Newly Developed COVID-19 Bundle Greatly Reduces Infection Fatality Rate for Highly Vulnerable Nursing Home Population

1.00 CME / 1.00 CMD Clinical / 1.00 MOC

 This session will present a COVID-19 PI bundle applied at a large public nursing home (NH) to greatly cut the infection fatality rate and new infection rate among its highly vulnerable population. Key topics covered will be: (1) the PDSA (Plan-Do-Study-Act) cycle and how it can be used to design a bundle to address COVID-19 or similar entities, (2) ethnic-racial risk factors and key social determinants associated with poor COIVD-19 outcomes, (3) application of evidence-based geriatric principles to avert and promptly treat some of the common complications of COVID-19 illness, and (4) how a bundle component geared toward palliative care to help lower the acute care transfer rate.

Presenters

Howard Finger, DO, is clinical ethics consultant at Coler Rehabilitation and Nursing Care Center and at Henry J. Carter Specialty Hospital and Nursing Facility, and he is co-chairperson of the NYC Health + Hospitals Bioethics Council. In conjunction with the Bioethics Council, in 2016 he helped develop an Algorithm for the Unbefriended to assist interdisciplinary care teams in making end-of-life treatment decisions when patients lack both decisional capacity and surrogates.  For his work with the unbefriended, Dr. Finger received the 2020 Foundation for PALTC’s Quality Improvement & Health Outcome Award for improving the quality-of-life for persons living in nursing homes. In the spring of 2020, Dr. Finger co-developed a COVID-19 Performance Improvement (PI) Bundle and served as PI team co-leader at Coler where it contributed to a large reduction in the COVID-19 infection fatality rate among its highly vulnerable resident population.  The PI bundle helped to address inequities in access to quality health care adversely impacting ethic-racial minorities as the standard of care was elevated equally for all during the pandemic with promising outcome results.

Rani Rao, MD, CMD, is Chief Medical Officer for Coler Rehabilitation and Nursing Center which is the largest public skilled long term care facility in the country. In addition to being a Board-certified internist and geriatrician, she trained as fellow in medical ethics at McLean Center of Clinical Medical Ethics, University of Chicago. Prior to joining Coler, she served as core faculty for Internal Medicine residency program, director of post-acute care service line and co-chair of medical ethics at Mercyhealth system of Northern IL and Wisconsin.

Deepa Vinoo, RN, is a board-certified geriatric nurse and an associate director of nursing at Coler, as well as the nursing director of our 150 bedded Memory Care Units. She holds an MSN degree in Psychiatric Nursing and is a Certified Dementia Care Practitioner. She previously helped lead our award-winning project “Reduction of Antipsychotics in Dementia Related Behavior’, and was the project director for "building palliative care in dementia at NY City Health+Hospitals/Coler. Ms.Vinoo has been leading Music & Memory program at Coler. During the pandemic, Ms. Vinoo was the nursing leader of our successful palliative care initiative

Learning Objectives

• Design a performance improvement bundle, to be applied by interdisciplinary teams at NH with vulnerable populations, utilizing the PDSA cycle, a methodology commonly employed in health care, to address COVID-19 or similar new viral illness, for which no evidence-based antiviral agents exist, by elevating the level of care, geared toward early identification of cases in order to limit spread of the illness and to avert or promptly treat common secondary complications such as dehydration before progression.
• Identify resident populations at greatest risk for poor COVID-19 outcomes, based upon national data and analysis, which includes ethnicity, race, and gender, as well as key social determinants of health such as poverty, homelessness, substandard housing, inadequate nutrition, mental illness, polysubstance abuse and smoking, in order to formulate a performance improvement initiative geared toward overcoming the inequities in health care that contributed to it, in order to mitigate the impact of the illness upon these highly vulnerable populations.
• Effectively manage or avert commonly encountered medical complications among NH residents that can also present as serious secondary complications in residents infected with COVID-19 such as dehydration, bacterial pneumonia, urinary tract infections, and urosepsis, by careful clinical surveillance during the early phase of COVID-19 to identify those most at risk for these complications and implement evidence-based geriatric principles tailored to each of these secondary complications as part of a facility wide performance improvement process.
• Apply a palliative care component to a COVID-19 or similar new viral illness performance improvement strategy to identify highly vulnerable NH residents with advanced life-limiting illnesses who are suitable for palliative MOLST (Medical Orders of Life-Sustaining Treatment) care team discussions directed toward maintaining quality of life and avoiding non-beneficial interventions that could potentially hasten their demise while, at the same time, lowering the acute care transfer rate.

Credit Information

Activity Created 3/2022

Credits Available Until 3/2025

Credit Statements:

CME: AMDA – The Society for Post-Acute and Long-Term Care Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDA – The Society for Post-Acute and Long-Term Care Medicine for Post-Acute and Long-Term Care Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CMD: This self-study activity has been pre-approved by the American Board of Post-Acute and Long-Term Care Medicine (ABPLM) for a total of 1.0 clinical hours toward certification or recertification as a Certified Medical Director (CMD) in post-acute and long-term care medicine. The CMD program is administered by the ABPLM. Each physician should claim only those hours of credit actually spent on the activity.

ABIM Maintenance of Certification (MOC): Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 Medical Knowledge MOC points and patient safety credit in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program.

Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Visit the Continuing Education page for information on if and how you can claim credit/hours for AMDA’s education.

 Disclosure Information:

The Society requires the disclosure of all speaker/faculty/planner’s relevant financial relationships; presence of off-label use of a device or medication; and discussion of any experimental, new or evolving topic prior to each accredited education activity.

If the learner perceives any bias toward a commercial product or service, advocation of unscientific approaches to diagnosis or therapy, or recommendation, treatment, or manners of practicing healthcare that are determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients please report this to the Society’s staff.

All relevant financial relationships have been identified, mitigated, and resolved.

• The following AMDA Education Committee members have financial relationships to report: Diane Sanders-Cepeda, DO, CMD — UHC E&I Retiree Solutions: Full-Time Employee; all others have no relationships with ineligible companies.
• The speakers have no relevant financial relationships.
• AMDA staff have no relationships with ineligible companies.