Sterile Solutions Supply Chain Disruption by Peritoneal Dialysis

 

To: All providers or those affected by the saline shortage From: Health Facilities and Emergency Medical Services Division URGENT ATTENTION REQUIRED - The Health Facilities and Emergency Medical Services Division needs assistance in updating information about who provides dialysis services at various facilities and the number of patients receiving dialysis at home. Hurricane Helene impacted one of the largest IV fluid suppliers, owned by Baxter International, in North Carolina. This has resulted in supply chain disruptions and gaps in supplies of normal saline IV fluids, irrigation fluids, sterile water, and certain dextrose solutions. Baxter has resumed shipping to hospitals and dialysis centers, and global plants are increasing production to meet U.S. needs. However, because of ongoing disruptions, some products remain on allocation. The division asks that you complete the Google Form linked below.  IF YOU OR SOMEONE IN YOUR FACILITY/AGENCY HAVE ALREADY COMPLETED THIS FORM YOU DO NOT NEED TO COMPLETE THE FORM AGAIN. The information in this form will help identify the number of patients receiving intravenous and peritoneal dialysis at various facilities and their locations. This form will also provide information on the number of patients receiving home dialysis for those facilities that provide home care services. Please include a reliable contact person and the facility or agency’s phone number.  Please complete this Google Form with the requested information.

Sterile Solutions Supply Chain Disruption by Peritoneal Dialysis

 

To: All providers or those affected by the saline shortage From: Health Facilities and Emergency Medical Services Division URGENT ATTENTION REQUIRED - The Health Facilities and Emergency Medical Services Division needs assistance in updating information about who provides dialysis services at various facilities and the number of patients receiving dialysis at home. Hurricane Helene impacted one of the largest IV fluid suppliers, owned by Baxter International, in North Carolina. This has resulted in supply chain disruptions and gaps in supplies of normal saline IV fluids, irrigation fluids, sterile water, and certain dextrose solutions. Baxter has resumed shipping to hospitals and dialysis centers, and global plants are increasing production to meet U.S. needs. However, because of ongoing disruptions, some products remain on allocation. The division asks that you complete the Google Form linked below.  IF YOU OR SOMEONE IN YOUR FACILITY/AGENCY HAVE ALREADY COMPLETED THIS FORM YOU DO NOT NEED TO COMPLETE THE FORM AGAIN. The information in this form will help identify the number of patients receiving intravenous and peritoneal dialysis at various facilities and their locations. This form will also provide information on the number of patients receiving home dialysis for those facilities that provide home care services. Please include a reliable contact person and the facility or agency’s phone number.  Please complete this Google Form with the requested information.

Update on Saline and Sterile Solutions Supply Chain Disruptions

 

To: Home Health Agencies, Administrators, and OASIS Coordinators From The .To: All who may be affected by the saline shortage  From: HFEMSD We are reaching out with updates on the supply chain disruptions affecting saline and other sterile solutions due to Hurricane Helene. The recent storm impacted the Baxter facility in North Carolina, which supplies a significant portion of IV solutions and irrigation fluids across the U.S. This has led to a temporary shortage of normal saline IV fluids, irrigation fluids, sterile water, and certain dextrose solutions. Baxter has resumed shipping to hospitals and dialysis centers, and other global plants are scaling production to support U.S. needs. However, due to continued disruptions, certain products remain on allocation. Current and Upcoming Actions: Supply Coordination: HHS and ASPR are working with public and private partners to stabilize the supply chain, expedite FDA assessments of alternative products, and increase domestic manufacturing. Preparation for Further Storm Impact: With Hurricane Milton potentially affecting supply, assets are being pre-deployed, and production is being shifted from at-risk areas. Guidance for Providers: HHS encourages providers to: Evaluate and conserve supplies, prioritizing critical use cases. Review guidance from Baxter and ASHP on managing and conserving fluids effectively. Baxter is working directly with customers regarding allocations, and additional updates are available on their website. HHS will continue to coordinate with manufacturers and distributors and keep healthcare providers informed as this situation evolves. Baxter newsroom Hurricane Helene updates ASHP - fluid shortages suggestions for management and conservation Thank you for your patience and cooperation as we work through these supply chain challenges together. .

March 2, 2023— Stakeholder Meeting Concerning The House Bill 1294 & House Bill 22- 1401

 

To: All Stakeholders  From: HFEMSD  The next House Bill (HB) 1294 Stakeholder Forum Meeting is scheduled for March 2, 2023, from 2:00 to 3:00pm. For this meeting, we will continue our conversation regarding rule changes in 6 CCR 1011-1, Chapter 2 as it relates to the passage of House Bill 22-1401- Hospital Nurse Staffing Standards. We will focus on the Stakeholder process for reviewing the proposed updated rule language.   The rule changes for 6 CCR 1011-1 Chapter 2 – General Licensure Standards have two parts. The first part affects all licensed health facilities, and brings into rule the requirement from Public Health Order 20-20 that facilities maintain an infectious disease, vaccine, and mitigation plan. The second part affects the following residential care facility types: All facilities licensed under 6 CCR 1011-1 Chapter 7, e.g. Assisted Living Residences All facilities licensed under 6 CCR 1011-1 Chapter 5, e.g. Skilled Nursing Facilities All facilities licensed under 6 CCR 1011-1 Chapter 8, e.g. Facilities for Persons with Intellectual and Developmental Disabilities, Group Homes, and Intermediate Care Facilities This second part brings into rule the requirement from Public Health Order 20-20 that requires those facilities to appoint an infection control officer, and that appointee’s duties related to infection control and the mitigation of infectious diseases. To participate, we have a number of resource links below.  HB 22-1401 Meeting Folder (includes meeting information  and invite/communication sign-up)  HB 1294 Stakeholder Forum Website (includes meeting information  and invite/communication sign-up)  Agenda Item Request Form   When:  Thursday, March 2, 2023, from 2:00- 3:00 p.m.  Where: This meeting will be held remotely via Zoom Join Zoom Meeting  https://us02web.zoom.us/j/83216415362 Meeting ID: 832 1641 5362 One tap mobile +17193594580,,83216415362# US +16694449171,,83216415362# US Find your local number: https://us02web.zoom.us/u/k9HAnr6w5 If you have any further questions or comments prior to the meeting please contact Tonie Miller at tonie.miller@state.co.us For more information on the purpose and function of the HB 1294 Stakeholder Forum:  The House Bill 1294 Stakeholder Forum is an opportunity to promote dialogue and transparency for all licensed healthcare facilities' issues of interest and concern. This forum is statutorily required for such purpose and had been postponed since the onset of the COVID pandemic.  During this time a smaller, Subject Matter Expert (SME) group members wishing to have ongoing discussions with the department about policy-level questions, issues regarding the financial impact of the pandemic, reimbursement rates for Medicaid providers, long-term planning to deal with healthcare worker shortages, and how to bring more people into the workforce was established.  Members of this group are encouraged to continue these discussions through the re-establishment of the HB 12-1294 Stakeholder Forum. Additionally, pursuant to C.R.S 25-3-113, the Stakeholder Forum consists of representatives from various types of provider facilities licensed by the department along with consumers, consumer advocates, ombudsmen, and other interested parties which meet at least four times each year for the Department to discuss and take into consideration the concerns and issues of interest to the forum members and other attendees regarding the development and implementation of rules and other matters that affect all licensed health care facilities.  Meetings are generally held virtually monthly, on the 1st Thursday of each month.

Updated Quality Management Planning Training is Now Live

 

To: All Licensed Providers   From: Noah Begley, Training Section Manager, HFEMSD   We are excited to share that we have updated and revised the Quality Management Planning training. It is live now on Train.org! You can access it by clicking the link above or by going to train.org and searching for the course ID 1108498 or by searching for the title.   This self-paced course is expected to take one hour and is geared toward new and seasoned personnel of all healthcare provider types responsible for carrying out quality management activities. You will be guided through an interactive review of a quality management program, reviewing the elements of a strong plan, and the documentation required to demonstrate program effectiveness. You will also be guided through a critical review of a sample quality management plan (QMP). The goal of this course is that you will have a better understanding of what constitutes a sound quality management plan with new tools at your disposal to review and improve upon your program. 

Updates Regarding Chapter 2 COVID-19 Vaccination Requirements

 

In August 2021, the Board of Health was asked by Governor Polis to enact a requirement that employees, direct contractors, and support staff who work for licensed healthcare facilities or agencies obtain vaccination against COVID-19. The Board of Health adopted the first set of emergency rules adopting this standard on August 30, 2021. Since that time, the Division has worked with stakeholders to revise these vaccination and reporting requirements in order to balance the necessity to obtain high rates of vaccination among employees, direct contractors, and support staff with the business needs of licensed healthcare facilities and agencies. These revisions have come before the Board of Health twice, once in December 2021 and again in March 2022. The Colorado Department of Public Health and Environment (CDPHE) does not intend to seek another set of emergency rules, nor does it intend to seek to make the current Chapter 2 regulations permanent. As such, the Chapter 2 COVID-19 Vaccine Requirements shall expire July 14, 2022.  When CDPHE began collecting data pursuant to the regulations, the reported vaccination rate was 87.6%. As of June 1, 2022, 94% of all staff in facilities are vaccinated. This number has remained steady over the past three months, based on information reported to CDPHE by licensed facilities. Overall, the Department is proud of the work of its licensed facilities and agencies to ensure compliance with the vaccine requirements and that 653 of facilities achieved 100% vaccination of eligible employees. Why did the Board of Health change the policy? First, as previously mentioned, the vaccination rate, as well as medical and religious exemption numbers, have remained steady for the past 3+ months. This indicates that all employees who will get vaccinated have done so. Second, HB22-1401 was signed into law by Governor Polis on May 18, 2022. While the bulk of this bill pertains to licensed Hospitals, there is language directing the Department to enact requirements for all licensed facilities and agencies related to infection prevention and control. While the Department has not yet determined what these requirements will be, the statute requires that they include provisions related to testing, vaccination, and treatment for COVID-19 in accordance with applicable recommendations and guidance. While the specifics will be worked out with stakeholders in the future, the Department envisions COVID-19 vaccination will be part of this conversation. Third, while the Department intends to let its state licensure vaccination requirement expire in July, it is important to note that the federal requirement for staff to be vaccinated or obtain a valid medical or religious exemption, through the Centers for Medicare and Medicaid Services (CMS), will still apply to any licensed facility that is certified by CMS to receive federal reimbursement. Approximately one-third of all licensed facilities are certified by CMS, and therefore their staff will still be subject to a vaccination requirement. Key takeaways for licensed facilities and agencies: Effective July 14, 2022, current obligations under Part 12 of 6 CCR 1011-1, Chapter 2 related to COVID-19 vaccination expire.  This includes the associated obligation to report into Colorado Health Facilities Interactive (COHFI) on a twice-monthly basis.  The requirements of Part 11 of Chapter 2 regarding vaccination against influenza are still in effect and not impacted by the expiration of these emergency rules.  Despite the expiration of these rules, facilities and agencies may maintain any mandatory vaccination policies they have adopted to date.  Long-term and residential care facilities (Skilled Nursing Facilities, Assisted Living Residences, Intermediate Care Facilities, and Group Homes) are still subject to the requirements of Public Health Order 20-20 and the Comprehensive Mitigation Guidance document.  Facilities certified by CMS are still subject to the federal government’s vaccine mandate.  CDPHE’s Health Facilities and EMS divisions will engage in conversations with stakeholders later regarding the implementation of HB22-1401, which will likely include some requirements around vaccination and vaccination policies.

CMS Revised Emergency Preparedness Guidance For In-Patient and Out-Patient Providers Related to Exercise Exemption based on A Facility's Activation of their Emergency Plan

 

Message to: Administrators, Executive Directors   From: Melanie Roth Lawson, Trainer and Emergency Response Coordinator     Re: CMS Provides Guidance and Clarifications on Emergency Preparedness Exercise Exemptions for Inpatient and Outpatient Providers Due to Ongoing COVID-19 Public Health Emergency (PHE)   Note: The updated guidance only applies if your facility is still currently operating under its activated emergency plan or reactivated its emergency plan for COVID-19 in 2021 or 2022.   CMS recognizes many facilities are still operating under an activated emergency plan during the COVID-19 Public Health Emergency. For those facilities, they are providing more guidance for inpatient and outpatient providers/suppliers, consistent with the exercise exemption authorized by the EP regulations.   To view the document, go here (URL https://www.cms.gov/files/document/qso-20-41-all-revised-05262022.pdf)   All of the changes are in RED.   This exemption states that during or after an actual emergency, the regulations allow for a one-year exemption from the requirement that the facility perform testing exercises. This exemption applies to the next required full-scale exercise only, not the exercise of choice, based on your facility's 12-month exercise cycle.   Please see the attached CMS guidance document. If you have any questions, please contact Melanie.Roth-Lawson@state.co.us or call 720-291-5929.

Voluntary Survey

 

All healthcare settings   From: HFEMSD   The below link for a survey is being sent to all facilities on behalf of a local community group who is researching healthy food options in healthcare settings.   This survey is not in any way associated with the Colorado Department of Public Health or the State of Colorado nor does the State endorse the survey or its contents. Your participation in this survey is voluntary.      https://docs.google.com/forms/d/e/1FAIpQLSfbsZDOFYEu7Rm47xUHQYxXAvpmrOUAsmNgUfDyFNFDTgnYJQ/viewform

IDR Policy

 

To: All licensed and state-certified providers From: HFEMSD The Division IDR Policy has been amended to include the process for review of focused surveys conducted pursuant to 6 CCR 1011-1, Chapter 2, Rule 12.4, “Reporting Requirements” for COVID-19 vaccination rate. The IDR instructions that accompany the deficiency lists also have been updated to track the process set forth in the revised IDR policy.  Elaine Sabyan

Board of Health Information for Chapter 2 – Vaccine Rulemaking

 

To: All Providers   From: HFEMSD   On August 30, 2021, the Board of Health adopted emergency revisions to 6 CCR 1011-1, Chapter 2 that established a requirement for all employees, direct contractors, and support staff to become fully vaccinated against COVID-19. Since that time, the Department has been working on revisions to these regulations, which will be presented to the Board of Health on December 15, 2021.   The proposed revisions can be found here.   For the December 15th meeting, the Board of Health will require all individuals who wish to provide public testimony to sign-up in advance at this link. Public testimony will be limited to one (1) hour, and signing up to testify does not guarantee there will be time for all individuals to testify at the hearing. To ensure your voice is heard, the Board encourages individuals to submit written testimony in advance of the meeting. Please email cdphe.bohrequests@state.co.us regarding any questions you may have or if you would like to provide public comment or written testimony.   Additional information on this meeting may be found on the Board of Health website.

REMINDER: ANNUAL HEALTH CARE WORKER INFLUENZA VACCINATION REPORTING IS REQUIRED

 

TO: All Licensed Healthcare Facilities in Colorado FROM: Colorado Department of Public Health & Environment (CDPHE) In February 2012, the Colorado Board of Health (BOH) passed rule 6 CCR 1011-1 Chapter 2 regarding influenza vaccination of employees in licensed healthcare facilities. Healthcare facilities are required to report data each spring. For the 2020-2021 influenza season, at least 90% of your employees should be immunized with the influenza vaccine. To report these data, you can use the National Health Safety Network (NHSN) or a new reporting tool that will be made available through the Health Facility Division this spring. Data should be submitted through only one of these electronic systems. Reporting to either system will meet state influenza vaccination reporting requirements. Reminder: If a facility has its own license and location, it must report separately, even if affiliated with a single hospital (i.e., Children's Hospital, University Hospital) or home health, assisted living, or nursing home corporation that has multiple sites. When a hospital or other facility type has multiple locations, those locations are licensed individually and therefore, should report separately. Home health agencies may have separate licenses based on different functions but are in the same location with the same staff so these facilities would report only once.  Reporting parameters are listed below for the 2020 – 2021 influenza season. Timeframe to count employees for denominator: October 1, 2020 – March 31, 2021. Minimum number of days employees must work to be counted in denominator: 1 day. Deadline to submit data: May 15, 2021. If you will be reporting through NHSN and have trouble accessing it, please send an email to NHSN@cdc.gov and in the subject line include “2020 – 2021 HCW Flu Reporting.” Important: Any facility already using NHSN to report state reportable infections or HCW influenza vaccination data should only report their data once through NHSN. HCW influenza vaccination data reported into NHSN, also fulfills state influenza vaccination reporting requirements. Note: If you report HCW influenza vaccination data through NHSN, please ensure that you have joined the Colorado Influenza Reporting Group and conferred rights; otherwise your data cannot be seen/accessed by the CDPHE. This can be down as follows: In NHSN, use the left hand blue navigation bar, click Group and Join Enter 27648 for both the group id and joining password Click Join Group At the Confer Rights page, scroll to the bottom of page and hit accept.   Additional resources can be found by visiting: https://www.colorado.gov/pacific/cdphe/board-health-rule-influenza-immunization.   For questions regarding the rule, please email Erica Bloom at Erica.Bloom@state.co.us.

Information - Alzheimer’s Association

 

To: Care Giver Leaders From: Jo Tansey, Section Manager Nursing Facilities Please see the attached forms from the Alzheimer’s Association to nominate caregivers of individuals with dementia or other cognitive challenges. What an important way to recognize those who give of themselves during these challenging times! Care Giver Letter to Nominator Caregiving Award Letter to Senior Care Professional Excellence Caregiving Nominator Form

CHANGE to Reporting Extension for Healthcare Worker Influenza Immunization

From: HFEMSD Current health facility rules require the reporting of influenza vaccination rates per 6 CCR 1011-1, Chapter 2, 11.2.3 “Facilities and agencies shall ensure that ninety percent (90%) of employees and direct contractors have received the influenza vaccine during a given influenza season. In order to demonstrate that the ninety percent (90%) rate has been met, facilities and agencies shall: (A) By May 15th of every year, report to the Department, in the form and manner specified by the Department, the vaccination rate for employees and direct contracts for the most recent influenza season” Governor Jared Polis declared a state of emergency in Colorado due to COVID-19 on March 11, 2020. Since that time, many employees of the Colorado Department of Public Health and Environment, including most members of the Health Facilities and Emergency Medical Services Division staff, have been working on the state’s response in some capacity. In early April, we sent a message extending the reporting period for healthcare worker influenza vaccination data from May 15, 2020 to August 1, 2020. We recently learned, that the portal that maintains the reporting tool will be shut down at the end of June. Therefore, all healthcare worker influenza vaccination data needs to be reported by June 15, 2020. We apologize for this change in guidance. If your agency is unable to report its facility healthcare worker influenza vaccination data by June 15, 2020, please email Erica.Bloom@state.co.us and she will help you report it in another manner. To report healthcare worker influenza vaccination by June 15, 2020, please go to: www.cohfportal-egov.com. If you have any questions, please email Erica.Bloom@state.co.us.

CMS Blanket Waiver Update – 5/1/20

To: Certified Facilities The Centers for Medicare and Medicaid Services (CMS) updated blanket waivers for its federally certified facilities to help healthcare providers contain the spread of novel coronavirus 2019 (COVID-19). These waivers are retroactively effective to March 1, 2020 and do not require an 1135 waiver application. All waivers issued can be located here: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf   Margaret Mohan Branch Chief Acute Care and Nursing Facilities Health Facilities and Emergency Medical Services Division

New Webinar Recording on Evacuating Persons with Dementia From Health Care Communities

To: Administrators and Directors

From: Greg Schlosser, Branch Chief, Health Facility Education and Quality Branch

The Health Facility Education and Quality Branch has just posted a recorded webinar on “Considerations for Evacuating Persons with Dementia from Health Care Communities.” It reviews actions providers can take before, during, and after an evacuation to prepare and protect their clients, patients and residents’ health and safety. This information may also be relevant to persons with other cognitive impairments.

To view the recorded webinar, go to https://www.youtube.com/watch?v=AhdHxoX_2DA&feature=youtu.be

If you have questions, please contact Melanie Roth at Melanie.Roth-Lawson@state.co.us or 303-692-2819.