Staff Instructions for COVID-19

April 6, 2020

Good morning.  Coronavirus cases in the US continued to climb over the weekend.  Almost 340,000 cases have been diagnosed in the US.  In North Carolina, there are 2978 cases and 39 deaths.  There are 261 patients hospitalized across the state.  The surgeon general is predicting a large increase in cases and deaths across the US this week.  In North Carolina, although we continue to see many new cases, it also looks like the rate of increase is slowing, perhaps pointing to some success of social distancing.

 

As mentioned in my update on Friday, the UNC Program on Integrative Medicine would like to contribute to our staff wellness program by offering PHS employees a virtual gentle yoga and mindfulness meditation opportunity.

 

To start, they will host a daily practice on Zoom from 7:30am-7:55am Tuesday-Thursday of this  week.  This first week will be a trial run, and participants will be asked to give feedback so that the offering can best meet the needs of PHS employees.

 

Leading the brief, simple sessions will be professor Susan Gaylord, PhD, an experienced mindfulness instructor, and Isabel Roth, DrPH, a registered yoga teacher and current postdoctoral fellow.

The practices will consist of a brief check-in, and a combination of mindfulness and gentle yoga practices. No previous experience with yoga or mindfulness practice is needed. 

Comfortable clothing is recommended. Participants are recommended to find a quiet spot to practice, with a chair available, and either a mat or carpeted area for practicing. If any pillows, blankets, or yoga props are available, participants are recommended to keep those nearby.

 

To participate, participants must complete a simple waiver by going to this link: https://unc.az1.qualtrics.com/jfe/form/SV_4Uiv1skmKEA7xZj  (signing the waiver produces the Zoom login info, and Zoom appointments for the week will be sent to the email you provide).

 

Any questions before Tuesday’s session can be directed to Isabel Roth who is cc:ed above.

 

I hope those who can will take advantage of this wonderful opportunity!

 

I also want to remind everyone that all staff in the clinical sites or in patient’s homes should be wearing masks.  We are hoping to build up enough supply of masks so that our patients can also wear them.  We are awaiting a shipment of touchless thermometers that will allow us to implement temperature checks for patients and staff entering our facilities.

 

We heard from HRSA on Friday that they will be distributing another round of funding to health centers in the next 1-2 weeks.

 

Hang in there—it’s only a 4-day workweek.

 

Abby

 

 

Abigail DeVries, MD |Chief Medical Officer

March 31, 2020

Good morning everyone.  This will be my last daily update for a while.  The amount of changing information seems to be slowing and I will be working with senior leadership and Jen Costello on a new communication strategy.  We now have an email address, covid@piedmonthealth.org, where you can direct questions or comments that you would like addressed.

 

  1. If you are sick, do not come to work. Contact your supervisor, who will help you get in touch with the employee health provider at your site. They will determine if you need testing for coronavirus. If the test is negative you can come back to work and continue to use a mask. If the test is positive, you will need to remain isolated until one of the following criteria is met: At least 7 days since symptom onset and ≥72 hours after symptom resolution (absence of fever without the use of fever-reducing medication and improvement in respiratory symptoms).

 

  1. In order to protect all of you, we are continuing to try to limit the number of staff in the building.  If you don’t need to be in the building, please work with your supervisor ASAP to get set up to work at home.  If you are working at a clinical site, you must wear a surgical mask while you are there—this protects you as well as other staff and patients that you come in contact with.  This is a CDC recommendation.

 

  1. Thermometers—The CDC also recommends that we check temperature on all staff and patients entering our building.  We want to implement this procedure as soon as we have supply.  We currently do not have enough probe covers and are unable to purchase touchless thermometers as they are out of stock.  If any staff are able to donate one to their site, please let us know!

 

  1. For providers doing telehealth, there is now a jointly-monitored email address, Telemd@piedmonthealth.org, that you can use for patients to send you photos if needed.  Patients should include their name and date of birth with the photo.

 

  1. Infection control tips, from Aletta:
    1. How can I care for a family member with the coronavirus disease at home? Avoid sharing personal items like food and drinks. Provide your sick household member with clean disposable facemasks to wear at home, if available, to help prevent spreading COVID-19 to others. Clean the sick room and bathroom, as needed, to avoid unnecessary contact with the sick person.
    2. Get Your Household Ready for Coronavirus Disease 2019 https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/get-your-household-ready-for-COVID-19.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprepare%2Fget-your-household-ready-for-COVID-19.html

 

  1. The most recent stimulus bill passed by Congress extended health center funding through October and contained an additional $1.32 billion dollars in emergency funding for health centers.  We are awaiting details on this funding.

 

Thank you all,

Abby

 

 

Abigail DeVries, MD |Chief Medical Officer

March 30, 2020

Good morning everyone.  North Carolina coronavirus cases are approaching 1200.  The governor’s stay at home order takes effect tonight for those counties not already under a local order.

  1. The state issued new guidance over the weekend regarding testing.  Most notably, we no longer need to fill out the PUI form; however, we still need to notify the county health department.  They also updated the criteria for sending specimens to the state lab.  This includes:
  2. Hospitalized patients
  3. Healthcare workers or first responders (e.g., EMS, law enforcement, fire department)
  4. Patients who live in or have regular contact with a high-risk setting (e.g. long-term care facility, homeless shelter, correctional facility, migrant farmworker camp)
  5. Persons who are at higher risk of severe illness and for whom a clinician has determined that results would inform clinical management
  6. Referring to Healthlink for a faster turnaround time is also an option.
  7. This week our top priority is firming up our telephonic workflow and creating access for our CHC patients.
  8. This NY times article gives some practical advice about what you can do to stop the spread: https://www.nytimes.com/interactive/2020/world/coronavirus-preparation-preparedness.html?smid=em-share
  9. And for those of you looking for childcare options, here is a resource: https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/N/NC_Emergency_Child_Care_Operations_Guidelines_Application_Form_03252020.pdf?ver=2020-03-25-203439-153.
  10. For folks looking to do something more, you can DONATE BLOOD: In healthcare settings all across the United States, donated blood is a lifesaving, essential part of caring for patients. The need for donated blood is constant, and blood centers are open and in urgent need of donations. CDC encourages people who are well to continue to donate blood if they are able, even if they are practicing social distancing because of COVID-19. CDC is supporting blood centers by providing recommendations that will keep donors and staff safe. Examples of these recommendations include spacing donor chairs 6 feet apart, thoroughly adhering to environmental cleaning practices, and encouraging donors to make donation appointments ahead of time. Thanks to Aletta Prinsloo for this suggestion.

Thanks,

Abby

 

Abigail DeVries, MD |Chief Medical Officer

March 25, 2020

Good morning everyone.

 

  1. Yesterday we received an additional $132,900 in grant dollars from HRSA.  We expect additional dollars once the next stimulus package is passed by the legislature.

 

  1. We are excited to offer pharmacy delivery services as one method of medication access to our patients.  We will be ramping up this offering in the coming days/weeks – please refer any interested patient to the pharmacy staff who will work with them to determine the best method of medication delivery – this may include onsite pharmacy pickup, mailing medications and/or home delivery services.  We want to maximize efficiency while making sure every patient has access to their medications, therefore pharmacy staff may work with patient to fill all available meds prior to arranging home delivery.  We will be billing via credit card over the phone for mailing and home delivery, and during this health crisis, we can coordinate this service without requiring patient signature at the time of delivery, thus reducing exposure to patients and staff.  Please contact Carl or Kelly with questions. We are all prepared to work with patients to take care of their medication needs.

 

  1. Telehealth workflows continue to develop.  Several sites have had good success with the team approach, most notably Prospect Hill.  Tune in for a repeat of the training webinar today at 8:15 if you missed it Monday.

 

  1. Please continue to monitor yourself for any symptoms of coronavirus and stay home if you do not feel well.  For those staff who have a thermometer at home, twice daily temperature checks are recommended.  If you do not, it’s just as important to note any cough or body aches.

 

  1. Please also continue practicing social distancing at work and at home.  We continue to focus on getting as many staff as possible set up to work at home to decrease the number of people at each location.

 

  1. Last, it seems like we have been operating in this disruption for months, but it’s really only been 2 weeks.  Stress levels are high amongst each other, our patients, and the community.  We are all drowning in emails. We are starting to feel disconnected from the people we used to spend hours with face to face.  You can’t read body language in an email or phone conversation, making it more likely to misinterpret each other.  Please take a deep breath before sending an email in frustration and try to see the best in each other. We welcome thoughts on how to stay connected and will be planning more frequent all-staff webinars (up next—Thursday at noon).  Consider ways your site or department can stay in contact.

 

Last night, our board (in their virtual meeting) gave you all a round of applause for your hard work and dedication. Thank you for all you are doing.

 

Abby

 

 

 

Abigail DeVries, MD |Chief Medical Officer

March 24, 2020

Good morning everyone.

 

Yesterday, the state issued new guidance on testing criteria as well as isolation and quarantine.  These were forwarded to the organization.

 

Specifically, DHHS is recommending that:
People with mild symptoms consistent with COVID-19 do NOT need testing and should be instructed to stay at home to recover.  Mild symptoms are defined as fever and cough without shortness of breath, difficulty breathing, chest discomfort, altered thinking, cyanosis.  We should test patients for whom clinical management would be different if they were infected with COVID-19; patients in high-risk settings (e.g., congregate care settings, long term care); and health care workers and first responders.

 

Sharon Reilly has gotten clarification from the state that we should also continue to test PACE participants with symptoms.

 

We plan to continue seeing patients with respiratory issues who need additional evaluation at our four respiratory sites AFTER they have had a telehealth visit with a provider at their home site.  The majority of patients with respiratory symptoms should be able to be cared for via telehealth. DHHS strongly recommends telehealth and we continue to implement this process across our CHC sites.

 

The recording of the telehealth webinar is posted on the R:drive under the COVID folder, telehealth subfolder.

 

Thanks!

Abby

 

Abigail DeVries, MD |Chief Medical Officer

March 23, 2020

Happy Monday, PHS.  I hope you were all able to get some rest and relaxation over the weekend.

 

North Carolina continues to see increasing numbers of patients with coronavirus.  We now have cases diagnosed in Alamance, Orange and Lee Counties, in addition to Chatham County.  More importantly, they have documented community spread, meaning they have diagnosed 2 individuals with coronavirus who don’t have a traceable exposure.  This will lead to some updated guidance from the state on who should get tested.  It also highlights the importance of social distancing, because anyone you come in contact with could be contagious.

 

Just two important announcements today.

 

  1. Tune in at 8:15 for a webinar on telehealth, especially if you are scheduled to participate in these visits this week.  There will be a recording and likely another live training for those unable to listen today.

 

  1. Starting this morning, all patients calling the health center with any kind of respiratory complaint (runny nose, sore throat, cough) or a fever will be given a telehealth appointment first.  If the provider determines an in-person assessment is needed and they have respiratory symptoms, they will be given an appointment with one of our Respiratory Care Teams (at Siler, Moncure, Carrboro or Burlington).  We will make every effort to keep patients with mild symptoms at home to decrease our exposure risk.

 

Thanks,

Abby

 

 

Abigail DeVries, MD |Chief Medical Officer

March 19. 2020

Good morning. We continue to see increasing numbers of positive cases of coronavirus in the U.S. and in North Carolina.  So far, it appears that all cases in NC were linked to travel or close contact with someone who traveled.  We expect this to change very soon.  So far, none of the 60 or so coronavirus tests we have done have come back positive, but many are still pending.

 

Here are some updates:

 

  1. Please see attached advice from Beth Childs about self-care during this challenging time.

 

  1. Our guiding principles for patient/participant care are as follows:

Anyone who does not absolutely need a face-to-face visit needs to stay home, for their safety and ours.  Anything that can wait, should wait.  For visits where the risk outweighs the benefit, we want to have patients arriving at a center populated by as few people as possible (staff and patients) to reduce everyone’s risk of getting too close to someone.  Last, we need to see respiratory cases outside to reduce exposure and conserve PPE.  This is a pretty big deviation from our normal mode of operating.    I know it is challenging as a provider to decide which category the patient falls into.  Remember, our biggest priority is social distancing.  And, we have FTCA to back us up.

 

  1. Please continue to conserve PPE, especially masks.  Patients with fever and cough should be seen for car testing and not receive a mask.  Our hospital partners are scrambling to make sure they have enough masks and the fact is, there are not enough masks in the US right now.

 

  1. We will have another all-staff webinar tomorrow morning at 8 AM.

 

Thanks for all you are doing,

Abby

 

 

 

Abigail DeVries, MD |Chief Medical Officer

March 18, 2020

Good morning everyone.  There are now 65 cases of coronavirus in North Carolina.  Still none in our main counties other than Chatham.  PHS staff has ordered over 50 tests—many of those will be resulted today.

 

I’ve attached two documents—one about HIPAA and one about social distancing.  Social distancing is critical at this point to “flatten the curve” or decrease the spread of coronavirus.  It is especially important for healthcare workers—we will need you to stay healthy and you will be potentially an exposure risk to your family and friends.

 

A few additional comments:

  1. Telehealth is coming, we promise!  We are getting things finalized.  The good news is that telephonic visits that providers have conducted over the past few days can be back-billed if they meet criteria.
  2. Email etiquette—we are all drowning a bit in the amount of information being sent out by our staff as well as outside agencies.  Please do not reply all to any emails sent out to the whole organization.  In addition, please refrain from sending out information to the whole organization unless directed to do so by a member of senior leadership.  Thanks in advance.
  3. Car testing workflows are being standardized but have been very effective at several sites.  We anticipate continued testing for COVID-19 at Moncure, Siler, Burlington and Carrboro as staffing and supplies allow.
  4. Mental health—see email sent out by Maureen Kelly.  Look for additional information in tomorrow’s update as well.  Let’s take care of ourselves and each other.  My challenge to you today—move when you can.  Get up from your desk and stretch at least once an hour, take a walk at lunch or after work.

 

Thank you all,

Abby

 

Abigail DeVries, MD |Chief Medical Officer

Piedmont Health Services

March 17, 2020

First, I want to thank everyone for pulling together yesterday to implement some major changes in workflows.  I visited 6 sites and was thoroughly impressed with how staff are working together.  I know lots of challenges remain as we sort everything out.

 

We now have 38 cases in North Carolina.  None in Alamance, Orange or Caswell Counties.  All cases are still linked to travel or exposure to a case that traveled.  This means we still have not detected community spread.  PHS is ahead of the curve in our preparations to protect staff and find cases.

 

  1. PACE Centers now have most participants at home and are working on participant and family communication and home visits.
  2. CHCs are stopping patients at the door to assess for fever and cough.
  3. Several sites have experimented with COVID sample collection in the patient’s car, limiting staff exposure and PPE use.
  4. Sylvan is now closed with staff and patients now redirected to Siler.
  5. Sylvan, Scott, Prospect Hill and Chapel Hill will not be COVID testing sites at the moment.  Siler, Moncure, Drew, Burlington, and Carrboro will continue to test for now.  This decision was based on staffing, geography, and PPE supply.
  6. Tip tool coming soon (likely today) on how to do both telephone and video visits.  Several medical and behavioral health providers billed out telephone visits yesterday.
  7. Dental, Medical and WIC continue to cancel non-urgent (or, for dental, procedures with great exposure risk to providers) appointments to encourage patients to practice social distancing.  See updated grid for this.  We are now including 12 mo WCC and IUD or Nexplanon insertion.
  8. Once telehealth guidance is out, we will pivot to doing cold and allergy visits via telehealth rather than in person.  Some sites are already experimenting with this.

 

That’s it for now.

Thanks,

Abby

 

 

Abigail DeVries, MD |Chief Medical Officer

Piedmont Health Services

88 Vilcom Center Dr., Suite 110

Chapel Hill, NC 27514

Phone (919)-537-7489

Fax (919)-933-9201

Cell (919)-360-9093

devriesa@piedmonthealth.org

www.piedmonthealth.org

Pronouns:she/her

Update: Sunday, March 15, 2020 6:16 PM

All PHS Staff

For tomorrow, non-direct patient care staff should stay home and await further instruction.  If you are able to work from home, please do.  If not, we will work our way around to you to identify what work we may have for you to do.  If you are not sure if this applies to you, please ask your supervisor. You will need to use PTO for the moment.  Please be patient as we get things organized.  Our first priority is your safety.

Any staff, including those in direct care, need to stay home if they are in a high-risk group.  This includes staff who are 60 and older, pregnant, or have chronic medical problems including immunosuppression, heart or lung disease (asthma included) or diabetes.  If you think that you fall into this category but wish to report to work, you need to clear this with your supervisor.  There will likely be work that we can have you do, and we will communicate that plan as soon as it is ready.  Again, you will need to use PTO.

Tomorrow morning we will also begin screening all patients before they are allowed to enter the building to reduce the risk of staff coming into contact with a patient who has coronavirus.

The health and safety of everyone is the focus and commitment.  Please practice safe distance and hand washing for you and your loved ones.

CHC Staff

We are piloting testing patients for coronavirus in their cars.  This will begin at Moncure on tomorrow and be extended to additional sites as soon as possible.   We have established guidelines for essential services and will work with sites to implement these guidelines starting this evening.

PACE Staff

Unless a PACE staff member has to stay home for child care or is in the high risk group for COVID-19, PACE staff will plan to come to work at the PACE center tomorrow by 8:30am.  In Morning Meeting, we will explain the plan, as it currently stands, for tomorrow, the next few days, and the coming weeks. Some staff will work only part of the day tomorrow, but all staff will be paid for a full day.  Staff are asked to arrive at work through the front entrance, where a staff member will conduct screening, explain where to go in the center, and how to behave with respect to standard infection control practices for COVID-19.  Staff should not arrive at the center before 8am.

Abigail DeVries, MD |Chief Medical Officer

Piedmont Health Services

88 Vilcom Center Dr., Suite 110

Chapel Hill, NC 27514

Phone (919)-537-7489

Fax (919)-933-9201

Cell (919)-360-9093

devriesa@piedmonthealth.org

www.piedmonthealth.org

Letter from Brian Toomey, CEO, Piedmont Health Services, Inc

As you all know there are changes rapidly occurring regarding the Coronavirus and we need you all to stay connected to information from PHS via email and text.

We are currently finalizing a plan for the safest place for staff to work and for patients to get care.  We will start with the following:

  • Starting today, March 15, 2020, staff who are in the high risk category –( over 65, medical conditions that compromise immune systems, etc. ) -should stay home unless approved to come to work by their supervisor
  • If you have the capacity with equipment needed and the approval of your supervisor you can work from home beginning tomorrow
  • We are working with IT and leadership to ensure that we get equipment for staff that need it and instructions on how to stay connected and still comply with rules while working outside
  • It is clear that dental procedures using high speed drills etc. are very high risk and should be stopped. If clinical judgment concludes we need to do something for the patient, it can ONLY be done in an environment that will be safe and should NOT be done if there is any uncertainty. Safety first please
  • Please use technology but also still follow the rules regarding HIPAA including what can be sent via text and email now that people are outside the facility
  • Communication is very important and the most effective tool for us at this point
  • We are developing a plan to ensure that our patients can get their prescriptions but only doing so following precautions for safe distance. We anticipate having a plan for delivering medications that will not put our staff nor patients at risk
  • Jen and the IT department will make sure we have instructions for connectivity.  We know we do not have enough extra lap tops for everybody and are asking staff to consider using their home computer, if possible, once IT discerns we can do so safely and appropriately
  • WIC rules are being developed by the state and we will distribute them as soon as we get them.
  • IT and staff will discern how to connect Behavioral Health and Care Management staff virtually
  • PACE staff have developed an individual care plan for participants including home visits, phone visits, medications, referrals that is remarkable for its complexity, individuality and commitment
  • We will be working together much more so in the next few weeks using our PHS resources to ensure care to all of our patients
  • PRACTICE SAFE DISTANCE
  • HANDWASHING

 

What is clear is how humbled and grateful I am to be part of such a committed group – let us be safe and work together.

 

More to come

 

Gratefully

 

Brian

 

Brian Toomey, CEO

Piedmont Health Services,Inc

88 Vilcom Center Dr., Suite 110

Chapel Hill, NC 27514

Phone:  919.537.7494

Email: toomeyb@piedmonthealth.org

www.piedmonthealth.org

Adjunct Associate Professor

Dept. of Family Medicine

UNC School of Medicine

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