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Instructions
for Completion of the COVID-19 Long-term Care Facility (LTCF):
Ventilator Capacity and Supplies Form (CDC 57.147)
Data
Field
|
Instructions for Data
Collection
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NHSN
Facility ID #
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The NHSN-assigned facility
ID will be auto-entered by the computer.
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CMS
Certification Number (CCN)
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Auto-generated by the
computer if the facility has previously entered the CCN number
during NHSN registration. See NHSN CCN Guidance document for
instructions on how to add a new CCN or edit an entered CCN.
|
Facility
Name
|
Auto-generated by the
computer if the facility has previously entered facility name
during registration.
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**Do
you have a ventilator dependent unit in your facility?
Select
“YES” or
“NO”
|
On the date of response,
does your facility have a ventilator dependent unit in the
facility?
Select
“YES” if your facility has a ventilator dependent unit
and continue completing the Module questions.
Select “NO”
if your facility does not have a ventilator dependent unit in the
facility and skip the remainder of this form.
|
Date
for which “ventilator
capacity and supplies” responses
are reported
|
Required.
Select the date on the calendar for which the responses are being
reported in the NHSN COVID 19-Module.
|
Important:
While daily reporting
will provide the timeliest data to assist with COVID-19 emergency
response efforts, retrospective reporting of prior day(s), unless
otherwise specified, is encouraged if daily reporting is not
feasible. At a minimum, facilities should report data at
least
once per week.
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Data
Field
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Instructions for Data
Collection
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MECHANICAL
VENTILATORS:
Total
number available in the facility
|
On the date responses
are reported in this Module,
enter the total number of mechanical ventilators available in
your facility. Include ventilators that are in use and not in
use.
Note:
|
MECHANICAL
VENTILATORS IN USE:
Total
number of ventilators in use
for residents who have
suspected or lab-confirmed COVID-19
|
On the date responses
are reported in this Module,
enter the total number of mechanical ventilators in use by
residents with suspected or laboratory positive (also referred to
as lab-confirmed) COVID-19.
Notes:
Include
portable ventilators that are in use.
Suspected
is defined as residents being managed or treated with the same
precautions as those with a laboratory positive COVID-19 test
result but have not been tested or have pending test results.
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VENTILATOR SUPPLIES
|
Do
you currently have ANY supply?
Select
“YES” or
“NO”
|
On the date responses
are reported into this Module,
does your facility have any ventilator supplies available for
use?
Select
“YES” if you currently have the ventilator supplies
needed to care for residents on mechanical ventilation.
OR
Select
“NO” if you currently do not have ventilator supplies
needed to care for residents on mechanical ventilation.
Note:
The response to
this question is based on all
needed ventilator supplies, including, but not limited to
tubing, flow sensors, connectors, valves. If the facility is
missing any supply item needed to care for residents on
mechanical ventilation, answer “NO”.
|
Do
you have enough for NEXT week?
Select
“YES” or “NO”
(Select
one
answer for each supply item)
|
On the date responses
are reported into this Module,
do you have enough ventilator supplies for next week (for
example, the next 7 days)?
Select
“YES” if your facility has enough ventilator supplies
for the next week.
OR
Select
“NO” if your facility does not have enough ventilator
supplies for the next week.
Note:
The
response to this question is based on all
needed ventilator supplies, including, but not limited to tubing,
flow sensors, connectors, valves. If the facility is missing any
supply item needed to care for residents on mechanical
ventilation, answer “NO”.
|
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | TOI Ventilator Capacity and Supplies |
Subject | NHSN LTCF Table of Instructions |
Author | CDC/NCEZID/DHQP |
File Modified | 0000-00-00 |
File Created | 2021-01-14 |