WLAVA:COVID19 ED Operational Updates
Revision as of 04:39, 18 March 2020 by Mceledon83 (Created page with "==LAC DPH COVID19 Resources== ===Definition of COVID19 Person Under Investigation (PUI)=== File:Https://www.wikem.org/wiki/File:Screen Shot 2020-03-17 at 7.27.23 PM.png|thum...")
- 1 LAC DPH COVID19 Resources
- 2 WLA ED Workflow
- 3 Official GLA PPE Recommendation
- 4 Airway Bag & Night B Attending Restocking Responsibilities
- 5 Your Health (and Ours)
- 6 CDC Return to Work Guidance
- 7 Miscellaneous Admin
- 8 GLA Sites
LAC DPH COVID19 Resources
Definition of COVID19 Person Under Investigation (PUI)
Suggested Criteria for Commercial Clinical Laboratory COVID-19 Testing (if Available)
LAC DPH COVID19 Physician Checklist
LAC DPH Home Isolation Handout
WLA ED Workflow
Whom To Notify of PUIs
- Call GLA ID: UCLA consult p89321.
- Notify LA County Dept of Public Health:
- 213-240-7941 (weekdays 8:30a-5p)
- 213-974-1234 and ask for physician on call (after-hours).
- Please notify Jonie, Neil, Manny, and Lisa by text if you have a PUI patient.
- Infectious diseases fellow (x40270/40271)
- Microbiology Department (x41259)
- Please make sure to document the PPE used in your chart as it will allow us to track your exposure category and will help us guide your work restrictions.
- I nfluenza and Respiratory Panel 2 (Biofire) now run together with a TAT of about 45 min to 1:15 hours after “accessioned” specimen is received.
- However, lab only has four modules. Each module processes one patient specimen. So four patients/specimens per hour (roughly).
- On top of this lab processes blood born bacterial ID, GI panels, and meningitis panels on those four modules.
- Plan is to prioritize Flu/RP2 and get more modules, but right now if we liberalize our ordering too much TAT will be longer. Use your best judgement.
- We are only collecting two nasopharyngeal swabs per patient (stop collecting oropharyngeal specimens).
AVOID AEROSOLIZING Procedures (if Possible)
- Do not use NEBS (we are trying to get MDI/spacer)
- NO to High flow NC
- NO to BIPAP
- Intubate early & in a negative pressure room (if available)
CODE Situation for COVID Cases
- DO NOT be a hero and RUSH IN
- Get an N95, Face SHIELD, gloves and gown
- There is increased risk of exposure during CPR-- N95 IS appropriate
- Staff safety is #1 PRIORITY
Official GLA PPE Recommendation
- Droplet, contact and eye protection is considered acceptable for the care of suspected or confirmed COVID-19 patients (when the supply of N95s cannot meet demand).
- Therefore, effective today, suspected or confirmed COVID-19 patients will be cared for with the following personal protective equipment (PPE):
- Surgical mask
- Eye protection (face shield or integrated mask/eye protection or goggles); personal glasses are not sufficient
- Isolation gown
- During this time, available N95 masks/PAPR should be reserved for procedures that are likely to generate respiratory aerosols (intubations, bronchoscopy, etc).
- For staff collecting nasopharyngeal/oropharyngeal swabs, surgical mask + face shield is sufficient protection (along with gloves, gown)
- PPE training 3/17 to 4/17 @ 8:30a - 4:00p Bldg 500, Rm 6043 (no reservation required)
- Next PAPR training session:
- 3/18/20 in room 3220 @ 10a (after ED meeting)
- 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...
- Next FIT Testing Session:
- 3/27/20 - 6:00am-2:00pm: 5W ICU B POD.
- Please complete online form prior to training:
- URL: http://respiratormedicalevaluation.com
- Organization Code: vala
N95 Mask 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
GLA Donning & Doffing Checklist
- N95 Donning & DoffingFile:PPE Donning.Doffing Checklist ER 2020 N95.pdf
- PAPR Donning & DoffingFile:PPE Donning.Doffing Checklist ER 2020 PAPR.pdf
Airway Bag & Night B Attending Restocking Responsibilities
- The two blue airway bags are stocked with N95 masks in main compartment.
- Two airway belongings bags are stocked with PAPR/Belt/Tube/Plastic cover for tube/Surgical gown and hood (BATTERIES NOT INCLUDED). Must bring battery.
- PAPR, belt, tube, and hood are REUSABLE only the plastic cover for tube is disposable. Will provide detailed informations on how to disinfect in next update.
Night B Attending:
- Please make sure airway bags have #3 N95 masks each.
- Please make sure two belongings bags are stocked with PAPR/Belt/Tube/Plastic cover for tube/Surgical gown and hood.
- Make sure PAPR batteries are charging.
If you have any questions or suggestions on Airway Bag improvements, please email Derrick.
Your Health (and Ours)
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.
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
- Medical students SHOULD NOT participate in any care for COVID — so they don’t spread in their community.
- Residents ok to see PUI patient, but no intubations (includes anesthesia residents).
Coding COVID19 Encounters
- For suspected COVID19 cases: Z20.828
- For confirmed COVID19 cases: B97.29
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
- Here are ways to contact me if you have questions:
- Links to GLA COVID19 documents and resources (https://dvagov.sharepoint.com/sites/VHAGLAMed/ed/default.aspx)
- VA screening scripts and resources (https://dvagov.sharepoint.com/sites/VACOVHAPublicHealth/HCI/SitePages/Home.aspx)
Emergency Alerting and Accountability System (EAAS)
- If you wish to receive alerts from the VA EAAS (https://alerts7.athoc.com/SelfService/VAEAAS)
- Any issue please contact Lonnie Miller at x40863