Changes Announced to Nurse Staffing Ratio, Space Waivers
On Feb. 1, the California Department of Public Health (CDPH) released All Facilities Letter (AFL) 20-26.6, which ends all nurse staffing ratio waivers for hospitals on Monday, Feb. 8. CDPH recognizes that any given hospital’s individual circumstances may necessitate that some waivers to be extended beyond Feb. 8 and plans to issue those letters on Feb. 5. Hospitals will receive a call from CDPH’s Centralized Program Flexibility Unit seeking information on whether additional staff from the state’s contracts with staffing agencies would obviate their need for a nurse staffing ratio waiver. CDPH has asked any hospitals that no longer have a continued need for a nurse staffing ratio waiver to contact their district office to let them know.
In addition, CDPH will no longer accept expedited staffing waiver requests. These were the more recently available waivers that went into effect upon submission to CDPH. As a result, CDPH will individually review all nurse staffing ratio waiver requests hospitals submit moving forward.
Finally, AFL 20-26.6 removed the March 1 expiration date of the waiver, which also suspends state licensing requirements related to space. As a result, hospitals can continue to temporarily use spaces they have converted. CHA has requested that CDPH provide advance notice before any future rescission of this AFL, so hospitals have time to convert any spaces back.
CDPH also released AFL 21-09, which makes explicit which hospitals can utilize the nurse documentation flexibilities CDPH previously announced. These are hospitals in the following counties, currently affected by the State Health Order on Hospital Surge: Fresno, Kern, Kings, Madera, Merced, San Benito, San Joaquin, Stanislaus, Tulare, Imperial, Los Angeles, Orange, Riverside, San Bernardino, San Diego, Santa Barbara, and Ventura.
CDPH Issues Quarantine Guidance for Health Care Personnel Exposed to COVID-19
Last week, CDPH issued AFL 21-08, providing quarantine guidance for health care personnel who may have been exposed to COVID-19. CHA requested this AFL to clearly articulate how CDPH views guidance from the Centers for Disease Control and Prevention (CDC) on this issue. Specifically, CDPH confirms it has adopted the CDC Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19. CDPH has also adopted CDC guidance on Strategies to Mitigate Healthcare Personnel Staffing Shortages.
With respect to the recent CDC guidance allowing for shorter quarantine periods, the AFL clarifies that shorter quarantine periods are available if a hospital is experiencing a staffing shortage. Specifically, hospitals may allow exposed health care personnel to return to work after a seven-day quarantine if the hospital is facing a critical staffing shortage and the employee receives a negative PCR test result from a specimen collected after day 5. Additionally, the AFL clarifies that hospitals may continue to use CDC guidance for staffing shortage mitigation strategies to determine when it is appropriate to allow asymptomatic health care personnel with exposure but no known infection to continue to work on-site during their 14-day post-exposure period. Finally, the AFL also addresses quarantine issues for health care personnel working at skilled-nursing facilities.
State and Federal Governments Issue Liability Protection for Vaccinators
On Jan. 27, Gov. Newsom issued Executive Order N-02-21, which provides protection from lawsuits for hospitals and other health care providers participating in the state’s vaccine administration program. On Jan. 28, the U.S. Department of Health and Human Services (HHS) included liability protection for additional categories of qualified COVID-19 vaccinators in the Public Readiness and Emergency Preparedness (PREP) Act.
The PREP Act authorizes the HHS Secretary to provide immunity from liability for the manufacture, distribution, administration, or use of “medical countermeasures,” except for claims involving willful misconduct. A medical countermeasure is any drug, device, or biological product used to diagnose, mitigate, prevent, treat, or cure a pandemic or epidemic. PREP Act immunity covers claims under tort or contract law, as well as claims related to compliance with state/local laws. Any lawsuit seeking an exception to PREP Act immunity must be brought before a special three-judge panel in U.S. District Court in Washington, D.C. To win, the plaintiff must prove willful misconduct was the proximate cause of death or serious injury by clear and convincing evidence. The PREP Act also establishes a program to compensate individuals for serious physical injury or death caused by a covered countermeasure.
CHA Updates COVID-19 Data Reporting Guidance
Due to the surge in COVID-19 cases and the addition of vaccination fields to the COVID-19 tracker, hospitals have asked for additional clarification on reporting COVID-19 data. To provide this clarification, CHA worked with CDPH and HHS to update its data reporting guidance and other supporting documents. Updates include:
- Data reporting guidance
- Added clarification for the ED and Overflow (EDOF) fields. Double-counting is permitted for COVID-19 confirmed and suspected EDOF patients with admission orders to ensure CDPH can appropriately capture the operational impact that these patients have in both the ED and inpatient (ICU or non-ICU) departments.
- Added information on how to classify health care personnel and patients receiving vaccines.
- Data dictionary
- Changes were made to the vaccine fields, where the language was clarified and bolded to highlight if the field was intended to collect data on health care personnel or patients. Hospitals that haven’t yet reported into the Previous Week’s First COVID Vaccine Doses field, but plan to begin this week, should include all doses given up to the first date of data entry.
In addition to the document updates, CHA has also posted:
- Unanswered questions and FAQs from the Jan. 14 CHA/CDPH webinar that have been addressed.
- Audio recording from the Jan. 14 CHA/CDPH webinar
Questions can be directed to [email protected].
Valencia Branch Laboratory Adds Transport Courier Service
To help mitigate the cost and distance barriers that have prevented some hospitals from using the Valencia Branch Laboratory (VBL), the state has developed a statewide network of drop boxes — the California COVID-19 Courier Network (CCN) — to transport COVID-19 test samples from VBL-affiliated test collection sites to the VBL. Current CCN drop-boxes can be found using the online locator tool. Over 40 sites are now operating across the state, with additional sites being added. To use the service, hospitals must be approved as a VBL site.
Updated Vaccination Primer Includes New Information for Hospitals
CHA has updated its COVID-19: Vaccination Primer for California Hospitals with information on California’s new standardized statewide approach, vaccine prioritization, and more.
State Offers Oxygen-Related Provider Hotline
To enhance the transparency of all oxygen-related equipment and supplies offered throughout the state, the California Health and Human Services Agency, in partnership with the Governor’s Office of Emergency Services, is offering a provider hotline for health care facilities and Medical and Health Operational Area Coordinators (MHOACs). It is designed to answer questions and connect respective health care facilities and/or MHOACs with local vendors and/or subject matter experts to provide oxygen-related support (e.g., Office of Statewide Health Planning and Development technical assistance/permitting support, general oxygen support inquires, and direct connections to vendors to expedite resolution of infrastructure and home oxygen challenges). The provider hotline can be reached at (833) 502-1245. More information is available in CHA News.
HHS Issues FAQs on Vaccination Fields
To understand hospitals’ efforts in vaccinating health care workers and the community against COVID-19, the HHS recently started collecting optional vaccination data. As a result, seven new vaccine-related fields were added to the CHA COVID-19 Tracking Tool last month. HHS has received many questions from hospitals seeking clarification on these new fields and has compiled and answered the most frequently asked questions. The FAQs reference vaccination fields by number, which can be found in the federal guidance document. The numbers in the FAQ also correspond to the vaccination fields in the CHA COVID-19 Tracking Tool as follows:
- #41 = Previous Week’s COVID Vaccine Doses
- #42 = Unvaccinated Personnel
- #43 = Personnel Receiving a Partial Series
- #44 = Personnel Receiving a Complete Series
- #45 = Total Personnel
- #46 = Previous Week’s First COVID Vaccine Doses
- #47 = Previous Week’s Final COVID Vaccine Doses
CHA is working with CDPH to update the data reporting guidance document to include new guidance on the vaccination fields. Questions can be directed to [email protected].
Next CDPH Office Hours: Feb. 5
CDPH will hold a COVID-19 Vaccination Office Hours call for hospitals on Feb. 5 from 9 to 10 a.m. (PT). To participate, visit this link.
Next CDPH Call for Health Care Facilities: Feb. 9, 8-9 a.m. (PT)
Dial: (844) 721-7239
Summary of Jan. 26 CDPH Call
CDPH has provided a summary of its recent weekly call with health care facilities.
Recent Media Coverage on Nurse Staffing Ratios
Here are a few stories on CDPH’s decision to end nurse staffing ratio waivers:
- Modern Healthcare: California ends fast-tracked hospital staffing ratio waivers; existing waivers to expire Feb. 8
- Becker’s Hospital Review: California waivers of hospital staffing ratios to expire Feb. 8
- San Francisco Chronicle: California nurses declare victory in battle over how many patients they can handle in coronavirus era
- KION: CA Nurses Declare Victory: All Waivers of Safe Staffing Standards Expire
Surge-Related Data Resources