Though both chloroquine and hydroxychloroquine demonstrated potent. Use clinical judgement, but generally should be called with: Having concerning chest pain (particularly if non-pleuritic, exertional & relieved with rest, pressure-like). Plasma is now available through FDA emergency use authorization for any hospitalized patient with confirmed or suspected COVID-19. A new response team called Show of Support (SOS) Team will begin on April 1 for non-violent behavioral emergencies that can’t be resolved with a unit level response. However, during the remaining 4 days of quarantine, the person must: If the test result is negative the individual should continue with self-quarantine and monitoring as described below. Contact the non-emergent police line for that municipality. an initial screening there and those with any respiratory symptoms are sent to the RSC. More serious symptoms (fever, dyspnea, diarrhea, poor PO intake, etc). ** Droplet Precautions PPE: surgical face mask, gloves, ** Contact Precautions PPE: isolation gown, gloves, ** Eye Protection: face shield, goggles or mask with fluid shield. A dedicated team member outside the room will serve as the liaison between the team leader in the room and the pharmacist outside the room, using closed loop communication. Pediatric Senior Resident will bring a special COVID-19 filter for resuscitation bag and bag of back up PPE (8 face shields and 2 of each size N95 mask) to all RRT and Code Blue events. Nursing’s intent is to limit the wait time of the patient’s ride and to limit the time the COVID positive patient spends in public areas. No clinical outcomes were assessed and only 6 patients received azithromycin. Message pharmacy via email ( to send limited kit*: Special Delivery Instructions (such as leave at front door on black bench). Patients with mild to moderate illness who are not severely immunocompromised: Symptoms (e.g., cough, shortness of breath) have improved/are improving. If one or both patients require a bed for treatment, only 1 will be treated at a time. If COVID-19 or Rule Out COVID-19, follow active COVID-19 processes. Leaves callback number for patient to reach HTT nurse. Patients that meet the inclusion criteria to receive hyperbaric treatment will be assessed daily with the following methods. At this time, professional societies in cardiology and nephrology are, Interleukin inhibitors (including anakinra, sarilumab, tocilizumab). The provider may override this protocol when they deem such action necessary or appropriate for a specific patient. The big day is coming! Valet staff will follow same disposal and cleaning instructions as described above. Provider explicitly states they will now call the emergency contact. Appropriate donning and doffing procedures may delay routine cardiac arrest care. To optimize MDI medication availability for patients. If a patient with symptoms and a high-risk exposure presents on day 6-14 post exposure, they should only be tested one time, ASAP. Respiratory syncytial virus (RSV) is a common cause of bronchiolitis, pneumonia, and other acute respiratory illnesses among children. University of Iowa Hospitals and Clinics Integrated Call … Monitor for symptoms of COVID and document temperature at a minimum of BID. A face shield, N95 mask, isolation gown, and gloves will always be worn by the HBO attendant at all times. Laboratory confirmed SARS-CoV-2 infection, Requires hospital admission for further clinical management, Indication for full therapeutic-dose anticoagulation, Acute venous thromboembolism (deep vein thrombosis or pulmonary embolism) within prior 3 months, Acute cardiovascular event within prior 3 months, Acute stroke (ischemic or hemorrhagic) within prior 3 months, Increased risk of bleeding, as assessed by the investigator, Acute or chronic renal insufficiency with estimated Creatinine Clearance< 30 ml/min calculated by the modified Cockcroft and Gault formula. Patient actively home monitored by HTT or ILI Respiratory Telemedicine: Note that if at any time, the provider has clinical concern there is a serious and imminent threat to the patient’s safety, a welfare check can be initiated irrespective of how many days or attempts have passed. A symptom-based strategy to discontinue transmission-based precautions is described below: Patients who have previously tested positive for COVID in the past 90 days should not be routinely re-tested if new symptoms develop.  “Influenza-like Illness (ILI)” Screening Clinic is being initiated at UIHC with Family Medicine in PFP Mon-Fri 7am-7pm and Sat-Sun 7am-5pm, along with video visit services, defer patients concerned about symptoms to the clinic and hotlines below i. This excludes patients being treated for pneumonia or pulmonary infections that are due to laboratory confirmed Legionella infection, laboratory confirmed or presumed Nocardia infection, or laboratory confirmed or presumed Nontuberculous mycobacteria (NTM). Dr. Alejandro Comellas, UIHC pulmonologist and head of the Respiratory Illness Clinic, began having conversations with other providers back in March, the month the virus was confirmed in Iowa, At the time, he said clinicians weren’t sure — and still aren’t — of the long-term effects of the virus. Animals: Keep your baby away from pets while they are sick. If no answer, will send UIHC: INFLUENZA LIKE ILLNESS RESULTS LETTER àCOVID Negative (Symptomatic). Assist patient to transfer) droplet, contact and eye protection PPE are needed. There is no medication with definite efficacy in pre- or post-exposure prophylaxis in any patient population. In some circumstances, public health may define the infectious period for an asymptomatic person as starting 10 days before the source person’s first positive test. If an individual has an additional exposure during their quarantine period the quarantine period will be adjusted such that the last possible exposure is counted as “day 0” of quarantine. Urgent/Essential procedure required, and pre-procedure screening approved by Surgical Services Subcommittee. A few essential issues need to be considered: 1. Provider explicitly states they will call back at specified time and provides ICC number on the voicemail (319-384-8819). People over the age of 60 and those with health conditions should not care for your baby if possible. Do not schedule non-essential procedure. Help our home-monitoring providers identify patients who qualify for a welfare check, Standardize the protocol for initiating a welfare check on COVI- patients. The HTT RN will leave their callback number for the day. We will continue our regular practice and use of approved dive tables based on the presenting illness of each patient. ED team member communicating results to place order for 5 days post-positive test. If the potentially exposed patient is not symptomatic they can be released from in-home quarantine after 7 days with a negative test or 10 days without a test. If a person presents on day 8, 9 , or 10 post exposure, test only ASAP. This including but not limited to: K. IV push medications will be done inside the patient’s room, L. Intermittent infusion will be infused via an Alaris Infusion Device located inside the patient’s room. 6. Nursing staff will take wheelchair into patient’s room, prepare patient for discharge (e.g. Quarantine and 7 day post exposure testing for high-risk close contacts. Attempt is made to reach emergency contact. 3. If utilizing tubing sets instead of or in addition to extension tubing, ports on tubing sets should not be used to administer medications, IV extension tubing may be used for the same amount of time as other IV tubing, Position patient in the room so that the least amount of IV extension tubing is used, Care should be taken to secure IV tubing and connection sites, Peripheral IV and Midline Catheter, non-infusing: every 24 hours, Peripheral IV and Midline Catheter, infusing: every 4 hours, Central Venous Devices, non-infusing: every 24 hours, Central Venous Devices, infusing: every 12 hours. RN places FOL161 (if HTT) or FOL159 (If ILI) order for next day follow up. Patients with a previous positive COVID-19 test in the past 180 days (counted from the first positive test) should not be retested prior to undergoing pre-procedure asymptomatic screening with a COVID-19 PCR test. Message pharmacy via email ( to, Special Delivery instructions (such as leave at front door on black bench). All relevant details necessary to complete order (i.e., dose, route and frequency for medications): Nasopharyngeal. *, Type of COVID-19 test (PCR or antigen is acceptable). When transportation staff arrives to unit, nursing will cover the patient with a clean sheet, place surgical mask on patient, clean handles of wheelchair with approved disinfectant. Then the pharmacist will document in the order comments that the medication was discontinued per azithromycin discontinuation protocol. Living donor kidney transplants have resumed. There remains limited clinical trial data available so serious and unexpected adverse effects MAY occur that have not been previously reported. A. Covid-19 prescreening will be documented in EPIC in accordance with hospital guidelines. M. Ensure that when connected to a central line, that lumens are either infusing or saline locked to avoid occlusion. This notification occurs before the test result is back. Patient temperatures will be taken daily and documented in EPIC. Provider also unable to reach patient the day after HTT nurse attempts intake. This is the process in which the provider can initiate a welfare check. (2020). Leaves a callback number for the patient or emergency contact to reach the HTT nurse. Consider PE and diagnostic CTA in the case of: Acute worsening of hemodynamic or respiratory status including: Tachycardia with imaging findings not consistent with worsening Covid-19 pneumonia, Certain ECG signs [right heart strain, sinus tachycardia, simultaneous T wave inversions in the inferior (II, III, aVF) and right precordial leads (V1-4)], Alternative: ECHO may be useful if patient is unstable, CTA is unavailable, or when there are contraindications for CTA. The emergency medicine tray should be left outside the room. Retrieved from  Prevention, C. f. (2020, May 4). Appropriate for welfare check if presence of serious and imminent threat to the patient’s safety. If the patient’s voicemail is full or not set up, HTT RN will attempt to reach emergency contact (see next step). The admitting floor staff will be responsible for transporting the patient from the Emergency Department to the admitting floor. If D-dimer is normal, but provider feels strongly that a lower extremity venous studies should be done, contact the vascular staff on call. Positive results-Symptomatic or High Risk Exposed Patients, 3. This information should be shared with the patient (or surrogate decision-makers) as it relates to the specific patient’s condition. McFarland Clinic Respiratory Clinics Respiratory Clinics are open 7 days a week. We do not have enough data or experience to be able to predict the risk of infection after this type of exposure. No “follow-up DVT” lower extremity venous studies will be performed without discussion with vascular staff on call. The person who notifies the exposed patient should provide them with the information in the discharge instructions for patients with potential exposure to SARS-CoV-2, including the date on which their 14-day home quarantine period is over. March 2020, Date Created Per HICS: 4/02/2020                                                             Date Amended Per HICS: (4/16/2020). The local environment of the COVID-19 Pandemic has enabled us to update the guidelines for PPE and COVID-19 testing in the operating rooms and procedural locations. Follow processes based on Infection status in Epic Storyboard. One set will be brought by HOM/nursing supervisor and one set will be on the defibrillator/monitor that is brought to the code. The testing orders and workflow remain the same for these cases. Return Reason: COVID negative, follow up for symptom resolution or FOL145 (FOLLOW UP PCP), or arrange follow-up in QuickCare or Urgent noting patient has been “Cleared for COVID.”. A. In the event multiple emergent cases arrive simultaneously and the patients are not from the same household up to 2 patients will be treated at the same time in order to maintain social distancing provided both patients can be seated. RN explicitly states they will now call the emergency contact. Remdesivir for adults and pediatric patients ≥12 years old and weighing ≥40 kg is the only FDA approved therapeutic agent. If you find you have no kits available when you look in your Omnicell, please contact the COVID-swab runner, and a kit will be delivered to you by the swab runner. Nurse Practitioner, ILI Clinic ... Respiratory Therapist "Sleeping as much as I can, talking with my therapist, cooking, cleaning, and running." Providers working within UIHC who prescribe azithromycin for pneumonia are included in this protocol. (2019). Follow appropriate processes based on the Infection/Isolation status in Epic Storyboard. 1.All COVID-PCR test results will be released to MyChart within 60 minutes of completion. Notary will sign appropriate form outside the patient room and use window or open door to view patient. For same day add-on cases identified after 1130, the ILI Drive Thru Clinic testing will be available between 1130-1700 Monday-Friday and 1130-1500 Saturday-Sunday. Do not discuss with the patient the type of exposure or their level of risk for developing COVID-19. UIHC 39th Annual Respiratory Care Seminar Handouts are underline links below Thursday, October 17, 2019 7:30 am . If an outpatient needs to be tested, place the order CON ILI Telemedicine (or REF716). Dermatology Mohs procedure or Dialysis patients), the patient will be tested the day prior to the first scheduled procedure. The patient will be required to use a surgical mask during the compression phase of the dive. The effort to consolidate nebulized treatments to be given at similar times should be done in order to decrease the use of additional personal protective equipment (PPE). Set goals and get tips with our app. If there is a concern about PPE use, please contact the Program of Hospital Epidemiology (PHE) at pager 3158. Will not communicate result to patient via telephone. *An indeterminate test result should be treated as a positive. Precautions, observations, considerations and circumstances for contacting provider: Staff utilizing protocol must document an order to initiate the protocol in patient’s medical record per the “Protocol Orders” clinical protocol. to 8:00am . Direct admission to the floor. A hospital, outpatient surgery provider, or outpatient procedure provider may conduct in-patient surgeries and procedures that, if further delayed, will pose a significant risk to quality of life and any outpatient surgeries or procedures if the hospital or provider complies with the following requirements: Adequate inventories of personal protective equipment (PPE) and access to a reliable supply chain without relying on state or local government PPE stockpiles to support continued operations and respond to an unexpected surge in a timely manner; and. If the source patient’s SARS-CoV-2 test is negative, the potentially exposed patient was not exposed, droplet precautions are discontinued, and a private room is no longer required. People: Keep baby in one room and away from other people in your home. In the pharmacist’s usual review of medications, they identify inhaled medications that are eligible for interchange pursuant to the collaborative practice. If the patient’s or emergency contact’s voicemail is full or not set up, there will be no message left for the patient or emergency contact. Provider also unable to reach patient the day after HTT nurse attempts intake. Pharmacy staff will call the patient’s room to counsel the patient, and the prescriptions will be sent up to the patient’s room. Protocol for initiating welfare checks, Anesthesia OR Decision Tree and Management Workflows, Anesthesia OR Summary Table – Management for COVID-19 and Unknown COVID Status, Explanation of COVID-19 Infection Screening Status, Intubation Guidelines for Patients with Known or Suspected COVID-19 Disease, Anesthetic Management of Pregnant Patients with Confirmed or Presumptive COVID-19, Surgical and Neurosciences Intensive Care Unit Guidelines for Postoperative Care of Patients of Varying COVID-19 Statuses, Regional Anesthesia Plan for COVID-19 Patients, COVID-19 Non-Operating Room Anesthesia (NORA) Guidelines, COVID-19 Emergency Department Pediatric Intubation Protocol, Pediatric Anesthesiology and Otolaryngology Guidelines for out of Operating Room Intubations during COVID-19 Pandemic, VIDEO: COVID-19 Defense Strategy: Intraoperative, VIDEO: COVID-19 Defense Strategy: OR Set-up, VIDEO: COVID-19 Defense Strategy: Preoperative, VIDEO: Doffing PPE in the Ante Room in SPU, VIDEO: Intubation in the OR for COVID+ Patients, VIDEO: Transport COVID Patients Into the OR (OR Entry), VIDEO: Transport of COVID Patient from the ICU (ICU Exit), VIDEO: Turning On & Recording Images with the Philips Sparq Ultrasound. 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