COVID-19 Knowledge for the Front Line Staff4:00 – 5:00 PM ET

July 30, 2020

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Introduction and Welcome

Lisa Sullivan, MSN, RNActing Director Division of Community and Population HealthiQuality Improvement & Innovation GroupCenters for Medicare & Medicaid Services (CMS)

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Meet Your Speakers

Alice Bonner, PhD, RNSenior Advisor for AgingInstitute for Healthcare Improvement (IHI)

COVID-19 Knowledge for the Front Line StaffAlice Bonner, IHILori Porter, NAHCANimalie Stone, CDC

July 30th, 2020

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Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA).

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Aim and Objectives

• Our aim is to provide knowledge and approaches to supporting the health and well-being of older adults, their care partners, nursing home team members and other stakeholders during COVID-19

• Objectives include: 1. learners will be able to discuss guidance on nursing home

workforce safety; 2. learners will discuss two or more ways to communicate

with residents, care partners, and between direct care staff and management during COVID-19

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Topics for Today

• Federal, State and local guidance on workforce safety –focus on PPE (personal protective equipment)

• Policies and procedures regarding resident well-being, safety, and the environment• Employee Health and Wellness • Our mental health and managing stress

• Employee support programs• Communication with direct care staff, management,

stakeholders and community• Peer support networks

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Personal Protective Equipment (PPE)

• Some areas in the U.S. struggle to obtain adequate and appropriate PPE

• Who is in the supply chain for your SNF/NF? • Do you know how to escalate urgent requests? To whom

and when?• Do you have a PPE burn rate calculator or similar tool, and

have you received training on how to use it?• What happens on off-shifts, weekends, nights?• Do you have telephone numbers/emails to reach

support persons/departments?

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PPE

• What may prevent/limit proper use of PPE and other infection prevention or control measures?• Inadequate or absent training and/or supervision• Lack of time (challenges with workflow)• Lack of adequate staff• Team members thinking that it is not a priority

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PPE

• If a new staff person comes into the SNF/NF, how would you determine whether or not they knew how to don/doff PPE appropriately?

• Is there a video/set of videos or other training materials available to you and your team? • Are they easily accessible? • Are you given time to watch them and practice

donning/doffing PPE?

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CDC VideosAvailable on YouTube orCDC website (www.cdc.gov)

Donning PPEhttps://www.youtube.com/watch?v=of73FN086E8

Doffing PPEhttps://www.youtube.com/watch?v=PQxOc13DxvQ

Donning and Doffing PPE (LSU/CDC)https://www.youtube.com/watch?v=1xy00pLT9M4&vl=en-US

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PPE Fundamental Principles

• Check for availability of all needed PPE and other supplies for resident’s care

• Check that waste receptables are available in appropriate places

• Arrange with co-workers that you are entering room in case you require their assistance (‘buddy’ system)

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PPE Fundamental Principles

Putting on (donning) PPEOrder is important. 1. Hand hygiene First2. Gown or similar covering 3. Mask or respirator: fit and type of mask is important4. Eye protection comes after the mask5. Gloves are last – cover gown at wrists

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PPE Fundamental Principles

Taking off (doffing) PPEOrder is important. Avoid contamination 1. Remove gloves first. Outside may be contaminated2. Remove and roll gown. Outside may be contaminated3. Hand hygiene – sanitizer and/or soap and water for 20

seconds4. May exit resident’s room5. Remove face shield or goggles6. Remove respirator or mask7. Perform hand hygiene

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CDC Resources

https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html

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CDC Resources

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CDC Resources

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PPE

• When you return to your work area, ask about how your organization obtains PPE

• Locate training materials or speak with your Director of Education about PPE training, use and supervision

• Know where the training materials are, when and how to access them

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Other Infection Prevention and Control Practices

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Other Infection Prevention and Control Practices

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Example of a State HHS Resource (Texas)

Keep your state’s document handy!

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Staff Health and Well-being Our mental health

• This is an unfamiliar virus• Uncertainty is the ‘new normal’

• High rates of sickness and death• May cause trauma to care partners, family members

and/or nursing home teams• Trauma-induced care and support of both residents

and staff is needed• High rates of worry, depression, anxiety, insomnia,

stress

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How have your work and your life changed during COVID-19?

• Please enter your responses in the Q&A Box at the bottom of your screen!

• We hear many stories from across the U.S. on weekday National Nursing Home Huddles

• What are the best or better practices that you have implemented?

• What are the primary things that keep you up at night?

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CAUSES OF OUR STRESS

Sarah Sjostrom, MSN, RN, ACNP-BCAssociate Chief Nursing OfficerHebrew Rehabilitation Center

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How Does this Happen during COVID-19?

Sarah Sjostrom, MSN, RN, ACNP-BCAssociate Chief Nursing OfficerHebrew Rehabilitation Center

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WHAT CAN WE DO? Create a dialogue between leadership and point-of-care staff

Sarah Sjostrom, MSN, RN, ACNP-BCAssociate Chief Nursing OfficerHebrew Rehabilitation Center

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Age-Friendly Care – 4Ms Framework

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Principles of an Age-Friendly Health System

1. 4Ms are a set2. Framework to organize care3. Goal is reliable practice4. Build on what you already do

www.ihi.org/AgeFriendly

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Communicating with Team Members, Care Partners and Community

• Set up regular conference or Zoom calls (phone in and computer links)• Frequency• Who will run them – a care partner? Social worker?

Administrator?• Arrange scheduled visits via computer or other user-

friendly system• Figure out workflow so that every person gets a (timely)

call back

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Communicating with Team Members, Care Partners and Community

• Some states have implemented a Nursing Home Resource Line for care partners, family members, stakeholders, the public• Seven days a week, 9 AM – 5 PM• Follow up with HHS, DPH or behavioral health as

needed• In addition to individual nursing homes having call-in

times, regions or states could have calls for nursing home employees, care partners/families from multiple SNF/NFs (peer network)

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Communicating with Team Members, Care Partners and Community

• Consider write ups with status updates in newsletters, local media (newspapers), social media, radio, cable TV, city or town websites• Consider how the state is reporting on number of cases,

number of hospitalizations, number of deaths, where testing has been done

• See reference slides with feedback from organizations in Alzheimer’s Association Project ECHO• Talk with CNAs! Ask for their input and ideas!!

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Nursing Home Programs to Support Team Members -examples

• Quiet room for staff • Access to food and essentials • Information on childcare or family care resources • Staff engagement programs – focus on CNAs• Resources for mitigating burnout • Resources for addressing grief and distress within the

context of the pandemic • See recommendations from Project ECHO under

resources/references

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Prevention

The best way to prevent the spread is to KEEP IT OUT.

Principles of Prevention and Infection Control in the Community• Wear a mask• Wear gloves or full PPE if indicated• Keep social distance (6 feet or more)• Avoid places with more than 10 people gathering (avoid

crowds)• WASH YOUR HANDS! WASH YOUR HANDS!!!

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Summary

• “This too shall pass” – focus on the present and the future

• Continue to create strong peer networks

• Thank you for your work at the point of care every day!!

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Resources Contained in the Final Slides

• Enrollment details for the IHI COVID-19 Rapid Response Network for Nursing Homes and IHI Weekly Huddles

• Best Practices on communications from assisted living residents in the Alzheimer's Association Project ECHO

• References on Stress and Mental Health

• CDC Resources and Links

• The National Nursing Home Social Work Network

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Enroll for Weekday Huddles!

Here is the link where you can register for the IHI COVID-19 Rapid Response Network for Nursing Homes and then receive access to our materials page up to 24 hours later.

If you have any trouble with the links, it sometimes helps to clear your cache and to use Google chrome. IHI’s customer experience team can also help; give them a call at 617-301-4800 during ET business hours if you need anything.

Best Practices on communication from assisted living residences in Alzheimer’s Association Project ECHO

• Use baby monitors to hear one another during window visits

• Tent visits (if permitted)

• Use white boards to communicate with care partners; staff take photos and share with care partners

• Laminate photos of care partners or families for residents

• Try Zoom meetings as Town Halls for care partners

• Post photos of activities on Facebook or other media

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Best Practices on communication from assisted living residences in Alzheimer’s Association Project ECHO

• Ask care partners to send a batch of letters so resident can open one each day

• Take pictures of tent or window visits to remind resident of the visits

• When using video platforms, turn off the video of the resident or cover it with a post-it (seeing their own image can be confusing)

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References on Stress and Mental Health

• Benzo RP, Kirsch JL, Nelson C. Compassion, Mindfulness, and the Happiness of Healthcare Workers. Explore (NY). 2017;13(3):201‐206. doi:10.1016/j.explore.2017.02.001.

• Centers for Disease Control and Prevention. Exposure to stress: Occupational hazards in hospitals. https://www.cdc.gov/niosh/docs/2008-136/pdfs/2008-136.pdf.

• Hobfoll, S. E., Watson, P. J., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., et al. (2007). Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry, 70(4), 283-315.

• Lai, J. et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020 Mar 23(3):3203976.doi 10.1001/jamanetworkopen.2020.3976.

• Morganstein, J.C. Inpatient notes: Preparing for Battle: How hospitalists can manage the stress of Covid 19. Ann Intern Med. 2020 April http://doi.org/10.7326/M20-1897.

Sarah Sjostrom, MSN, RN, ACNP-BCAssociate Chief Nursing OfficerHebrew Rehabilitation Center

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CDC Resources and Links

Preparing for COVID-19 in Nursing Homeshttps://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html

Responding to Coronavirus (COVID-19) in Nursing Homeshttps://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-homes-responding.html

Using Personal Protective Equipment (PPE)https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html

The National Nursing Home Social Work Network

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https://clas.uiowa.edu/socialwork/nursing-home/national-nursing-home-social-work-network

1-800-799-7233Or, if unable to speak safely,

text LOVEIS to 22522

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Thank you!

Thank you

abonner@ihi.org

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Meet Your Speaker

Lori PorterCo-founder and CEONational Association of Health Care Assistants (NAHCA)lporter@nahcacna.org

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Announcement – Project ECHO

COVID-19 CLINICAL ROUNDS - Special SessionTransitions of Care: From Acute Care To Long Term Care

A Peer to Peer Virtual Community of Practice

Tuesday, August 4, 202012:00 PM - 1:00 PM EDT

11:00 AM - 12:00 PM CDT10:00 AM - 11:00 AM MDT9:00 AM - 10:00 AM PDT

For Registration and Connection Information: https://echo.zoom.us/webinar/register/WN_qxLtUFY5RGKqF8sCqzi2GA

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Open Discussion and Questions

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Join Us!

Join us for the next

National Nursing Home COVID-19 Training

on Thursday, August 6, 2020

from 4:00 - 5:00 pm ETRegistration Required:

https://zoom.us/webinar/register/WN_w16sb6o8TBa-PR7oAFNg2g

COVID-19 Surveillance to Enable Early Detection and Response to Outbreaks: National Healthcare Safety

Network (NHSN) Mandatory Data Collection

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Thank You

Your opinion is valuable to us. Please take a moment to complete the post event assessment here:

https://www.surveymonkey.com/r/07_30_20

We will use the information you provide to improve future events.

This material was prepared by The Bizzell Group (Bizzell), the Data Validation & Administrative Contractor, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. 12SOW/Bizzell/DVAC-0111-06/23/2020