Form 0920-1290 COVID-19 Module - LTCF Resident Impact and Facility Capa

Long-term Care Facility Component

Instructions for Completion of the COVID-19 Long-term Care Facility (LTCF): Resident Impact and Facility Capacity Form (CDC 57.144)

Data Field	Instructions for Data Collection
NHSN Facility ID #	The NHSN-assigned facility ID will be auto-entered by the computer.
CMS Certification Number (CCN)	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.
Date for which “resident impact and facility capacity “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.

RESIDENT IMPACT

Data Field	Instructions for Data Collection
ADMISSIONS: Residents admitted or readmitted who were previously hospitalized and treated for COVID-19	If this is the first time Admission counts are being entered in the NHSN COVID-19 Module, facilities are required to: Enter the number of residents newly admitted or readmitted to the LTCF this week from the hospital where they were treated for suspected or laboratory positive COVID-19. Please follow instructions in #3 for subsequent data entries. Facilities are encouraged, but not required, to provide Admission counts since January 1, 2020: At any time, facilities may enter the number of residents admitted or readmitted to the LTCF from a hospital where they were treated for suspected or laboratory positive COVID-19 since January 1, 2020. Please follow instructions in #3 for subsequent data entries. If this is not the first time Admission counts are being entered in the NHSN COVID-19 Module: Since the last date Admission counts were entered in the Module, enter the number of residents newly admitted or readmitted to the LTCF this week from a hospital where they were treated for suspected or laboratory positive COVID. Note: Include only newly admitted or readmitted residents since the last date these counts were entered in the Module regardless if the resident(s) is still in the facility.
CONFIRMED: Residents with new laboratory positive COVID-19	If this is the first time Confirmed counts are being entered in the NHSN COVID-19 Module, facilities are required to: Enter the total number of residents with a new laboratory positive COVID test result this week. Please follow instructions in #3 for subsequent data entries. Facilities are encouraged, but not required, to provide Confirmed counts since January 1, 2020: At any time, facilities may enter the number of residents with a new laboratory-positive COVID-19 test result, including residents who remain in the LTCF, as well as residents who were transferred out of the facility, admitted to another facility, or died since January 1, 2020. Please follow instructions in #3 for subsequent data entries. If this is not the first time Confirmed counts are being entered in the NHSN COVID-19 Module: Since the last date Confirmed counts were entered in the Module, enter the total number of residents with a new laboratory-positive COVID-19 test result this week. Notes: Include only new laboratory positive COVID-19 residents since the last date these counts were entered in the Module. Include residents with new laboratory-positive COVID-19 results regardless if the resident(s) is still in the LTCF. For example, the count should include resident(s) that remain in the facility, were transferred out of the facility, admitted to another facility, as well as those who died.
SUSPECTED: Residents with new suspected COVID-19	If this is the first time Suspected counts are being entered in the NHSN COVID-19 Module, facilities are required to: Enter the number of residents in the LTCF who have been or are being managed as though they have COVID-19, but do not have a laboratory positive COVID test result this week. Please follow instructions in #3 for subsequent data entries. Facilities are encouraged, but not required, to enter Suspected counts since January 1, 2020: At any time, facilities may enter the number of residents in the LTCF who have been or are being managed as though they have COVID-19, but do not have a laboratory positive COVID-19 test result since January 1, 2020. Please follow instructions in #3 for subsequent data entries. If this is not the first time Suspected counts are being entered in the NHSN COVID-19 Module: Since the last date Suspected COVID-19 counts were entered in the Module, enter the number of residents who have been or are being managed as though they have COVID-19, but do not have a laboratory positive COVID-19 test result, including residents who remain in the LTCF, as well as residents who were transferred out of the facility, admitted to another facility, or died. Notes: 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. Residents with a laboratory negative COVID-19 test result, but whom continue to be managed or treated with the same precautions as laboratory positive COVID-19 residents because of exposure and/or suggestive signs and symptoms should be included in this count. Include residents with new suspected COVID-19 regardless if the resident is still in the LTCF. For example, the count should include suspected resident(s) that remain in the facility, were transferred out of the facility, admitted to another facility, as well as those who died.
TOTAL DEATHS: Residents who have died in the facility or another location	If this is the first time Total Deaths count is being entered in the NHSN COVID-19 Module, facilities are required to: Enter the total number of residents who have died for any reason in the LTCF or another location for the first week of data reporting. Please follow instructions in #3 for subsequent data entries. Facilities are encouraged, but not required to, enter the Total Deaths count since January 1, 2020: At any time, facilities may enter the total number of residents who have died for any reason in the LTCF or another location since January 1, 2020. Please follow instructions in #3 for subsequent data entries. If this is not the first time the Total Deaths count is being entered in the NHSN COVID-19 Module: Since the last date the Total Deaths count was entered in the Module, enter the number of residents who have died for any reason in the LTCF or another location. Note: Include only counts of new resident deaths for any reason since the last date these counts were into the Module. Note: Include both COVID-19 related deaths AND non-COVID-19 related deaths.
COVID-19 DEATHS: Residents with suspected or laboratory positive COVID-19 who died in the facility or another location	If this is the first time the COVID-19 Deaths count is being entered in the NHSN COVID-19 Module, facilities are required to: Enter the total number of deaths among residents suspected of having COVID-19 AND residents with a laboratory-positive COVID-19 test result for the first week of data reporting, including residents that died in the LTCF or another location. Please follow instructions in #3 for subsequent data entries. Facilities are encouraged, but not required, to enter total COVID-19 Deaths since January 1, 2020: At any time, facilities may enter the total number of deaths among residents suspected of having COVID-19 AND residents with a laboratory-positive COVID-19 test result since January 1, 2020, including residents that died in the LTCF or another location. Please follow instructions in #3 for subsequent data entries. If this is not the first time the COVID-19 Deaths count is being entered in the NHSN COVID-19 Module: Since the last date the COVID-19 Deaths count was entered in the Module, enter the total number of new deaths for both, residents suspected of having COVID-19 AND residents with laboratory positive COVID-19. This includes residents that died in the LTCF or another location. Note: Include only counts of new COVID-19 deaths since the last time these counts were entered in the Module. Notes: Suspected is defined as residents being managed or treated with the same precautions as those with laboratory positive COVID-19 but have not been tested or have pending test results. Residents with a laboratory negative COVID-19 test result, but whom continue to be managed or treated with the same precautions as laboratory positive COVID-19 residents because of exposure and/or suggestive signs and symptoms should be included in this count.

FACILITY CAPACITY AND LABORATORY TESTING

Data Field	Instructions for Data Collection
ALL BEDS: (FIRST SURVEY ONLY)	Enter the total number of resident beds in the facility. Note: After the first time the total number of resident beds in the facility is entered, the count will auto-populate for future sessions. If the resident bed count changes, the user may update the count.
CURRENT CENSUS: Total number of beds that are currently occupied.	On the date responses are being reported in the Module, enter the total number of residents that are occupying a bed in the facility.
TESTING: Does your facility have access to COVID-19 testing while the resident is in the facility? If “YES,” what laboratory type are the specimens sent for testing? Select all that apply.	Required. Answer “YES” if on the date responses are being reported in the Module, the LTCF has access to COVID-19 testing that can be performed while the resident remains in the LTCF Otherwise, answer, “NO”. Conditional: If “YES” is answered indicating that testing is available to be performed while the resident remains in the LTCF, select one or more of the locations where the specimens are sent for testing: □ State health department lab □ Private lab (hospital, corporation, academic institution) □ Other Note: Other should be selected only if the location is not included in the available selections.

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