CURRENTLY AT CHW

CONNECT’S COVID-19 RESOURCE PAGE

PLEASE NOTE: ALL HYPERLINKS BELOW WILL BRING YOU TO CONNECT’S RESOURCE PAGE.

WORKFLOW AND ROUNDS UPDATES CAN BE FOUND ON OUR MAIN HOME PAGE AS THEY WILL BE FREQUENTLY UPDATED.

MIS-C
TESTS/ADMISSIONS
EPIC
PPE
ROUNDS
RESPIRATORY CARE
CODE/RRT

MIS-C MANAGEMENT

MIS-C hospital flow sheet can be found here.

  • All patients with shock or hemodynamic instability require ICU monitoring
    • Also consider patients with encephalopathy, respiratory failure, or other toxic appearing patients.
    • As of Jan 2023, troponin is no longer criteria for admission to ICU
  • ECHO should be completed on W4/W5 in a patient who is hemodynamically unstable and should not delay admission to ICU for patients meeting criteria
  • Any patient who has worsening end organ dysfunction despite escalating inotropes or discussion for mechanical support should be discussed with CICU.
  • In patients with cardiac dysfunction IVIG should be given over an extended period of time to minimize volume overload.
  • Patients with may transfer out of the ICU when they have demonstrated improvement in their clinical status. The requirement for troponins to downtrend has been removed.

TESTS/ADMISSION

Currently our Testing Criteria is all patients being hospitalized, regardless of symptoms. In addition, if an inpatient develops new infectious symptoms, requires escalation of care, or has a visitor who has suspected of confirmed COVID-19 they will be tested.

Our current testing recommendations can be found hereDownload

CHW Operative Plan for COVID Positive Patients can be found here.

  • PATIENT PLACEMENT (updated 11/27/21)
    • Patients being admitted from the ER
      • All patients will have 15 minute test completed in ER along with 90 minute test
        • Patient placement should be based on diagnosis and 15 minute test results
          • If the presumptive test is negative and the patient is asymptomatic, patients can be placed in a neutral room
          • If the rapid 15 minute test is positive, patients should be placed in a NEGATIVE pressure room with Heightened Isolation Precautions
          • All W4 room are now negative pressure isolation
    • Direct admits: ie transports or clinic admissions
      • Asymptomatic: 15 minute test with 90 minute confirmatory test. Patients should be placed in a neutral room
      • Symptomatic (HFNC, BIPAP, Vent, Trach Vent, Continuous Nebs, Q2 respiratory treatments)
        • Patients should go to appropriate unit in a NEGATIVE pressure room with Heightened Isolation Precautions
        • Patients will have a 15 minute and 90 minute test completed
          • If presumptive negative from 15 minute test, may move to standard isolation precautions per patient care needs
          • Patient may move out of negative pressure room after 90 minute test confirmation
          • If positive, patient will remain in negative pressure room
    • Oncology Patients
      • Will undergo a 15 minute and 90 minute confirmatory test
      • Placement should be on W5 and negative pressure rooms if symptoms deem appropriate and again follow steps listed above in blue for testing movement
      • IF the patient is already hospitalized on the HOT unit and moving to the ICU due to new onset of symptoms they should be placed in a NEGATIVE pressure room until their testing comes back
      • Patients that are Critically Immunocompromised Patients will only require one negative 90 minute test.
    • Trauma Patients
      • If history is unknown should be placed in NEGATIVE pressure room and will remain in heightened isolation precautions until 90 minute confirmatory test is negative.

So to summarize, patients no longer need to be admitted to Special Isolation Units. Placement will be based on their symptoms and presentation and guided by results of the 15 minute test.

NEGATIVE pressure rooms should be utilized for: known COVID positive patients, Symptomatic Patients awaiting test results, patients with unknown status ie unable to test or refuse testing, and patients that are symptomatic with CONFIRMED DIRECT primary exposure.

 Patient Type Patient Placement Repeat Testing Isolation Criteria to move out of HIP isolation Notes 
Symptomatic CIP Placed in negative pressure room until 90 min (PCR)  confirmatory test resulted None HIP Negative test result from 90 minute (PCR) confirmatory test 
Asymptomatic CIP CIP patient placement None Immunocompromised N/A 
Symptomatic SOT WITHOUT CIP label Placed in negative pressure room until 90 min confirmatory test resulted None HIP Negative test result from 90 minute (PCR) confirmatory test CIP status to be discussed on acceptance of admission, if  there is provider desire to treat as CIP due to change in patient  status, Admitting team to page  IP to add CIP alert 
New patient admission requiring respiratory interventions*(see below for criteria), with no known exposure Placed in negative pressure room until 90 min (PCR)  confirmatory test resulted None HIP Negative test result from 90 minute (PCR) confirmatory test Continue to use normal isolation practices based on symptoms present after COVID test  resulted 
Admitted patient needing new respiratory interventions* requiring transfer to ICU If emergent transfer prior to test result, place in negative pressure room until 90 min (PCR) confirmatory test resulted None HIP Negative test result from 90 minute (PCR) confirmatory test Continue to use normal isolation practices based on symptoms present after COVID test  resulted 
Admitted patient requiring increased respiratory interventions*NOT needing  transfer to ICU Stay on current unit None Contact Droplet N/A Move to negative pressure on current unit if testing positive for COVID. Continue to use  normal isolation practices based on symptoms present after COVID test resulted 
Patient requiring respiratory interventions*  AND  CONFIRMED exposure within the last  2 weeks Placed in negative pressure room 72 hours after initial test HIP Stay until result of  72 hour test At 72 hours, order 90 minute (PCR) test. Parents should stay in room with patient for duration of visit, limit movement in the hospital. Once 72 hour test is resulted, if negative, place in a NEUTRAL pressure room 
Asymptomatic patient  OR  Patient without need for respiratory interventions* AND CONFIRMED direct PRIMARY** exposure within the last  2 weeks Placed in neutral pressure room until 90 minute (PCR) test result 72 hours after  initial test Continue to use normal isolation  practices based on symptoms present N/A At 72 hours, order 90 minute (PCR) test. Parents should stay in room with patient for duration of visit, limit movement in the hospital 
Patient transfer with COVID test completed at  OSH, or direct admits placement Placed in negative pressure room if respiratory interventions* until 90 min (PCR) test resulted; all others placed in neutral pressure until 90 min (PCR) test resulted Repeat testing at  CHW HIP isolation if respiratory interventions*, or normal isolation practices based on symptoms present. Negative test completed at CHW 
Pre procedure or repeat OR/sedation Normal placement Repeat procedures  will accept a test  within 72 hours if no other  circumstances have changed. Continue to use normal isolation  practices based on symptoms present N/A 
Confirmed or suspected MIS-C patient Negative pressure until 90 minute test resulted None HIP Negative 90 minute test Pending COVID IgG does not require any specific isolation. 
Updated 10/1

*Respiratory Symptoms with the Following Interventions:  Acute Care: defined as HFNC ≤8LPM, IPV Respiratory Treatments, Continuous Nebs, Q2 ; Critical Care: defined as Respiratory Failure (HFNC, BIPAP, CPAP,Trach Vent, IPV Respiratory Treatments, Continuous Nebs) Testing: 15 minute Abbott Test along with the 90 minute test 
** Primary direct exposure: direct contact with a caregiver with confirmed COVID ; Indirect exposure: A patient that was exposed to a caregiver that was exposed 

*** May discontinue isolation when at less than 20 days when the illness is mild to moderate and the patient is not severely immunocompromised AND a provider confirms:  At least 10 days have passed since symptoms first appeared, At least 24 hours have passed since last fever without the use of fever-reducing medications and symptoms have improved; Asymptomatic patients who are COVID + must stay in isolation for 10 days since the date of the positive COVID test 

EPIC

  • The Current Test Order is as follows in Epic :
  • Once in the order set you will see the following screen
Select Novel Coronavirus 19 NAAT… it will then guide you to the next screen
For Symptomatic Patients, the above options populate.
For asymptomatic patients you will see the above options.

MIS-C Order Set is also available in Epic. Be Sure to select the COVID-19 IgG PRIOR to giving the patient IVIG! It is not preselected in the order set.

EPIC HAS MANY USER-FRIENDLY RESOURCES AVAILABLE FOR COVID-19 INCLUDING ORDER SETS, PATIENTS LISTS, AND DISCHARGE INFORMATION. CLICK HERE FOR MORE DETAILS.

PPE

  • The most up to date information for PPE can be found here.
  • GOWNS:
    • We have transitioned to the yellow cloth gowns for isolation in rooms, these may be placed in the soiled linens bin after each use.
  • BUNNY SUITS:
    • Should be worn for any COVID 19+ patient. They are to be disposed in the room prior to exiting.
  • MASKS:
    • As of 11/27 we have reached a new masking phase at CHW.
      • If you are working in non patient care and unable to maintain 6 foot distancing, wear your surgical mask.
      • Direct patient care, low risk situation: Surgical Mask with eye protection
      • High Risk patient care situations
        • Confirmed COVID-19, all Aerosolizing procedures, Heightened Isolation precautions: Fit tested N95 covered with Isolation mask and eye protection or CAPR
        • Aerosolizing procedures are defined as: HFNC > 15LPM or >2L/Kg, IPV respiratory treatments, Continuous nebulizer treatments, Q2 nebulizer treatments, BIPAP/ CPAP, Patients with a tracheostomy, Patients on mechanical ventilation, Patients undergoing a bronchoscopy
  • Please remember to place your surgical mask in a BROWN PAPER BAG when not in use and utilize the mask for that specific patient room.
  • For positive COVID-19 patients procedure mask used to cover the N95 should be discarded after each encounter with the COVID positive patient, and the N95 should be discarded at the end of your shift.
    • A best practice tip from a staff member: ensure that your mask goes in the bag facing the same way every time to help keep YOU safe from cross contamination.  
    • Now that the PPE hotline all the units have a limited supply of Prestige Ameritech ProGear regular-sized N95 masks
      • To receive a small size Ameritech ProGear, contact Distribution

RESPIRATORY CARE

The goal of caring for patients in which we are investigating for Covid-19 is to reduce aerosolization of secretions. Per Dr. Gedeit’s Email on 3/17/20 the current recommendations are for Covid-19 positive patients:

The most recent information can be found on Connect here.

  • Whenever possible the escalation of respiratory care will be:
    1. Low Flow Nasal Cannula
    2. Oxymask
    3. Non-rebreather mask
    4. THEN depending upon the pathogen discuss whether or not High Flow Nasal Cannula can be safely administered.
    5. If High Flow Nasal Cannula can not be administered safely utilize non-invasive ventilation through the Servo (filtered expiratory limb)
    6. Invasive ventilation
  • Use MDI instead of nebulized meds
  • Using HEPA filters on ventilators in Covid-19 positive patients
  • Use closed suctioning systems.

Resuscitation equipment: All resuscitation equipment should be filtered using our regular filters and disposable equipment only. (RCP should place filters, see images below.). If intubating, do not bring all equipment into the room.

CODE/RRT

  • The most recent information for CODE/RRT response can be found here on Connect
  • Rapid Response Activations
    • The Call Center will be asking screening questions prior to activating the RRT.
    • If the patient is on W11/W12 in CAPR Isolation, the RRT team will be alerted to bring their CAPR
    • The transport team will continue to respond and will bring N-95 masks
  • Code Blue Activation (Command Center Approved)
    • ALL MEMBERS OF THE CODE TEAM MUST WEAR VESTS
    • See the list of those who should be in the room and nearby outside the room below…

INTUBATION GUIDELINES CAN BE FOUND HERE

In case of a surge and if needed, Ventilator Triage information is available here.

Information for coding/billing can be found here.

Employee wellness information regarding work policies, testing, and isolation during this time can be found here.