections If a resident is treated for an infection that has been reported to PSRS and following treatment the symptoms resolve for a reasonable period of time clinical judgment should be used to determine reasonable if the symptoms return and the resident once again meets the criteria this should be reported as a second infection 22 MAY 2009 VERSION 2 0 For example if a resident suffers from recurrent urinary tract infections UTIs and after treatment with either antimicrobials or removing the catheter the symptoms have cleared for a reasonable period of time and the onset of signs and symptoms occurs once again if the criteria are met the nursing home must report a new UTI despite the resident s history of chronic infection However if the resident exhibits ongoing signs and symptoms and does not clear even with treatment or removal of the catheter the infection should be reported only once How do we use the results of chest x rays Chest x rays are not used as criteria when determining whether a resident has an HAI They may be used to determine whether a resident had a pre existing pneumonia upon transfer from another facility or from the community If a chest x ray is obtained and a physician or radiolo
101. nter into PA PSRS at the end of each month These totals must be entered separately for each unit or care area your facility has set up in PA PSRS PSRS Pennsylvania Patient Safety Reporting System VERSION 2 0 103 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM EXAMPLE UTILIZATION DATA COLLECTION FORM Month 2 004 Catheter bays structions Use this form te collect resident days Lu Resident Days facility has defined In PA PSRS Use different foem for each unit Conduct a houde wide census each day ta collect resident days and catheter y days The daly census ard o y tatheber days should he performed at b the sansa time every diy Resident days specifications NENNEN AERE Record the number of occupied bads cn the unit inyeurcount INCLUDE occupied beds amd EXCLUDE unoccupied beds being held for hospitalized residents Catheter days specifications a Beoord the number of resident with indwelling foley catheters on thi unit I Ga Reporting utilization data to PA PSAS At the end of each month for each unt add all the daily numbers ta pet the total numbers af resident days and catheter days far that unit for that month Each unit s manih catheter days will be reported separately in PA PSAs 2 tad HJ Pa
102. o screen through more reports click Next or click on a specific page number By default this screen shows reports submitted in the past 45 days To filter this list for a shorter timeframe click on New Date Range just below the menu bar as shown below The maximum difference between Start Date and End Date is 45 days Selecta new date range then click proceed Start Date 03 17 2008 8 cmmaannyy End Date 18 20 2008 TT VERSION 2 0 39 MAY 2009 To find a specific report when you already know the ID number select Event Report from the menu bar then select Retrieve Event Report by Report ID This will take you to the screen shown below Enter the Report ID and press Retrieve Report PA Pennsylvania Patient safety PS RS Reporting System Wednesday December 3 2008 Help Retrieve Event Report by Report ID Exclude Amendment Humber Enter Specific Report ID Retrieve Report ls 50 To Main Page To find reports older than 45 days use the search function described under Searching Reports in Chapter 6 Data Analysis Amending a Submitted Report PAS After you submit an infection report to PA PSRS the report may be amended for up to 45 days It may be appropriate to amend reports to correct details that upon further investigation turned out to be incorrect to augment reports with the results of laboratory tests or to update reports as circumstances change You can see
103. odically distributes program announcements via e mail concerning items of general interest such as upcoming training sessions and the introduction of system improvements and enhancements Some correspondence is in the form of program memoranda Program Memoranda can be located within PA PSRS under the Resources tab 64 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING BLANK FORM Help Desk If you encounter any problems or difficulties using the PA PSRS system first refer to this Manual to see if the task you are trying to perform is addressed The Manual is also available online at the PA PSRS Web site http www papsrs state pa us You will need to log onto the system to access the Manual The Manual will periodically be updated by issuing Program Memoranda to reflect incremental changes to the system If the Manual does not address your problem or question contact the PA PSRS Help Desk to answer questions regarding Incidents or Serious Events during business hours 9 00 a m 5 00 p m Monday Friday exclusive of holidays via toll free telephone 866 316 1070 Fax 610 567 1114 or e mail Support papsrs state pa us If you have questions related to the Department of Health s work on HAI prevention they can be contacted at PA Department of Health PA DOH Healthcare Associated Infection Prevention Phone 717 425 5422 Fax 717 525 5514 E mail
104. of Health DOH staff may contact you to follow up on individual reports submitted to the system For example When a report may represent a new or emerging threat to patient safety e When program staff would like to request more detail than is contained in the report e To provide the facility with relevant feedback from PA PSRS or from other authoritative sources of patient safety information e When there is the possibility of immediate patient jeopardy Patient Safety Advisories The Patient Safety Authority and the PA PSRS Program staff issue quarterly Patient Safety Advisories with supplements as necessary to facilities and providers Based on actual reports submitted through PA PSRS Advisory articles include clinical guidance that will be useful as part of your ongoing quality improvement and patient safety activities The Advisories are distributed electronically to all PA PSRS users and are also available on the Patient Safety Authority Web site at www patientsafetyauthority org Click on Patient Safety Advisories in the left hand navigation menu Patient Safety Recommendations The Patient Safety Authority may periodically issue recommendations to facilities consistent with Act 13 These recommendations may be made on a facility specific or statewide basis for the purpose of reducing the number and severity of infections Program Announcements and System Administration VERSION 2 0 The PA PSRS Program peri
105. oing the chart surveillance If a resident is transferred to a hospital with symptoms of an infection but the criteria are not met while in the nursing home is this considered a nursing home HAI if the resident develops subsequent symptoms in the hospital The nursing home must conduct surveillance using the resident s in house records after transfer to the hospital and determine if the signs and symptoms prior to transfer meet the criteria If the criteria are NOT met for nursing home HAls then regardless of the diagnosis in the hospital the nursing home will not report the infection A resident is transferred to hospital for change in mental status and has a skin tear when transferred He stays 24 hours and returns 24 hours later The resident develops a cellulitis at the skin tear site within 48 hours of readmission Is this infection considered hospital acquired If the resident upon return to the nursing home meets the criteria for a skin and soft tissue infection this infection will be counted as a nursing home related infection as it occurred within 48 hours of RE ADMISSION and does not involve insertion of an invasive device while in the hospital It is considered incubating at the time of transfer to the hospital for the mental status change 25 MAY 2009 VERSION 2 0 Is the 48 hour incubation rule evidence based There is no rule for an incubation period CDC does not define such however infection control professio
106. omments you would like us to review regarding this resident s infection Submit Report Top of Page Cancel Return to Questions 1 2 3 11 Information contained in this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authority All rights reserved lt TIT gt VERSION 2 0 80 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING EVENT TYPE TAXONOMY Infection Report Form Other Infection Meningitis PA Pennsylvania Patient Safety Wisdnasday 2006 PSRS Reporting System Time remaining 8 Reset Timer Help Event Report Organization Manor Care Infection Criteria questions Other Meningitis 2 Which of the following criteria does the resident meet Physician diagnosis of Meningitis and Check THREE or more ofthe following with no other recognized cause Fever Headache Stiff neck Meningeal signs as determined by a physician Cranial nerve signs as determined by a physician Irritability OOOO0O0O Next Page Top of Page Cancel Return to Question 1 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0182004 Pennsylvania Patient Safety Authority All rights re
107. only the previous two months It is important to stay current on this data because of this limitation Enter Utilization Data for February 2009 skilled Nursing Short Term Rehabilitation Urat Nursing Unt Dementia Unit Ventilator Dependent Urat 4 Urt Care rea Type Care rea Care rea Care rea 2 Care rea 3 Care Area 4 Care rea 5 Enter Utilization Data for March 2009 Mixed Unit skilled Nursing Short Term Rehabilitation Unt Nursing Unit Dementia Ventilator Dependent Urat VERSION 2 0 Care rea Type Care rea Central Wing East Wing North Wing south Wing West Wing Resident Days BE 100 C Lu co 1502 cl cel Resident Days Dietinitions Catheter Days 5000 3 Definitions Catheter Days MAY 2009 Viewing and Printing Reports You may view or print an event report at any time after it has been submitted to PA PSRS Please be careful however about the security protections you put in place within your own facility regarding printed reports Since the information you submit to PA PSRS is confidential and sensitive consider how frequently you want to create printed versions of your PA PSRS reports Be sure to treat any printouts with the appropriate level of security PA Pennsylvania Patient Safety PSRS Reporting System Thursday December 4 2008 Help Event Report De hn ba Date Rang
108. ordance with those same laws 0182004 Pennsylvania Patient Safety Authority All rights reserved PA 3 Pennsylvania Patient Safety PSRS Reporting System Monday April 13 2009 Time remaining 14 48 Reset Timer Help Event Report Organization Manor Care 12 3 Resident Name Required Last First MI 4 Social Security Number Required 5 Resident date of birth Required Date mimniddiyyyy 6 of Resident years 7 Gender of Resident select one Required O Male O Female 8 Date of most recent admissionire admissian Required Date mmiddiyyyy 8 9 Resident admitted as select one Required O Long term care O Shartterm skilled Rehabilitation and or medical care 10 Infection confirmation date i e date of determining that infection met crieteria Required Date mmiddiyyyy mu 11 What care area is this resident assigned to Required Select Care Area v NextPage Top of Page Cancel Return to Questions 1 2 Information contained in this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authority rights reserved VERSION 2 0 69 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING BLANK FORM PA Pennsylvania Patient Sa
109. ort to PA PSRS you must be logged onto the system as a PA PSRS User as opposed to the Facility System Manager From any screen follow these steps e Place your cursor over the Event Report box in the Navigation Bar A drop down menu will appear Click on Create New Event Report PA Pennsylvania Patient Safety PSRS Reporting System Thursday December 4 2008 Help Even Repon Vew print Analytica Data Toots Date Range 10 27 Create New Event w date range Showing Report Selected Report ID Amend Event Report aini ati c Report ID Event Days Remaining Infection Confirmation Date amp Time Retrieve Event Report By to Amend Date Report Submitted Report ID 10410617 North Wing B Respiratory tract infection 31 11 20 2008 11 20 2008 16 14H 10410590 South Wing D Gastrointestinal tract infection 23 11 12 2008 11 12 2008 08 44H 10410572 South Wing C Skin and soft tissue infection 16 11 05 2008 11 06 2008 14 13H 10410563 East Wing E Other 12 11 01 2008 11 01 2008 03 53H Prev Next Screen 1 e next screen that appears see below asks you to select the type of infection you would like to report A selection can be made from the drop down box titled Type of Infection Level 1 e Follow the same selection process for Levels 2 and as necessary not all Infection Types have second or third level sub categories associated with them If
110. ortable Infections and the criteria for each Chapter 5 Event Reports teaches you how to enter new reports locate and amend submitted reports enter utilization data and review report status Chapter 6 Data Analysis teaches you how to work with your facility s data to generate meaningful reports to inform your patient safety and quality improvement activities This chapter teaches you how to formulate and run data queries as well as how to produce and save data tables and graphs Chapter 7 Communications explains where to turn for technical assistance provides necessary contact information and discusses other types of communications you may receive from the Authority or its contractors Appendix A Reporting Screens provides hardcopies of the portions of PA PSRS used in reporting HAI events which may be useful in submitting reports Appendix B Event Type Taxonomy provides the complete list of event type codes used by nursing homes in PA PSRS Appendix C Public Notice of Nursing Home Reporting Requirements provides a reprint from the Pennsylvania Bulletin of Nursing Home reporting requirements for healthcare associated infections Appendix D Utilization Data Collection Form provides a sample form for your facility to use while collecting resident days and catheter days 2 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING INTRODUCTION The Scope of PA PSRS
111. ou want by clicking on the name and then by clicking on the Generate Report button in the bottom right corner of the page Alternatively you can set other parameters for your report by clicking on the Additional Criteria hyperlink VERSION 2 0 51 MAY 2009 PA Pennsylvania Patient Safety Friday August 22 2008 PSRS Repor ting system Organization ABC Nursing Home Help Report Selection Catheter Associated Urinary Tract Infection Rate Report style Chat Tabular Catheter Utilization Respiratory Tract Infection Rate Respiratory Tract Infection Vaccination Proportion Respiratory Tract Infection Vaccination Failures Skin and Soft Tissue Infection Rate Gastrointestinal Infection Rate Detailed Infection Listing Miscellaneous Tabular Reports Generate Report Go To Main Page Additional Criteria VERSION 2 0 52 MAY 2009 Types of Analytical Reports The following reports will be available as illustrated below If a user tries to run a report that relies on denominator data they are late in inputting an error message will appear explaining this with a link to the page where denominator data is entered Symptomatic Catheter Related UTI Rate Line graph showing for each month x axis the number of UTIs divided by the number of catheter days multiplied by 1 000 A tabular version is available User can drill down to unit level Catheter Associated Urinary Tract Infection CAUTI Rate Facility 68
112. ove the cursor through the questions just as you would when originally submitting a report until you reach the question you want to amend Make the necessary corrections When you have made all the changes you wish to save your amended version of this report you must go to the last page and click on the hyperlink that reads Submit Report Otherwise your changes will not be saved Please note that an Amended Report will be assigned a modified Report Number to distinguish it from the original report See Report History later in this Chapter for details Each amendment will have a suffix number 01 99 indicating the number of revisions made to the report Utilization Data VERSION 2 0 In addition to collecting reports of infections PA PSRS also requires each nursing home to collect and report the number of resident days and the number of catheter days This information is used to calculate infection rates rather than just the number of infections The system includes a screen that allows any PA PSRS User to enter information on the following denominator fields each month the total number of resident days and catheter days for the month This information must be captured at the care area level A facility that establishes a single mixed unit care area would only enter a single number for each month s resident days and a single number for each month s catheter days A facility that establishes five care areas would have
113. ovement activities For example facilities are able to generate statistical tables and graphs of their own data for internal use and analysis See Chapter 6 Data Analysis for samples Facilities can also export data from PA PSRS to perform customized analyses see Chapter 6 Data Analysis System Confidentiality and Data Accessibility VERSION 2 0 PA PSRS is a Web based application with several layers of security including Secure Socket Layer SSL encryption technology automatic log off after 15 minutes of idle time and intrusion detection systems To help ensure security the following steps are taken e Each user of the system must register once Each user is associated with single reporting facility e Allinformation transmitted from the facility to the PA PSRS application is encrypted using industry standard SSL technology e Users will be required to change their password every 90 days e PA PSRS resides on the Commonwealth s system and hence has all the protection that the Commonwealth has for other secure applications including intrusion detection systems 3 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING INTRODUCTION The reports you submit to PA PSRS are strictly confidential and will be available only to the parties and in the manner specified by law Data from the system will be accessible as follows e The Patient Safety Authority
114. p of Page Cancel Return to Questions 1 2 3 11 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authority All rights reserved VERSION 2 0 68 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING BLANK FORM Infection Report Form Symptomatic Urinary Tract Infection Resident without Urinary Catheter P Pennsylvania Patient safety Wednesday December 3 2008 PSRS Reporting System Time remaining Reset Timer Help Event Report Organization Manor Care Infection Criteria questions Symptomatic Urinary Tract Infection Resident without Urinary Catheter 2 Which ofthe following criteria does the resident meet Check THREE or more ofthe following with no other recognized cause Fever and or chills New burning pain on urinating dysuria frequency or urgency Flank or Suprapubic pain or tenderness self described or identified upon examination Gross hematuria or change in character of urine L1 D B BI BJ Change in mental and or functional including incontinence status from daily baseline Next Page Top of Page Cancel Return to Question 1 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in acc
115. phylococcus aureus VRE vancomycin resistant enterococcus ESBL extended spectrum B lactamase Streptococcus species non S pneumoniae Streptococcus pneumoniae pneumococcus Acinetobacter species Clostridium difficile C diff Legionella species Mycoplasma pneumoniae Chlamydophila pneumoniae Influenza virus OOOOOOOO0000 13 Facility response to this infection for the resident check one Required O No treatment Treatment in the nursing home Transferred to another facility for treatment of this infection or its consequences 14 Has the resident died check one Required Yes No Unknown 15 Did the resident receive the influenza vaccine for this year s influenza season October 1 through March 31 check one Required O Yes Unknown a state reason Not eligible contraindicated Offered and declined Not offered Inability to obtain vaccine Other Please specify Po 16 Atthe time of submitting this repart is the resident s pneumococcal vaccine status up to date check one Required O Yes No O Unknown O0000 a Ifno state reason Mot eligible contraindicated Offered and declined Mot offered Inability to obtain vaccine Other Please specify Po 17 Please enter any additional comments you would like us to review regarding this resident s infection 00000 Submit Report Top of Page Cancel Return to Questions 1 2 3 11 Information
116. porting Information from the left hand menu There you will find the Contact Information Form for updating the name and contact information for your facility s IPD Can PA PSRS be accessed from any computer Generally PA PSRS can be accessed from any computer that has an Internet connection and a browser Do we need to change our PA PSRS password Yes the system will prompt you to change your password every ninety days for security reasons Your password may be any combination of between six and eight letters or numbers VERSION 2 0 49 MAY 2009 Chapter 6 Data Analysis PA PSRS allows you to analyze data from your own facility Using this analytical feature you can Generate data tables from your own facility s submitted reports e Produce charts and graphs that track the number and types of reports submitted by your facility over time in different categories e g by event type by care area etc e Query the database to look for patterns or trends e Download data tables and graphics for use in presentations and reports to your Board your Patient Safety Committee or others You can also download your facility s data from PA PSRS and import it to a database or spreadsheet application to perform custom analyses on your own Refer to Standard Data Export at the end of this section VERSION 2 0 50 MAY 2009 Accessing Available Reports To access available reports select Analytical Data Tools from
117. quires that health care facilities provide mandatory educational programs for all personnel including physicians Create a category of Lower Respiratory Tract Infection Combining Pneumonia with Bronchitis Tracheobronchitis We received 11 comments regarding combining pneumonia bronchitis and tracheobronchitis into one category Comments noted that the criteria for pneumonia require a chest x ray CXR In clinical practice the diagnosis of respiratory infection is frequently documented without obtaining a CXR The proposed criteria if they rely on a CXR would miss a large portion of clinical disease If a CXR is not done the criteria would result in a diagnosis of bronchitis leading to inaccuracy in the reporting system very low rates in the separate pneumonia category Response We created a category of Lower Respiratory Infection LRTI which includes bronchitis tracheobronchitis and pneumonia We revised the criteria for LRTI in the event that a CXR is performed For 30 calendar days from the date of this publication the Authority is accepting public comment about the uniform reporting requirements established jointly by the Authority and the Department of Health under Chapter 4 HAI of the MCARE 40 P S 1303 401 et seq 2007 Submit comments electronically by means of e mail to the Patient Safety Authority at patientsafetyauthority state pa us The Authority will review comments received and publish an additional Notice
118. ra 2008 PSRS Reportin System Time remaining EDT Reset Timer Help Event Report Organization Manor Care Infection Criteria questions Other Viral Hepatitis 2 Which ofthe following criteria does the resident meet Positive antigen or antibody test for Hepatitis A B C or delta antigen and Check TWO or more ofthe following with no other recognized cause Fever Anorexia Nausea vomiting Abdominal pain Jaundice History of transfusion within the previous 3 months OOOOO00 Next Page Top of Page Cancel Return to Question 1 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0162004 Pennsylvania Patient Safety Authority All rights reserved PA 3 Pennsylvania Patient Safety PSRS Reporting System Monday April 13 2009 Time remaining 14 48 Reset Timer Help Event Report Organization Manor Care 12 3 Resident Name Required Last First MI 4 Social Security Number Required 5 Resident date of birth Required Date immidd 6 Age of Resident years 7 Gender of Resident select one Required O Male O Female 8 Date of mostrecent admission re admission Required Date mmidayyy 1 8 9 Resident admitted as select one Required Long term care Shortterm skilled Rehabilitation and or medic
119. re associated infections HAls were developed for hospitals and are generally not applicable to nursing homes In 1991 McGeer et al developed a set of definitions for determining HAls in long term care The criteria were developed by modifying the CDC definitions and taking into consideration the difference in population services and resources The criteria set forth below have been developed in accordance with the requirements of Act 52 using McGeer criteria and further modification of the CDC based criteria Key Points in Defining Infections in the Elderly e is a localized or systemic condition that was not present or incubating upon admission to a facility e All signs and symptoms of an infection must be acute new or rapidly worsening e Non infectious causes should always be considered before defining an infection e Achange in mental or functional status is often indicative of a developing infection e Physician diagnosis plays a significant role in defining certain infections particularly where laboratory and radiology resources would be preferable but are limited e Antimicrobial treatment alone is not indicative of an HAI e elderly population a fever is defined as o An oral or equivalent temperature of 100 4 F 38 C or an increase of 2 F 1 12 C over baseline Note Tympanic thermometers are widely used in long term care and manufacturer s recommendations together with baseline temperatures are
120. rent Page option found in the Print dialog box VERSION 2 0 66 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING BLANK FORM Infection Report Form Symptomatic Urinary Tract Infection Resident with Indwelling Urinary Catheter P Pennsylvania Patient Safety Wednesday December 3 2008 PSRS Reportin system Time remaining En Reset Timer Help Event Report Organization Manor Care Infection Criteria questions Symptomatic Urinary Tract Infection Resident with Indwelling Urinary Catheter 2 Which ofthe following criteria does the resident meet Check TWO or more ofthe following with no other recognized cause Fever and or chills with no other source Flank or suprapubic pain or tenderness self described or identified upon examination s Gross hematuria or change in character of urine Change in mental and or functional status from daily baseline OOOO Next Page Top of Page Cancel Return to Question 1 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0182004 Pennsylvania Patient Safety Authority All rights reserved PA 3 Pennsylvania Patient Safety PSRS Reporting System Monday April 13 2009 Time remaining 14 48 Reset Timer Help Event Report Organization Manor Care 12 3 Resident Name Required Last
121. rinary catheter this screen will ask you to check two or more criteria that the resident meets On the other hand if you selected Other Meningitis you would see a screen with criteria relating to Meningitis For complete details of all Detailed Questions screens please refer to Appendix AJ e Click Next Page when finished VERSION 2 0 32 MAY 2009 PA Pennsylvania Patient Safety Wednesday December 3 2008 FSRS Reporting System Time remaining BE Reset Timer Help Event Report Infection Criteria questions Symptomatic Urinary Tract Infection Resident without Urinary Catheter 2 Which ofthe following criteria does the resident meet Check THREE or more ofthe following with no other recognized cause Fever and or chills New burning pain on urinating dysuria frequency or urgency Flank or suprapubic pain or tenderness self described or identified upon examination Gross hematuria or change in character of urine Change in mental and or functional including incontinence status from daily baseline he 9 DW DS T Next Page Top of Page Cancel Return to Question 1 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0182004 Pennsylvania Patient Safety Authority All rights reserved Helpful Tip To move back and forth between screens do not use your browser s Back and Forward
122. ring this Not ffered year s influenza season 356 10 Received AUTOR this Inability to obtain vaccine facility 363 13 Offered and declined 16 Not eligible contraindicated 2295 VERSION 2 0 56 2009 Reasons for Non Current Pneumococcal Vaccine Status in Reported Infections by Percentage Facility Q1 2008 Mot offered Not eligible contraindicated 4690 Offered and declined 4796 Skin and Soft Tissue SST Infection Rate Line graph showing for each month x axis the number of SST infections divided by the number of resident days multiplied by 1 000 User can drill down to SST subcategories e g burns decubitus ulcers etc A tabular version is available User can drill down to unit level Skin and Soft Tissue Infections and Rates Facility SST Infection Rate Infections per 1000 Resident Days Skin and Soft TEsue Infections tB5 S571 55T Rate VERSION 2 0 57 MAY 2009 Skin and Soft Tissue Infections Devices Pie chart showing for most recent quarter default time period configurable for all SST device related reports the percentage of reports in each category e g tracheostomy site G tube etc User can drill down to unit level Device Related SST Infection by Percentage Facility Q2 2008 Tracheostomy site 1776 In dwelling drain site Peripheral central IV 255 catheter site 2196 Supra pubic catheter site 1276 Gastrointestinal Inf
123. rior to the date of mandatory reporting for nursing homes PA PSRS will distribute User IDs and passwords for the FSM and one PA PSRS User These will be sent electronically to each facility s IPD If we do not have contact information for your facility s IPD account information will 3 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING INTRODUCTION be sent to your Nursing Home Administrator If you do not receive account information prior to the date of mandatory reporting contact PA PSRS at 866 316 1070 Log on Steps 1 From the PA PSRS Home Page enter your User ID and Password in the appropriate dialog boxes 2 Press the button marked Click here to Login As a first time user you will be prompted to change your assigned password 3 This will bring you to the Main Menu where you will be able to perform several different functions You can also bypass the Main Menu by checking a box to go directly to the reporting form if you want to submit a new event report VERSION 2 0 Once you log onto the system the screen you see will depend on whether you have logged in as the PA PSRS User or the Facility System Manager see User Roles above If you have logged on as the PA PSRS User you will go directly to the Main Page see below The main page lists all the reports your facility has submitted By default this page will show reports submitted in the last 45 days
124. ritten notification Likewise they contend that Act 52 does not add this requirement for nursing facilities The comments request that the requirement for written notification be dropped Response Act 52 amends MCARE by adding a chapter titled Health Care Associated Infections It has been determined that Serious Event reporting including written notification to the patient resident or legal representative is required No changes have been made in response to these comments Lack of Radiology Laboratory Resources to Define Infections We received 22 comments regarding the inability to define certain HAI that require confirmation via radiology or laboratory resources The comments noted that nursing homes are fundamentally a different type of clinical setting than the hospital and diagnostic testing options are limited Comments further state that laboratory and radiology services are virtually always off site and are not readily available for every facility For example chest X rays CXRs for pneumonia are often unavailable and subject to interpretation resulting in the majority of physicians in nursing homes treating the resident versus treating the CXR Comments further State that HAls will be missed if the criteria rely on lab x ray findings in conjunction with clinically based criteria and that physician diagnosis plays a key role in identifying infections in the NH setting Response The criteria for determining infections have bee
125. rsion is available LRTI Histogram showing for each month x axis a stacked bar consisting of two series the percentage of LRTI reports in which the resident s PPV status was was not current ILI Histogram showing for each month x axis a stacked bar consisting of two series the percentage of ILI reports in which the resident was was not vaccinated Vaccination Report for Residents with Lower Respirtory Tract Infections Facility Mar Apr May El PPV Status Mot Current EI PPV Status Current VERSION 2 0 55 MAY 2009 Vaccination Report for Residents with Influenza Like Illness Facility May E 1015 Not Vaccinated El ILIs Vaccinated Respiratory Tract Infections Reasons for Non Vaccination Two charts one for flu vaccine and one for pneumococcal pneumonia vaccine PPV status A tabular version is available Flu vaccine Pie chart showing for more recent quarter default time period configurable for all RTI reports in which the patient had not received the flu vaccine in that facility the percentage in each category e g not in this facility contraindicated etc PPV status Pie chart showing for most recent quarter default time period configurable for all RTI reports in which the patient s PPV status was not up to date the percentage in each category e g contraindicated refused etc Reasons for Flu Vaccine Failure in Reported Infections by Percentage Facility Q1 2008 Not in facility du
126. s aureus VRE vancomwycin resistant enterococcus ESBL extended spectrum B lactamase Streptococcus species non S pneumoniae Streptococcus pneumoniae pneumococcus Acinetobacter species Clostridium difficile C diff Legionella species Mycoplasma pneumoniae Chlamydophila pneumoniae Influenza virus OO OOOOOOO000 13 Facility response to this infection for the resident check one Required No treatment Treatment in the nursing home Transferred to another facility for treatment of this infection or its consequences 14 Has the resident died check one Required O Yes O No O Unknown 15 Date of catheter insertion Required Date mmiddyyy E Or Resident admitted with catheter 16 hat is the current medical justification for this resident s indwelling urinary catheter check all that apply Required Urinary retention that cannot be treated or corrected medically or surgically far which alternative therapy is not feasible Contamination of Stage Ill ar IV pressure ulcers with urine which has impeded healing despite appropriate personal care for the incontinence Terminal illness or severe impairment which makes positioning or clothing changes uncomfortable or which is associated with intractable pain P Other Please specify OG Unknown 17 Please enter any additional comments you would like us to review regarding this resident s infection Submit Report To
127. s infection for the resident check one Required O No treatment Treatment in the nursing home Transferred to another facility for treatment of this infection or its consequences 14 Has the resident died check one Required O Yes O No O Unknown 15 Please enter any additional comments you would like us to review regarding this resident s infection Submit Report Top of Page Cancel Return to Questions 1 2 3 11 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authority All rights reserved VERSION 2 0 78 MAY 2009 Infection Report Form Other Infection Intra abdominal infection peritonitis deep abscess PA Pennsylvania Patient Safety Wednesday December 3 2008 PSRS Reportin system Time remaining Timer Help Event Report Organization Manor Care Infection Criteria questions Other Intra abdominal Infection peritonitis deep abscess 2 Which ofthe following criteria does the resident meet Check TWO or more ofthe following with no other recognized cause Fever Nausea vomiting Abdominal pain Jaundice and Check ONE ofthe following L Physician diagnosis of an intra abdominal infection Radiographic evidence of infection O Organismis cultured from drainage from surgically placed dr
128. ser can drill down to look at individual infection types individual MDROS or individual units A tabular version is available Number of MDRO by month 59 MAY 2009 MDRO Rate by Month BMRSA EVRE E ESBL VERSION 2 0 60 MAY 2009 RecordiD 1234567 1234633 1234650 1234815 1235094 1235304 1235327 1235545 1235811 1235872 1230108 1236231 1236396 1236514 VERSION 2 0 Detailed Infection Listing A tabular report listing key fields from each infection that facility has reported in the past month all infection types and all units User can configure timeframe infection types and units to include or exclude Key fields include Confirmation Date Infection Type Treatment Level Patient Age Patient Sex Care Area see Chapter 3 page 15 on defining Care Areas No graphical view available Treatment Confirmation Submission Infection Type S soaring A Age Gender Care Area S iw DW to E Level esM Date Date amp Time 4 Gastrointestinal Treatment nti 81 F PEENE 8 3 2008 8 4 2008 a Viral nursing home unit 3 Skin and Soft Tissue i Treatment Ventilator d Device associated 67 M 8 2 2008 8 4 2008 nursing home dependent unit iii G tube site 3 Skin and Soft Tissue e Cellulitis No treatment 44 M Mixed unit 8 4 2008 8 4 2008 1 Catheter related Treatment len j 75 F pemenm 3 6 2008 8 7 2008 urinary tract infection nursing home unit 2 Respiratory tract L t
129. served PA 3 Pennsylvania Patient Safety PSRS Reporting System Monday April 13 2009 Time remaining 14 48 Reset Timer Help Event Report Organization Manor Care 12 Mil 3 Resident Name Required Last First 4 Social Security Number Required 5 Resident date of birth Required Date immidd 6 Age of Resident years 7 Gender of Resident select one Required O Male O Female 8 Date of most recent admission re admission Required Date 99 ze 9 Resident admitted as select one Required O Long term care O Short term skilled Rehabilitation and or medical care 10 Infection confirmation date i e date of determining that infection met crieteria Required Date rmiddiyyyy 1 11 What area is this resident assigned to Required Select Care Area v Next Page TopofPage Cancel Return to Questions 1 2 Information contained in this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authority rights reserved VERSION 2 0 81 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING EVENT TYPE TAXONOMY PA Pennsylvania Patient Safety Monday December 8 2008 PSRS Reporting System Time remaining 8 Reset T
130. sibilities and separate User IDs and passwords The first role the Facility System Manager FSM is responsible for e Assigning user IDs and passwords to other users in the facility and conversely removing user IDs and passwords e Establishing care areas that will help define the location of events within a facility See the chapter Facility Management for steps the Facility System Manager must take before using the system for the first time The second role is that of a PA PSRS User One person may serve as both a PA PSRS User and the FSM or a facility may designate a different person for each role A PA PSRS User is responsible for e Submitting reports e Amending reports e Viewing and printing reports e Analyzing data from the system VERSION 2 0 1 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING INTRODUCTION VERSION 2 0 2 MAY 2009 A facility may designate more than one individual to serve in the PA PSRS User role This will enable several people to submit reports directly to PA PSRS on behalf of the facility At a minimum each nursing home must have one individual serving as a PA PSRS User and generally this person should be the facility s primary point of contact for infection prevention activities i e the individual responsible for the facility s formal Infection Control Plan submitted to the Department of Health under Act 52 We wi
131. skilled Rehabilitation and or medical care 10 Infection confirmation date i e date of determining that infection met crieteria Required Date mimiddiyyyy 0 11 What care area is this resident assigned to Required Select Care Area v Next Page Top of Page Cancel Return to Questions 1 2 Information contained in this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 01 2004 Pennsylvania Patient Safety Authority All rights reserved VERSION 2 0 77 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING EVENT TYPE TAXONOMY PA Pennsylvania Patient Safety Monday December 8 2008 PSRS Reporting System Time remaining 8 Reset Timer Help Event Report Organization EDS Administrators 12 as laboratory testing done Required O Yes O No a lfyes were any ofthe following organisms identified check all that apply MRSA methicillin resistant staphylococcus aureus VRE vancomycin resistant enterococcus ESBL extended spectrum p lactamase Streptococcus species fnon S pneumoniae Streptococcus pneumoniae pneumococcus Acinetobacter species Clostridium difficile C diff Legionella species Mycoplasma pneumoniae Chlamydophila pneumoniae Influenza virus OO L1 DJ DJ DJ DJ D D DJ DJ 13 Facility response to thi
132. stem is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0182004 Pennsylvania Patient Safety Authority All rights reserved VERSION 2 0 14 MAY 2009 Infection Report Form Skin and Soft Tissue Infection P t Pennsylvania Patient safety Wednesday December 3 2008 PSRS Reporting System Time remaining EDU Reset Timer Help Event Report Organization Manor Care Infection Criteria questions Skin and Soft Tissue Infection 2 Which ofthe following criteria does the resident meet Purulent drainage pustules or vesicles atwound skin or softtissue site x Check FOUR or more ofthe following signs and symptoms Fever with no other recognized cause Heat Redness Swelling Pain or tenderness L1 E31 D DB BJ DJ Serious drainage Next Page Top of Page Cancel Return to Question 1 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0182004 Pennsylvania Patient Safety Authority All rights reserved PA 3 Pennsylvania Patient Safety PSRS Reporting System Monday April 13 2009 Time remaining 14 48 Reset Timer Help Event Report Organization Manor Care 12 li 3 Resident Name Required Last First MI 4 Social Security Number Required 5 Resident date of birth Required
133. sub categories are applicable the drop down list for the appropriate level will become enabled e When you have selected the infection type and applicable sub categories click Next Page to proceed to the next screen VERSION 2 0 31 MAY 2009 PA Pennsylvania Patient Safety PSRS Reporting System Wednesday December 3 2008 Time remaining Reset Timer Help Event Report 1 Type of Infection being reported Select only one If resident has mare than one infection a separate must be submitted for each type of infections Required Type of Infection Lewel 1 Select Event Type xj Sub Categor Level 2 bul Other specify Sub Category Level 3 Other specitwr Next Page Top of Page Cancel Information submitted wia this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0182004 Pennsylvania Patient Safety Authority All rights reserved Helpful Tip At any point during the report submission process you can click on the Help link in the upper right hand section of the screen This will open a copy of this Training Manual in a new browser window Screen 2 Infection Criteria e next questions you see will depend on what Infection Type you chose on the first screen For example if you selected Symptomatic urinary tract infection and sub category Resident with indwelling u
134. submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0182004 Pennsylvania Patient Safety Authority All rights reserved VERSION 2 0 72 MAY 2009 Infection Report Form Respiratory Tract Infection Influenza like Illness Event Report PA Pennsylvania Patienf Safety Infection Criteria questions Respiratory Tract Infection Influenza like Illness 2 Which ofthe following criteria does the resident meet Fever must be checked and Check THREE or more ofthe following during Influenza season October 1 to April 30 Chills Headache or eye pain Sore throat Dry cough Myalgias OOOO00 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws Malaise loss of appetite 016 2004 Pennsylvania Patient Safety Authority All rights reserved Next Page Top of Page Cancel Return to Question 1 Wednesday December 3 2008 PSRS Reporting System Time remaining Reset Timer Help Organization Manor Care PA 3 Pennsylvania Patient Safety PSRS Reporting System Monday April 13 2009 Event Report 3 Resident Name Required Last First 4 Social Security Number Required 5 Resident date of birth Required Date fmmiddiyyyy 6 Age of Resident years 7 Gend
135. take some time especially for larger facilities it is something you only need to do once However it will save you time in the long run and will greatly enhance the usefulness of the analyses you can generate with PA PSRS in the future How many care areas you define in your facility is up to you but the more areas you define the more useful the analytical reports will be to you In Chapter 5 we demonstrate the charts and graphs you can run to monitor infection prevention efforts in your facility Some of these charts allow you to drill down on individual units or care areas so you can focus your efforts on the areas in your facility with the highest infection rates This may also be helpful in isolating the causes of some infections that vary by care area such as different practices or techniques used by staff in different areas or if infections are associated with particular equipment For example if you operate a small 20 bed nursing home even if you have two resident wings you might not bother creating multiple care areas but this means that you will not be able to 12 MAY 2009 VERSION 2 0 generate separate reports for each wing On the other hand if you operate a 100 bed nursing home with residents of different acuity in different locations it would be of benefit to you to set up multiple care areas and monitor infection rates in each location separately When choosing the Care Area Type for any unit follow this rule of
136. tatus change How should facilities address any conflicts between Minimum Data Set MDS coding RAI criteria and Act 52 HAI definitions Act 52 has its own set of unique criteria for reporting of HAls to state and has no bearing on other criteria or coding for reporting of infections to other agencies such as CMS The Authority and DOH cannot make recommendations for the use of Act 52 criteria for other purposes Specific HAI reporting requirements under Act 52 for PA PSRS reporting do not change the nursing home s obligations to other entities that require HAI reporting Does a nursing home report infections that were present on admission from the hospital or the community Infections reported by the nursing home must not be present or incubating on admission Each type of infection should be considered individually when assessing the incubation period How determine if an individual is colonized with MRSA or an MDRO MRSA screening by the hospital is mandatory when a resident is transferred from a nursing home to the hospital There are no State requirements for routine screening of residents presently residing in a facility Once a resident is identified as MRSA positive the nursing home is mandated to have policies and procedures for placement of residents with MDROs Does Norovirus fall into the HAI reportables Yes individual cases of Norovirus regardless of how many occur must be reported to PA PSRS as individual
137. te of bone infection e Drainage at suspected site of bone infection 5 Primary bloodstream infection Criteria TWO or more blood cultures drawn on separate occasions documented with a common skin contaminant e g diphtheroids Bacillus sp Propionibacterium sp coagulase negative staphylococci or micrococci or A SINGLE blood culture documented with a pathogenic organism non contaminant and ONE of the following Fever or new hypothermia core body temperature of 35 C e Drop in systolic blood pressure of gt 30 mm Hg over baseline e Change in mental or functional status Note Organism in blood culture is not related to infection at another site secondary bacteremia e g positive blood culture secondary to a urinary tract or lower respiratory tract infection VERSION 2 0 20 MAY 2009 Frequently Asked Questions Criteria VERSION 2 0 If a skin and soft tissue infection progresses to Osteomyelitis do we report both infections or only one Which one Both infections are reported if they are in the list of reportable infections The only time a secondary infection is not reported is in the case of a bloodstream infection whereby a primary source such as a UTI or LRTI is the documented source of the bloodborne infection Then that primary infection only would be documented Is a confirmed case of Shingles reportable as a skin and soft tissue HAI Shingles is NOT reportable It was eliminated from the l
138. ter the Report ID in the dialog box in the upper right of your screen labeled Selected Report ID Rather than type in the Report ID clicking on a Report ID number in the left column will enter it for you Click on View Print in the Navigation Bar 3 Click on Report Amendments in the pop up menu 4 The amendments to the selected report open in a new browser window When you are done viewing the amendments simply close the browser window Blank Forms You can use paper copies of blank forms that contain all of the questions and possible selections for PA PSRS event reports These may be useful as checklists when collecting information to report events to PA PSRS To access the blank forms online click on Blank Forms from the Navigation bar then select which form s you want from the pop up menu Hard copy blank forms can be found in Appendix A of this manual All forms are provided in Adobe Acrobat format Viewing and printing these files requires Adobe Acrobat Reader a free software application available from Adobe Systems Incorporated To obtain this software under the Blank Forms pop up menu select Download Adobe Acrobat and follow the instructions on the screen Resources VERSION 2 0 You can access training materials and system update information on line while logged in to PA PSRS These may be used as reference material and or training aides To access system resources click on Resources from the
139. term care setting The criteria are presented at the end of this notice as Exhibit B Nursing homes will report to both the Authority and the Department through a single web based interface the Pennsylvania Patient Safety Reporting System PA PSRS Using a single reporting system eliminates the need for duplicate reporting to both the Authority and the Department The format for electronic reporting is being established by the Authority in consultation with the Department and the HAI Advisory Panel and will be addressed during training programs for nursing homes VERSION 2 0 92 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM PUBLIC NOTICE OF NURSING HOME REPORTING REQUIREMENTS Training will include opportunities for both in person and online education relating to the infection list criteria and format for reporting A series of in person training sessions will be held in locations throughout the State between January and March 2009 Nursing homes will be notified of available training opportunities through direct mailings outreach to industry associations and future public notices Serious Event Reporting The occurrence of an HAI in a nursing home is a Serious Event as defined by 302 of the MCARE Act Act 13 If an HAI meets the criteria for reporting as per Exhibit B that HAI shall be reported to the Authority as a Serious Event as required by Act 13 and Act 52 subject to the additional requirements as described in this
140. terococcus ESBL extended spectrum B lactamase Streptococcus species non S pneumoniae Streptococcus pneumoniae pneumococcus Acinetobacter species Clostridium difficile C diff Legionella species Mycoplasma pneumoniae Chlamydophila pneumoniae Influenza virus 1 D D D BJ BI B BI B1 00 13 Facility response to this infection for the resident check one Required No treatment Treatment in the nursing home Transferred to another facility for treatment of this infection or its consequences 14 Has the resident died check one Required O Yes Unknown 15 Did the resident receive the influenza vaccine for this year s influenza season October 1 through March 31 check Required O Yes No Unknown a Ifno state reason Not eligible contraindicated Offered and declined Not offered Inability to obtain vaccine Other Please specify PO 16 Atthe time of submitting this report is the resident s pneumococcal vaccine status up to date check one Required O Yes O Unknown O0000 a Ifno state reason Not eligible contraindicated Offered and declined Not offered Inability to obtain vaccine Other Please specify Po 17 Please enter any additional comments you would like us to review regarding this resident s infection 00000 Submit Report Top of Page Cancel Return to Questions 1 2 3 11 Information submitted via this reporting sy
141. the menu bar then select Event Report Data Analysis This will take you to the main Report Selection screen where you can select which analytical report you wish to create PA Pennsylvania Patient Safety PSRS Reporting System Thursday December 4 2008 Help Event Report Utilization Data View Print Blank Forms Np nalytica Data Tools Date Range 10 21 2008 to 12 04 2008 new date range Search Submitted Event Showing Reports Selected Report ID pa Event Report Data tion Confirmation Date amp Time Report ID CareArea Event Type Analysis Date Report Submitted TIL TL Data Export 10410617 North Wing B Respiratory tract infection 31 11 20 2008 11 20 2008 16 14H 10410590 South Wing D Gastrointestinal tract infection 23 11 12 2008 11 12 2008 08 44H 10410572 South Ving C Skin and soft tissue infection 16 11 05 2008 11 06 2008 14 13H 10410563 East Wing E Other 12 11 01 2008 11 01 2008 03 53H Prev Mext The following reports are available e Symptomatic Catheter Related UTI Rate e Catheter Utilization e Lower Respiratory Tract Infection Rate e Influenza Like Illness Infection Rate e Respiratory Tract Infections Proportions Vaccinated e Respiratory Tract Infections Reasons for Non Vaccination e Skin and Soft Tissue Infection Rate e Skin and Soft Tissue Infections Devices e Gastrointestinal Infection Rate e Unit Infection Rates e MDROs e Detailed Infection Listing Simply select which report y
142. thumb If 80 of the residents in a given care area are of a certain type acuity e g skilled nursing ventilator dependent etc designate the care area as that type of unit If fewer than 80 of the residents are of the same type acuity designate that care area as a Mixed Unit Edit Delete Care Area When this menu option is selected the list of defined care areas is displayed The user can then select any one of the care areas for editing PA 3 Pennsylvania Patient Safety 45 PSRS Reporting System Wednesday April 8 2009 Help Edit Delete Care Areas Care Area Name Care Area Type TV TL Central Ving Mixed Unit East VVing Skilled Nursing Short Term Rehabilitation Unit North Wing Nursing Unit South Wing Dementia Unit West Wing Ventilator Dependent Unit When editing a care area the user can change the Care Area Name or relate the existing Care Area to a different Care Area Type If the Care Area is not needed there is also an option to delete a care area by clicking the Delete button see screen on next page Deleting a care area or editing it to designate it as a different type of unit will not affect infection reports submitted prior to the change If you change the unit type reports submitted prior to the change will reflect the old care area type and reports submitted after the change will reflect the new care area type Pennsylvania Patient Safety PSRS Reporting System Wednesday April 8 2009 Help Edit D
143. ts reserved lt Reset user passwords An FSM has the ability to reset user passwords when needed This can be done when editing a user profile by clicking the Reset Password button and following the instructions on the screen For convenience the user will be emailed their new password Advanced user administration The FSM also has the option to list all users that can access the system on behalf of their facility inactivate their access delete the user reset their password and update user specific information like telephone and email address VERSION 2 0 10 MAY 2009 PA 3 Pennsylvania Patient Safety PSRS Reporting System Thursday December 4 2008 Help M Edit User Information No User Id Name Active Role Group 1 FSM MC Smith John Y Facility System Manager 2 kmiller Miller Kathy b d IPD 3 slewis Lewis Samantha PA PSRS User R Care Area Administration VERSION 2 0 In PA PSRS each event report includes a question Number 11 about the care area or unit to which the resident is assigned The PA PSRS data analysis function allows you to analyze your facility s reports by location and ask such questions as e What locations in our facility most frequently report Urinary Tract Infections e Doreported Influenza like illnesses ILI s in some locations appear more cyclical than ILI s in other locations e Two resident floors have vastly different r
144. uired O No treatment Treatment in the nursing home Transferred to another facility for treatment of this infection or its consequences 14 Has the resident died check one Required O Yes O No O Unknown 15 Please enter any additional comments you would like us to review regarding this resident s infection Submit Report Top of Page Cancel Return to Questions 1 2 3 11 Information submitted via this reporting system is protected under applicable State and Federal law and shall only be used or disclosed in accordance with those same laws 0182004 Pennsylvania Patient Safety Authority All rights reserved VERSION 2 0 84 MAY 2009 Infection Report Form Other Infection Osteomyelitis P Pennsylvania Patient Safety Wednesday December 3 2008 PSRS Reportin system Time remaining EIN Reset Timer Help Event Report Organization Manor Care Infection Criteria questions Other Osteomyelitis 2 Which ofthe following criteria does the resident meet oO Physician diagnosis of osteomyelitis and Check TWO or more ofthe following with no other recognized cause h Fewer O Localized swelling Tenderness at suspected site of bone infection Heat at suspected site of bone infection o Drainage at suspected site of bone infection Next Page Top of Page Cancel Return to Question 1 Information submitted via this reporting system is protected under applicable State and Federal law and shall o
145. urinary catheter Resident without urinary catheter B Respiratory tract infection 1 2 Lower respiratory tract infection obneumonia bronchitis tracheobronchitis Influenza like illness C Skin and soft tissue infection 5 6 Vascular or diabetic ulcer chronic non healing Decubitus ulcer pressure related Burn associated Device associated a Tracheostomy site b Peripheral central IV catheter site c G tube site d Supra public catheter site e In dwelling drain site f Other please specify Cellulitis Other please specify D Gastrointestinal tract infection E Other 1 Meningitis A O N Intra abdominal infection Peritonitis deep abscess Viral hepatitis Osteomyelitis Primary bloodstream infection 90 MAY 2009 This page was left intentionally blank VERSION 2 0 91 MAY 2009 Appendix C Public Notice of Nursing Home Reporting Requirements Reporting Requirements for Nursing Homes under Chapter 4 of the Medical Care Availability and Reduction of Error MCARE Act 38 Pa B 5239 Reprinted from the Pennsylvania Bulletin Volume 38 Number 38 Available from the internet http www pabulletin com secure data vol38 38 38 1 740 html Purpose The purpose of this notice is to give long term care nursing facilities nursing homes final notice of their reporting requirements to the Patient Safety Authority Authority and the Department of Health Department under C
146. us month s entries An email will be sent to the IPD of the facility asking them to review their utilization data for the previous month and to correct it if necessary 41 MAY 2009 Specifications e Resident days All nursing homes should conduct a house wide census each day and record the number of occupied beds on each unit identified by the facility i e for each care area defined in PA PSRS At the end of each month for each unit add all the daily numbers of occupied beds to get the total number of resident days for that unit for that month Each unit s monthly resident days will be reported separately in PA PSRS The daily census should be performed at the same time each day at a time decided by the facility The daily census should INCLUDE all occupied beds and EXCLUDE unoccupied beds being held for hospitalized residents e Catheter days Each day all nursing homes should collect and record the number of residents with indwelling foley catheters on each unit i e for each care area defined in PA PSRS At the end of each month for each unit add all the daily numbers of catheterized residents to get the total number of catheter days for that unit for that month Each unit s monthly catheter days will be reported separately in PA PSRS Catheter days should be collected at the same time each day at a time decided by the facility Entering Utilization Data The Utilization Data menu is used to enter and edit th
147. users may change their password at any time by taking the following steps From the Log In Screen click on the word here in the text next to the password box that reads Click here to change your password Enter your User ID in the first box In the second box enter your old password In the third box enter your new password In the last box retype your new password to confirm When finished click on the button that reads Click to Change Password The system will prompt you to change your password every ninety days for security reasons Your password may be any combination of between six and eight letters or numbers VERSION 2 0 7 MAY 2009 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING INTRODUCTION This page was left intentionally blank VERSION 2 0 8 MAY 2009 Chapter 3 Facility Management How to set up and maintain the system for your organization Role of the Facility System Manager The Facility System Manager is responsible for two functions in the system e Assigning user IDs and passwords to other users in the facility or conversely removing user IDs or passwords if for example a person is no longer employed by your facility e Establishing care areas that will help define the location of events within the facility The Facility System Manager and PA PSRS User both perform different functions however itis possible for an i
148. zation data a Prevention Designee View print infection and 2 c2 IPD analytical reports Create edit user accounts Create edit care areas 2 PENNSYLVANIA PATIENT SAFETY REPORTING SYSTEM TRAINING MANUAL AND USERS GUIDE FOR NURSING HOME REPORTING INTRODUCTION Logging On VERSION 2 0 PA PSRS is accessed via a secure password protected Web site via the Internet You can access the system from any computer that meets the following specifications e Microsoft Windows 98 or better including Windows NT v4 0 Windows 98 98SE Windows ME Windows 2000 Windows XP or Windows Vista e Microsoft Internet Explorer Version 5 5 Service Pack 2 or better Netscape version 6 0 or better e Support for session cookies non persistent e Support for JavaScript e Local administrative privileges during installation of ActiveX controls required to generate graphical reports e Access to the internet e e Mail account e Adobe Acrobat Reader V4 0 You will be able to download Adobe Reader directly from the PA PSRS main screen To reach the PA PSRS Home Page direct your browser to the following URL http www papsrs state pa us Patient Safety Authority P PSRS Pennsylvania Patient Safety Reporting System User ID Password Click Here to change your password ssword Forgot your passw Click Here To Login check here to enter Report To log on to the system you will need your User ID and password P

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