CMS-10210 CAUTI Validation Template

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Overview

Definitions
Template
NHSN ICU Location
FY18 Submission Instructions

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Sheet 1: Definitions

Catheter-Associated Urinary Tract Infection (CAUTI) Validation Template
In support of validation for the Hospital Inpatient Quality Reporting Program for the Fiscal Year (FY) 2018 Payment Determination:
• Each hospital selected for CAUTI validation is to produce a list of positive urine cultures for intensive care unit (ICU) patients.
• The line list should include all final results for all positive urine cultures with >= 105 colony-forming units (CFUs)/ml collected during an ICU stay.
• For each patient confirm:
1) The patient had an ICU admission during this hospital stay; and
2) The patient had a positive urine culture collected during the ICU stay with >= 105 CFU/ml. (If the patient was not in the ICU when the culture was drawn, do
not include these on the Validation Template. Exclude positive cultures with more than 2 organisms present even if results are >=105 CFU/ml.)
	FY 2018 - CAUTI Validation Template
	(Use this template for positive urine cultures beginning with 3Q15 - all quarters must be submitted on separate templates)
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.
Provider ID/CCN*	Hospital's 6-digit 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 CAUTI 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.
Positive Urine Cultures (Y/N)*	Select Yes or No from the dropdown list. Does the hospital have any final results for positive urine cultures for ICU 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 (do not type "N/A", "none", etc.).
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 CAUTI 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 patient.
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 ICU Location*	Select from the drop down list, the NHSN ICU location to which the patient was assigned when the positive urine culture was collected. Include only cultures collected during an ICU stay. Only locations from the drop down will be accepted; do not use a hospital-assigned location.
Lab ID*	Lab ID, accession number or specimen number corresponding to positive urine culture.
Urine Culture Date*	Provide the date the urine culture was collected in MM/DD/YYYY format.
Urine Culture Time	Provide the time the urine was collected if easily available.
PRA Disclosure Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1022.The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimates(s) or suggestions for improving this form, please write to CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, MD 21244-1650. Expiration Date: xx-xx-xxxx

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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*

Positive Urine Cultures (Y/N)*

Patient HIC*

Patient Identifier*

Birthdate*

Sex*

Admit Date*

Discharge Date*

First Name

Last Name

NHSN ICU Location*

Lab ID*

Urine Culture Date*

Urine Culture Time

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Sheet 3: NHSN ICU Location

	NHSN Locations Included in the Hospital IQR Program's CAUTI Reporting
CDC DESCRIPTION	DETAILS	CDC 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
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

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Sheet 4: FY18 Submission Instructions

USER GUIDE AND SUBMISSION INSTRUCTIONS

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The FY 2018 Validation Template User Guide and Submission Instructions, along with supporting documentation, can be downloaded from QualityNet

under the [Hospitals-Inpatient] tab drop-down and selecting “Resources” (direct link below):

https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier3&cid=1140537256076

The only acceptable method of sending Validation Templates is through the QualityNet Secure Portal Secure File Transfer Mailbox.

Validation Templates contain Protected Health Information (PHI) and cannot be sent via personal email -- even if a template were sent encrypted from a secure

workplace email, it would still be considered a security violation.

It is recommended to submit Validation Templates at least a week prior to the submission deadline in case there are difficulties with

transmitting files and to allow time for revisions/corrections when necessary.

If you are unable to log in to the Secure Portal, the first person to contact is your hospital's QualityNet Security Administrator.

If your Security Administrator is unable to reestablish your access, you will need to contact the QualityNet HelpDesk at (866) 288-8912.

It is recommended hospitals have two QualityNet Security Administrators at all times to ensure the ability to upload Validation

Templates to My QualityNet by the established submission deadlines.

TEMPLATE COMPLETION & SUBMISSION TIPS

Prior to submitting Validation Templates to CMS, it is recommended that quality assurance is performed on the data within the template.

Review the [Definitions] tab to ensure correct information is entered in each field.

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Do not add, delete, rename, or change the order of the tabs.

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Do not add, delete, or rename column headings.

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Do not leave the first row blank or skip rows between patient data.

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Make sure the State field contains the 2 character abbreviation for your state, not the full state name.

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Verify the Calendar Quarter listed on each Validation Template is correct.

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Review all dates for accuracy and correct format as specified on the [Definitions] tab.

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If a patient has not been discharged from the hospital, enter ‘Not Discharged’ for the Discharge Date field.

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Append the file name with the 6-digit CCN/Medicare ID#, followed by an underscore and the quarter.

For example: 012345_3QYY_FY18_CAUTI_ValidationTemplate.xlsx

• When submitting templates via the [Compose Mail] button under the Mailbox section on the Secure File Transfer screen, input the subject of the message

with the 6-digit CCN/Medicare ID#, Submission Quarter, and Template type(s) attached.

For example: CCN 012345 3QYY CLABSI & CAUTI Validation Templates

• When choosing recipients, do NOT select any individual person(s) from the recipient list; only select the "VALIDATION CONTRACTOR" recipient.

Individual accounts are not regularly monitored—sending to any one individual risks delay in processing.

• As soon as the Validation Support Contractor has downloaded the template(s), Secure File Transfer will deliver an automatic email letting the submitter

know the file has been downloaded. After a file has been downloaded, it will be in the queue for processing.

• It is suggested that users verify a message has been sent by clicking on the [Sent] link under the Mailbox section of the Secure File Transfer screen.

The message should be in your Sent folder with a status of "Received".

NOTE: It typically takes 10 or more minutes for messages to appear in the Sent folder with a "Received" status. Please, do NOT re-send messages

multiple times, as this significantly delays processing and requires version confirmation.

• You will receive email confirmation (usually within 48 hours of being downloaded) from the Validation Support Contractor letting you know the Validation

Templates were processed. If you do not receive a processing confirmation, please include your hospital's 6-digit CCN/Provider ID in an

email to

[email protected].