The Pulse

What Everyone Needs to Know for April 1, 2020

• Starting Thursday, April 2, Children’s is changing its visitation policy. Only one visitor will be allowed at a time to any facility. Exceptions will be made for end-of-life care, neonates and other special circumstance. In addition, no sick caregivers will be allowed on our premises. If a parent is symptomatic, another caregiver should accompany the patient. Please learn more about this updated policy, including any exceptions, on myChildren’s and The Pulse.
• Children’s Physicians is temporarily restructuring the visit structure to its offices, with full implementation by Monday, April 6 and continuing through April 30, or whenever we can safely return to normal practices. As part of this restructuring, we will divide our offices into well-check locations and  infectious sick-visit locations, minimizing infectious patients being seen at all clinics.For specific location details and important screening updates, read more on  MyChildren’s and The Pulse.
• Cavi-wipes, cavi-spray, bleach wipes and hand sanitizer are no longer available to order via capsure shopping. If you have checked your par and still need these items, please send an email request to ICLOGISTICS@CHILDRENSOMAHA.ORG. With your request, please include your name and number, requesting department and cost center, Oracle number, item description and quantity, delivery location and justification for the order.
• Children’s will soon launch a new podcast to answer community questions about COVID-19. From medical questions to ideas for keeping kids active and entertained at home, our experts will answer questions from our Facebook community on what they want to know about COVID-19. More information about how you can listen and share this podcast will be available next week on myChildren’s.

What Everyone Should Do for April 1, 2020

• Watch the recording of today’s clinical Town Hall video here. A summary of the session will be available tomorrow.
• Review updated patient processes related to COVID-19. Visit the COVID-19 intranet page, then click on the Patient Care Processes button. New information has been posted  related to isolation and care guidelines, daily cleaning list, supply tracking form and a parent teaching handout, as well as new screening guidelines.
• Please click here for a video message from Dr. Maloney for April 1, 2020.
• Watch this helpful video from Mike Vance, Behavioral Health, on tips for effective, caring work behaviors during the COVID-19 pandemic.
• Watch a helpful video from Sarah Klein, Behavioral Health, on tips when working at home during the COVID-19 pandemic

Effective April 2, Children’s is changing its visitation policy. Only one visitor will be allowed at a time to any facility. Two caregivers will continue to be designated as visitors for each inpatient child; however, only one may visit at a time. Exceptions will be made for end-of-life care (including critical care patients at the discretion of Incident Command), neonates with their mother if less than 72 hours post-partum, or if there is complicated discharge training or rooming in.

In addition, no sick caregivers will be allowed on our premises. If a parent is symptomatic, another caregiver should accompany the patient. If a caregiver with symptoms arrives with a child at the Emergency Department, Respiratory Access Center (RAC) or any other location, they will be masked and wait for another caregiver to arrive.

Children’s Physicians is temporarily restructuring its visit structure. The restructuring goes into effect immediately with full implementation by Monday, April 6, and will continue through April 30, or whenever we can safely return to normal practices. As part of this restructuring, we will divide our offices into well-check locations and infectious sick-visit locations, minimizing infectious patients being seen at all clinics.

Well-Check Appointments 
Well-check appointments – both urgent and routine – will be held at the following locations:

• Bellevue – 4802 Shannon Drive, Bellevue, NE
• Dundee  – 4825 Dodge St.
• Eagle Run – 13808 West Maple Road
• Mission Village – 16909 Q St.
• Spring Valley (scheduled appointments only) – 4104 S. 50th St.

Infectious Sick Visits
The offices listed below will be designated for sick visits:

• Creighton – 2412 Cuming St., Suite 103
• Dundee Flats – 4835 Dodge St
• Val Verde – 9801 Giles Road, Suite 1
• West Village Pointe – 110 N. 175th St.

We are directing patient families to call their home Children’s Physicians office to make new appointments. Home office staff will assist them in scheduling the appointment at their new location. We have done our best to make the new location nearest to the patient family’s original home office.
 
Children’s Physicians, Council Bluffs,  Plattsmouth and Kearney offices will continue operating with well-check appointments during the morning and sick visits and walk-in visits in the afternoon. Children’s Physicians, Gretna, Embassy Park and UNMC offices will temporarily close. Staff members are contacting patient families who have April appointments scheduled at these locations with rescheduling options.

Children’s Physicians will continue to strictly screen individuals before entering our offices. All appointments to our offices will be limited to the patient, accompanied by one adult. We realize there may be necessary exceptions.

Children’s team members with questions or concerns about COVID-19 should call the Employee Health at 402.955.6020 and select option #9. This line will now have coverage Monday through Friday, 7 a.m. to 4 p.m. For non-urgent needs, please leave a message and you will be contacted the next business day. For urgent needs, please contact the House Supervisor at 402.955.7901. Please don’t hesitate to reach out to Employee Health; we care about you and we’re here for you!        

Feeling Sick at Work? If a health care worker develops a fever and/or respiratory symptoms while at work , they must notify their manager, remove themselves from campus, self-isolate and call the Employee Health COVID hotline at 402.955.6020 (option #9, please see details above).

• Employees: please do not come to the Employee Health clinic if you have a fever, cough, shortness of breath or sore throat.
• Managers: please do not send your employees to Employee Health if they are experiencing symptoms of COVID-19.

Our world and our work are changing rapidly every day, and we are all doing our best to evolve and adapt to new realities brought about by the COVID-19 pandemic. One challenging reality is that, as COVID-19 cases continue to escalate in our community, it stands to reason that health care workers—employed by some of the largest organizations in our city—will be affected. We are all human, and this virus is stealthy; as is well-documented, many with COVID-19 are asymptomatic for the duration of illness or for a  period of illness.

External Communication Approach

Our colleagues at Nebraska Medicine were the first to alert media that they had a caregiver with a presumptive positive test. When we announced a provider had received a positive test last week, we followed suit; there was precedent in our community and at children’s hospitals nationwide for this kind of proactive release. However, with a significant increase in cases in our city and state, communication leaders at local health systems have agreed that we will no longer distribute proactive, external releases about our physicians, providers or employees who are self-isolating or have a positive COVID-19 test. If asked by a reporter to confirm information, each health system will follow its own protocol or preference in responding.

This played out this evening, Tuesday, March 31, as Children’s was contacted by KETV to confirm information they had received about a Children’s team member testing positive for COVID-19. We responded in a brief, broad and accurate manner with the approved statement below:

Yes, we can confirm that.

As COVID-19 cases continue to rise in our community and health care workers are affected, our hospital epidemiologists, working with our Employee Health and Infection Prevention teams, respond to staff and patient exposures based on the CDC’s defined categories of risk and individual levels of contact. This response includes communicating closely with patients and staff members who come in contact with a positive individual and advising them on proper precautions to take. Patients will be closely be monitored for signs and symptoms of new illness, particularly fever and cough.

Our  top priority is the safety and health of our patients, families, staff and fellow community members. Like every health care organization at this challenging time, we are working diligently to prevent the spread of COVID-19 and protect our community.

While public health agencies have a different role and responsibility in disclosing case totals and details, our current external communication approach will be guided by what information is necessary, helpful and of service to our community and to our team. We will balance our desire to be transparent with the obligation to protect our staff, patients and families and stay focused on our critical work. At Children’s, we also recognize our obligation to protect the privacy and health information of our employees. The law protects this—and that does not change because of this pandemic.

Internal Communication Approach

When a staff member has tested positive for COVID-19, our response is anchored by what is safest for our patients, families, team members and community.

Children’s Employee Health and Infection Prevention teams, as well as our hospital epidemiologists, will  respond to staff and patient exposures based on the CDC’s defined categories of risk and individual levels of contact. This response includes communicating closely with patients and staff members who may have been affected and advising them on proper precautions to take.

As we conduct this process and investigate the extent of exposure, all individuals involved will be reminded that the name of the employee/patient is confidential and protected by HIPAA. If you learn that a member of the workforce has tested positive outside of this confidential process, please do not share the name of that individual with others, even if they disclosed it to you.

Please adhere to—and trust—the policies and procedures we have put into place for the safety and protection of our patients, families, staff and community. We are all responsible for protecting each other at this unprecedented time—and treating others how we would want to be treated. That’s the thinking behind social distancing, and that’s our intention as we navigate COVID-19 together.

Thank you for the important work you are doing to serve and care for our community.

What Everyone Needs to Know for March 31, 2020

• Children’s team members with questions or concerns about COVID-19 should call Employee Health at 402.955.6020 and select option 9. This line is covered Monday-Friday, 7 a.m. to 4 p.m. For non-urgent after-hours needs, leave a message and you will be contacted the next business day. For urgent needs, contact the house supervisor at 402.955.7901.
• If a health care worker develops a fever and/or respiratory systems at work, notify your manager, remove yourself from campus, self-isolate and call the Employee Health COVID-19 hotline at 402.955.6020, option 9. Please DO NOT come to Employee Health if you have a fever, cough, shortness of breath or sore throat. Managers, please do not send employees to Employee Health if they are experiencing symptoms of COVID-19.
• Patients and parents who may present with respiratory signs and symptoms may be given one mask each for a required visit. Hospital ear loop masks will be reserved for Children’s staff, as well as for those that require one due to symptoms.
• As Methodist moves to a strict no visitor policy effective April 1, please note Children’s staff will no longer have access to Methodist’s cafeteria. Please use Children’s cafeteria for your dining needs.

What Everyone Should Do for March 31, 2020

• Review updated patient processes related to COVID-19. Visit the COVID-19 intranet page, then click on the Patient Care Processes button. A new process has been published related to COVID-19 admission unit placement guidelines. View the document here.
• Please click here for a video message from Dr. Maloney for March 31, 2020.
• Please return empty hand sanitizer bottles to Central Supply daily.
• Children’s second clinically-focused, virtual Town Hall will be held Wednesday, April 1 at noon to address questions and concerns specifically related to COVID-19 and patient care. Dr. Christopher Maloney and Dr. Kari Simonsen will share answers and guidance based on questions submitted. Updated login information can be found on myChildren’s and The Pulse.

Children’s requires providers to complete training on prescribing opioids to ensure safety and compliance with Nebraska’s Legislative Bill 931, which aims to limit opioids for children ages 0 to 18. CMEs can be obtained via the intranet for those who prescribe opioid medication. The deadline for 2.5 CMEs in opioid education and 0.5 CMEs in prescription drug monitoring program is Oct. 1. Contact Jessica Goeller, D.O., Pediatric Anesthesiology, with questions.

CME opportunities available via Children’s intranet. If you have access to Children’s intranet, read more here.

Children’s Pharmacy & Therapeutics committee has voted to restrict the inpatient utilization of anti-infective medications (Kaletra (lopinavir/ritonavir), hydroxychloroquine and remdesivir) for off-label treatment of COVID-19-positive patients to Children’s Infectious Disease division. Epic is being updated to notify providers of the restriction. These medications will require an indication and stop date to be consistent with Children’s standard of practice for other anti-infectives. If you have an inpatient who tests positive for COVID-19 and are considering using  these medications, please page the on-call Infectious Disease attending physician at 402-888-1127 for an urgent consult. 

Children’s Pharmacy is also keeping track of its supply of albuterol inhalers and nebulizers, and reporting inventory to Incident Command daily. Currently, the pharmacy continues to be able to purchase these medications and the supply is good.

Children’s is taking precautionary measures to control the spread of COVID-19 while ensuring CDC guidelines for social distancing are followed. Because some certification renewal courses such as PALS and PEARS through Children’s have been cancelled, the American Heart Association (AHA) has granted a 60-day extension on certification renewals. The extension may be further extended, based on the evolving COVID-19 public health situation. If you have a life support certification that lapses during this time, and you are unable to renew due to a course cancellation, your privileges will not be impacted. The Clinical Education department will contact you via email as soon as the renewal course(s) have been rescheduled. 

Congratulations to Donny Suh, M.D., MBA, who has been nominated for the position of chairperson-elect of the American Academy of Pediatrics Section of Ophthalmology. The elected section leaders will take office on Nov. 1, 2020.

Read more here