WLAVA:COVID19 ED Operational Updates

  • Website Last Updated 4/19/20

BREAKING NEWS

Number of COVID-19+ cases at GLA: 49 (mostly CLC)

NEW MASK GUIDANCE

  • COS (Chief of Staff) new mask guidance.
    • 1860 and 1870 N95 respirators are being distributed only to the OR and Procedure Center.
    • ED is receiving only 3M 8000 N95 respirators.
    • We only have about 50-60 of the 1860/1870 left for the entire ED (MDs, RNs, ICTs, etc).
      • We will not be resupplied with 1860/1870s.
    • If consultants come down to the ED asking for 1860s/1870s, please inform them that ED does not have those masks for distribution to consultants.
      • They will be receiving 8000s N95s.
    • Remind consultants that 8000s are N95 respirators and this is an ID guideline.
      • The only legitimate reason they can request an 1860s/1870s is if they failed formal fit test for 8000s.

WHAT MASK SHOULD I WEAR?

  • PAPR:
    • Provider intubating.
  • 3M 8000 N95 Respirator:
    • All providers working in the ED who passed fit testing. Please get fit tested for these.
      • Airway buddy.
      • Personnel seeing PUIs.
      • Nurse performing NP swab.
      • Consultants evaluating patients in ED.
    • Do not need to wear a surgical mask over these.
      • Discard with every PUI. Can continue to wear if evaluating non-PUI.
  • 3M 1860/1870 N95 Respirator:
    • CODES or intubations.
    • Providers that failed formal 8000 N95 fit testing.
    • Wear a surgical mask over this and discard surgical mask with every PUI.
    • If used for a CODE or Intubation, discard the N95.
    • If used daily because you failed 8000 N95 fit test, save these using paper bag method.

3M 8000 N95 FIT TESTING

  • EVERYONE needs to be fit tested for the N95 8000s as these will be the ones handed out. Next fit test dates are:
    • Monday 4/22 8am-11:30am – Room 3232.
    • Tuesday 4/21 6am-11am – ED (tentatively).

MASK DECONTAMINATION SUSPENDED

  • SPS is no longer collecting masks. Contrary to our previous update.
  • Discard the 8000 N95 respirators (we have ample supply).
  • Save 1860s/1870s for future use as long as they weren't used for code/intubation.
    • Use paper bag method.
    • We are currently evaluating ways of decontaminating internally but for now, keep them for future reuse.

AIRWAY REMINDERS

NEW INFORMATION

  • Treat All Intubations as PUIs:
    • It is up to your discretion if you want to PAPR vs N95
      • please wear the recommended level of PPE GLA ID recommends for aerosolizing procedures.
    • Please remember to document your PPE in CPRS note.

AIRWAY GENERAL INFORMATION

  • See Airway page for detailed ED attending airway duties:
    • Anesthesia covers all inpatient airways including ED COVID airways from 7a-7p.
    • Anesthesia can be called for impending COVID airways if 2 hours notice can be given.
    • ED Attending Airway Responsibilities:
      • Write intubation note
      • Please hand off the pager to the responsible Intubating attending as below
      • Airway Team should restock cart and medications after each use
      • Report anything missing to Derrick, Miguel and COVID champions
  • ED COVID Airway Team:
      • Afternoons: Intubating 4P-MN Main ED; Buddy 4P-MN FT
      • Overnight: Intubating COVID 11P-7A; Buddy MN-8A (11p-7A ok)
      • Weekends: Intubating COVID 7a-7p and 7p-7a; Buddy ANY available attending (for continuity MN-8A preferred)

AIRWAY MAIN PAGE

WLAVA: COVID-19 ED Airway Main

PPE REMINDERS

NEW INFORMATION

DEVICE CLEANING

  • If you cannot find Sani Cloth AF3 (grey top), here are alternate ways to clean devices
    • Glidescope:
      • Super Sani-cloth (Purple top)
      • Contact time: 2 minutes
    • Ultrasound (new): Sonosite EDGE II:
      • Monitor: Alcohol
      • Transducer: Bleach wipes (leaves residue)
    • Ultrasound (old): Turbo:
      • Monitor: Alcohol
      • Transducer: Super Sani-cloth (purple top)

FIT Testing

  • EVERYONE needs to be fit tested for the N95 8000s as these will be the ones handed out. Next fit test dates are:
    • Monday 4/22 8am-11:30am – Room 3232
    • Tuesday 4/21 6am-11am – ED (tentatively)

PPE GENERAL INFORMATION

GUIDANCE ON DONNING & DOFFING FOR ED PATIENT ENCOUNTERS

PATIENT ENCOUNTER SCENARIOS & DETAILED PPE

Patient Encounter Scenarios and Detailed PPE

FOR PATIENTS W/COVID19 ISOLATION PRECAUTIONS

Donning and Doffing Guidance for Patients w/COVID-19 Isolation Precautions

FOR PATIENTS W/O COVID19 ISOLATION PRECAUTIONS

Donning and Doffing Guidance for Patients w/o COVID-19 Isolation Precautions

PPE MAIN PAGE

WLA VA PPE Main Information Page

TENT REMINDERS

NEW INFORMATION

EMPLOYEE SYMPTOM SELF-REFERRAL TOOL

  • Employee self-referral tool helps employees decide how to best manage their symptoms, when they can return to work, and when to get tested for COVID-19.
  • We can use this tool, but mainly to assist other employees.
    • Please use and distribute this so that people can present to the correct location (Employee Health, Tent, or ED) and so they know how to correctly self-triage their symptoms/exposures.
  • GLA VA Employee Symptom Self-Referral Tool

EST GENERAL INFORMATION

    • EST open M-F 7a-11p &Sa-Su 10a-10p
    • please check in with the EST nurses at the start of your shift and leave them your name (so they can reach you by Vocera).
    • Please pick up the VA iPad assigned for EST Telehealth so you can see patients using FaceTime (so you don’t have to walk back-and-forth).
      • We are still working out if the ED MSA or the ED Charge Nurse will be in charge of EST VA iPad sign in/sign out. This will hopefully be resolved tomorrow.

TENT MAIN PAGES

ADMINISTRATIVE REMINDERS

NEW INFORMATION

PIV EXEMPTIONS

  • Computer access without card = PIV exemption
  • If you would live long-term computer access without your PIV badge, email Jonie by MONDAY 3/20
  • Send her your NT user name if you know it (VHAGLAxxxx or VHAWLAxxx)
  • We will submit a request that may get us x 60 mo access for COVID - no promises

ADMINISTRATIVE GENERAL INFORMATION

WLA VA ID COVID-19 TESTING ALGORITHM

  • Do not need to consult ID to order COVID-19, please review algorithm below to determine if your patient is eligible for COVID-19 testing.
WLA VA Tent Testing Algorithm

HOW TO PLACE PATIENTS ON ENHANCED DROPLET PRECAUTIONS

  • Please have a low threshold to place patients on isolation for COVID-19.
  1. Start a new note:
Start New Note
  1. Type in 'Isolation Note:'
Isolation Note
  1. Select Enhanced Droplet Precautions for COVID-19 patients:
Enhanced Droplet Precautions
  1. Once you finish the isolation note template, go to 'Orders' menu and sign the isolation order:
Isolation Order

ADMINISTRATIVE MAIN PAGE

WLAVA:COVID19 ADMINISTRATIVE

Miscellaneous Reminders

Location of N95 Masks at GLA

  • Stored in Med Room (badge access only)
  • GLA N95 Brand/Model:
    • We primarily carry: 3M 1870+
    • We have a stock of small masks: 3M 1860S

VA Scrubs

  • Please see COVID-19 Update #15 email 'Scrubs' MS Word document for details on how to access ScrubEX.
  • It took some effort but we finally secured enough scrubs to cover all ED/FT provider shifts each day.
  • However, we have to make sure to return them at the end of each shift. If you do not return it then that means the provider coming in after you will not have scrubs.

GLA Showers

  • No Lockers - Bring your own towel/clothes
  • Ground Floor (Basement):
    • Women’s Locker Room: Rm 0435 passcode 2169
    • Men’s Locker Room: Rm 0403 passcode 2168
  • ​​​5th Floor (OR Showers):
    • Women’s Locker Room: Rm 5076 passcode 5324
    • Men’s Locker Room: Rm 5075 passcode 5321

Alternative Housing

  • The Fisher house is available for those who are interested and need housing options away from family.
  • Please contact Neil if interested and include exact dates and details. **Preference to Distance > DEMPS > Risk at home > # Consecutive shifts.

EDUCATION/SIMULATION REMINDERS

MOCK CODE DRILLS

  • If you are having a slow shift, please consider running a few mock code drills so that we can ensure our nursing staff is well prepared. Our nursing staff is a little rusty when it comes to critical care, so it isbetter we iron out any issues in preparation for the future.
  • Hospitalists are doing daily weekday drills (M-F) at 11AM in 3rd floor conference room (there will be no overhead announcements).
  • Reference Documents:

GENERAL PPE TRAINING

  • PPE training 3/17 to 4/17 @ 8:30a - 4:00p Bldg 500, Rm 6043 (no reservation required)

SIM LAB TRAINING

  • Email Cindy Koh or Carol Lee if you have not been signed off on airway PPE donning and doffing simulation.

FIT TESTING

  • To clarify, you need to be FIT tested yearly at each facility you work because the brand and type of mask may be different. Your face may change shape with age/weight/pregnancy etc...

GLA/CDC Return to Work Guidance

Your Health (and Ours)

  • If you develop a fever and/or resp symptoms- notify Neil/Jonie immediately. We know how hard y'all want to work - but it's important to stay healthy and keep away from others to avoid further spread of disease to coworkers and patients and additional need for quarantine.

GLA Provider Exposure Risk Algorithm

  • Please protect yourself from inadvertent exposure by making sure patients that have any hint of being a potential PUI (i.e., epidemiological risk factors, URI sx, any respiratory sx, etc.) are wearing a face mask (can use conical or level 1/yellow mask).
Interim Guidance at GLA during regular staffing mode for ASYMPTOMATIC employees WITH PROLONGED CLOSE CONTACT with a COVID-19 patient

CDC Return to Work Guidance

  • Guidance on what to do if you think you were exposed to COVID-19 and are asymptomatic:
    • We are using the CDC updated recommendations on public health management of healthcare personnel (HCP) with potential exposure in a healthcare setting to patients with COVID-19 (see below). This updated guidance allows for asymptomatic HCP who have been exposed to a COVID-19 patient to continue to work AFTER consultation with their occupational health program (see table below for details on exposure risk).
  • We are counting on your self-referral.

Miscellaneous Admin

iMED Consents for COVID PUI Patients in Isolation

Detaining PUI or COVID19 Confirmed Patients

  • It seems that without any specific quarantine order (rare that we will have an official order on our patients)- we cannot detain patients against their will unless we do not think they have capacity- which is a separate issue.

Medical Student & Resident Rules Regarding PUI Pt Care

Coding COVID19 Encounters

  • For Suspected or Exposure to COVID19 or Exposure: Z20.828
  • For Confirmed COVID19: B97.29
  • Other suggested ICD10 codes include (but not limited to):
    • Acute Upper Respiratory Infection, J06.9
    • Cough, R05
    • Viral Infection unspecified, B34.9
    • Fever unspecified, R50.9

Dexter Moved Out

  • Use ‘UM Review’ label on EDIS to communicate with him.
  • If you are interested in not having to change your admission orders 50 times.
    • Here are ways to contact me if you have questions:
      • VA cell: 626 314 9774
      • VA Pager *11 p73284

Donations (PPE/Food etc.)

  • Please contact Alexia Lunningham, Chief of Voluntary Services at (310) 268-4350 or alexia.lunningham@va.gov to coordinate.
  • Staff members are not permitted to solicit funds or items on behalf the hospital.

GLA Sites

COVID19 ED Sharepoint

High Consequence Infection (HCI) Sharepoint

Emergency Alerting and Accountability System (EAAS)

Other WLA VA Pages


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