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Q I P M O LT C S U P P O R T G R O U P

Q I P M O N U R S E S* C RY S TA L P L A N K * C A R O L S I E M * D E B P O O L *

* K AT Y N G U Y E N * M E L O DY S C H R O C K * * W E N DY B O R E N *

H E L P F U L L I N KS

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PPE

• Healthcare Coalition PPE ordering: now online process; https://survey123.arcgis.com/share/35c0d11050b04a809028d2caf9fd45fd?portalUrl=http://mophep.maps.arcgis.com

• Strategies to conserve PPE: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html

• Health Guidance : DHSS Interim Recommendations for PPE Sterilization, Re-use and Extended Use, 4/10/2020: https://www.health.mo.gov

PPE• Masks:

– https://mst.qualtrics.com/jfe/form/SV_3gYuEBernXtZ845

– https://www.mask-match.com/

– https://getusppe.org/

• Face Shields:

– H&H Color Labs- David Drum- ddrum@hhcolorlab.com

– Trabon Group / USAShields Website https://usashields.com/

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PPE

• Hand Sanitizer:

– J. Rieger & Company https://www.jriegerco.com/contact-us

– Kansas Canning Company/City Bity Farms https://kansascitycanningco.com/collections/all

– Allen’s ordinary: Kent Hendrix 573-673-6974/kent@allensordinary.com

– Dog Masters Distillery 210 St. James Street, Columbia 573-777-6768 https://krcgtv.com/news/local/dogmaster-distillery-makes-hand-sanitizer

• https://www.distilledspirits.org/distillers-responding-to-covid-19/distilleries-making-hand-sanitizer/?gv_search=&filter_4_4=Missouri&mode=any

ADMISSION/DISCHARGE FORMS

• Admissions https://cdn.ymaws.com/www.mohealthcare.com/resource/resmgr/covid-19/3-26-20_HospitalToFacilityTr.pdf

• Transfers to hospital https://cdn.ymaws.com/www.mohealthcare.com/resource/resmgr/covid-19/3-26-20_PostAcuteCareNBehavi.pdf

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COVID-19 SURVEY/SELF ASSESSMENT

• COVID-19 Self Assessment

• COVID-19 Focused Survey Tool

• COVID-19 LTC Surveyor Training video

GUIDANCE FOR DIFFICULT CONVERSATIONS

• Conversations for serious illness; https://swhpn.memberclicks.net/assets/SIC%20COVID%20Guidelines.pdf

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C R I S I S I N C R I S I S

M E L O DY S C H R O C K , R N , B S N , R A C - C T

Q I P M O C L I N I C A L E D U C AT O R

COVID-19 PANDEMIC

• We are in the middle of a pandemic which has set many homes in to crisis mode:

– Staffing crisis

– PPE crisis

– Increased infection control requirements

– Emotional crisis: depression as a result of social distancing

– Toilet paper crisis

– Increased stress: balancing aspects of life

– Unknown…

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CURRENT EMERGENCY PREPAREDNESSPROGRAM

• Facility based Emergency Preparedness Program- “facility-based” to mean the emergency preparedness program is specific to the facility. It includes but is not limited to hazards specific to a facility based on its geographic location; dependent patient/resident/client and community population; facility type and potential surrounding community assets- i.e. rural area versus a large metropolitan area.

• REQUIRES annual review; however, with current conditions during a pandemic, some considerations may have been missed

CRISIS ON TOP CRISIS

• Natural Disasters:

– Tornado

– Flash Flooding

– Earthquake

– Lightening Strikes

– Fire

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YOU’VE PRACTICED

Tornado Drills Earthquake Drills Fire Drills

Tis the seasonTornado/Severe Storms/Pop-up storms/

straight line winds

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THINK WHAT IF…?• Shelter in Place:

• Have masks (in our current situation: homemade, cloth, tissue/paper towel with rubber bands, whatever you have available for residents)

• Totes on each hall with flashlights, masks, census, extension cords for air beds or oxygen concentrators- call light back up (bells, squeakers, etc.)

• Emergency cart education/review: suction, O2, etc.

• Mark 6’ increments in your home

• Stagger across hall if needed

• Isolation areas/rooms: have bathrooms/shower rooms clear

• Emergency access phone (land line vs cell phone)

• Prepare for relocation to other homes: name bands, mini careplan cards

TORNADO WATCH

• Tune in local radio and monitor weather radio.

• Follow your policy

• Census review (who is there, who isn’t)

• Close windows, blinds, curtains

• Put masks on residents

• Check emergency equipment, flashlights

and batteries

• Gather extra pillows and blankets

• Prepare for relocation

– Ensure halls clear

– Clear bathrooms/shower rooms for isolation units

• Bed ridden: turn facing interior wall with pillows to back

A watch indicates that tornados may potentially develop as reported by the National Weather Service or through other reports (television, radio, community warning sirens, etc.)

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TORNADO WARNING

• REMAIN CALM

• Follow policy

• Guide least dependent/ambulatory residents to chairs in halls(or designated area in your home) with pillow or blanket to cover and protect

• Assist wheelchair residents to hallway

with pillow or blanket

• Bed ridden residents moved in beds to interior corridor walls or move to interior area of room (as far away from windows as possible, cover with extra blankets/pillows and pull privacy curtain

A warning indicates that a tornado has been sighted in the immediate area as reported by the National Weather Service or through other reports (television, radio, community warning sirens, etc.)

TORNADO COMBINED WITH COVID-19 • Should you have rooms/wings with COVID positive residents

– Attempt to shelter in place: bathrooms or shower rooms

– Make sure they are masked

– Keep COVID positive residents in a relocation area away from non affected residents.

– If unable to move out of room: pull to most interior location (furthest from window) cover with extra blankets, pull privacy curtain around bed.

– It is recommended that you follow Centers for Disease Control (CDC) guidelines for COVID-19 transmission prevention, including physical distancing, and any additional guidelines set by your local emergency management agency

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LIFE OVER LIMB:

• Weather is unpredictable.

• It is possible, and it has happened that a tornado crops up suddenly.

• Do your best, to relocate residents & maintain safety to all involved.

G U I D E L I N E S T O P R E PA R EF O R T H E C O V I D - 1 9

S U R G ED E B B I E P O O L , B S N , R N , L N H A

K AT Y N G U Y E N , M S N , R N

Q I P M O C O N S U LTA N T / C L I N I C A L E D U C AT O R

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PREPARATIONA. Bed census/capacity

• Determine current bed census and capacity for admissions/readmissions.

• Identify area(s) for quarantine/isolation and/or cohorting current resident(s) with suspected or know COVID-19 virus including room changes if necessary.

• Contact sister facilities or homes with current mutual aid agreements to discuss bed availability, i.e. accepting current residents with or without known infection depending on need. Consider shelter in place if available in the area.

• Identify resident(s) with potential to discharge home or lower level of care within the community.

• Establish a relationship or agreement with a commercial testing laboratory for a test kit or the method of obtaining SARS CoV-2 samples and the system for sending specimens from the facility.

C MS QS O - 2 0- 2 5 - N H2 0 1 9 CO V ID -1 9 LO N G-T ER M C A R E FA CI L I T Y

T R AN S F E R S C EN AR IO S 4 / 1 3 / 2 02 0• LTC Facility Transfer Scenarios

• In response to the recent questions related to cohorting, CMS is providing supplemental information for transferring or discharging residents between facilities. In general, if two or more certified LTC facilities want to transfer or discharge residents between themselves for the purposes of cohorting, they do not need any additional approval to do so. However, if a certified LTC facility would like to transfer or discharge residents to a non-certified location for the purposes of cohorting, they need approval from the State Agency. Please see the attachment, “LTC Facility Transfer Scenarios” for a depiction and explanation of these scenarios.

• Contact: For questions or concerns regarding this memo, please contact DNH_TriageTeam@cms.hhs.gov.

• Effective Date: Immediately. This policy should be communicated with all survey and certification staff, their managers and the State/Branch training coordinators within 30 days of this memorandum.

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PREPARATION

B. Staffing

• Identify current available staff within the building to meet current resident needs.

• Identify required staff to meet potential influx of admissions including nursing, dietary and therapy.

• Identify ancillary staff to assist with non-nursing tasks: tray delivery, linen delivery, restocking of supplies or activities.

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PREPARATION

B. Staffing (continued)

• Address how to provide consistent staffing to limit resident and/or staff exposure (nursing housekeeping, therapy).

• Brainstorm ideas to prevent potential staff burnout.

• Plan for employee absences and create a back-up or on-call system.

• Provide continued education and support for staff to update them on the disease process and guidelines for care.

PREPARATION

C. Supplies

• Conduct an inventory of PPE currently available in the facility (masks, gowns, gloves, N95 masks, face shields) and identify where items are located and how to access.

• Identify a person and system for tracking supply usage and restocking of used items, list and log the supply inventory.

• Conduct an inventory of current oxygen concentrators, nebulizer machines, E tanks, cannulas/masks, pulse oximeters, etc., and location(s) and other respiratory equipment.

• Conduct an inventory of linens, housekeeping supplies, beds, mattresses, pillows. Identify if an emergency supply is available and its location.

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PREPARATIONC. Supplies (continued)

• Conduct an inventory of available food, beverages including required emergency supply and disposable items including plates, cups and utensils.

• Conduct an inventory of available medical equipment, e.g. wheelchairs, walkers, tube feeding/IV pumps, mechanical lifts and bathing equipment.

• Conduct an inventory of disinfectants and other environmental cleaning products.

• Contact appropriate vendors to discuss potential need and availability of supplies including delivery options.

• Establish a cleaning schedule for equipment.

PREPARATIOND. Communication

• Administrator to meet with Department Heads to discuss preparation requirements.

• Administrator and Director of Nursing to meet with Medical Director.

• Establish a protocol for notification of local public health entities and DHSS of positive cases.

• Establish method for family notification including condition updates.

• Provide staff with information on preparation guideline for the surge.

• Have a family and resident notification process for when a case of COVID-19 is identified.

• Communicate and assess consideration for discharge of any residents that can be cared for in the home setting.

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CONTINUING CARE

A. Bed Census/Capacity

• Twice daily meetings to discuss census, bed availability, potential admissions/readmissions and placement of resident(s).

• Continue to review current resident(s) for potential discharge options.

• Maintain open lines of communication with sister facilities or homes within the area identifying bed availability and needs.

• Designate/design and reserve isolations sections/room(s).

CONTINUING CAREB. Staffing• Address staffing needs at least every shift including fluctuation with census.• Consider staggering shifts to cover high care need times and prevent potential

burnout.• Provide frequent breaks when/if possible to allow staff to regroup, communicate with

family to de-stress.• Brainstorm with staff on ways to decrease stress and prevent burnout. Provide

emotional support as needed.• Monitor employee health checking for exposure (temperature log each shift).• Consider incentives, free meals to employees during this difficult time.

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CONTINUING CARE

C. Supplies

• Review supply inventory at least every shift.

• Monitor and restock high traffic areas.

• Maintain open communication with any/all vendors, coalition, DHSS on need and availability of supplies.

• Contact HHC if unable to obtain supplies from primary vendors.

• Follow CDC guidelines for use and reuse of PPE.

CONTINUING CARED. Communication

• Maintain open lines of communication with hospitals, EMS, local public health departments, DHSS and vendors.

• Keep staff updated with current CMS, CDC and DHSS guidelines.

• Encourage staff input where possible with assignments, resident placement and identification of resident care needs.

• Allow residents, staff and families the opportunity to share concerns, frustrations and compliments.

• Keep lines of communication open with all concerned stakeholders utilizing phone, zoom, skype or other means for residents, families and staff.

• Be ready (letters, calls) to families and residents to inform of any active cases and planning for care in home settings.

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RESOURCES

• ASPR Healthcare Preparedness and Response Capabilities

• Missouri Department of Public Safety-State Emergency management agency (SEMA)

• https://www.ametsoc.org/index.cfm/ams/about-ams/ams-statements/statements-of-the-ams-in-force/tornado-sheltering-guidelines-during-the-covid-19-pandemic/

• www.cms.gov

• www.cdc.gov

• www.nursinghomehelp.org

ALL STAFF

The QIPMO team thanks each of you for your patience, compassion and perseverance in this challenging time.

With love, QIPMO Nurses and Coaches