COVID-19 Module Overview for Long-term Care Facilities
Hi. Everyone, welcome. To the Centers for Disease Control, and Prevention's, national, healthcare safety, network training for long-term care facilities. Participating. In the Cova 19, module, this. Is a live training today and it is being recorded so I just have a few housekeeping rules, I want to go over please use the Q&A box to type in your questions, throughout the presentation the, chat box will be disabled. We, will do our best to answer your questions, as they come in we, do ask that you wait, until the end of the session before submitting, definition. Specific, questions, as I will likely answer, those. Questions, for you before the end of the presentation. The. Slides, and the recording will, be available on, our web site as soon as possible, as soon as we can get that closed captioning. Requirement. Done in the, meantime we, do have slides, other. Training slides for, similar, to this, module training today on our website, and we also have the guidance document. And with. That I'm going to go ahead and, get started here for. Those of you who may be new to the national healthcare safety work network also, referred to as NHSN. I want. To begin by introducing these, Centers for Disease Control and, Prevention's, national, healthcare safety, network, to you you. Will hear me refer to this as CDC's. NHSN. Or an ageism. NHSN. Is a secure. Internet based, surveillance, system, that is managed, by the CDC, the. Surveillance system, is open to a diverse, number of healthcare facilities, across the United States that. Enables. The enables, various, reporting, options, such as healthcare associated, infections, also refer to as h8 eyes other. Things, such as adherence, to clinical, practices, known to prevent, healthcare associated, infections. And more. Including. The new co vat19. Module. In. Response. To the köppen 19 pandemic, the CDC's, NHSN. Developed. A code, 19 module, within the existing, NHSN. Long-term, care facility, component. Given. In HSN's, role as a shared, platform for, healthcare, associated, infection. Surveillance as well as. Our collaboration. With long-term care facilities, and partners, within. The nation, NHSN.
Provides A valuable foundation. For coop 19, surveillance, I do. Want, to remind you that the long-term care facility, kovat 19 module was officially, released to, enrolled. Long-term. Care facilities, on April, 28, 2020. Additionally. At the, same time we had our long-term care facility Cova 19 webpage, that was launched, which. Was open to the public and, this. Webpage, provides a wealth, of information and. A variety of. Useful. Documents, for surveillance and reporting of copán 19 we, do maintain, this website and it is updated. Pretty much daily as new. Materials, become available including. New training, dates new. Guidance documents. Etc. To. Assist. With response, efforts, and HSN, will share the kovat 19 data with state and local health departments, so, they will have the information needed to, quickly respond. And provide resources. To the long-term care facilities, across the US, NHSN. Will also be the platform for sharing required. Data elements, with the Centers for Medicare. And Medicaid Services also. Refer to as CMS data. Will also. Be used by CDC's, emergency, COBIT 19, response, teams, as well. As the US Department, of Health and Human Services, also referred, to as HHS. Kovat. 19, tracking system, which. Is maintained, in the office, of the assistant, secretary of, preparedness, and response these. Data will be accessible, to you all as individual. Long-term care facilities, as well as to group users such as at the corporate, level. Entities. Which have multiple, long-term care facilities, under one, umbrella, this. Includes, a data dashboard within, the NHSN, application which. Will allow quick access to, analyze, data and reports, this, is coming soon, it is not currently available out I just want to point that out and. Lastly. This module, does not collect, resident, level or staff. Level, data. The. Goals of the long-term care facility, Kovan 19 module, are to better understand, the challenges faced. By long-term, care facilities, during this horrible, pandemic. And to, identify the resources. That will, enable, priorities. For Public Health Action and this. Is to protect the, vulnerable populations. That you all work with as well, as to better. Meet, your needs, by having, a greater understanding of, the staffing and supply, availability. And our shortages. Long-term. Care facilities. Eligible. To report data into, this module include, enrolled. Skilled, nursing, facilities, and/or nursing. Homes that is considered one facility type. Also. Assisted. Living, facilities, and residential. Care facilities, as, well. As intermediate chronic. Care facilities, for the developmentally. Disabled. Any, three. Of these set of these facility, types may enroll as the, individual, facility, type into the module. Or, end. To NHSN. Full. Reporting, if you would like. As. You. Probably all know by now, participation. In this long-term care facility, Cova denied team module does require facilities to, be actively, enrolled in, NHSN. With. A designated. Person, having access, through secure, access management. System, which is referred. To as, Sams. Active. Long-term, care facilities, who, currently have access to, NHSN, should, have immediate, access to, the module if you just take a look on your left navigation. Menu. You should seek oh good night tab, as an option and you may begin reporting. For. Those facilities. That. Are not enrolled you. Must first register and, enroll with, NHSN, online, and this, does include completing. The SAMS registration. Which is known as our security checkpoint, where. The user will be given a Sam's. Login. ID which, will be your, your, your. Password, or not excuse me not your password but your email. Address and then, you will also be, giving given, a temporary password in, which you will update to, your own password. If. Your, facility has, previously.
Enrolled And with NHSN, but, is no longer able to gain access for, whatever reason, we do ask that, you, please contact nhsn, user support at. NHSN. At, cdc.gov. For, assistance, and included. In the subject line enrollment. Assistance, for previously, enrolled long-term. Care, facilities, so that you may be, triaged. To the appropriate, person we. Are asking, facilities, to not reenroll. A previously. Enrolled long-term, care facility, because this causes, many issues including. Issues with with, data analysis. Again. I wanted to provide you with a visual, of what, I, consider the main three. Components. To enroll the, main three processes, so again as I just discussed first. You have to register. Your. Facility. With NHSN. We have to know who you are so, the way that you do that is you accept, the NHSN. Rules of behavior and that, link is on our LTC. F-cove it 19, web. Module. Web page under, enrollment and, once. You accept. The rules of behavior you, will complete, the, NHSN. Registration. Process, the online registration, process. Within. 72. Hours business. Hours you, should be receiving, an email, from Samms no reply and, that. Email will give you instructions, to register. With. Sam's now registering. With Sam's is a different part this again is our security, checkpoint, where, you are going to be. Selecting. Your, password. As well, as answering some security, questions so that we know who you are as a person and then. Once you complete that, the. Final process is to enroll the. Long-term care facility, with NHSN. And as. Part. Of that enrollment you will be completing, the as a final, step you will need to accept the NHSN, agreement, to participate in, consent, which, once you log in after you complete Sam's you. Should be able to log in on the Sam's, website. And. From. There you should see a pop-up box. Or an alert that. Will guide you through that final process, of accepting. That and they just send agreement to participate. This. Slide is really a duplicate, of what, I just talked about I wanted, to keep it in my slides because this. Is what you will see on the, LTC, f-cove it 19, webpage, as. Part of the, guidance documents, it's exactly. The same process the same steps this, slide just gives a little bit more. Details for you. Here. Is the link I have been referring to to the LTC, F kovat 19, webpage, again. From, this page users, will see the enrollment, section if you kind of scroll down and that's, where you can find more information as, well as the steps for enrolling your facility. There. Are some terms that you may hear, me, or others refer to when we are speaking about the Cova 19 module that I just wanted to briefly, go over with you one. Is pathway, so, each section, in the module is organized, by a specific focus. And we call that a pathway so there are four pathways or, for specific focuses. Within this module that I'm going, to talk about today and then. Data element, is the. Response, or the count that you as the user provide, two specific. Questions, within, the pathway, so basically answers, to the questions. This. Module, does have four separate. Reporting, pathways, that enable, an assessment, of the copán nineteen and long-term. Care facilities, the. Pathways, include. Resident, impact, and facility. Capacity. Next. We have staff, and personnel impact. Then. We have supplies, and, personal. Protective, equipment or, PPE and. Lastly. We have ventilator, capacity. And supplies, as, you. Open each of these pathways as, I'm. Going to show you you will see that the data elements, for each pathway include. A combination. Of counts. As well. As yes, or no responses. Here. Is a list of the topics that are covered across. All four pathways I, don't, want to spend a lot of time on this slide I just wanted you to have this in your slide so these are the data elements.
That That. Respond. That you will be answering. As. You go through the pathway, and. Again. We're gonna we're going to talk about each of these individually. As we move forward. It. Is. Expected, that users, will consistently. Collect, and enter data and to the NHSN, long-term care facility, kovat 19 module, while. Daily, reporting, is encouraged, we do understand, this option. May not be feasible for, many of the, reporting, long-term care facilities, however. Long-term. Care facilities, should report no less than, week and this. Is really, essential, to, maintain. Up-to-date, data as we. Need this data for national, surveillance and Public Health response as. Previously. Mentioned the date the data elements, for each pathway include, a combination of count and yes or no type questions, if, your, facility will be reporting. Daily, as. Outlined. On on this slide. The. Selected, calendar, date must, reflect the date in which the responses. And counts are collected. And reported for. Facilities. That are not reporting. On a daily, basis, including. Facilities. Electing, to report, once a week or more the, selected, calendar, date in responses. To the yes-or-no questions. Must continue, to reflect, that. Specific. Date in which date data, are being reported and I'll go into more detail as we progress through the slides. For. Questions, requiring, counts. Such as death, counts, confirmed. Case counts. For. These questions. You. Will only report, new counts. Since. The last time, those, counts, were reported, for that specific, question okay, so each time you report, you're. Only reporting the new counts, since, the last time you reported, these data into the module, and we're going to really. Go into detail of how this works but first I just want to give you a few surveillance tips. Regardless. Of the frequency. That your, facility chooses. To report data it is important, that data be collected, at the same time each day and, this includes weekdays, and weekends. You. If reporting, once, a week it is, important, to report on the same day every, week so for example if you choose Monday's. Report, Mondays. Every. Monday or Fridays every Friday and we, do encourage facilities. To use a line list or, the. NHSN, data collection, forms, to document, daily counts, if you're not going to be reporting, into the module daily and this. Way you have some, consistent. Method, of collecting. Your count data so, that when you actually sit down in front of the computer to enter these data into NHSN you, have it already in front of you and they've been consistently, counted at the same time each day so. That your data and. Your analysis, will be consistent. For your facility and this, is important, also, when, comparing. Data at a national, level so that we are comparing apples to apples and, oranges, to oranges I. Do. Want to give you a few. Updates since. The, initial. Training. That was provided on this module we've. Had some things changed, and we've received a lot of great feedback, from, our long-term care facilities, and our partners, and as, a result. We have made some, changes to the to the module. So. The if if you, have. Not already started, reporting, then these changes, aren't really changes, to you but if you have already started reporting please be, aware of these changes and as as I. Approach. The slide that is a change, I will be sure to let you know that it is a change or an update so. First let's. Talk about reporting, counts for the first time in the NHSN, Copa 19, module, if. This. Is the first time, that, you have actually. Logged in to this module and you're, going to be answering questions okay so you have not logged in before and you have not, answered any count, questions. So the very, first time, you. Log in to enter. Data into this long-term care facility kovat 19, module.
You. Will be entering. Counts. Based. On that, week. Only. New. Counts, based on that week do. Not include. Retrospective. Counts, but. That occurred, before May 1st ok. So, let's say that eyes, decide. That. The I've, enrolled my facility, and my first date, that I'm going to enter data for the very first time and that this module is going to be May, then. I'm only going, to include. New. Counts. Since, May, first, so one week okay. This. Is very important and and I'll continue, saying, this as we go through the module so, believe. Me by the end of this training you will have this down pat so don't worry if you're a little bit confused right now I think, by the end it's end of the training you will have it you will all be experts, and then you can do my job for me. Okay let's go to the next slide here so after, the. First date that counts, are entered, into the. Module, and I'm and I'm speaking of counts, okay so remember there's a combination, of counts, and yes, and no type questions, right now I'm just talking about the counts so, after, you've logged in you've, entered, counts, into the four pathways I, let, us say I'm a eight and. Then. Let's say you log in again on May. 12th, on. May. 12th, you, are only going, to enter. The, new, counts. That, have occurred. Since. You entered data are, those. Counts, on May 8th okay. So you're, only reporting. The new counts. Since. The last time you reported, these counts, into the module, and this, is very important, because our goal is for, every time, you're reporting counts. Is to only capture. New counts, that have occurred, since the last time you entered the data and that's. Really why it's, so important, to try to collect the data at, the same time every day because. Let's say that. You. Collect data every day at 9 a.m. and, you document, it on on, your on your spreadsheet. At. 9 9, 8 9 8 a.m.. Mr., Smith is. Being. Treated as a suspected. Case. Okay he has all the signs and symptoms but, you have not received a positive lab, test, so, what 9 8 9 a.m. you have not received that positive, lab test so he gets, counted as a suspected. Because you, know let's say he's new for that week this is suspected. The. Next day at, 9, 8 9 a.m.. You still haven't received the. Counts, okay. He's. Still there, he's not you don't want to count him as a duplicate, but let's say the next day maybe the 11th, at 9 a.m. mr.. Smith, has, tested, his results, are positive he'll. Get counted then as well so he will, for that week go. In as, one. Suspected. And, one. Confirmed. And that's. Why it's so important, to collect, data at the same time every, day if, possible. And, this. Just keeps your data consistent. I. Want. To talk a little bit about reporting. Retrospective. Counts, and. This is an update okay so if a facility would like to submit, retrospective. Aggregate, counts, so, retrospective. Total, counts, prior to the module, being released, so prior. To let's say prior to May 1st there. Is an option, to do this and. Again. This. Instruction. Has been updated, since the initial training, for. Those of you who have not already entered. Retrospective. Aggregate, count data based on the earlier guidance, that was given, or if. You would just like to make edits, based on, this. New guidance please follow these instructions, so. Specifically. To, submit, counts, that occurred prior to May, 1st, which. Is what we're considering, aggregate. Retrospective. Counts, so, to submit, your accounts. That occurred prior to me first you're, going to use the calendar feature, that I'm going to show you and, you're going to select a calendar, date prior. To May 1st and, it. Is there that you will enter the total number of counts, for each question, that you have count data for.
That. Will include, between. January, 1st all. The way all the way to April, 30th if these. Data are not available that's. Okay you can leave it blank you can revise later this is not a CMS, requirement, this is not an NHSN, requirement, but, if you would like to be able to document, the morbidity, and mortality that. Your facility. Experienced. Prior, to this. Long term care facility, koba, 19 module, becoming, available, then. We're giving you the option to do that and we. Would encourage you, to do that. And. And and, so you but you would need to do it, independently. Of data. That gets, entered from. May first forward, okay and I'm going to show you an example of this so don't worry. Okay. So now. That I've covered. Those basics. Which feel like a lot more than basics, but, I am, going to take you to the fun part let us get started with NHSN. And how, do you report, these. Data, to. Begin reporting, into. This covin, 19, module. You. Will sign. Into the NHSN, application remember. You have to enroll first, so. Enrolled facilities, must login to. The long-term care facility, component, and once. You are logged in you will be taken to your NHSN. Home page which. Will look similar to what you're seeing on this screen for. Those, of you who are enrolling in just, the köppen 19, module, your screen may look a little bit different, as you won't see all of the options that you're seeing on this screen but that's okay because. The kovat 19, module, is exactly, the same regardless, of which. Facility. Which. Long-term, care facility, is reporting. And in which type of access, you have so. The first step that you will do as you will click into that Kovan 19, bucks, on the left navigation menu. And. When. You do that this. Is what you're going to see a calendar, and, this, calendar, will default, to the current month as you can see I know that the screen may be small babe you can see at the top from April, 26th. Of April, 2002. June. 6. 2014. The. Module, tab and you default to this calendar. You. Can enter, all the way up into the present, date. Users. May also. What. Just happen here let me go back okay. Users, may also enter. Retrospective. Data so just as I spoke about if, you want to enter, the retrospective. The old data that prior to May first you. Have you. Can click at the, very top left-hand screen you, can click one. Of these this. Back arrow. Icon. Here and go to all, the way back to January, if you want to so if you wanted to enter your data your retrospective. Data by month all, the way back to January, 1st 2020. You can do that or you, can just select one, day, before. May, 1st and enter it all on that day it is your choice or you don't have to do it at all and. So. The, other thing. I wanted to show you actually, it's on the next screen ok the next thing I wanted to show you it which is a really nice feature built. Into this calendar, it that, enables, you to quick, in, able the facility, to quickly, validate.
If A record is complete, or incomplete so as you can see at the top up here I have a square around it, for. Each of the four pathways if. The. Record, is complete, meaning, all of, the questions, in that pathway have, been answered, and saved that, pathway will, be highlighted. Green if. The. Record, is missing. Even. One. Question. The, the pathway. Will be highlighted. As like. A tannish, yellow, color so you can see on this screen that on. Is. That April 1st the, resident, pathway. The. Supplies in the ventilator all of those have all the questions have been answered but then if you look at the the. Following day on April 2nd, the the. Resident, impact path the way for. Something, was left unanswered. So let's so, want, to point this out again we're going to go into more details, another. Important, feature that, I want to point out to you all is if you look at the bottom, of the calendar, you, will see additional reporting. Options data. Submission, options, include. Annual data entry where you actually manually. Enter the data, you. Can you also have the option, for CSV. Files, submitted, by individual, facilities, or bulk, CSV. File, upload. For multiple, facilities these. Options, are available at the bottom of the calendar page as you're seeing in the screen here and then, facilities, also have the option, to export any, data that you enter into, a, table, format, using, the export. CSV. Option. And so these are tabs and you would just click click. Directly into, the tab to and follow the, instructions. During. Today's presentation I, will be focusing, on manual, data entry so, actually, - this manually, sitting in from the computer, and typing in in the data if you. Are interested. In learning more about uploading. Data or any, of our templates, they are all available on, our. Long-term. Care facility, köppen 19 web page, which. I have here, also. I would encourage you, if you look under facility, resources. You will see, a facility. Guide to. Using the Cova 19 module, that, guide is very similar to the, slides that I'm presenting today so I, would. Say not, to use both but, either or if. The slides work better for you use my slides if, the facility, resource, guide is better use the resource guide but essentially you're going to get the same information. Also. On that same webpage we. Do have data collection. Forms, and form, instructions, for each pathway. And they're. Located, if you scroll down the page under. I think it says data collection, forms and instructions and you will see one for each of the four pathways, these. Can be particularly. Particularly. Useful for, facilities, reporting, count, data in the module once per week because it will allow you to use the forum's to collect the, counts, and then have all the four maybe keep them in a folder, for, the. Day that you're going to sit in front of the computer and actually enter the counts, and again. Each, of these forms, are, the pathways, they have instructions. For how. To answer, each question and. And, I strongly. Encourage, you to. Especially. Until you get used to entering, data and to, into, this module that you use these form, or these instructions, we call them table, of instructions. But. I strongly encourage you to use these table, of instructions so. That your, understanding, and. Your interpreting. Each question. The. Way it is meant to be interpreted, because, the, the question, may sound one way to you but then when you read the instructions. It. May be interpreted, by, and they just send a little bit differently, so I encourage you to please review those instructions, prior to entering data. Okay. So. Now we're moving on to step two so step one we logged, in right we click we got to our calendar, we're. Right here so. Step two when, you are ready to begin entering. The data so. Your count data and answering, your yes and no questions, you're gonna sit in front of your computer you're gonna log in you're, gonna click on the copa90. Module, you're gonna get this, calendar, view and you're, gonna click in the date for, which your, facility, will be entering, data okay, so. For. This presentation, I will be using May 8 as the date that I would, like to answer. Questions. So I'm going to click, in to May 8. Again. Since this is so, important, I do want. To repeat this, the.
First, Time so, let's say today is, my first time entering, data, into, this module May, 8th is my first time I will, be entering count. Data, to. Include my, new counts, for this week only ok, so I'm going to include May 1st to May 8th, for my count data because, today, is my very first time entering data into, this. Copán 19 module. So. Here we go so I've clicked on May, 8 and this is what what. Will appear a new, window, will open up and you're going to see all four pathways the. Screen, will automatically. Default to the resident, impact, and facility, capacity, pathway, but, that does not mean that you have to start with that pathway you could click into, any of the four pathways to, begin entering, data. You. May this, this module. Gives you a lot. Of flexibility. You, may navigate to, and from each pathway during, one session you, do not have to save each session, individually. Unless you want to come back later and enter. Additional data or you. Can just decide right, now I have, ten minutes all I have time for is, to enter data in one pathway you can enter that save it come back later, and enter, your data later. So. There's no right. Or wrong as, far as when, you. Access, these pathways as long as you're meeting your your, reporting. Requirements, okay so. You can go in more than one time and in a day you can go in as many times as you want you, can edit the, data that, you input there, is so much flexibility. A couple. Things on, this, screen, I just. Want to point out the. Top at the very top appear you can see it it shows you the date so 5/8 2020. And then. Each of the four pathways so, the the one highlighted, is the default, this is what you automatically, see. And. I think that's all I want to show you on this screen so let's go down to, the next screen here, okay so I, clicked, on the. Resident, impact, and facility, capacity, pathway, okay so this is the first pathway. This. Pathway, focuses. On the impact, of Kovan 19 on residents, on facility. Capacity, and availability. Of. Kovin 19 testing, for residents, this. Pathway has a total, of nine questions. That. Are divided, into two sections you can see at the top there, are resident, impact, count. Questions. And then, at the bottom is facility. Capacity, laboratory. Testing. Again. As you can see at the top the date for which responses, are reported, as auto-populated, based on the.
Selection. And in, the calendar and I selected, May 8th I. Do. Want to point out that this. Pathway is unique, compared. To the rest of the pathways because you'll notice if you look down here at the bottom next to testing, you'll see that red asterisk. What. That means is that this. Pathway does, have, a required, question. That, must be answered in order to save the, pathway, this, is the only pathway, that is like that, so. We. Let's see I think on the next slide yeah so in the next slide we're gonna talk about that so this is what your pathway looks like for resident, impact and facility, capacity, say the first is your resident impact you, can see these are boxes which mean their counts, the. Second part is asking. About your. Facility capacity. So you're all beds your current census and testing. Again. I just want to mention that each pathway has its own data collection, form as well, as set of instructions, that we encourage, users, to use into, especially until you get used to the, meaning of each question. There. Are a total of five questions, as I mentioned in the first in the, first section all of which are counts, it is, important, to enter, a response, even if the response, is zero. So I'm going to repeat this, even. If the response, is zero. You must, enter a, response, if you. Leave it if you leave a count box, blank. That. Means that. You. Did not enter data that means it is incomplete, and that is how CMS, will interpret, a blank box so, if you mean to report zero make sure you enter a zero, in the box very. Important, okay. As I mentioned earlier when responding. To data elements, that require counts, such as what you're seeing here under, your resident, impact you're, only going, to enter the new counts, since the last time counts, were entered for that particular. Data element, or. If. This is the first time you're reporting you're going to enter the number of cases for. That for this week so, since we're pretending, in this session that this is the first time I'm reporting data into, this module. On May, 8th I am, going to enter counts. All new counts, since, May, first so for that week I'm entering, all new, counts. For. The first one admissions. You, can see here, admissions. For. This module is defined, as residents. Newly, admitted or. Readmitted. To the long-term care facility, from a hospital, where, they were treated, for suspected. Or, laboratory. Positive. Koban 19, since the last date, admission, counts were entered, or. The. New counts for this week if this is the first time reporting, so, today is, my first time reporting, so I'm going to enter all newly. Admitted residents. Since May 1st all, the way to mate May 8th. If, I report, again on May 10th, I will only enter the, new residents. For a May 8th to, May 10th. But. Today I will enter from. May 1st to May 8th this is my first time reporting, the. Next definition and, count data is confirmed. NHSN. Defines confirmed. As the number, of residents, who haven't newly. Identified as. Having. A laboratory, positive. Kovat 19. Again. Since the last date, confirmed, 19. Counts were entered into the module, or, this. Week the new counts for this week if this is the first time I'm reporting, these. Confirmed, counts, counts. Will include residents, who remain in the long-term care facility, as well. As residents. Who were transferred, out of the facility, admitted. To another facility or died and this is another example of. Why it is important, to do. Your counts. Every day at the same time let's say mr. snip, had. A confirm positive, on May 1st, at. 9:00, a.m. I, counted, him let's. Say at, 12:00. P.m. mr.. Smith was transferred, to another facility. He, still included, in my count right because at 9:00 a.m. he was in my facility and that's what I did my count so. That's why it's important, that you, do your counts, at the same time if possible. Next. I want to talk about suspected. Suspected. Is defined as residents. Newly managed, as though they have cope in 19 because. They. Have signs, and, are symptoms, suggestive. Of kovat 19. But. Do not test, positive, do, not have a positive laboratory, Kovan, 19 test result this, could be because a test not a test has not been performed, or a. Test is pending, it. Could also be that the. Resident, had, a negative, test but. That resident, is still highly, suspicious, as, being positive because, of the signs and symptoms that. He. Or she is displaying. Again. This count for suspected, does, include, residents, who remain in the facility, at the time of your count as. Well. As residents, who were transferred out of the facility admitted. To another facility or died after. Your count. Okay. Going down the list the. Next, question. Is asking, about total, deaths. Total. Deaths is defined, as residents, who died for any reason, in the long-term care facility or in, another location, since, the last time, total. Death counts, were entered into the module or if. This is the first time you're entering total, death counts, you're going to enter the counts, for this week only you.
Will Include. Count. Deaths, for any reason, which will. Likely, include, Cova 19 related deaths and. Non. COBIT 19 related, deaths. Next. Cova 19, death count is defined, as number of new deaths for. Residents, was suspected, and. Laboratory. Positive, koban 19, since. The last date kovat 19. Death counts were entered or. This. Week if it's the first time reporting, you. Will include residents, who died in your, long-term, care facility, or in, another location. Next. I will review, the final section of the resident impact, and facility, capacity, pathway. All. Beds. That. Is defined, as the total number of licensed. Resident, beds in the facility, once. You enter your bed count this bed count will save, and. Pre-populate. On future, dates so, you only have to enter it once unless, you're licensed the bed count changes, and then you would need to change it but otherwise don't change it, current. Census. On the. Date, you. Are reporting. Your. Responses. So that would be May 8 for us right we're reporting on May 8 on May 8 the day. That you're reporting the data into the module enter, the total number of residents that are occupying, a bed and in. Your facility, so. This is really important, that you do not get, current. Census, confused, with all beds all beds, will likely not change because, all beds is based on youth the number of licensed, beds that. Your license to operate in, your facility. Period. The, current census, is based on today, today, the date you're entering, data so today, that I'm entering data in this examples, may 8th house, are. Occupying, a bed in my, facility today. Does. Not include bed holds, it, includes, how many residents, are in my facility today now. I've. Heard, from some long-term care facilities, that. Is possible, that, the census, current census could, exceed, the actual. Number. Of licensed bed counts because some long-term care facilities, are having, to. Bring. In additional beds, to to. To. To. Handle. The surge or they're having to move, residents. To other floors, in, which or other units in which they.
Aren't. Licensed. For so. That is okay we. Don't want you to change the bed count that you're licensed for instead we. Want you to identify, those. Surge that, the surge capacity, embeds. In your current census, on the day you are reporting. Next. Testing, is a yes, or no type. Question. That is required to be answered, on the. Date responses. Are being entered, into the, module. Does. Your facility, have access, to kovat, 19, testing. That can be performed while the resident, remains in the facility, that is important, if you're, sending your resident out of the facade, of the facility, for testing then that would be a no for, that answer but. If you have available testing. That can be done while the resident, is in-house then. You answer yes this, is another question that will, remain. The same answer, once you answer it once it stays, the same for all future entries, unless, you change it you do have the ability to change it if you answer, no then, you're done with this page and you can save it if you, answer, yes then. You do need to answer. What, laboratory. Type. You. Use for, testing, where are these swabs. Or, specimens. Sent for testing you your options are the State Health Department private. Labs such as a hospital corporation. Academic. Institution. If, neither. Of those are applicable, select. Other you, may select more than one here. And remember. Testing, must be answered, in order to save this. Pathway if you, do not answer, this, and you. Save. You're going to get a popup message that says you must answer and. Then. If you click cancel. It's going, to delete all of the data you've, entered so you don't want to click cancel okay, so be sure that you click Save so, this is what a complete. Pathway looks like for the resident impact and facility capacity, pathway, you. Can see I answered all the questions, again. Remember. For the top section, the. Counts, if the, count is zero, do not leave it blank enter a zero okay, and once, I've entered I'm going, to click Save so I can show you what it looks like once you click Save you go to this, calendar view here and you'll, receive a message that says successfully. Saved the record and then. You're gonna see your record, that you just completed is either, gonna be green or it's, going to be the tan color tan. Means you've you left, one, or more questions. Unanswered green. Means you've answered all of the questions, and. If. For some reason. It comes, up tan then, you can just click back into that record and in answer. The question, it's if you accidentally. Overlooked the question very easy to edit. The. Next pathway I will, I will be reviewing is the staff and personnel impact. Pathway, this pathway focuses, on the impact of kovat 19 on staff, and, facility. Personnel including. Staffing. Shortages, the, pathway, as you can see on this screen includes. A total of seven questions with, three requiring, counts. And the, remainder being yes or no, type answers. NHSN. Defines, staff. And facility, personnel as anyone, working or volunteering in. The facility, which, includes, but is not limited to. Contractors. Full-time. Part-time employees. As needed. Employees, are referred, to as PRN, staff, temporary. Staff, resident. Caregivers, shared, staff so let's say you're phlebotomist. Who. You maybe share between the. Skilled nursing facility. And the, hospital, for example that. Person, is, considered. Yours, if that person, becomes suspected, or confirmed or. Died that person would still be included in your counts. Okay. Let's just take a deep dive. As. You, know by now I sound. Like a broken record we. Do have the data collection forms, and instructions for, you and. Let's. Take a look so I split. This up into sections so it makes it easier for you to see on the screen so the first three questions in the staff and personal impact pathway. Assess. Suspected. And confirmed. Kovin 19, related, morbidity, and mortality among. Your staff and facility, personnel. Just. Like the other count, data discussed. These. Questions. Require new. Counts. Only, since. The last time, that, count was entered into the module, for this specific, question right, or if, it's the first time your, facility, is entering, counts. Under this, pathway it, will be the new counts, for for, the week okay.
Confirmed. Is. Defined, as staff and facility, personnel newly. Identified with. A laboratory, positive. Kovat 19, test, results, since the last date, confirmed, counts. Were entered into the module so, since for, this training, we're saying that this is May 8th is the first day we started entering data I'm going. To include all of my confirmed. Lab. Positive. Kovat 19 test results. All my staff who have lab positive, koba 19 test results, from, May 1st to May 8th, okay less. Fast-forward, to, May. 15th. On, May. 15th, when I log in the report I will only include, any new staff, or, facility, personnel who. Were newly. Identified, as, having a positive coab in nineteen since. I reported. From a eight so would be from May, 8th whatever, time I did my counts. To. May. 15th whatever time I did my count so remember we're not you do not want, to report duplicates, you do not want to make it look, like you have more cases than you had so you're only including, those new cases each time you report. Going. Down to suspected. Suspected. Is to, find a staff and facility, personnel being newly managed, as though they have covered 19, since the last date the suspected, counselor entered into the module. You. So, again, these are, your. Staff, who. Have, signs and symptoms that are suggestive of. Koba, 19, but have, not had a positive lab. Result, so maybe their lab, test is pending or. They. Have not had a test completed. Yet and, then. The last count. Box on this page is Koba 19, deaths and this, is defined as new deaths deaths. For, staff and facility personnel with suspected, as, well. As those, with, laboratory, positive, Kobin 19, okay, since, the last date, that, the Cova 19 death count for staff and facility, personnel were entered. Okay. Go into, the next, section. Of the, staff and personnel impact, pathway, this, section, focuses on, staffing, shortages, and the responses, are based on yes or no and anytime. You have yes/no. Type questions, those. Responses. Are based on the date, you, are answering, them, so. We're. Pretending, May 8th is the date we're completing, the survey so we'll May 8th to, the, safe today's May 8th I'm. Going. Down the list do I have any any staffing, shortages, in nursing, staff including. Registered, nurses licensed, licensed, practical, nurses vocational. Nurse yes or no, clinical. Staff including. Physicians physician, assistant, advanced practice, nurses, aides. Certified. Nursing, assistants, nursing aides medication, aids medication. Technicians, or any, other staffer. Facility, not listed, above, so. You will identify, staffing. Shortages, on this, day the day you're answering the responses. And. NHSN. Does, not. Provide. Guy. A lot of guidance as far as what's considered a staffing, shortage, we ask that, your. Responses, be based on. Your. Individual. Facility. Needs, and internal. Policies, for staffing ratios. You. Here. Is an example of a survey. That has been answered for, the staff and personnel, impact. Pathway, so, I've answered all of the questions you'll, notice that peer at the top fork over 19 deaths I had, zero deaths, so I actually entered, a zero remember a blank. Count. Equals. Incomplete. Data so, I entered I entered, a zero so once you are done you. Could if you if you still, wanted. To complete the entire four, modules I could just skip over and click on supplies and personnel continue entering, data and each each module. Would save in between my, selections, but if I wanted to take, a break go get coffee, go. Eat lunch then, I would go to the bottom click, Save, when I click Save I.
Will. Receive this message that, my record has saved and then, I will notice, on May 8th that, is green. Meaning that I answered, all questions, for. That pathway. The. Third pathway is, the supplies, and personnel. Personal. Protective, equipment pathway. Or PPE, and this. Pathway, assesses. The availability, of personal, protective equipment and, hand, hygiene in, the facility. There are two columns for each of the six supply items listed, each, response, is a yes or no and, is, based on the current, availability. Of, supplies. So, today today, the day I'm entering these data may eight do I have any the. Next column. Based. On May 8 do. I have enough for, one week, ok. So, you will go down each. Of these rows, here. In 95. Masks today, today. That may on May 8 do, I have any in 95. Mask yes or no the. Next column do I have enough for. One week. Next. Surgical. Mask do, I have any and, and. What, we're speaking about when we're saying any. That means any, for. Your for your staff, to, use the. So, we're trying to identify if, you have a shortage, in your facility. Once. You've completed the yes or no you. Go to the bottom and you click save or, again. You could go to the next pathway, if you wanted to but let's click Save. And. We're. Going to save and. Then. You'll notice I get my popup message that says successfully. Saved and then my supplies, has, been answered for May 8th and I completed, it because it's showing me that it's green. Next. The. Last the. Fourth in the final pathway is the ventilator, capacity. And supplies pathway, this. Pathway assesses. Ventilator, capacity, and supplies for, the long-term care facilities. Specifically. With ventilator, dependent, units. And/or. Ventilator. Beds, this is an update, so if if you listened, to an earlier, presentation. The. Answer. Previously. Only included, dependent. Units however I received some, feedback from, some of our skilled. Nursing facilities, telling me that we, don't have dinner later specific.
Units, But because, of kovat. 19 we, do have ventilator, dependent, beds now so. If your facility has been ventilator. Dependent, units and/or, ventilator, dependent, beds then, you will answer yes, and again this is based on the day you were answering the survey just, like, all yes/no so may 8 do. I have. Ventilator. Dependent, units and/or beds in my facility. Your. Response, to this question the very first time you answer it will. Remain for, any other time you log in so if I answer no to, this question, I won't, have to ever come back to. This module again, because this answer, will stain I know every, time I log in and I can skip this fourth pathway, if I, enter answer. Yes then I will need so the remainder of the form will populate and, I will need to answer those, questions, and. Again. If if, you, answer yes or no and, in the future, the. Answer changes you do have the ability to make edits. They. Collection, forms I'm going to skip past because, by now I think you all know we have data collection, forms and instructions, okay. So let's, pretend for, our. Sake that we do have ventilator. Dependent, beds in our facility, the, first section, and, I. Answered yes so the rest of the page populated, for me so the first section, asks, me to count questions, is, asking. Me. Mechanical. Ventilators, which is defined as the number of mechanical ventilators. Do I have in a facility so on today, May 8 how, many mechanical. Ventilators, do, I have in my facility and, this does include ventilators, that are in use as well. As not in use it also includes. Ventilators. That. You. Can transport. The. Next one mechanical. Ventilators, in use is defined. As number two today, on, the day I'm answering the survey. What. Is the number of mechanical, ventilators, that I haven't used for residents, who have suspected. Or confirmed. Kovat. 19. Okay. Then. We're going to go down to the final, section which. Refers. To supplies. And, this is one question. Divided. Into two columns. Yes. Or no and so, again because it, is a yes or no question it, is based on, today. Again. Today. Do. I have any. Ventilator. Supplies. Needed, to care for these ventilator, residents, yes or no the, next. Column. Do, I have enough for, one week yes or no and this. This, question, is an all-or-none so. Basically, if, you. Have everything. You need that. Means, yes if you're, missing one thing if you're missing a flow sensor or, a connector, or a valve then, it's no is all or none okay. Once, so this is what it looks like the complete, pathway. I have answered everything and then I click, Save, and. Now. I can, see for May 8th that. I have, completed, all four pathways and, they're. All complete, because, they're all green right. So. What. Is wrong with this picture. So. Here. If. You, look at May 7th. My. Resident, impact, pathway. My. Resident, impact, and facility, capacity, pathway, is color, coded as tan and remember. Tan if you look at the top box up here means, that on May 7th, I've. Started. Entering. Data for this pathway but, I said I saved it but, I did, not enter all, of the data this, could be, intentional. Because maybe when I started, entering data I didn't have everything I needed and I plan on going back and entering it later which is perfectly, fine you can do that that's, your right or I just. Got tired or my shift ended and I just wanted to go ahead and enter what. I knew at the moment that's fine so, now. I want. To edit this all I have to do is click, inside. The, pathway on resident, and, when. I do that you see on this left-hand side here the pop up box comes, up that, that, shows again, at the top all of the pathways but it comes up to the pathway that I clicked which, was my resident, impact, of facility capacity, and you, can see here, I left.
A Box blank, because, I forgot, that dr. Antilla, told me that if we had 0 deaths I had to actually enter, 0, deaths so now I remember, so I'm gonna go ahead and, I'm, gonna enter, my 0, because thank goodness, we had zero deaths reported. For. That. Week or, the, last time I entered data from that date and so I went ahead and I entered my zero and then I save it and bam. It. Comes up as green which means it's complete and, I'm super excited ok. That. Was a lot of work you guys need to just take a deep breath we, got through all four pathways and, now. I'm going to just give you some. Takeaways. And some reminders, and these are things that I really. Want you to remember okay, so. I'm gonna just give, you just a minute to take a couple deep breaths and, get ready we have about, 20. More slides to go but these won't be these. Won't take as much brainpower okay. So. The first thing I want to remind you is that for, the best Internet experience. With, NHSN, you, need to have an update, internet, browser and, we. Do recommend Internet. Explorer the latest version, but. It's not required I think in my in, a previous, my, earlier training I said it was required and the, our techies, told me nope you're wrong it's not required so, it's not required but it is recommended. You, can also use the latest version of Microsoft edge, Chrome. Firefox. Safari. Those. Are the recommended, ones if. You have other browsers. Or older, versions, of the. These, recommended, browsers. The. Pathway, may or may not work, for you the application, may or may not work because. Some features, may be incompatible, so. Please. Review, I think I have a link yeah I do have a link at the bottom of the page. Review. That if it. Makes sense to you you. Are super, technical technology. Smart. Because half, of that does not make a lot of sense to me but. If. You have a technology. Person, in your facility, who. Could help you with that I would. Pull them in if you have any questions and we, do have technology experts. In, our group so if you have any questions, about your browser or, if you need help updating. Your browser please. Let us know and we will help you do that it probably will not be me helping you do that but it will be one of our technology. Experts. So. The next thing I just wanted to remind you which I think you could probably you're gonna dream about this is that data, elements. Can system, counts. And yes. Or no responses. Right the, responses. To the yes-or-no. Questions. Are based on the date, you, are answering, those responses. Right. Whereas. There's some different rules for the count data but, the yes or noes are based, on the date you're actually sitting in front of that computer, entering. That data. Or. Your, counts. Remember. This is this is is an update that we've already talked about but I just want to repeat it again because it's very very important so that you are submitting, the most accurate, data possible the. First time, that. A long-term. Care facility enters. Counts, into the, long-term care facility, Cova 19 module, unless, otherwise specified, in, the instructions, the. Counts. For each question, must, include the number of new, counts. For. That week and I, interpret, that week as the previous seven days but not not, to go before May 1st so, for example if. You're. Reporting first on May 8 like I did in my example, I would include, all the way back to May 1st do not include anything. Prior to May 1st, for. Your first set of counts. Because that's considered retrospective. Data and we've, already talked about how you will enter that ok. So your. Counts, again include, your admissions, for previously, treated, kovin 19, residents. You're suspected, and confirmed COBIT, 19, for residents, and staff your total deaths your koba 19 deaths those are just some examples of counts. Again. We talked about this but a facility, may enter, aggregate. Which means total. Retrospective. Which means back, data older data from, January 1st. 2020. All the, way to April, 30th. 2020. But remember, in order. To submit these, counts. You, must select, a date on the calendar prior. To May 1st okay. So hit, that back button if you have to you can submit on April. 30th if you want but just don't. Submit, those old. Counts, in May so select. A date prior to mates and if. You have a lot of time on your hands which I doubt any of you do but, if you wanted, to submit these by month you could but, you are certainly not required and in, fact, entering. These aggregate.
Retrospective. Data is completely. Optional but. It is encouraged, so that we get an idea of what. You all have gone through since, January. Up. Until April before this module was available. Okay. Again. Very very important, if your, answer, is zero, be, sure that you enter zero, a blank, data. Element, meaning a blank response, equals. Missing data and this is really important, for those of you who have CMS, mandates, you do not want to leave anything blank. Okay. For suspected. This, was an update, I'm in earlier, from, earlier, training, where, we did. Not. We. Did not require, suspected. To have signs and symptoms, we've received a lot of questions about this from facilities, who. May. Be put maybe put, all residents. On isolation. Initially, even. Though they're. Not really suspected. But they do that to rule out infection, so. That's why we updated, the definition. For suspected. To, include, residents. Without a positive, lab test but. They're being managed. As though they have kovat 19 because, they. Have signs, and/or, symptoms. In accordance. With the CDC's, guidelines, for, the evaluation of, persons under investigation, and, if. You look at the, instructions. For this form there's, actually, a hyperlink, that takes you to the CDC's. Web. Page that gives you those signs and symptoms, okay and this, may include residents, who have not been tested at all. Because. We know that it is hard to stick a long, skinny. Q-tip, up an, older, person's, nose especially an older person with dementia you may think you're trying to kill them. It. May also include negative. Results, because again we know that it is difficult, to, get that q-tip up there and in. A resident, who is confused. And, really, doesn't understand, why you are, attacking, him, or her with, some kind of device. That looks like it came from ours we understand, that and we know that if you don't get a good swab it's probably, going to be negative even though. The resident could very well be positive, so if you get a negative result but that resident. Does, have those signs and symptoms, you can include the resident, as I suspected. And, then. If, the, resident, is it is, meets, the above, definitions. And is in your facility, on the day you do your counts, include, that resident, in your count even, if the resident, later, gets, transferred.
Out Of the facility or dies okay so don't remove, the. Resident from the cows if the resident, is no, longer in your facility, on the day your reporting, is based, on the day you collected. The, counts, okay so remember counts. Every, day at the same time you're going to try to get those counts, okay and then then enter, them at the end of the week or whatever day you choose to enter the counts. Another. Takeaway I wanted to give you is just remind you that the. Definition. For a ventilator. Dependent. Unit now, includes, facilities that, have ventilator, dependent, units and/or, beds so, this is a little different from the initial presentation just, to give you an update and. Now want, to give, you an example, so if your head hasn't started spinning by now it's. Really gonna start spinning now because we're gonna do an example okay. And. I'm gonna try to not get myself confused, with this example. Okay so, dhq. P. Skilled, nursing facility this is a fake nursing, facility, by the way is, a, 125. Bed, facility, that recently, completed NHSN. Enrollments. And to, the long-term care facility, köppen 19 module, ms, b is the, NHSN, facility, administrator. Who, will be entering the data into the NHSN, long-term, care facility, Kovac module, or. Her, organism. Her organization. Determined, responses. Will be entered, every Friday beginning. On May 8th the. Facility, has been using the NHSN, data collection. Forms, to. Collect counts, every morning at 10:00 a.m. since, May first okay remember these collection, forms are on the Cova 19 website which was, shown on previous, slides if you forgot. From May 1st at 10:00 a.m. all, the way to 10:00 a.m. on, May 8 this. This, facility, had the following, new, counts, so price since prior, to May 1st the. Facility, had 10 admission, / readmissions. Of residents, previously, hospitalized. And treated for Koba 19, they. Also had 21, lab positive. Koba 19 residents. 13. Residents, with signs and symptoms, suggested, at coba 19, nine, deaths among. Residents and. Seven. Koba 19, deaths among, residents so. On Friday May 8 the miss be gets her coffee and, she, sits down in, front of the computer and, she's ready to log in so she logs in to NHSN, long-term. Care facility, kovin 19, that's not supposed to be COBIT 10 koban. 19 module, if someone on my team can, remind me to fix out on my slide, so. The Cova 19 module and she reports, the, responses. In the resident, impact, and facility, capacity, pathway, because she doesn't really have a lot of time to, complete all of the pathways right, now, so. When she logs in remember, she goes to the left side of that navigation.
Panel, On, her NHSN, home screen when, she clicks the Kobo 19 she comes to this calendar, you can see this calendars, blank right because. This is the very first time that, any, data is being reported into this module okay. So, at the very top you. Can see the. Dates. Some. Instructions, so let's click on May 8. All. Right so this is these, are the data that, Miss B has entered you can see at the top because. She selected. May 8 on the calendar, that date, pre-populated. At the very top appear, she. Selected, the resident, impact, and facility, capacity, pathway, because that's what she had the data for right now and she, entered the numbers that she had on her forms. She. Entered, her bed count now. The. Tricky part about, this is that. Oh no actually this isn't the tricky part because she's answering answering based on the day I got myself confused so today, on, May. 8th she. Answered yes because. Today. On May 8th her facility, does, perform. In-house. Koban, 19 testing, on residents. And they, submit these specimens, to the State Health Department ok, so, again she. All of these counts, are new counts, for, this week since it's the first time she's been reporting. All. Beds. Includes. All of the licensed, beds in her facility which may. Not is likely not to change in future submissions, but. Her census. Is based on today how, many of those beds are occupied and remember the census, can change and will change and it, is possible, that your current, census, will exceed, your licensed bed count if you get a surge, capacity okay. So she enters. Everything and she clicks saved and. She's. Super excited to. See that everything, saved successfully, and. She, gets a green for resident, okay. That. Means she answered all of her questions. After. Entering responses. In in, the, the D resident, impact, and facility, capacity, pathway, Miss B decided, that she wanted, to document the morbidity and mortality Cova, 19 had on her, long-term care facility before, the, NHSN, long-term, care facility, koba 19 module was available for reporting so. She has. Those counts, available, since, she knows because she'd listened, to doctor, until his training, she, knows that, she must select, a reporting, date prior to May 1st, to enter. The the. Retrospective. Also, referred to as the the, older, data. On. The, calendar, so she uses, that arrow back, button, at the, top of the calendar and she selects. Another date. And this. Is what she's going to report the facility, has the following, retrospective. Counts, from January, 1st to. April 30th, many. You may, not have these counts, until maybe March is what I'm hearing. Like March to April and that's okay if you didn't have any in January, or February that, is okay just enter what you have it doesn't it. We're. Not asking this to be perfect we're not asking you to do. A lot of digging, we're just asking entering enter, what you know even, if you're not completing, the entire, count. Record, just enter what you know so, she does know that she had 200 positive, lab positive, residents, during this time period from January, 1st to April 30th she also, knows, that she. Had 10 lab positive, staff she. Has zero staff, death thank, goodness related. To Coppa 19, she, had 75. Total resident, deaths and, then 59, kovat 19, related the resident, deaths so remember these, are her aggregate. Counts, from, January, 1st to, April 30th, so these are her old counts, before the module, so. She goes to her calendar, and. She's. Going to select on a date before maith, May, 1st, so if she had to she, could go up to the top left-hand corner and select the back button, were circled, here by the calendar, but, because May 30th is showing, since his calendar shows a you. Know shows a expanse, of time period, she. Clicks on May 30th, she. Opens, up the resident, impact, and facility pathway, and she, enters, the counts, from, January 1st to April 30th. 2020. And these, are the counts that she knows so, she knew that she had 200, confirmed residents, with La Paz Attack Ovid she, knew that she had, 75. Total, deaths which. Include. Kovat, and non-covered related. Deaths and, she. Knew that she has, 59 kovat. 19. Specific, deaths that, occurred either in her facility are in, another location. Now. She, does not know, the admissions, she does not know these suspected, perfectly, fine that's okay because this is not required she. Does not know what the bed count was back then it, probably, is the same that it is now 125, but she's not 100%, certain, so she leaves it blank she, did not know what, the census was so remember census, is based on the date you.
Were Reporting. Into the module see look at the very top she's, reporting, on, April. 30th. Right. She doesn't remember the census for April 30th so she's gonna leave it blank and that's okay, the. Only thing that, she does have to remember because it is required, only, in, this one module, is she has to remember if she did testing, its if the facility, had, testing. During, that time period for, residents. In-house, testing, meaning the testing, was done performed. On the residents why they were in the facility, and so. She looks back in her records. And she realizes, no we. Did not have testing, during that time so, she selects, no and she's, done okay. And she. Will save her, record. Okay. She's gonna get a message that says your record, was saved successfully. Remember. You're always gonna get this message that, says saved. Successfully, even. If it's incomplete, because it's, just verifying, that yes and HSN is saved what, you entered okay, but. You notice appear because she entered on April. 30th, it does show is an incomplete, record, because. She. Did not enter, all. Of the, of. The data because she didn't know it and that's okay there's no requirement, to enter the retrospective. Count, data so, you're not going to be penalized for that and you're not expected. To do a lot of work and digging to find those data so that's okay that that April thirtieth, is showing us incomplete, was important, is she was able to enter the data that she knew right from. January 1st to April 30th and she entered that if at, any time she. Comes. Across. More. Data for, that older, time period, she can always, go back and edit and, add additional. Data okay. Okay. So this is showing a, duplicate, okay. Let's. See what I'm get out here, oh. Okay. This is okay so mrs. B I I remember, now she also, wanted, a report some. Of the morbidity. Data that. Impacted. Her staff, in personnel. From. Kovac. 19 okay so again, she. Can. She. Could have clicked, directly, from that resident. Impact. And facility, pathway, tab, directly, to the staf