BALTIMORE — Quality experts at the Centers for Medicare & Medicaid Services will be taking a closer look at sepsis rates in nursing homes while continuing broader efforts to improve infection control, leaders said Wednesday.
“When we’re looking at readmissions and talking to our QIN-QIOs, the most common reason for readmission is typically related to sepsis,” said Colleen Frey, director of the CMS Division of Community and Population Health, referring to regional quality improvement groups that work with nursing homes.
“When we were looking at what would be our focus for this year, we decided we absolutely have to look at sepsis,” she added, speaking on the final day of the CMS Quality Conference.
Quality Improvement Organizations are already able to support nursing homes looking for additional resources, Frey said. But CMS also is working with the Centers for Disease Control and Prevention and the Sepsis Alliance to develop more education on best practices for preventing, recognizing and treating sepsis, Frey said.
“In the nursing home, where we really want to focus is on making sure that the staff is well-trained on the identification of early sepsis before it becomes really dramatic,” she said. “As you know, sepsis is kind of a runaway train if you don’t stop it early.”
She also said nursing homes that work with family members to explain sepsis — a bloodstream infection caused by bacteria — might also see results, given that family members involved in care or visiting frequently might be first to notice changes in a patient’s conditions.
Another way of lowering sepsis rates, which are already tracked by CMS, would be to do a better job of preventing other, more localized infections, such as UTIs, Frey said.
Keeping the ‘home’ in nursing home
While CMS has not moved to add a sepsis metric to its expanding value-based payment plans, research and efforts at this early stage could inform later initiatives or incentives. The CMS focus may not be wholly self-initiated. The Health and Human Services Office of Inspector General is expected to issue audit findings this year on potentially preventable hospitalizations of Medicare-eligible skilled nursing residents, including those who need acute care for UTIs, sepsis and four other conditions.
Prior OIG work identified that skilled nursing facilities “often did not provide UTI prevention and detection services in accordance with its residents’ care plans, increasing the residents’ risk for infection and hospitalization.”
The OIG has also kept up broader pressure on nursing home infection control standards and capabilities.
Last month, CMS announced it would enact Enhanced Barrier Protection requirements for nursing homes where patients have active multidrug resistant organisms infections or are known carriers. The new rules were developed in line with existing CDC guidance for other provider types, Eimee Casal, manager for the Division of Nursing Home’s Quality and Safety branch, reminded providers Wednesday.
But nursing home leaders have raised concerns that the more routine use of gloves and gowns, even around patients not actively infected, would take away from a nursing facility’s homelike feel, increase costs and take up more valuable staff time.
Casal said the March 20 QSO Memo was intended to “give a very clear and concise guidance” to be used by both surveyors and nursing home frontline staff. The rules went into effect April 1, and Casal noted it left nursing homes some discretion as to where and when to use additional PPE in patients with multidrug-resistant organisms not targeted by the CDC.
“We honed in on, who is this for, how will this impact the nursing home, how do we keep the ‘home’ in nursing home?” she said. “We still need to realize, this is their home where they live.”
