CMS-10210 MRSA Validation Template

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Overview

Definitions
Template
NHSN Location

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Sheet 1: Definitions

Methicillin-Resistant Staphylococcus Aureus (MRSA) Validation Template In support of validation of laboratory-identified MRSA events reported as part of the Hospital Inpatient Quality Reporting program for the Fiscal Year (FY) 2017 payment determination. Each hospital selected for MRSA validation is to produce a list of all final results for blood cultures positive for MRSA in either an intensive care unit (ICU) or non-ICU location during their stay.
FY 2017 - MRSA Validation Template (blood cultures positive for MRSA for discharges beginning 3Q14)
FIELD (* indicates required field)	DESCRIPTION	SECTION
NHSN Facility ID*	The National Healthcare Safety Network (NHSN)-assigned facility ID under which your hospital submits NHSN data.	Hospital Information Section Complete the first row in the spreadsheet. The information provided in the first row will be applied to all positive blood cultures listed on the template.
Provider ID/CCN*	Hospitals CMS Certification Number.
Hospital Name*	Hospital Name associated with CCN.
State*	Enter the 2 character abbreviation for the state in which the hospital is located.
Calendar Quarter*	Select from the dropdown list the calendar quarter to which the MRSA Validation Template pertains.
Hospital Contact Name*	Hospital contact name for CMS to contact with questions.
Contact Phone*	Phone number for hospital contact listed.
Contact Email*	Email address for hospital contact listed.
Blood cultures positive for MRSA (Y/N)*	Select Yes or No from the dropdown list. Does the hospital have any final results for blood cultures positive for MRSA for patients in the calendar quarter referenced?
Patient HIC*	The patient's Medicare Beneficiary Number, also known as the health insurance claim (HIC) number. No dashes, spaces or special characters should be included. Must be between 7 and 12 characters. This field is required for Medicare patients when the HIC number is known. Leave blank if not applicable.	Blood Culture Section Complete for every final blood culture positive for MRSA.
Patient Identifier*	The patient identifier assigned by the hospital. Use the same patient identifier that would be submitted to NHSN if the episode of care (EOC) would be reported as a laboratory-identified MRSA bacteremia event.
Birthdate*	The patient date of birth using MM/DD/YYYY format.
Sex*	Select Female, Male or unknown from the dropdown list to indicate the sex of the patient.	Patient Information Section Complete once per patient episode of care.
Admit Date*	Enter date patient was admitted to hospital in MM/DD/YYYY format.
Discharge Date*	Enter date patient was discharged from the hospital in MM/DD/YYYY format. If a patient has not been discharged from the hospital enter ‘Not Discharged’ for the Discharge Date field.
First Name	First name of patient.
Last Name	Last name of patient.
NHSN Location*	Select from the drop down list, the NHSN location to which the patient was assigned when the blood culture positive for MRSA was collected.	Blood Culture Section Complete for every final blood culture positive for MRSA.
Lab ID*	Lab ID, accession number or specimen number corresponding to positive blood culture.
Blood Culture Date*	Provide the date the blood culture was collected in MM/DD/YYYY format.
Blood Culture Time	Provide the time the blood was collected if easily available.
End of spreadsheet

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Sheet 2: Template

NHSN Facility ID*

Provider ID/CCN*

Hospital Name*

State*

Calendar Quarter*

Hospital Contact Name*

Contact Phone*

Contact Email*

Blood cultures positive for MRSA (Y/N) *

Patient HIC*

Patient Identifier*

Birthdate*

Sex*

Admit Date*

Discharge Date*

First Name

Last Name

NHSN Location*

Lab ID*

Blood Culture Date*

Blood Culture Time

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Sheet 3: NHSN Location

NHSN Locations Included in the Hospital IQR Program's MRSA Reporting
	CDC LOCATION LABEL	LOCATION DESCRIPTION	CDC LOCATION CODE
Inpatient Adult Critical Care Units	Burn Critical Care	Critical care area specializing in the care of patients with significant/major burns.	IN:ACUTE:CC:B
	Medical Cardiac Critical Care	Critical care area specializing in the care of patients with serious heart problems that do not require heart surgery.	IN:ACUTE:CC:C
	Medical Critical Care	Critical care area for patients who are being treated for nonsurgical conditions.	IN:ACUTE:CC:M
	Medical/Surgical Critical Care	An area where critically ill patients with medical and/or surgical conditions are managed.	IN:ACUTE:CC:MS
	Neurologic Critical Care	Critical care area for the care of patients with life-threatening neurologic diseases.	IN:ACUTE:CC:N
	Neurosurgical Critical Care	Critical care area for the surgical management of patients with severe neurologic diseases or those at risk for neurologic injury as a result of surgery.	IN:ACUTE:CC:NS
	ONC Medical Critical Care	Critical care area for the care of oncology patients who are being treated for nonsurgical conditions related to their malignancy.	IN:ACUTE:CC:ONC_M
	ONC Surgical Critical Care	Critical care area for the evaluation and management of oncology patients with serious illness before and/or after cancer-related surgery.	IN:ACUTE:CC:ONC_S
	ONC Medical-Surgical Critical Care	Critical care area for the care of oncology patients with medical and/or surgical conditions related to their malignancy.	IN:ACUTE:CC:ONC_MS
	Prenatal Critical Care	Critical care area for the care of pregnant patients with complex medical or obstetric problems requiring a high level of care to prevent the loss of the fetus and to protect the life of the mother.	IN:ACUTE:CC:PNATL
	Respiratory Critical Care	Critical care area for the evaluation and treatment of patients with severe respiratory conditions.	IN:ACUTE:CC:R
	Surgical Cardiothoracic Critical Care	Critical care area specializing in the care of patients following cardiac and thoracic surgery.	IN:ACUTE:CC:CT
	Surgical Critical Care	Critical care area for the evaluation and management of patients with serious illness before and/or after surgery.	IN:ACUTE:CC:S
	Trauma Critical Care	Critical care area specializing in the care of patients who require a high level of monitoring and/or intervention following trauma or during critical illness related to trauma.	IN:ACUTE:CC:T
Inpatient Pediatric Critical Care Units	ONC Pediatric Critical Care	Critical care area for the care of oncology patients ≤18 years old who are being treated for surgical or nonsurgical conditions related to their malignancy.	IN:ACUTE:CC:ONC_PED
	Pediatric Burn Critical Care	Critical care area specializing in the care of patients ≤ 18 years old with significant/major burns.	IN:ACUTE:CC:B_PED
	Pediatric Cardiothoracic Critical Care	Critical care area specializing in the care of patients ≤ 18 years old following cardiac and thoracic surgery.	IN:ACUTE:CC:CT_PED
	Pediatric Medical Critical Care	Critical care area for patients ≤ 18 years old who are being treated for nonsurgical conditions. In the NNIS system, this was called Pediatric ICU (PICU).	IN:ACUTE:CC:M_PED
	Pediatric Medical Surgical Critical Care	An area where critically ill patients ≤ 18 years old with medical and/or surgical conditions are managed.	IN:ACUTE:CC:MS_PED
	Pediatric Neurosurgical Critical Care	Critical care area specializing in the surgical management of patients ≤ 18 years old with severe neurological diseases or those at risk for neurological injury as a result of surgery.	IN:ACUTE:CC:NS_PED
	Pediatric Respiratory Critical Care	Critical care area for the evaluation and treatment of the patients ≤ 18 years old with severe respiratory conditions.	IN:ACUTE:CC:R_PED
	Pediatric Surgical Critical Care	Critical care area for the evaluation and management of patients ≤ 18 years old with serious illness before and/or after surgery.	IN:ACUTE:CC:S_PED
	Pediatric Trauma Critical Care	Critical care area specializing in the care of patients ≤ 18 years old who require a high level of monitoring and/or intervention following trauma or during critical illness related to trauma.	IN:ACUTE:CC:T_PED
Inpatient Neonatal Units	Well Baby Nursery (Level I)	Hospital area for evaluation and postnatal care of healthy newborns. May include neonatal resuscitation and stabilization of ill newborns until transfer to a facility at which specialty neonatal care is provided.	IN:ACUTE:WARD:NURS
	Step down Neonatal Nursery (Level II)	NOTE: The categories of Level II, listed below, are classifications from the American Academy of Pediatrics, Definitions of hospital-based newborn services. Level II neonatal care (specialty) Special care nursery: level II units are subdivided into 2 categories on the basis of their ability to provide assisted ventilation including continuous positive airway pressure. Level IIA: has the capabilities to • Resuscitate and stabilize preterm and/or ill infants before transfer to a facility at which newborn intensive care is provided. • Provide care for infants born at >32 weeks’ gestation and weighing ≥1500 g (1) who have physiologic immaturity such as apnea of prematurity, inability to maintain body temperature, or inability to take oral feedings or (2) who are moderately ill with problems that are anticipated to resolve rapidly and are not anticipated to need subspecialty services on an urgent basis. • Provide care for infants who are convalescing after intensive care. Level IIB has the capabilities of a level IIA nursery and the additional capability to provide mechanical ventilation for brief durations (<24 hours) or continuous positive airway pressure.	IN:ACUTE:STEP:NURS
	Neonatal Critical Care Level II/III	Combined nursery housing both Level II and III newborns and infants.	IN:ACUTE:CC_STEP:NURS
	Neonatal Critical Care Level III	A hospital neonatal intensive care unit (NICU) organized with personnel and equipment to provide continuous life support and comprehensive care for extremely high-risk newborn infants and those with complex and critical illness. NOTE: The categories of Level III below are classifications from the American Academy of Pediatrics, Definitions of hospital-based newborn services.1 These classifications are all considered Level III nurseries in NHSN. Level III (subspecialty) NICU: level III NICUs are subdivided into 3 categories: Level IIIA: has the capabilities to • Provide comprehensive care for infants born at >28 weeks’ gestation and weighing >1000 g. • Provide sustained life support limited to conventional mechanical ventilation. • Perform minor surgical procedures such as placement of central venous catheter or inguinal hernia repair Level IIIB NICU: has the capabilities to provide. • Comprehensive care for extremely low birth weight infants (≤1000 g and ≤28 weeks’ gestation). • Advanced respiratory support such as high-frequency ventilation and inhaled nitric oxide for as long as required. • Prompt and on-site access to a full range of pediatric medical subspecialists. • Advanced imaging, with interpretation on an urgent basis, including computed tomography, magnetic resonance imaging, and echocardiography. • Pediatric surgical specialists and pediatric anesthesiologists on site or at a closely related institution to perform major surgery such as ligation of patent ductus arteriosus and repair of abdominal wall defects, necrotizing enterocolitis with bowel perforation, tracheoesophageal fistula and/or esophageal atresia, and myelomeningocele. Level IIIC NICU has the capabilities of a level IIIB NICU and also is located within an institution that has the capability to provide ECMO and surgical repair of complex congenital cardiac malformations that require cardiopulmonary bypass.	IN:ACUTE:CC:NURS
Inpatient Specialty Care Areas (SCA)	Inpatient Dialysis SCA	Hospital specialty care area for patients who require dialysis as part of their care. These patients may be chronic or acute dialysis patients.	IN:ACUTE:SCA:DIAL
	Pediatric Dialysis SCA	Hospital specialty care area for patients ≤18 years old who require acute dialysis as part of their care. These patients may be chronic or acute dialysis patients.	IN:ACUTE:SCA:DIAL_PED
	Pediatric Solid Organ Transplant SCA	Hospital specialty area for the postoperative care of patients ≤18 years old who have had a solid organ transplant (e.g., heart/lung, kidney, liver, pancreas).	IN:ACUTE:SCA:SOTP_PED
	Solid Organ Transplant SCA	Hospital specialty area for the postoperative care of patients who have had a solid organ transplant (e.g., heart/lung, kidney, liver, pancreas).	IN:ACUTE:SCA:SOTP
Inpatient Adult Wards	Antenatal Care Ward	Hospital area for observation, evaluation, treatment or surgery of high risk pregnancy patients.	IN:ACUTE:WARD: ANTENAT
	Behavioral Health /Psych Ward	Area for the evaluation and treatment of patients with acute psychiatric or behavioral disorders.	IN:ACUTE:WARD:BHV
	Burn Ward	Hospital area for evaluation and treatment of patients who have burns.	IN:ACUTE:WARD:B
	Ear/Nose/Throat Ward	Hospital area for the evaluation, treatment, or surgery of patients with ear, nose, or throat disorders.	IN:ACUTE:WARD:ENT
	Gastrointestinal Ward	Hospital area for evaluation, treatment or surgery of patients with disorders of the gastrointestinal tract.	IN:ACUTE:WARD:GI
	Genitourinary Ward	Hospital area for the evaluation, treatment or surgery of patients with disorders of the genitourinary system.	IN:ACUTE:WARD:GU
	Gerontology Ward	Hospital area for the evaluation, treatment or surgery of patients with age-related diseases.	IN:ACUTE:WARD:GNT
	Gynecology Ward	Hospital area for the evaluation, treatment, or surgery of female patients with reproductive tract disorders.	IN:ACUTE:WARD:GYN
	Jail Unit*	Overnight stay patient care area of a hospital or correctional facility used only for those who are in custody of law enforcement during their treatment.
	Labor and Delivery Ward	Hospital area where women labor and give birth.	IN:ACUTE:WARD:LD
	Labor, Delivery, Recovery, Postpartum Suite (LDRP)	Hospital suite used for labor, delivery, recovery and post-partum (LDRP) -- all within the same suite.	IN:ACUTE:WARD:LD_PP
	Medical Ward	Hospital area for the evaluation and treatment of patients with medical conditions or disorders.	IN:ACUTE:WARD:M
	Medical/Surgical Ward	Hospital area for the evaluation of patients with medical and/or surgical conditions.	IN:ACUTE:WARD:MS
	Neurology Ward	Hospital area where patients with neurological disorders are evaluated and treated.	IN:ACUTE:WARD:N
	Neurosurgical Ward	Hospital area for care of patients whose primary reason for admission is to have neurosurgery or to be cared for by a neurosurgeon after head or spinal trauma.	IN:ACUTE:WARD:NS
	ONC Leukemia Ward	Area for the evaluation and treatment of patients with leukemia.	IN:ACUTE:WARD:ONC_LEUK
	ONC Lymphoma Ward	Area for the evaluation and treatment of patients with lymphoma.	IN:ACUTE:WARD:ONC:LYMPH
	ONC Leukemia/Lymphoma Ward	Area for the evaluation and treatment of patients with leukemia and/or lymphoma.	IN:ACUTE:WARD: ONC_LL
	ONC Solid Tumor Ward	Area for the evaluation and treatment of oncology patients with solid tumors.	IN:ACUTE:WARD:ONC_ST
	ONC Hematopoietic Stem Cell Transplant Ward	Area for the care of patients who undergo stem cell transplant for the treatment of cancers and/or blood or immune system disorders.	IN:ACUTE:WARD: ONC_HSCT
	ONC General Hematology/Oncology Ward	Area for the evaluation and treatment of patients with cancer and/or blood disorders.	IN:ACUTE:WARD: ONC_HONC
	Ophthalmology Ward	Hospital area for care of patients whose primary reason for admission is to have eye surgery or to be cared for by an ophthalmologist after eye trauma.	IN:ACUTE:WARD:OPH
	Orthopedic Ward	Hospital area for evaluation, treatment or surgery on bones, joints, and associated structures by an orthopedist.	IN:ACUTE:WARD:ORT
	Orthopedic Trauma Ward	Hospital area where patients with orthopedic injuries or disorders are evaluated and treated.	IN:ACUTE:WARD_ORT
	Plastic Surgery Ward	Hospital area for the care of patients who have reconstructive surgery performed by a plastic surgeon.	IN:ACUTE:WARD:PLS
	Postpartum Ward	Hospital area for the patient who is recovering from childbirth.	IN:ACUTE:WARD:PP
	Pulmonary Ward	Hospital area where patients with respiratory system conditions or disorders are evaluated and treated.	IN:ACUTE:WARD:PULM
	Rehabilitation Ward	Hospital area for evaluation and restoration of function to patients who have lost function due to acute or chronic pain, musculoskeletal problems, stroke, or catastrophic events resulting in complete or partial paralysis.	IN:ACUTE:WARD:REHAB
	School Infirmary*	Overnight stay patient care area of a school infirmary or health center (e.g., private residential school or college campus).
	Stroke (Acute) Ward	Hospital area for evaluation, stabilization and treatment of patients who have experienced an acute stroke.	IN:ACUTE:WARD:STRK
	Surgical Ward	Hospital area for evaluation and treatment of patients who have undergone a surgical procedure.	IN:ACUTE:WARD:S
	Telemetry Ward	Hospital area dedicated to providing evaluation and treatment of patients requiring continuous cardiac monitoring.	IN:ACUTE:WARD:TEL
	Vascular Surgery Ward	Hospital area for evaluation and treatment of patients who have undergone vascular surgery.	IN:ACUTE:WARD:VS
Inpatient Pediatric Wards	Adolescent Behavioral Health Ward	Hospital area for evaluation and treatment of patients between the ages of 13 and 18 with acute psychiatric or behavioral disorders.	IN:ACUTE:WARD: BHV_ADOL
	ONC Pediatric Hematopoietic Stem Cell Transplant Ward	Area for the care of patients ≤18 years old who undergo stem cell transplant for the treatment of cancers and/or blood or immune system disorders.	IN:ACUTE:WARD:ONC_HSCT_PED
	ONC Pediatric General Hematology/Oncology Ward	Area for the evaluation and treatment of patients ≤18 years old with cancer and/or blood disorders.	IN:ACUTE:WARD:ONC_HONC_PED
	Pediatric Behavioral Health Ward	Hospital area for evaluation and management of patients ≤18 years old with acute psychiatric or behavioral disorders.	IN:ACUTE:WARD:BHV_PED
	Pediatric Burn Ward	Hospital area specializing in the evaluation and treatment of patients ≤18 years old who have tissue injury caused by burns.	IN:ACUTE:WARD:B_PED
	Pediatric Ear, Nose, Throat Ward	Hospital area for evaluation and management of patients ≤18 years old with disorders of the ear, nose and/or throat.	IN:ACUTE:WARD: ENT_PED
	Pediatric Genitourinary Ward	Hospital area where patients ≤18 years old with disorders of the genitourinary system are evaluated and treated.	IN:ACUTE:WARD: GU_PED
	Pediatric Medical Ward	Area for the evaluation and treatment of patients ≤18 years of old with medical conditions or disorders.	IN:ACUTE:WARD:M_PED
	Pediatric Medical/Surgical Ward	Hospital area where patients ≤18 years old with medical and/or surgical conditions are managed.	IN:ACUTE:WARD: MS_PED
	Pediatric Neurology Ward	Area for the evaluation and treatment of patients ≤18 years old with neurologic disorders.	IN:ACUTE:WARD:N_PED
	Pediatric Neurosurgical Ward	Hospital area for care of patients ≤18 years old whose primary reason for admission is to have neurosurgery or to be cared for by a neurosurgeon after head or spinal trauma.	IN:ACUTE:WARD:NS_PED
	Pediatric Orthopedic Ward	Hospital area where patients ≤18 years old with orthopedic injuries or disorders are evaluated and treated.	IN:ACUTE:WARD:ORT_PED
	Pediatric Rehabilitation Ward	Hospital area for evaluation and restoration of function to patients ≤18 years old who have lost function due to acute or chronic pain, musculoskeletal problems, stroke, or catastrophic events resulting in complete or partial paralysis.	IN:ACUTE:WARD:REHAB_PED
	Pediatric Surgical Ward	Hospital area for evaluation and treatment of patients ≤18 years old that have undergone a surgical procedure.	IN:ACUTE:WARD:S_PED
Inpatient Step Down Units	Adult Step Down Unit (e.g., post-critical care)	Hospital area for adult patients that are hemodynamically stable who can benefit from close supervision and monitoring, such as frequent pulmonary toilet, vital signs, and/or neurological and neurovascular checks.	IN:ACUTE:STEP
	ONC Step Down Unit (all ages) (e.g., post-critical care)	Area for oncology patients who are hemodynamically stable and can benefit from close supervision and monitoring, such as frequent pulmonary toilet, vital signs, and/or neurologic and neurovascular checks.	IN:ACUTE:STEP:ONC
	Pediatric Step Down Unit (e.g., post-critical care)	Patients ≤18 years old that are hemodynamically stable who can benefit from close supervision and monitoring, such as frequent pulmonary toilet, vital signs, and/or neurological and neurovascular checks.	IN:ACUTE:STEP:PED
Inpatient Mixed Acuity Units	Adult Mixed Acuity Unit	Hospital area for the evaluation and treatment of adult patients whose conditions are varying levels of acuity (e.g., critical care, ward-level care, step-down type care, etc.). Such a care area may be comprised of patients followed by different hospital services (e.g., coronary, medical, surgical, etc.). This care area may or may not include “acuity adaptable” or “universal” beds (i.e., this model of patient care allows a patient to stay in the same bed during all phases of his care, from critical care through lower levels of care).	IN:ACUTE:MIXED:ALL_ADULT
	Pediatric Mixed Acuity Unit	Hospital area for the evaluation and treatment of pediatric patients (≤18 years old) whose conditions are of varying levels of acuity (e.g., critical care, etc.). Such a care area may be comprised of patients followed by different hospital services (e.g., coronary, medical, surgical, etc.). This care area may or may not include “acuity adaptable” or “universal” beds (i.e., this model of patient care allows a patient to stay in the same bed during all phases of his care, from critical care through lower levels of care).	IN:ACUTE:MIXED: ALL_PEDS
	Mixed Age Mixed Acuity Unit	Hospital area for the evaluation and treatment of a mixture of adult and pediatric patients whose conditions are of varying levels of acuity (e.g., critical care, ward-level care, step-down type care, etc.). Such a care area may be comprised of patients followed by different hospital services (e.g., coronary, medical, surgical, etc.). This care area may or may not include “acuity adaptable” or “universal” beds (i.e., this model of patient care allows a patient to stay in the same bed during all phases of his care, from critical care through lower levels of care).	IN:ACUTE:MIXED:ALL
	ONC Mixed Acuity Unit (all ages)	Area for the evaluation and treatment of a mixture of adult and pediatric oncology patients whose conditions are of varying levels of acuity (e.g., critical care, ward-level care, step-down type care, etc.). This care area may or may not include ''acuity adaptable'' or ''universal'' beds (i.e., this model of patient care allows a patient to stay in same bed during all phases of care, from critical care through lower levels of care).	IN:ACUTE:MIXED:ONC
Inpatient Operating Rooms	Cardiac Catheterization Room/Suite	A room or rooms in a hospital equipped for the performance of heart catheterizations for diagnostic or therapeutic purposes. Operating Room requirements for air changes, temperature, humidity and surfaces must be met.	IN:ACUTE:OR:CATH
	Cesarean Section Room/Suite	A room or suite in a hospital equipped for the performance of obstetric and gynecologic surgeries and for the care of the neonate immediately after birth. Operating Room requirements for air changes, temperature, humidity and surfaces must be met.	IN:ACUTE:OR:LD
	Interventional Radiology	A room or suite in a hospital where diagnostic or therapeutic radiologic procedures on outpatients and/or inpatients occurs. Operating Room requirements for air changes, temperature, humidity and surfaces must be met.	IN:ACUTE:OR:RAD
	Operating Room/Suite	A room or suite in a hospital equipped for the performance of surgical operations. Requirements for air changes, temperature, humidity and surfaces must be met. (For outpatient operating room, use Ambulatory Surgery Center designation or other specialty OR shown in Outpatient Locations section of this chapter).	IN:ACUTE:OR
	Post Anesthesia Care Unit/Recovery Room	Hospital area designated for monitoring patients for immediate effects of anesthesia before either going home or on to an in-patient care area.	IN:ACUTE:OR_STEP
Inpatient Chronic Care Units	Inpatient Hospice*	Area where palliative care is provided to the dying patient.
	Chronic Alzheimer's Unit*	Area where care is provided to patients diagnosed with Alzheimer's syndrome for extended periods of time. Formerly called Long Term Care Alzheimer’s Unit.
	Chronic Behavioral Health/Psych Unit*	Area where care is provided to patients with psychiatric or behavioral-disorder diagnoses for extended periods of time. Formerly called Long Term Care Behavioral Health/Psych Unit.
	Chronic Rehabilitation Unit*	Area where evaluation and restoration of function is provided to patients who have lost function due to acute or chronic pain, musculoskeletal problems, stroke, or catastrophic events resulting in complete or partial paralysis. Formerly called Long Term Care Rehabilitation Unit.
	Chronic Care Unit*	Area where care provided for patients with chronic disease or disabilities for extended periods of time. Formerly called Long Term Care Unit.
	Ventilator Dependent Unit*	Area where care is provided to patients whose respirations depend on the use of a ventilator for extended periods of time.
End of spreadsheet		* Include only inpatient episodes of care billed under the hospital’s acute care CMS certification number (regardless of payer)