The Pulse

Tim Jacoby, vice president of Construction and Real Estate, has announced his resignation, effective Aug. 7. Tim led Children’s Facilities division, ensuring compliance with the Joint Commission and other regulatory standards, and expanding Children’s physical footprint in a variety of ways, most notably the development of the Indian Hills Campus and the Hubbard Center for Children. Tim is going to San Diego to serve as the corporate vice president of Facilities with Scripps Healthcare in San Diego, which brings him closer to his family in the area.

A transition plan is being developed while we work with CBRE to support the construction of the Hubbard Center for Children and conduct a search for his replacement.

Please watch this week’s COVID-19 video, featuring Kari Simonsen, M.D., pediatrician-in-chief, reminding us to use face coverings while coming in and out of the hospital, as well as out in public. She also announces more testing will be available to surgical and pre-surgical areas.

Just Kids Health, a podcast from Children’s, has been created to help keep children healthy, safe and strong. During this unprecedented time, Children’s experts respond to parents’ important questions surrounding COVID-19 and discuss families’ concerns in these podcasts, intended as a resource for families. 

In the latest in a series of episodes dedicated to the mental health of children, we talk to Children’s Behavioral Health experts, Sean Akers, Ph.D., and Jennifer McWilliams, M.D., Behavioral Health, about depression. When and why does it develop? And perhaps most importantly, what resources are available to seek clinical help for a child.

Listen here

Ketamine
The Nebraska State Board of Nursing has released an advisory opinion stating registered nurses (RN) may administer Ketamine for moderate sedation. Previously, the RN could only administer Ketamine for intubation purposes with direct supervision by the provider, or to an intubated, ventilated patient in intensive care. The provider performing the procedure must have competence and credentialing in advanced airway management, including emergency intubation and the ability to abandon the procedure and rescue the patient from unintended deep sedation or general anesthesia. All other assessment and monitoring requirements remain in place.

Other updates

• The policy applies to all ages in the intensive care setting (previously > 6 months)
• The pre-sedation assessment for patients in the intensive care setting is not applicable due to frequency of assessments and continuous monitoring

For patients receiving intranasal or intramuscular moderate sedation, a peripheral IV (PIV) is recommended but not required.  If the PIV is placed, it should be maintained until the patient is no longer at significant risk for cardiorespiratory depression.

Read the policy

“Open”

“Because”

As more test platforms and supplies have been secured, Children’s is now offering expanded testing opportunities for our patients. Starting the week of June 29, Children’s is expanding testing opportunities for symptomatic and asymptomatic patients (pre-operative, procedural, inpatient and outpatient). Contact Chris North, Lab, or Jiri Bedrnicek, M.D., Pathology, with questions. 

Click here to read the SARS-CoV2 Patient Testing Guidance, which includes an Epic ID number for reference.  Preference lists will be automatically updated as testing becomes available.

In addition, Children’s continues to identify strategies to safely increase the number of patients able to undergo procedures and surgeries via additional testing opportunities for surgical patients. 

• Starting June 29, Children’s requires COVID-19 testing on all patients requiring general anesthesia.  
• Surgical Services will use the Sofia Antigen test for all pre-op/procedure patients. This method ensures real time testing prior to the procedure and provides timely results.
• The Antigen test will replace the PCR testing in asymptomatic pre-op patients. 

* Antigen is generally detectable in upper respiratory specimens during the acute phase of infection. Positive results indicate the presence of viral antigens, but clinical correlation with patient history and other diagnostic information is necessary to determine infection status.

Read the Surgical Services COVID-19 Testing FAQs

What Everyone Needs to Know for June 24, 2020

• Starting today, COVID-19-specific communication will be shared via Children’s internal communications channels, MyChildren’s (for employees) and The Pulse (for medical staff), instead of through regular emails to all staff. This change in cadence reflects the decommissioning of Incident Command, fewer and less urgent COVID-19 updates and how the pandemic has become part of our everyday reality at work. We will continue to use email when there are important, time-sensitive updates that all staff need to know. Please check MyChildren’s, The Pulse and Children’s internal COVID-19 page for information going forward.

• Operational committee work continues to guide Children’s response to COVID-19, and our dedicated COVID-19 inbox continues to be a resource for staff. Please email covid@ChildrensOmaha.org with specific questions or concerns.

• Update to COVID-19 respiratory specimens processing – Respiratory specimens must be hand-delivered to the laboratory for processing. However, this does not apply to pre-op testing specimens, because these aren’t specimens of patients under investigation (PUIs). You can review the full CDC recommendation on myChildren’s and The Pulse.

• Universal Masking for Non-Clinical Areas

When and where should I wear my mask as a non-clinical employee?

• All staff should wear masks upon entering the facilities, even on nights and weekends when staffing might be lower or you might encounter fewer people. Everyone should wear a mask in public places and common areas such as entrances, lobbies, bathrooms and elevators.

Where can I take off my mask?

• An individual in his/her workspace (lab, office, cubicle, etc.) must wear a mask unless they are at least 6 feet away from any other person.
• If you are in an office and someone enters to converse, both individuals must wear a mask unless they are able to maintain the proper distance.

How can I eat or drink when I am supposed to wear a mask?

• Eating and drinking is permitted in limited areas. To drink or eat, ensure you are 6 feet away from others, perform hand hygiene, remove the mask, drink/eat, perform hand hygiene and replace your mask.

Who can I call if I have questions about the best mask for me to wear?

• Remember that the work that you do may determine the type of mask you should wear. Ask your supervisor if you have questions.

• Self-Monitoring and Testing for ALL Employees

When should I not report to work and call Employee Health and my Supervisor for further direction?

• If you have symptoms consistent with COVID-19, such as a fever greater than 100.0, sore throat, shortness of breath or a loss of sense of smell or taste.
• If you have been in contact with anyone in or outside of your household who has been exposed, or is currently being tested for COVID-19.
• If you are being tested for COVID-19 due to an exposure or are symptomatic.

If I am being tested do I need to stay home from work?

• Yes – if you or anyone you have come in prolonged close contact with in the last 14 days is being tested due to symptoms of COVID-19 OR you have been exposed, please follow up with employee health and do not report to work.
• If you are being tested through Test NE for data purposes but are asymptomatic and have had no known exposure, you can work with the universal mask policy. 

• Travel Reminders

Business-related travel at Children’s remains on hold at this time. The CDC recommends you stay home as much as possible, especially if your trip is not essential. Even at home and in your local community, practice social distancing, especially if you are at higher risk of severe illness. Don’t travel if you are sick and don’t travel with someone who is sick. If you have to travel outside of your local community, please see the CDC’s travel guidelines here. If you do choose to travel, here are some guidelines:

• Please follow any state and local travel restrictions currently in place. It is possible that some state and local governments may put in place travel restrictions, stay-at-home or shelter-in-place orders, or mandated quarantines upon arrival or even state border closures while you are traveling. For more information and travel guidance, check with the state or local health department where you are, along your route and at your planned destination. Just because there are no restrictions at the time you plan to leave, that does not mean there won’t be restrictions in place when you arrive.
• Domestic Travel (outside of your local community) – At this time, you will not be required to quarantine for a period of time upon return to work, as long as you are symptom-free, i.e. no fever, cough or shortness of breath, loss of sense of smell or taste and follow the Universal Masking standard initiated on March 31, 2020.
• International Travel OR Travel by Cruise Ship – Nebraskans returning home from international travel (should self-quarantine and self-monitor for 14 days upon return/arrival. Every healthcare worker who returns from international travel should continue to notify Employee Health upon return for return to work instructions.   DHHS reference can be found here: COVID-19 Traveler Recommendations.

Zebulon (Zeb) J. Timmons, M.D., has been named division chief of Pediatric Emergency Medicine. Prior to joining Children’s, Dr. Timmons held several roles at Phoenix Children’s Hospital, including director of Quality and Safety – Emergency Medicine, vice-chair of Pediatric Emergency Medicine, medical director for Sepsis Care and associate director of Patient Safety and Quality. He will join Childrens on Aug. 1.

Dr. Timmons received his medical degree from Creighton University School of Medicine. He completed his Pediatrics residency at Rush Medical College in Chicago, and his fellowship in Emergency Medicine at Phoenix Children’s Hospital. He is an assistant professor of Pediatrics at UNMC College of Medicine.

The American Association of Critical-Care Nurses (AACN) recently conferred a silver-level Beacon Award for Excellence to Children’s NICU. The Beacon Award for Excellence — a significant milestone on the path to exceptional patient care and healthy work environments — recognizes unit caregivers who successfully improve patient outcomes and align practices with AACN’s six Healthy Work Environment Standards. Units that achieve this three-year, three-level award with a gold, silver or bronze designation meet national criteria consistent with Magnet® Recognition, the Malcolm Baldrige National Quality Award and the National Quality Healthcare Award. Congratulations to Children’s NICU team for working together to meet and exceed the high standards set forth by the Beacon Award for Excellence!

The committee is trained to assess, document, investigate and manage violent threats and security risks to the organization, applying a consistent framework in order to secure the safety of all Children’s employees, providers, visitors, families and patients. They are trained to classify threats as Low, Medium or High Level, and address accordingly. Committee members are available to consult with and provide support to providers, staff, visitors, family members and patients.

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