Announcements

Hello my friends,

I want to share with you a list of some items that I have gathered myself and from other local ED leaders here.

We will be using this list as we start a communication strategy this next week to our members, however I want to send this along to you as I know that you most likely are already planning in your own institutions.

If you have questions on how we have been handling this please let me know. We are working on a way to have our members ask questions and for us to respond to them around COVID-19.

I cannot stress enough right now basic hand hygiene and as you work at your institution securing PPE. We have had our own staff in the hospital stealing boxes of mask.  Our HR team has actually issued a notice out to all caregivers including providers that theft will not be tolerated and will result in corrective action including termination. Last night some how we had about 100 boxes of mask go missing.

This week I sent an email out to all state presidents and presidents-elect asking for feedback as far as what they are hearing. I did get some responses, however if you can please make sure you are in contact with your states as well and raise up any concerns your states are having. Please remember the great resource we have at https://www.ena.org/practice-resources/COVID-19 which ENA’s dedicated page to COVID-19. If you have not listened to the podcast I suggest you take a listen.

Thank you for all that you are doing for your local team and for our ENA members. I truly appreciate each one of you and thanks for all the messages checking in on me to make sure I am doing okay here in Washington.

The following are items in which we have heard questions about or as those of us facing COVID-19 had for advice. Of course, as this situation develops and changes daily and sometimes hourly things I want to reiterate that you need to be following your local facility policies/procedures.

PPE

• First secure your surgical mask and sanitizers from the general public- they will walk off
• Even within your facility by your own staff they will walk off, so figure out ways to have your PPE secured

Sorting patients

• Figure out a way to sort patients at your door and have a place to put possible patients vs your general ED waiting area
• This will require creative thinking, signage, facilities support, safety officer, registration

Isolation procedures

• The isolation procedures continue to change- the CDC initially stated airborne with contact precautions and WHO was saying droplet with contact. I can tell you there are a lot of organizations that are now adopting WHO guidelines.
• Current recommendation is still to have negative airflow rooms for any aerosolizing treatments, so you need to make sure you have plenty of negative airflow rooms. If you do not then you need to figure out who you can handle this
• If you need a negative airflow room and you do not have one- what do you do?

EVS

• EVS support is critical to be able to turn rooms over and extra cleaning in your facility of all the high touch areas
• Know what the requirements will be for cleaning the different type of rooms you may have
• The more patients, the public, and staff see EVS cleaning this help them understand the organization is doing what they can

Communication

• There will be a lot of communication that comes out from many different sources, so figure out a way to condense it to what your staff needs to know
• I can tell you I do this with a date and time as these are critical because things changes throughout the day and you want to make sure the team is aware of the most up to date information
• Facility needs to be proactive with communication to the community about what you are doing
  • If you are limiting access to the hospital
  • If you are screening at the door, why you are doing this

School closing

• Be prepared for your local schools to close- is there something that can be done to support staff with childcare needs

Testing procedures

• Criteria on who gets tested and how to handle the test is always changing. You will need to work closely with infection prevention team on the criteria.
• Will your infection prevention require a phone call for clearance to test?
• Do you have to have clearance from your local health department to test?
• When you get clearance to test- how do you get the test to lab?
  • Where I am at the instructions have been not to send via the tube station as if the sample opens up it will contaminate the whole system. This means not sending any flu/RSV/ possible COVID19 swabs. So, what is the plan to get them to lab?

Transporting patients

• What will your procedures be transporting patients through your hospital?
• What will your procedures be transporting your patients out of your hospital?

Where will admitted patients go?

• If you are admitting patients to your facility where will they be admitted to?
• Cohorting patients in a central location in your hospital is ideal
• Facilities to look to see if they can make a whole unit negative airflow

Supplies PAPR/CAPR

• Make sure your batteries are working
• You have back up air filters
• How will you clean them?
• Reusing hoods

Call volume- dedicated line

• If you can set up a dedicate phone line for people to ask questions so they are not calling your main ED number

Simulation training early

• Start training/simulation early

Shift champion each shift- monitor staff for PPE and tracking of patient