COVID-19

Coronavirus Protocol: Employee Education

March 26, 2020

*(subject to change with new developments)

PRE-VISIT SCREENING

Effective immediately, all clinicians must conduct a screening immediately before each visit. PLEASE USE TEMPLATE NAMED “COVID-19 PRE-VISIT SCREEN SCREENING” and place into your treatment note. At start of care visits, the Admission Summary template has been updated with screening questions.

Please ask your patients the following 3 screening questions:

  • 1 – In the past 14 days have you or anyone in your home traveled outside of CO? [yes/no]
  • 2 – Exposure: In the past 14 days, have you or anyone in your home had close contact with anyone diagnosed with or suspected to have COVID-19? [yes/no]
  • 3 – Symptoms: Do you or anyone in your home have new cough, fever, or shortness of breath? [yes/no]

Please educate your patients on the following 3 visit protocols they must follow:

  • 1 – Physical Distancing: Inform patients that anyone else living in the home must leave the room while you are there for your visit, preferably 15 minutes prior to your arrival so the air can be cleared. If patients require translation and need a caregiver in the room, ask that they stand 6 feet away from you and the patient, if space permits. If caregivers need teaching, try to do so over the phone after your visit. 
  • 2 – Covering Face: Ask your patient to cover their mouth with a mask, bandana, t-shirt or tea towel during your entire visit, whether or not they have any respiratory symptoms.
  • 3 – Daily Temperature Checks: Educate your patients and their caregivers to check their temperature on a daily basis and keep a log.

Once these questions have been answered, include the response in your visit note to document that you conducted the pre-visit screening. If the responses indicated a potential risk or exposure, immediately notify the management team and hold off on your visit until further orders are received by the patient’s doctor.

Please screen your patients on the morning of your visit, prior to driving out to them. And don’t forget to also ask the screening questions about anyone else who is living in the home with them or has visited them in the last couple of days. 

Also, if they don’t answer your pre-visit call and you decide to drive to your patient’s home to see if you can do your visit, please ask them the screening questions at the door before entering the home.

For all patient visits, please ask your patients and their caregivers/family members to use their own hand soap, alcohol hand sanitizer, masks, PPE, etc. for themselves and save your limited supply for your own use.

PERSONAL PROTECTIVE EQUIPMENT

All clinicians wear a mask for every single home health visit. Regular mask, not N95, unless patient symptomatic with respiratory illness.

You may reuse your mask from visit to visit by observing the following protocol:

  1. Wash/sanitize hands thoroughly as described above before removing your mask.
  2. Afterwards, remove the mask and place the outside surface face down and the inside part facing upward in a cardboard/shoe box or a brown bag with a flat bottom so the mask does not roll or tumble around.

***If anyone has run out of masks/PPE and needs some, please contact Tammie 720-979-1436 to obtain supplies who will report to Paige, Administrator. 

***We are keeping very tight counts of all PPE supplies, Please call Paige prior to coming to office, supplies will be gathered for you and delivered to your car upon arrival. 

PATIENT SIGNATURES 

When obtaining Electronic signature using patient finger, please observe the following protocols in the sequence listed:

  1. Clinician and patient must wash hands with soap and water for 20 seconds.
  2. Clinician must wipe down cell phone or tablet screen with alcohol wipe thoroughly for 20 seconds.
  3. Request the patient to sign on the screen using their finger.
  4. Clinician must wipe down cell phone or tablet screen and stylus, if applicable, with alcohol wipe thoroughly for 20 seconds.

When obtaining signature on Paper Sheet using a pen, please observe the following protocols in the sequence listed:

  1. Clinician and patient must wash hands with soap and water for 20 seconds.
  2. Preferably, patient must use their own pen to sign. Ask your patients to prepare a pen prior to your visit. 
  3. If they don’t have a pen, clinician must wipe down their own personal pen with alcohol wipe thoroughly for 20 seconds.
  4. Request patient to sign on the visit verification sheet using the pen.
  5. Clinician must wipe down their own personal pen with alcohol wipe thoroughly for 20 seconds.
  6. Scan a PDF of the signature page and send to office.

DEVICE USE

Ask your patient if they have a thermometer, BP machine or pulse-ox machine you can use for them so you don’t have to use yours. 

If you need to use your own BP cuff, manual or electronic, please observe the following protocol:

  • Cleanse your BP cuff and device with a Cavi-Wipe before and after use.
  • Place a paper towel on the inside part of your BP cuff that touches the patient’s skin or clothes.

If you need to use your own Thermometer, please observe the following protocol:

  • Wipe down the thermometer with an alcohol wipe before and after use, and always use a thermometer cover/filter.

If you need to use your own Pulse-Ox machine, please observe the following protocol:

  • Ask patient to wash their hands with soap and water for 20 seconds. If that’s not possible, then to sanitize their hands with alcohol sanitizer.
  • Wipe down the pulse-ox on the inside and outside surfaces thoroughly with an alcohol wipe before and after use.

CHARTING IN THE HOME

Please don’t take your laptop and tablet devices into patient’s homes for charting. We highly recommend that you limit the amount of time you are in a patient’s home to only hands-on care and head-to-toe assessment and avoid spending extra time there for doing non-essential things like charting. 

During your pre-visit calls, ask questions that will allow you to complete documentation in advance of your visit. Try to complete documentation in your car before visiting your next patient or in your own home.

NURSING BAG USE 

If at all possible, only take with you what you need for your visit and not your entire nursing bag. 

Here are alternative options instead of full nursing bags

  • Fanny pack: These bags are great as they wrap around your waist and do not need to be placed on any surface in a patient’s home. You can put your BP cuff, pulse-ox, thermometer, phone, pen and even some small medical supplies in there.
  • Cross-Body Bag: These are also great in that you can bring the back to the front of your body to get items that you need, and then get it out of your way by flipping it on to the back of your body when you are bending over and doing wound care.
  • Supplies in a Disposable Bag: Carry wound care and foley catheter supplies into the patient’s home in a Zip-lock or disposable trash bag that you can easily leave in their home when you have used up the supplies. You should not take that bag back with you inside your car.
  • Bag-in-a-Bag: Place your BP cuff/equipment and medical supplies in a bag and put that bag inside a disposable trash bag. When you are done with your visit, you can take the inside bag out and take it back to the car with you and throw the outside bag away in their trash.

TEMPERATURE CHECK

Check your temperature every morning before leaving the house to do visits. 

Ask your patients to check their temperature on the morning of your scheduled visit and to report to you if they are developing a fever. If your patient is likely to comply, ask them and their family members to develop a habit of checking their own temperature daily during the next few weeks.

WHEN TO CALL THE DOCTOR 

Please contact the doctor for further instructions if any of the following symptoms are present:

  • Temperature of 100.4°F; and/or
  • New onset of cough that is not a common occurrence or is not allergy related; and/or 
  • Shortness of breath.

DO NOT panic and go into a doctor’s office, urgent care or emergency room. All healthcare clinics and facilities are asking that individuals call their doctor first before going into any facility so they can be properly screened and told exactly what to do and where to go. 

Avoiding Urgent Cares, Doctor’s offices and Emergency Rooms will protect you from being exposed to COVID-19 in case you don’t have it and it will prevent others from being exposed to it in case you do have it.

Of course, if at any time you feel that you are having a medical emergency, please call 911. 

PATIENT EDUCATION 

Agency staff will need to educate all new and current patients on the following:

  • Patients and/or their caregivers will need to check the patient’s temperature every day and inform you or the Agency office if they have a temperature of 100.4°F, cough, or shortness of breath. 
  • During the course of our treatment, if a patient is found to potentially have COVID-19, we will stop all visits until we speak to their physician and the CDC for further guidance.
  • If weather permits, patients should ventilate rooms in their homes with open windows to clear the air and keep it moving.

NEW ADMISSIONS

We are actively admitting new patients because hospitals and clinics are trying to keep patients out of hospitals and under the watchful eye of home health care clinicians. Patients with known exposure or confirmed cases of COVID-19 will be admitted on a case by case basis dependent on staffing and supply of PPE. Our intake department conducts a pre-admission screening call to ensure safety for you and your patients. 

MEDICAL SUPPLY – OFFICE CURBSIDE PICK-UP

With recommendations to limit groups of people to 10 or less, we have drastically cut the number or people in the office. All case managers and members of our management and support staff are working from home. As such it is difficult for us to stop work and gather supplies and meet with clinicians when they “drop in”. Effective immediately, no other personnel, other than Dr. Mark and Paige, are able to access the office unless otherwise permitted by Dr. Mark or Paige.

**Please call the office prior to coming in for supplies. We will gather your supplies in advance and deliver them to you curbside. Please let us know when you’ll be out front and someone can bring the supplies to your car. 

ADMISSION PAPERWORK, NOMNC SUBMISSION AND ALL OTHER PAPERWORK

Please submit ALL signed paperwork only by scanning and emailing to our Medical Records Coordinator- Annette Thorsted at athorsted@transitionshp.com

Please DO NOT scan and upload directly into the patient’s chart and do not submit a picture of it.

  • Consents (Admission consent, Agency Disclosure Notice, Written Notice of Home Care Consumer Rights)
  • Patient Individualized Emergency Plan
  • Advance Directive/DNR/POLST – If they give you a copy 
  • Discharge Instructions
  • Visit Verification Sheet 

Please scan and email them to Annette.

Please DO NOT take a picture – use a scanning app and ensure it is in PDF form for clarity and legibility. 

AGENCY UPDATE

Since 3/13/20, we have been tracking:

  • Patients who have visited the ER, are coughing/sick, have concerns about sick relatives who have visited them, etc. and need follow up phone calls to ensure they are not COVID-19 positive.
  • Medical supplies inventory.
  • PPE inventory and upcoming shipment dates.
  • Clinicians who call in sick due to their own illness or that of a family member.

We have implemented a 1 clinician per patient rule to limit exposure for both the patients and staff. Some patients will have more than one staff member if it is essential to their safety and recovery on a case by case basis. We encourage staff to taper clinicians in as appropriate to their situation to provide needed care. We will be implementing telehealth calls and follow-up phone calls for those patients who will be having their visits reduced.