July 2, 2020

We spoke this week with Penny Shaw, who represents nursing home residents on a commission appointed last month by the U.S. Centers for Medicare & Medicaid Services. The commission will assess nursing home response to COVID-19 and identify best practices to ensure safety and quality of care in the future. It is expected to issue its report to CMS by September 1.

Shaw requires ongoing care for Guillain-Barre syndrome and has lived in a nursing home since 2002. She is well known in the state and across the country as an advocate on issues related to aging and disability. Using a motorized wheelchair for transportation, Shaw is very active in the community. Like others in the state, she currently follows Governor Baker’s stay-at-home advisories while continuing her advocacy work.

A recent analysis by the Pennsylvania Patient Safety Authority offers learnings for acute care hospital leaders interested in gaining a better understanding of factors that may contribute to COVID-related adverse events. Among 343 events studied, "exposure to a patient with or suspected of having COVID-19" was the most frequent adverse outcome (50%), including potential exposure of staff. The next most frequent event was "missed or delayed test or result" (31%). The analysis grouped factors associated with these outcomes into 13 categories, ranging from admission screening and inadequate disinfection to isolation integrity and resource availability. The Safety Authority found that the single leading factor in these events, which took place in the earliest days of the pandemic in Pennsylvania, was laboratory testing (47%), but that more than one-third of the adverse events (36%) could be traced back to more than one associated factor.

An updated COVID-19 Response Toolkit helps care teams have timely, meaningful conversations about what quality care and quality of life may mean to patients, especially to those at high risk of becoming very sick from the coronavirus. Developed by the Serious Illness Care Program at Ariadne Labs , the toolkit includes resources tailored for inpatient, outpatient and long-term care teams and health systems. Sample questions include: With all that’s going on, what are you most worried about? What abilities are so important to you that you can’t imagine living without them?

The toolkit also includes a guide for patients, developed in partnership with The Conversation Project . This prompts patients to think about what they would want if they became seriously ill and to talk with members of their family, others likely to support them through an illness, and their care teams. Many of the toolkit resources are also available in French, Spanish, Portuguese, Cape Verdean Creole, Haitian Creole and Vietnamese.

Thank you, readers, for generously sharing stories about ways you are not just coping with COVID-19, but adapting and improving work along the way. We’d love to share even more of them in this newsletter. Please  let us know  about how your organization is managing challenges presented by the pandemic.