Snapshots of COVID-19 in the Field: Relias Experts Share Firsthand Experiences

Because Relias depends on the expertise of many hands-on experts working in the healthcare field, we wanted to see how they are faring as they work to deter the coronavirus disease outbreak. We care about our subject matter experts who care for others, so we checked in to get their firsthand insights.

Our healthcare experts contribute to Relias by writing our courses, peer reviewing our content, field testing new education modules, and more. They ensure that our products meet our clients’ real needs, not just those we can anticipate via strategic research.

Therefore, as we continue to seek understanding of the current state of preparedness and response to the COVID-19 pandemic across the U.S., we naturally sought the perspectives of the healthcare experts allied with Relias.

We will share a few of those firsthand accounts with you so that you can see some snapshots of how COVID-19 has affected their lives and their contributions to diagnosing the disease, hindering the spread of the virus, and treating those who need care.

ICU RN, east coast hospital system

Updated April 6, 2020

I work at a large east coast hospital system in the ICU, and our precautions and policies have been evolving rapidly. Staff have been told to prepare for “80% of the staff to contract the virus.” Anxiety levels are high, and personal protective equipment (PPE) supply is low. I will try to summarize how things have progressed over the last few weeks.

Visitors

Three weeks ago, our hospital began restricting visitors to one support person per patient in the building at any given time. As of two weeks ago, NO visitors are allowed on the premises. Exceptions are being made on a case-by-case basis in the pediatric hospital, birthing units, or at the end of life, with a strict screening process required for any support person.

Clearing Out, Preparation

Elective surgeries and procedures have been cancelled, and the hospital where I work is preparing by emptying beds as much as possible. Our ICU has been designated a COVID-19 unit, and HEPA air filters have been installed in each room window to convert them all (12 beds) into negative pressure rooms for airborne isolation precautions. Another 28-bed unit has been designated a COVID-19 unit for confirmed cases or persons under investigation (PUI) for COVID-19. Plans are in place to convert two other units when and if they are needed. No COVID-19 patients are allowed on our third floor at this time, as it is designated for surgical patients. We are not yet at capacity but are seeing patients both young and old, with history or without, becoming critically ill as a result of this virus.

Staff

Three weeks ago, staff were instructed to only use our designated staff entrance. Initially, screening of each staff member was done at the start of each shift by a member of the management team to confirm staff were without symptoms and had no recent travel or exposure. Now, when a staff member ‘badges in’ it is assumed as an attestation that they are safe to work. Due to staffing shortages, staff are only to call out sick if they have a fever of >100°F. It is concerning that staff showing symptoms are still being asked to work if they don’t have a fever.

• A number of staff members have resigned as a result of feeling inadequately protected.
• Staff are fearful for their own safety as well as the safety of their family. Many have distanced themselves from loved ones and children. My 5-year-old niece has not seen her mother or father for three weeks.

Monitoring

“Hall monitors” are now required for each patient with suspected COVID-19 to monitor and document who is going in and out of the room. (This is simply monitoring for presence, not quality of PPE use or isolation measures.) In our staffing computer system, we have also implemented the use of a designated icon that is placed next to each staff member’s name who is caring for a patient on isolation related to COVID-19.

PPE

In the ICU only, we are using CAPR devices (full hood/shield covering over the head) for staff caring for anyone on isolation with a suspected or confirmed case of COVID-19. This is due to the increased risk of aerosolization in our unit related to intubations, procedures, and more advanced oxygen administration devices. Special training classes and online learning were required to review safe “donning and doffing” procedures, as well as training for “donning and doffing assistants.” We only have 6 CAPRs for our 12-bed unit that must be shared among staff. A foam comfort band is typically in the hood, which nurses were removing after each use and saving for reuse. We have now run out of those comfort bands, and nurses are having to use disposable feminine sanitary pads in their place.

• Contact precautions for MRSA have been suspended to preserve PPE, specifically gowns.
• Over the last few weeks, staff members have had to fight for the right to wear masks throughout their time at the hospital. They were only allowed to don a mask if they were entering a specified COVID-19 room. As of April 2, staff can now wear a loose-fitting surgical mask at all times. In the ICU, each staff member is given a brown paper bag with the person’s name on it, containing one surgical mask (labeled with name), and one N95 (also labeled with name). They are told to try to make them last for five days.
• N95 masks are being saved and cleaned for reuse using a UV sterilization process.

In general, cleaning of workspaces, phones, hardware, and so on has increased dramatically. We are all hyper-aware of our hygiene and everything our hands touch. A friend works as a nurse on a med-surg unit in the hospital (without CAPRs) and says the team members feel very unsafe with the limited PPE available to them currently, but they are actively trying to find solutions and support one another. Their unit has begun primary care for patients on isolation (meaning the RN is the sole provider, no nurse tech to assist with tasks), which has also been challenging.

The turnaround time for testing was initially WAY TOO LONG. Tests from our hospital were taking anywhere from 6 to 10 DAYS to come back with a definitive result. Meanwhile, patients were being transferred between units and moved throughout the hospital for testing and procedures with seemingly inadequate precautions. To us, this was RIDICULOUS, considering another test was available locally at another hospital system that provided results in four hours. As of April 1, a 24-hour test finally became available, and all previously tested patients or staff were retested.

In my opinion, the public and government officials should be aware of the inconsistencies in testing abilities and staff protection between healthcare institutions. If a hospital 20 miles down the road can receive test results more quickly, the technology should be shared for the greater good of society. If another local system is requiring or allowing staff to wear masks, the same protection should be given to staff everywhere. Ideally, I would think the government should mandate the sharing of capabilities and policies between facilities. The facilitation and funding for the rapid production of more effective tests and PPE should be a priority if we are truly going to make a difference and decrease exposure and spread of this virus.

Nursing House Supervisor – PRN at a midwestern urban hospital

Updated March 27, 2020

I can’t share how many patients I’ve seen with COVID-19 or whether they’ve been admitted to the hospital. But I can say that the majority of symptomatic patients have come back negative after a precautionary period.

The anticipation of what might or likely will come and the fear and anxiety are what has staff I work with up at night. The unknown of what’s to come is the scariest at this point. There is so much information out there in the media, and coming from the CDC, from the federal government, and state government, and coming down from the organization we work for that it is hard to process it all. Then it is ever-changing and sometimes by the hour.

I think the fear of running out of resources, especially masks, is the highest. The information from the CDC a few days ago saying that a “bandana” would be a suitable substitute for a surgical mask confused them.

I don’t think they grasped that the likelihood of having no other options was very real. Instead, this looked like a devaluing of their safety. It was hard to process that it may get that bad and is that bad in some places of the world and country.

The management teams are flat-out exhausted. They’ve been working 80-plus-hour weeks to prepare new workflows, processes, and policies for an unprecedented scenario with an ever-changing expectation. The team I work for had an impromptu meeting from 2 a.m. to 5 a.m. simply because none of them could sleep and all realized they were up and emailing each other anyway…so they decided to conference call.

It is really sad because all of this work is barely alleviating the fears of their staff. Sadly, as new information becomes available and the leadership teams adapt, the staff doesn’t even see the work that is being done to keep them safe. To the staff, it looks as if management doesn’t know what to do.

The truth is that the ladder of information has hundreds of rungs above their managers, and they are only one rung below them. Trying to receive the tidal wave of information and package it safely for an unknown situation is so impossible that tensions and stress are very high.

I think we will see a new era of resource management, especially in the realm of disposables, following this pandemic. For example, consider what an expiration date means on an unopened box of masks and how they’ve been thrown away by the case in former instances (or shipped to third-world relief centers). I would presume we will see mandatory stockpiles and conservation as we’ve never done. Previously, we used the “when in doubt, throw it out” mentality when evaluating whether something was used, soiled, or contaminated. Now we have to be much more careful and even be aware of potential reuse scenarios of many of these products.

Lab tech in a midwestern state

Updated March 26, 2020

I can only speak for a small physician’s lab here. So far, we have no cases of COVID-19 isolated here.

Our town of about 50,000 has been very proactive. Schools were closed due to spring break, and students never went back after that. Our health department has tested five people and all came back negative. All tests at the health department are sent to the state public health lab, and results come back in 24 to 48 hours.

Testing privately is also available through our lab as a send-out. It runs about $200, and specimens are sent to a lab on the east coast, as our usual consulting lab is overwhelmed. Any lab that completes these tests must have special biosafety equipment (cabinets).

Because we are low on the M-4 media that the sample swab is stored in, they are now accepting flocked swabs in sterile saline.

The CDC has recommended that only patients come to the clinic, and that they not bring healthy family with them. Temperatures are taken upon arrival, and anyone with an elevated temp is given a mask and removed from the waiting area. There is now a separate entrance and waiting area for patients on immunotherapy or chemotherapy.

Healthy clinic and lab are in the mornings, and sick clinic in the afternoons. Nonessential medical appointments (refills and follow-ups, mole removal, wellness, and so on) have been rescheduled for two months and beyond.

Early on, the hand sanitizer (attached to the wall) disappeared from all the exam rooms! Theft of masks has been an issue as well.

No walk-ins are allowed for lab during sick patient hours. Patient samples for COVID are taken in a separate room, with PPE (including N95 mask) and disinfection after each patient with suspected infection. Nothing is reused for any patient.

COVID testing is limited to those who show symptoms of fever and difficulty breathing, and have history of exposure risk. This is because of the limited supply of sample kits. More kits are coming, though.

Influenza A and B are screened, as it is still flu season, and there are positives here for flu.

We are staying upbeat, and taking this one day at a time!