COVID-19 Clinical Information
Modified on 7/7/2021 at 12:37pm

Patient care resources, including clinical and surgical processes, and COVID-19 information for UI Health Care clinicians.

We have developed this page in response to the COVID-19 outbreak in Iowa. This situation is rapidly evolving, and we will update this site as often as possible. Please contact Epidemiology (319-356-1606) with questions about the management of specific patients.

This site is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. All information is meant for use by health care workers and not the general public. If you think you may have a medical emergency, call 911 or go to the nearest emergency room immediately. No physician-patient relationship is created by this web site or its use. Neither the University of Iowa nor its employees, nor any contributor to this web site, makes any representations or warranties, express or implied, with respect to the information provided herein or to its use.

Symptoms of COVID-19

Symptoms of COVID-19
Updated on 05/08/2020 at 8:07 am

For confirmed COVID-19 cases, reported illnesses have ranged from mild symptoms to severe illness.

According to the Centers for Disease Control and Prevention (CDC), frequently reported signs and symptoms include:

  • Fever (83–99%)
  • Cough (59–82%)
  • Fatigue (44-70%)
  • Anorexia (40-84%)
  • Shortness of breath (31-40%)
  • Sputum production (28-33%)
  • Myalgias (11–35%).

Sore throat has also been reported in some patients early in the clinical course.

Less commonly reported symptoms include: headache, confusion, rhinorrhea, sore throat, hemoptysis, vomiting, and diarrhea. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms.

Anosmia or dysgeusia are frequently reported symptoms that are very unusual in non-COVID-19 viral illnesses.

Age is a strong risk factor for severe illness, complications, and death.  Heart disease, hypertension, prior stroke, diabetes, chronic lung disease, and chronic kidney disease have all been associated with increased illness severity and adverse outcomes.

The CDC believes at this time that symptoms of COVID-19 may appear in as few as 2 days or as long as 14 days after exposure.

COVID-19 treatment guide

COVID-19 therapeutic guidance
Updated on 01/19/2022 at 3:09 pm
Pharmacist Collaborative Practice Protocol: Azithromycin Discontinuation Protocol

PROTOCOL TEMPORARILY CREATED PURSUANT TO AUTHORITY OF HOSPITAL INCIDENT COMMANDER ACTIVATED IN RESPONSE TO COVID-19. EFFECTIVE UNTIL FURTHER NOTICE.

Date Created Per HICS:       4/2/2020                                        Date Amended Per HICS:

University of Iowa Hospitals & Clinics (UIHC)

Pharmacist Collaborative Practice Protocol

Azithromycin Discontinuation Protocol

I.  Purpose & Goals

Purpose

  • The purpose of this protocol is to limit azithromycin durations of treatment in the setting of pneumonia

Goals

  • To optimize medication management of azithromycin for patients with pneumonia.
  • To improve adherence to prescribed treatment

II.  Providers Authorized

  • Providers working within UIHC who prescribe azithromycin for pneumonia are included in this protocol.
  • Pharmacists working within UIHC may provide care to patients pursuant to this

III.   Responsibilities Authorized by this Protocol

Pharmacist Scope of Practice

  • Medication Therapy Management:
    • Acute care pharmacists may discontinue azithromycin per protocol once a patient being treated for pneumonia has received a cumulative azithromycin dose of 1500 mg in adults or 30 mg/kg (up to 1500 mg) in pediatric patients (this includes cumulation of all intravenous and oral doses).
    • 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). It also notably excludes azithromycin orders intended for immunomodulatory effect.

Provider Responsibilities

  • The provider is responsible for the general supervision of the patient’s care.
  • The provider will be available to discuss care pursuant to this protocol if needed.
  • The provider may override this protocol when they deem such action necessary or appropriate for a specific patient.

IV.  Documentation/Communication

  • The pharmacist shall document all interventions and activities appropriately in the patient’s electronic medical
    • The pharmacist will discontinue the azithromycin order per pharmacist protocol. Then the pharmacist will document in the order comments that the medication was discontinued per azithromycin discontinuation protocol.
  • Circumstances that shall cause the pharmacist to initiate communication with the patient’s provider:
    • Need to initiate therapy OR when there is question regarding indication for azithromycin therapy OR if the pharmacist identifies alternative reason (besides 1500 mg limit) for discontinuing / modifying azithromycin therapy indication for azithromycin therapy
    • Critical lab
    • Adverse drug reaction necessitating physician evaluation in the professional judgment of the pharmacist (i.e., patient allergies, adverse drug reactions, drug interactions, etc.).
  • If a medication error occurs, it will be reported per UIHC

V.  Quality Assurance

  • On an annual basis, the Antimicrobial Stewardship team will review a subset of patients to confirm that appropriate care is being provided pursuant to this protocol.
  • This protocol will be reviewed and updated every three years or more frequently based on changes in clinical

VI.  Pharmacist Training and On-going Competency

  • Each new pharmacist who provides care pursuant to this protocol will be trained and evaluated during an orientation period. Therapeutic plans and electronic notes will be reviewed during the orientation period as part of that

VII.  Related Standard(s)

PC-PCI-05.54, “Pharmacist and Physician Participation in Collaborative Drug Therapy Management”

UIHC Community Acquired Pneumonia MicroGuide

VIII.  References

·       Socan M. Treatment of atypical pneumonia with azithromycin: comparison of a 5-day and a 3-day course. J Chemother. 1998 Feb;10(1):64-8.

Date created: 3/26/2020

Source: Department of Pharmaceutical Care

Date of Pharmacy and Therapeutics Subcommittee approval:

4/2/2020

Date effective:

Date Revised: Date Reviewed:

Drug Monitoring Considerations for COVID Positive Patients
Updated on 05/29/2020 at 5:04 pm

This document is intended to guide clinical teams in evaluating whether routine monitoring of a patient can be delayed if the patient has a lab-confirmed COVID-19 infection. Please consult with the listed pharmacy contact for any questions.

Nebulizer Treatment to Metered Dose Inhaler Interchange to minimize risk of exposure to staff
Updated on 07/20/2020 at 1:26 pm

University of Iowa Health Care

Guidance on Treatment Options for Patients with SARS-CoV-2

PROTOCOL TEMPORARILY CREATED PURSUANT TO AUTHORITY OF HOSPITAL INCIDENT COMMANDER ACTIVATED IN RESPONSE TO COVID-19. EFFECTIVE UNTIL FURTHER NOTICE.

Date Created Per HICS: 7/15/2020                                                             Date Amended:

University of Iowa Hospitals & Clinics (UIHC)

Pharmacist Collaborative Practice Protocol Nebulized Treatment to Metered-Dose Inhaler Interchange

  1. Purpose & Goals

Purpose

  • Manage use of metered-dose inhalers (MDIs) and nebulized treatments to optimize drug delivery and minimize risk of exposure to staff. This protocol outlines pharmacist managed therapeutic interchange of select metered-dose inhalers and nebulization

 

Goals

  • To optimize medication delivery of inhaled
  • To optimize MDI medication availability for patients.
  • To minimize risk of exposure to staff members who administer or assist with administration of inhaled drug

 

ii.          Providers Authorized

  • Providers caring for adult and pediatric inpatients and observation patients at UIHC will automatically be enrolled in this protocol. Pharmacists providing care to adult and pediatric inpatients and observation patients may act pursuant to this

 

iii.         Responsibilities Authorized by this Protocol

Pharmacist Scope of Practice

  • Once a patient has been identified as having a nebulized treatment that qualifies for substitution, the pharmacist should evaluate the need for the medication. If the need for the medication is not apparent, the pharmacist should contact the provider to discontinue. If the medication is necessary, the pharmacist will contact the RN or respiratory therapist caring for the patient to determine if the patient is capable of proper MDI use.
    • Continuous nebulization is not eligible for conversion to an MDI.
    • If a patient has a severe, life-threatening respiratory disease and/or is unable to perform proper technique (due to respiratory status or age) required for MDI use, patient may continue to receive the nebulized therapy. The prescriber, Nursing staff, and Respiratory Therapy should be consulted to determine the necessity of the medication and the safest and most appropriate product and dosage form for adequate drug delivery.
  • If the patient is receiving a medication via nebulization that does not have an MDI alternative, the patient should be maintained on nebulization treatments for all pre-medications. 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).
    • If patient is receiving other nebulized treatments that are able to be switched to an MDI, but the schedule is such that the timing cannot be aligned with the nebulized treatments (that do not have an MDI alternative), then the nebulized treatments that can be switched to MDI should be switched to MDI. For example, if patient is receiving aztreonam (which cannot be switched to an MDI) and is receiving albuterol for a premedication for that aztreonam treatment, then the albuterol premedication should NOT be switched to an MDI; however, if the patient receives albuterol nebulization independent of the aztreonam, that order should be switched to MDI in order to decrease exposure to staff and conserve PPE) .
  • If the patient has been determined to be capable of proper MDI technique, and all nebulized treatments can be switched to an appropriate MDI, the pharmacist will place the appropriate orders as outlined in Appendix A.
Steroid Equivalent Dose
Betamethasone 3 mg
Cortisone 100 mg
Dexamethasone 3 mg
Hydrocortisone 80 mg
Methylprednisolone 16 mg
Prednisolone 20 mg
Prednisone 20 mg
  • If a patient is receiving an equivalent of a 20 mg or more of systemic (enteral or IV) prednisone daily (see equivalency chart below), then the inhaled steroid (neb or MDI) may be discontinued.
    • Once the systemic steroid is discontinued or the daily dose falls below an equivalent of a 20 mg or more of systemic (enteral or IV) prednisone daily, the pharmacist may restart the inhaled steroid via MDI. If a nebulized treatment is necessary, the attending provider must be contacted.
  • In addition to the medication orders outlined in Appendix A, the pharmacist will also place an order for a spacer (e.g., an Aerochamber) device to be used with the appropriate MDIs.
  • Additionally, if a patient has an active order for a PRN nebulized treatment, but the medication has not been used in 48 hours, the order may be discontinued by the pharmacist.

Provider Responsibilities

  • The provider is responsible for the general supervision of the patient’s
  • The provider will be available to discuss care pursuant to this protocol if
  • The provider may override this protocol whenever he or she deems such action necessary or appropriate for a specific

Medical Director Responsibilities

  • Jason Wilbur, MD, Clinical Professor, Family Medicine, Co-Chair, Pharmacy & Therapeutics Working Group (or his designee) will oversee the responsibilities of the pharmacists and providers operating under this protocol.

 

iv.         Documentation/Communication

  • The pharmacist shall document all interventions through placement of new or modified orders in the manage orders
  • Circumstances that shall cause the pharmacist to initiate communication with the patient’s provider:
    • Clarification on indication or dosing for therapy
    • Adverse drug reaction necessitating physician evaluation in the professional judgment of the
  • If a medication error occurs, it will be reported per standard

 

v.          Quality Assurance

  • This protocol will be reviewed and updated annually or more frequently based on changes in clinical

 

vi.         Pharmacist Training and On-going Competency

  • Each pharmacist who provides care pursuant to this protocol will be trained and evaluated during an orientation

vii.       Related Standard(s)

PC-PCI-05.54, “Pharmacist and Physician Participation in Collaborative Drug Therapy Management

viii.      References

 

ix. Signatures

For signed hard copies, please contact Jamie Smesler at 353-7376

 

Date Date
Jason Wilbur, MD Clinical Professor Family Medicine

Co-Chair, Pharmacy & Therapeutics Working Group

University of Iowa Hospitals and Clinics

Michael Brownlee, PharmD, MS, FASHP Chief Pharmacy Officer

Associate Director

Co-Chair, Pharmacy & Therapeutics Working Group University of Iowa Hospitals and Clinics

Date created: July 2020

Source: Department of Pharmaceutical Care

Date of Pharmacy and Therapeutics Working Group approval:

Date of HICS approval: 07/14/2020

Date effective:

Date Revised: 07/15/2020

Date Reviewed:

Appendix A

Metered-Dose Inhaler and Nebulization Therapeutic Interchange Protocol

Purpose: The goal of this protocol is to optimize drug delivery via either metered-dose inhalers (MDIs) or nebulization treatment, minimize risk of exposure to staff, and reduce waste by enabling pharmacists to implement therapeutic interchange through a collaborative practice agreement.

Policy: Pharmacists will be able to convert nebulized treatments to therapeutically equivalent MDIs on all adult and pediatric inpatients and observation patients unless otherwise specified.

Scope: Adult and pediatric inpatients and observation patients at UIHC are subject to this protocol.

Procedure:

  1. A provider places an order for an inhaled medication included in Tables 1 & 2 (listed below).
  2. In the pharmacist’s usual review of medications, they identify inhaled medications that are eligible for interchange pursuant to the collaborative practice
  3. Pharmacists will contact the patient’s RN or respiratory therapist who will assess the ability of the patient to properly use an MDI.
    1. If a patient has a severe, life-threatening respiratory disease and/or is unable to perform proper technique (due to respiratory status or age) required for MDI use, patient may continue to receive the nebulized therapy. The prescriber, Nursing staff, and Respiratory Therapy should be consulted to determine the necessity of the medication and the safest and most appropriate dosage form for adequate drug delivery.
  4. When a pharmacist receives an order for any of the medications listed in Tables 1 or 2, and the patient is capable of using an MDI properly, they will discontinue the order and enter the appropriate medication, dose, and frequency for therapeutic interchange and place an order for a spacer device.
    1. If a patient is on systemic steroids (doses ≥ 20 mg prednisone daily) the pharmacist will discontinue inhaled steroids, both nebulized and/or MDI formulation. Upon discontinuation, the pharmacist will enter a comment in the “RPh To-Do” handoff indicating:
  • Planned end date for systemic steroids if known
  • Reminder to resume inhaled steroid when systemic steroid dose is < 20 mg prednisone equivalent daily
  • If the patient is a pediatric patient, the attending faculty physician must be notified
  1. All orders will be placed under “Pharmacist Protocol” and will not require co-signature by the original
  2. PRN orders for nebulized treatments may be discontinued if the medication has not been administered for 48 hours (or more).

 

Therapeutic Interchange: Nebulized TreatmentstoMDIs

Nebulizer Solution Ordered Medication Order Placed by Pharmacist
Short-acting Anticholinergics
Ipratropium 0.02% Ipratropium bromide (Atrovent HFA®), 2 inhalations with dosing interval to match the original order
Short-acting Beta-2 Agonists
Albuterol 0.083% Albuterol MDI (Ventolin HFA®) 2 inhalations with dosing interval to match original order
Short-acting Beta-2 Agonist – Short-acting Anticholinergic Combinations
Albuterol-ipratropium 2.5-0.5 mg/3 mL (DuoNeb®) Albuterol MDI (Ventolin HFA®) 2 inhalations with dosing interval to match original order

 

NICU: dose determined by consult with ordering provider with dosing interval to match original order

NOTE: The pharmacist must contact the physician to determine if the patient has a need for either ipratropium bromide (Atrovent HFA®) 2 inhalations with dosing interval to match the original order OR Combivent® Respimat® 1 inhalation with dosing interval to match the original order

Corticosteroid
Budesonide nebulizer solution*

0.25 mg/2 mL

or

1 mg/2 mL

If a patient is receiving an equivalent of a 20 mg or more of systemic (enteral or IV) prednisone daily, inhaled corticosteroid therapy is not necessary. The budesonide nebulizer solution should be discontinued, and no alternative MDI should be ordered.*

 

Non-Ventilated Patients:

  • 12 years of age or older: Fluticasone furoate (Arnuity Ellipta®) 1 inhalation of 100 mcg or 200 mcg once daily, based on prior asthma therapy and disease severity
  • 5 to 11 years of age: Fluticasone furoate (Arnuity Ellipta®) 1 inhalation of 50 mcg once daily
  • Younger than 5 years of age: Fluticasone propionate HFA 44 mcg inhaler, 1 to 2 inhalations twice daily, based on prior asthma therapy and disease severity
  • NICU: dose determined by consult with ordering provider with dosing interval to match original order

 

Ventilated Patients:

  • 12 years of age or older: Fluticasone propionate HFA 110 mcg or 220 mcg inhaler, 1 to 2 inhalations twice daily, based on prior asthma therapy and disease severity
  • 5 to 11 years of age: Fluticasone propionate HFA 44 mcg or 110 mcg inhaler, 1 to 2 inhalations twice daily, based on prior asthma therapy and disease severity
  • Younger than 5 years of age: Fluticasone propionate HFA 44 mcg inhaler, 1 to 2 inhalations twice daily, based on prior asthma therapy and disease severity
  • NICU: dose determined by consult with ordering provider with dosing interval to match original order

* If a patient is on systemic steroids (doses ≥ 20 mg prednisone daily) the pharmacist will discontinue inhaled steroids, both nebulized and/or MDI formulation. Upon discontinuation, the pharmacist will enter a comment in the “RPh To-Do” handoff indicating:

  • Planned end date for systemic steroids if known
  • Reminder to resume inhaled steroid when systemic steroid dose is < 20 mg prednisone equivalent daily
  • If the patient is a pediatric patient, the attending faculty physician must be notified
COVID-19 Monoclonal Antibody Treatment Cheat Sheet
Updated on 09/17/2021 at 1:30 pm

Who is eligible for COVID-19 monoclonal antibody therapy?

Patients who are COVID positive Mild to moderate symptoms that started within the past ten days

High risk of progression to severe disease (must have at least one risk factor)

  • Age 65 and older
  • Obesity or being overweight (BMI >30 kg/m2)
  • Pregnancy
  • CKD
  • Diabetes
  • Immunosuppressive disease or immunosuppressive treatment
  • Cardiovascular disease (including congenital heart disease) or hypertension
  • Chronic lung diseases (ex – COPD, asthma [moderate to severe], interstitial lung disease, cystic fibrosis and pulmonary hypertension)
  • Sickle cell disease
  • Neurodevelopmental disorders (for example, cerebral palsy) or other conditions that confer medical complexity (ex – genetic or metabolic syndromes and severe congenital abnormalities)
  • Having medical-related technological dependence (ex – tracheostomy, gastrostomy, or positive pressure ventilation not related to COVID-19)

What is the pharmacy team workflow for screening, education and scheduling of antibody therapy?

Tested positive at UIHC Tested positive outside of UIHC
Eligible patients will automatically appear in an antibody report managed by the pharmacy team if symptoms developed within the past 8 days. Please do not send additional messages to EPIC inbasket pool if a patient is getting tested/tested positive here and their chart is up to date. These patients will appropriately appear on the report if eligible.

 

Inclusion is based on:

  • Past medical history
  • Age
  • Weight and height
  • Date of symptom onset
Patients must be seen by ILI provider prior to consideration for antibody therapy

 

After ILI appointment, potential patients should be referred to the Epic inbasket pool ‘RX COVID ANTIBODY THERAPY’

 

These patients will NOT APPEAR in the pharmacist antibody report; a message must be sent for pharmacists to screen for eligibility and schedule if appropriate.

 

If patient who is referred is NOT a candidate for infusion, pharmacy team will NOT notify patient.

What can I do to ensure eligible patients are appearing in the report and pharmacists are able to appropriately screen patients who tested positive outside UIHC?

What to do Why it’s important
Update problem list/past medical history Patients with no PMH will not appear in the pharmacist antibody report. No PMH makes it hard fSor pharmacists to screen for eligibility via chart review.
Update current height and weight If the patient’s weight/height is too old, they will not appear in the report. Weight can also fluctuate over time; and accuracy helps ensure BMI >30.
Correct date of symptom onset The antibody report sorts patients by onset of symptoms; those who have been sickest the longest are contacted first to ensures we can offer soonest infusions. If this is inaccurate, patients may not be contacted until all slots are filled for the day, which could risk them not being scheduled within the 10 day window.
If external positive, entering external result in results tab Pharmacists cannot schedule patients to receive therapy without the external positive COVID test present.

Please contact Emily Walsh (Emily-b-walsh@uiowa.edu) or Heidi Wood (Heidi-wood@uiowa.edu) with questions.

Download a PDF version

COVID-19 Antibody Therapy Outpatient Process
Updated on 09/28/2021 at 3:36 pm

COVID-19 testing

Testing criteria
Updated on 05/13/2021 at 1:56 pm

Symptomatic Patient Testing Criteria (“NOVEL CORONAVIRUS COVID-19”)

Asymptomatic Patient Exposed to COVID-19 Criteria (“COVID-19 HIGH RISK EXPOSURE”)

  • Patient was in close contact (spending more than 15 minutes total over a 24-hour period within 6 feet) of a person with lab confirmed COVID-19 infection
  • Recommended sample collection is 7 days after last exposure to the person with COVID-19 during that person’s infectious period.  If a patient presents between 8-10 days after the last exposure, they will be tested once on ASAP. If they present 11-14 days after last exposure, the decision to order the test will be based on a conversation between the patient and provider.

 Screening test criteria (“COVID-19 Asymptomatic Screen: RESTRICTED”)

  • Urgent/Essential procedure required, and pre-procedure screening approved by Surgical Services Subcommittee. – No test if patient is fully vaccinated
  • Pre-transplant – Perform COVID-19 test
  • New admission, not pre-surgical – No test if patient is fully vaccinated
  • Discharging to congregate settings – Depends on the facility
  • UI Student Athlete or Athletics Staff – Perform COVID-19 test
  • Pre-research screening – Perform COVID-19 test
  • Inpatient retest – No test if patient is fully vaccinated
  • Pre-Travel Screening – Up to the patient and/or airline
Ordering and collecting a COVID-19 test
Updated on 12/15/2020 at 8:29 am

RE-TESTING FOR COVID-19 in symptomatic patients who have not tested positive in the last 90 days.

Patients with COVID-19 typically have high titers of virus in the oro- and nasopharynx and therefore, the OP or NP swab is a sensitive test. However, over the course of the illness, the levels of virus in the upper airway decline – even in patients with progressive lower respiratory tract illness.  Most asymptomatic COVID-19 patients also have high viral titers, though the kinetics of viral load are not well understood very early in infection.

Therefore, there are two scenarios where retesting may be necessary:

  1. The patient tested negative but was very early in their course of illness, and/or were asymptomatic, and/or did not have COVID-19 (these scenarios cannot be distinguished in most cases).  The patient later developed symptoms consistent with COVID-19, and met criteria for symptomatic testing.  Sample type for retesting in this case may be NP, OP or sputum.
  2. The patient presented with a long course of illness (>=7 days) and an NP or OP swab was negative.  Repeating an NP or OP swab in this case is not recommended as it does not access the lower respiratory tract where virus is more likely to be found; sputum, tracheal aspirate or BAL is recommended for retesting in these cases.

Retesting will be screened for in Epic on an active basis, and cases not approved will have testing canceled. Page *4903 to discuss circumstances with the pathology resident on call to streamline approval if criteria are met.

RE-TESTING FOR COVID-19 in symptomatic or high-risk exposed asymptomatic patients who have previously tested positive within the last 90 days.

 Patients with a previous COVID-19 infection may test positive with the PCR test for weeks or months after an infection.  For this reason, a test-based strategy to return to work or discontinue isolation is not recommended.  A symptom-based strategy to discontinue transmission-based precautions is described below:

  1. Patients with mild to moderate illness who are not severely immunocompromised:
    1. At least 10 days have passed since symptoms first appeared (or since positive test if asymptomatic) and
    2. At least 24 hours have passed since last fever without the use of fever-reducing medications and
    3. Symptoms (e.g., cough, shortness of breath) have improved/are improving
  2. Patients with severe to critical illness or who are severely immunocompromised:
    1. 20 days have passed since symptoms first appeared (or since positive test if asymptomatic) and
    2. At least 24 hours have passed since last fever without the use of fever-reducing medications and
    3. Symptoms (e.g., cough, shortness of breath) have improved

Patients who have previously tested positive for COVID in the past 90 days should not be routinely re-tested if new symptoms develop.  Re-testing could be considered if symptoms are highly specific for COVID (loss of taste or smell with fever or respiratory symptoms) AND the patient had a recent high-risk exposure (within 6 feet of a person with lab confirmed COVID for more than 15 minutes over a 24 hour period during the source person’s infectious period).  Patients with symptoms and a high-risk exposure should be tested ASAP and, if first test is negative, again on day 7-10 of quarantine if they present on day 1-5 post exposure.  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.

Patients with a previous positive COVID test in the past 90 days who have had a high-risk exposure and are currently asymptomatic do not need to quarantine and retesting is not recommended.

Patients with a previous positive COVID test in the past 180days should not be retested prior to undergoing pre-procedure asymptomatic screening with a COVID PCR test. Similarly, hospitalized patients without a known high-risk COVID exposure who have had a previous positive COVID test in the past 180 days should not be retested upon admission or routinely throughout their hospital stay.

Typical turnaround time for COVID-19 testing
Updated on 07/09/2021 at 1:37 pm

For COVID-19 PCR specimens originating from locations other than the UI Health Care main campus, results will typically be available by noon the day after the specimen is received in the Microbiology lab. (Pre-procedural specimen results will typically be available the evening prior to the procedure).

Providers can view all results in Epic once results have been verified. MyChart results are available less than 1 hour after availability in Epic.

Do not call the laboratory to ask about timing of results; this delays testing for all patients. Predicted turnaround times will not be provided for individual cases. Surgical subcommittee guidelines describe planning scheduled and unscheduled surgical cases around COVID-19 testing.

Random access (also known as “rapid” or “stat”) testing is automatically performed in cases approved by HICS. This type of testing is not orderable and is not available by request.

Universal Maternal Testing for COVID-19
Updated on 07/17/2020 at 12:42 pm

COVID-19 Swab Kits available to most patient care areas
Updated on 07/01/2021 at 9:18 am

Effective on or before Thursday, July 1, 2021, COVID-19 Swab Kits will be available to most patient care units/clinics on the main UI Hospitals & Clinics campus via the Omnicells. As of that date, if you need a swab kit in order to collect a specimen from a patient for COVID-19 testing, first check your Omnicell for the kit. If you do not have Omnicells in your unit/clinic you can order the NP swab from Processed Stores at 6-1784 for PS#157252 NP Swab COVID-19 or PS#157253 OP Swab COVID-19.

After COVID-19 swab specimens are collected, the lids must be securely tightened, and they must be double bagged before being placed into a tube carrier. The specimens should be sent directly to the microbiology lab at tube station #160. If a clinical area doesn’t have access to the pneumatic tube system, please follow normal processes to request service from the pathology runners during daytime weekday hours. Outside of daytime weekday hours, specimens will need to be transported to the microbiology lab by the clinical area.

Kits will be placed in each Omnicell based on recent or anticipated testing needs. Staff from Processed Stores will replenish the kits, using products supplied by Pathology, as they replenish other Omnicell supplies.

Questions? Contact Heidi Nobiling (heidi-nobiling@uiowa.edu) if you have questions or concerns about this change.

Q&A: COVID-19 (SARS-Cov-2) Serological Testing
Updated on 06/18/2021 at 8:41 am

NP Specimen Collection
Updated on 07/01/2021 at 9:19 am

 

Management of COVID-19 inpatient exposure
Updated on 10/18/2021 at 10:55 am

COVID-19 inpatient exposure is defined as sharing an inpatient room for 15 minutes or longer with a source patient with laboratory confirmed SARS-CoV-2 during the source patient’s infectious period.

  1. Source patient is symptomaticThe infectious period begins 48 hours before the source patient’s symptom onset and ends when the source patient meets criteria for discontinuation of COVID-19 isolation precautions.
  2. Source patient is asymptomaticThe infectious period begins 48 hours before the source patient’s first positive test and ends 10 days after the source patient’s first positive test (or when patient meets criteria for discontinuation of COVID-19 isolation precautions if becomes symptomatic).

Note: University Employee Health Clinic will perform contact tracing for exposed employees. See here for employee exposure information.

Management of exposed patients:

  • Have the source (infected) patient don a medical grade mask immediately. The source patient must wear the mask continuously until they have been moved to a private room.
  • Notify exposed patient’s attending provider of the potential exposure.
  • Care for exposed patient in a private room. Place an order for Droplet precautions. (While all staff are currently following “universal” droplet precautions by wearing a medical grade mask, placing an order for droplet precautions communicates the need for a private room in the EMR and bed management systems).
  • Quarantine and post exposure testing guidance for exposed patients:

Choose the correct category (vaccinated, unvaccinated or recently recovered ≤ 90 days)

Vaccinated*

Date of last exposure:

Dates of precautions:

Due date of test(s):

If discharging during precaution period:

 

If remaining inpatient during precaution period:

 

a. Test as soon as potential exposure is confirmed a. Test as soon as potential exposure is confirmed
b. Attending provider notifies patient they were potentially exposed to COVID-19 b. Attending provider notifies patient they were potentially exposed to COVID-19
c. Remain in Droplet precautions until discharge c. Remain in Droplet precautions for 14 days post-exposure (day 0 is day of last exposure)
d. No home quarantine is needed but should wear a mask indoors in public for 14 days or until test result is negative

 

d. During precaution period, monitor for symptoms of COVID-19 and document temperature at a minimum of BID. If the exposed patient develops any symptoms of COVID-19 after their initial screening test, they should be placed in Modified Airborne/Contact/Eye protection precautions and tested for COVID-19.
e. Test 3-5 days post-exposure (day 0 is day of last exposure)

 

e. Test on day 5 (and on day 10 if still admitted) post-exposure (day 0 is day of last exposure) – no test needed on day 14
f. Self-monitor for symptoms and if develop, test

 

f. If discharging after day 5 test:

1. No outpatient testing is needed unless symptoms develop

2. No home quarantine is needed

3. Self-monitor for symptoms and if develop, test

g. Discharge instructions: use SmartPhrase .coviddischinst or SmartText HCI: COVID-19 Exposure Discharge

 

h. If discharging prior to day 3-5, use SmartSet “ILI:RESPIRATORY ILLNESS CLINIC ORDERS” (REF 7386). In the Follow-up section, choose FOLLOW-UP – ILI RESPIRATORY CLINIC (Asymptomatic High Risk Exposed Testing). Fill out accordingly including the date the test is needed.

 

Unvaccinated

Date of last exposure:

Quarantine dates:

Due date of test(s):

If discharging during quarantine period:

 

If remaining inpatient during quarantine period:

 

a. Test as soon as potential exposure is confirmed a. Test as soon as potential exposure is confirmed
b. Attending provider notifies patient they were potentially exposed to COVID-19 b. Attending provider notifies patient they were potentially exposed to COVID-19
c. Remain in Droplet precautions during the quarantine period c. Remain in Droplet precautions for 14 days post-exposure (day 0 is day of last exposure)
d. Home quarantine is recommended

 

IDPH recommends a 14-day quarantine but there are options for early release.

d. During quarantine period, monitor for symptoms of COVID-19 and document temperature at a minimum of BID. If the exposed patient develops any symptoms of COVID-19 after their initial screening test, they should be placed in Modified Airborne/Contact/Eye protection precautions and tested for COVID-19.
e. Test at 7 days post-exposure§ (day 0 is day of last exposure) e. Test on day 5 (and on day 10 if still admitted) post-exposure (day 0 is day of last exposure) – no test needed on day 14
f. Self-monitor for symptoms and if develop, test f. If discharged after day 5 test and before day 8:

1. No outpatient testing is needed unless symptoms develop

2. Remain in home quarantine through day 7, released on day 8

3. Self-monitor for symptoms and if develop, test and remain in home quarantine

4. Discharge instructions: use SmartPhrase .coviddischinst or SmartText HCI: COVID-19 Exposure Discharge

g. Discharge instructions: use SmartPhrase .coviddischinst or SmartText HCI: COVID-19 Exposure Discharge
h. If discharging prior to day 5-7, use SmartSet “ILI:RESPIRATORY ILLNESS CLINIC ORDERS” (REF 7386). In the Follow-up section, choose FOLLOW-UP – ILI RESPIRATORY CLINIC (Asymptomatic High Risk Exposed Testing). Fill out accordingly including the date the test is needed.
i. If patient desires not to be tested, then remain in home quarantine through day 10.

 

Recovered from COVID-19 within the last 90 days

Date of last exposure:

Precautions dates:

If discharging during precaution period:

 

If remaining inpatient during precaution period:

 

a. Attending provider notifies patient they were potentially exposed to COVID-19 a. Attending provider notifies patient they were potentially exposed to COVID-19
b. Remain in Droplet precautions during the precaution period b. Remain in Droplet precautions for 14 days post-exposure (day 0 is day of last exposure)
c. No home quarantine is needed but wear a mask indoors in public for 14 days post-exposure (day 0 is day of last exposure) c. No testing indicated unless symptoms develop
d. No testing indicated unless symptoms develop d. During precaution period, monitor for symptoms of COVID-19 and document temperature at a minimum of BID. If the exposed patient develops any symptoms of COVID-19, they should be placed in Modified Airborne/Contact/Eye protection precautions and tested for COVID-19.
e. Self-monitor for symptoms and if develop, test
f. Discharge instructions: use SmartPhrase .coviddischinst or SmartText HCI: COVID-19 Exposure Discharge

 

Patients should (regardless of category):

·       Social distance

·       Self-monitor for symptoms for a total of 14 days post-exposure

·       Follow all other safety measures recommended by Public Health

·       Not get tested if 14 days have passed since last exposure unless symptomatic

 

*Individuals are considered fully vaccinated 14 days after completion of their vaccination series (i.e. 2 weeks after the second dose in a 2-dose series or 2 weeks after a single-dose vaccine). Documentation is needed to confirm status.

If an exposed patient is discharged prior to discovery of the exposure and the source patient has been deemed infectious, the attending who discharged the patient or an alternate provider designated by the discharge attending will perform these notifications with the support of the Program of Hospital Epidemiology if needed (pager 3158). Determine if the patient falls within vaccinated, unvaccinated or recently recovered category and follow the “if discharging during ___ period” for the applicable category.

Patient is notified if they are discharging or are remaining inpatient, even before confirmation occurs that source patient is or is not infectious. If determined to be non-infectious, then attending provider will update the patient that they’re not considered exposed.

  • Do not disclose to the exposed patient specifics of who the source of the exposure was or other details about the exposure. Per Legal, this should be referred to as “a potential exposure.”
  • Do not discuss with the patient the type of exposure or their level of risk for developing COVID-19. We do not have enough data or experience to be able to predict the risk of infection after this type of exposure.

§Could occur as early as 5 days but 7 days preferred.

Post exposure test costs will be covered by UIHC.  PHE will provide patient and test details to Risk Management.

References

(CDC), Centers for Disease Control and Prevention. (2021, July 29). Quarantine and Isolation. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html

(IDPH) Iowa Department of Public Health. (n.d.). COVID-19 (SARS-CoV-2). Retrieved from IDPH Epi Manual: https://wiki.idph.iowa.gov/epimanual/Home/CategoryID/522

 

ILI COVID-19 Testing Algorithm
Updated on 12/15/2020 at 11:01 am

Protocol for ordering point of care rapid COVID-19 testing using the Abbott ID
Updated on 08/17/2020 at 8:00 am
SUBJECT/TITLE: Protocol for Ordering Point of Care Rapid COVID-19 Testing Using the Abbott ID Now for Patients Undergoing Procedures or Surgery During  the Emergency Disaster Declaration Time Period 
PURPOSE: To ensure rapid testing and availability of results for COVID-19 prior to procedure or surgery (planned / potential aerosolized generating procedure).
TARGET POPULATION: Patients undergoing surgery in the Main Operating Room (MOR), Ambulatory Surgery Center (ASC), Stead Family Children’s Hospital (SFCH), and procedural locations.
DEFINITIONS: None

CRITERIA:

  1. Asymptomatic patients scheduled to undergo a procedure or surgery at UIHC.
    Note: COVID-19 screening is to be done within 24 hours of scheduled procedure/surgery unless otherwise specified in Contraindications.
  2. Class A, Class B, or awaiting test result would delay procedure
  3. Performed on Abbott ID Now platform

CLINICAL ASSESSMENT/SCREENING:

  1. Allergies: Not applicable.
  2. Contraindications: Refer to 2019 Novel Coronavirus (Covid-19) Information Hub for Employees for most current criteria.
    1. If a patient has COVID-19 symptoms, the provider will need to place the COVID-19 symptomatic screening order. This testing is completed by the Microbiology Lab.
    2. If two invalid results occur, the provider will need to place the COVID-19 asymptomatic screen by PCR: restricted. This testing is completed by the Microbiology Lab.
    3. Nasopharyngeal route of testing not available (e.g. nasopharyngeal should not be used for patients with a history of nasal trauma, bleeding disorders, nasal medications, or deviated septum). Nasal and throat routes of testing not approved by UIHC for use on the Abbott ID Now.

DETAILS OF THE ORDER: The RN/LPN/MA/Clin Tech/Paramedic will place an order in the EHR under the surgical/procedural encounter using the order mode “per protocol” for the following:

  1. Name of treatment, test or medication: POC COVID-19 (aka Asymptomatic Rapid COVID-19) POC90
  2. All relevant details necessary to complete order (i.e., dose, route and frequency for medications): Nasopharyngeal.
  3. Monitoring parameters if indicated: None
  4. Precautions, observations, considerations and circumstances for contacting provider:
    1. Positive result
    2. Two invalid results

DOCUMENTATION REQUIREMENTS:

  1. Staff utilizing protocol must document an order to initiate the protocol in patient’s medical record per the “Protocol Orders” clinical protocol.
  2. Indicate location of documentation in the medical record: Lab tab of Chart Review and Results Review.

RELATED STANDARDS:

Surgical Subcommittee Guidelines – Asymptomatic Pre-procedure Screening Guidelines

REFERENCES:

External positive COVID-19 test results
Updated on 01/12/2022 at 12:24 pm

Interim process for patients with an external COVID-19 positive test: 

Documentation of a positive result from outside entity or a home test may include: 

  • Two patient identifiers (if testing performed at external laboratory) 
  • Collection date of test 
  • Type of COVID-19 test (PCR/NAAT or antigen is acceptable) 

This documentation (if testing performed at external laboratory) should be scanned into Media of patient’s EHR as well as entered accordingly into the Enter/Edit result function (step-by-step instructions available in linked document).
 

If acceptable documentation cannot be obtained, then follow approved processes for testing at UI Health Care prior to procedure and on admission. 

If a patient reports a positive home test , regardless of symptoms: 

  • With the result ≤10 days ago 
    • Consider the patient COVID positive and isolate  
  • With the result >10 days ago 
    • Test the patient using the appropriate COVID-19 test based on clinical status
      • Positive result: isolate (chart will flag as COVID-19, recently recovered will initiate when infection resolved)
      • Negative: no isolation (chart will not be flagged as COVID-19 and recently recovered banner will not initiate) 

Surgical services guidelines

Surgical Subcommittee Guidelines- Asymptomatic Pre-Procedure Screening Guidelines
Updated on 01/20/2022 at 8:14 am

Hospital Incident Command System (HICS) Directive January 19, 2022

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. The following revised guidelines are for all patients, regardless of vaccination status, undergoing procedures in any procedural location at UIHC scheduled on January 24, 2022 and after.

The guidelines apply to all procedural locations at UIHC.

Please note that perioperative/periprocedural personnel may elect to use PPE such as respirators (i.e., N95 or CAPR) and eye protection, even if the patient has a negative COVID-19 test result.

COVID testing procedures and OR/Procedural processes

When should a scheduled surgery be delayed?

  • Consideration should be given to delaying all nonessential procedures for at least 49 days following the first documented positive COVID test result because of increased risk for perioperative/periprocedural mortality and pulmonary complications during this 7-week period. (See Surgical Services Guidelines section for Positive COVID-19 Test below)
  • Nonessential surgery should not be scheduled within 5 days after any vaccine dose due to the potential impact of vaccine side effects.

If indicated, when should asymptomatic pre-procedural COVID-19 testing be performed?

  • Testing will be required for all scheduled procedures the calendar day prior to the procedure. The specimen must be collected by 11:30 a.m. the day prior to surgery.
    • Exception: If a surgical case is coordinated with another procedure the day prior to the surgical case (e.g., dermatology Mohs procedure or dialysis patients), the patient will be tested the day prior to the first scheduled procedure. A negative test result is good for 2 days (day of test is Day 0, test is valid until Day 2 at 2359).
  • A negative COVID-19 test result is good for 2 days for inpatients undergoing a procedure for which asymptomatic preprocedural COVID-19 testing is required (day of test is Day 0, test is valid until Day 2 at 2359).

Who should not undergo asymptomatic pre-procedural COVID-19 testing?

  • Patients known to be Recently Recovered from COVID-19 (i.e., the patient has a positive COVID-19 test* within the past 180 days and is deemed non-infectious; see Surgical Services Guidelines section for Positive COVID-19 Test below) should not undergo asymptomatic pre-procedural COVID-19 testing
  • Patients who do not qualify for asymptomatic pre-procedural COVID-19 as outlined below should not undergo testing

Who should undergo asymptomatic pre-procedural COVID-19 testing?

Patients undergoing scheduled and add-on procedures are to be tested for asymptomatic pre-procedural COVID-19 by UIHC Department of Pathology based on procedure location and anesthesia type, unless Recently Recovered from COVID-19.

  • Patients scheduled for procedures in SFCH OR and Peds Cath Lab are to be tested for asymptomatic pre-procedural COVID-19, regardless of scheduled anesthesia type.
  • Patients scheduled for procedures in the following locations are to be tested for asymptomatic pre-procedural COVID-19 ONLY if the procedure is scheduled with General Anesthesia or General Anesthesia with Block as the Anesthesia Type for the procedure. Cases scheduled with Regional Anesthesia, Regional (Bier Block), Monitored Anesthesia Care, Monitored RN Care, or No Monitored Care will no longer be tested.
    • Main Operating Rooms
    • Ambulatory Surgery Center
    • Urology Cystoscopy Suite
    • Labor and Delivery Unit
    • Adult Cardiac Cath Lab and HVC Minor Procedure Suite
    • Electroconvulsive Therapy (ECT)
    • Interventional Radiology

If the anesthesia plan changes to General Anesthesia pre-operatively or intraoperatively on the day of the procedure, a point of care rapid COVID test will be performed.  (For rapid testing protocol, see Protocol for Ordering Point of Care Rapid COVID-19 Testing Using the Abbott ID Now).

  • Patients scheduled for procedures in the following locations are to be tested for asymptomatic pre-procedural COVID-19 ONLY if the procedure is scheduled with Anesthesia support for the procedure. Cases scheduled with no Anesthesia support will no longer be tested.
    • Digestive Health Center Procedure Suite
    • Radiation Oncology
    • MRI/CT
    • SFCH LL2 Procedure Suite
    • Bronchoscopy Lab
    • Sleep Study Suite

Testing Locations and Responsibilities

  • Patients will be required to come to Urgent Care – Holiday Road, Johnston, Bettendorf, Cedar Falls, or Muscatine the calendar day prior to their procedure for testing. Specimen collection times for each site have been structured to allow the courier to deliver specimens to UIHC by the appropriate cut-off time to allow for timely resulting.  Pre-procedure patients who do not report for their specimen collection at the appointed time may be subject to rescheduling of their procedure.
    • The surgical or procedural team will be responsible for ordering the test, notifying the patient of the test and time constraints, and communicating with the patient regarding decision to proceed with or postpone procedure if positive test result.
    • Patients should be instructed to self-isolate in their home or local hotel/motel between testing and the procedure.

Additional Guidance for Emergent/Urgent Procedures

Patients undergoing add-on procedures are to be tested for asymptomatic pre-procedural COVID-19 following guidance above based on location and anesthesia type. Additional guidance for point-of-care rapid COVID-19 testing and PPE are provided below:

  • Level 1/2 Emergency procedures will be performed with Modified Airborne/Contact/Eye Precautions (including gowns, gloves, N95 respirators, and eye protection) for all providers in the operating room, unless one or more of the following applies:
    • The patient has been inpatient AND has a negative COVID-19 test in the chart that is ≤ 2 days old (Day of test is Day 0, test is valid until Day 2 at 2359)
    • A COVID-19 rapid test obtained after the patient has arrived in the operating room is negative: the procedure may start with Modified Airborne/Contact/Eye Precautions and revert to Standard precautions once a negative test result is available. (For rapid testing protocol, see Protocol for Ordering Point of Care Rapid COVID-19 Testing Using the Abbott ID Now)
    • The patient’s infection status is known to be “Recently Recovered from COVID-19” (i.e., the patient has a positive COVID-19 test within the past 180 days and is deemed non-infectious; see Surgical Services Guidelines section for Positive COVID-19 Test below).
    • General anesthesia is not planned
  • Level 3 Add-on procedures that cannot be delayed for COVID-19 testing will be performed with Modified Airborne/Contact/Eye Precautions (including gowns, gloves, N95 respirators, and eye protection) for all providers in the operating room, unless one or more of the following applies:
    • The patient has been inpatient AND has a negative COVID-19 test in the chart that is ≤ 2 days old (Day of test is Day 0, test is valid until Day 2 at 2359)
    • A COVID-19 rapid test obtained prior to the operating room is negative. (For rapid testing protocol, see Protocol for Ordering Point of Care Rapid COVID-19 Testing Using the Abbott ID Now)
    • The patient’s infection status is known to be Recently Recovered from COVID-19 (i.e., the patient has a positive COVID-19 test within the past 180 days and is deemed non-infectious; see Surgical Services Guidelines section for Positive COVID-19 Test below)
    • General anesthesia is not planned
  • Level 4/5/6/Elective Add-on procedures are to be tested for asymptomatic pre-procedural COVID-19 following guidance above based on location and anesthesia type unless infection status is known to be Recently Recovered from COVID-19 (i.e., the patient has a positive COVID-19 test within the past 180 days and is deemed non-infectious; see Surgical Services Guidelines section for Positive COVID-19 Test below)

*An indeterminate test is considered positive.

Process for patients with a previous COVID-19 positive test:

Documentation is needed for acceptance of outside entity or home tests. For information on documentation of a positive COVID-19 test from an outside entity or home test, see External positive COVID-19 test results.

If acceptable documentation cannot be obtained, then follow approved processes for testing at UIHC prior to procedure.

Consideration should be given to delaying all nonessential procedures for at least 49 days following the first documented positive COVID test result because of increased risk for perioperative/periprocedural mortality and pulmonary complications during this 7-week period. The risk of proceeding with the procedure within the 7-week period should be weighed against the risk of delaying the procedure. The rationale for proceeding within the 7-week period should be documented in the medical record. If there is a difference of opinion about proceeding with a case during this 7-week period between anesthesiologist and surgeon, the Executive Medical Director of Perioperative Services is to be consulted to adjudicate.

Positive COVID-19 test based on timeframe

Day 0–49 Day 50–180 >180 days
  • If procedure must be scheduled, do not test. Follow processes based on Infection status in Epic Storyboard.
    • If COVID-19 or Rule Out COVID-19, follow active COVID-19 processes.
    • Otherwise, follow the isolation listed. Use of a negative pressure operating room is not needed.
  • Do not test; proceed with procedure. Follow processes based on Infection status in Epic Storyboard.
    • If COVID-19 or Rule Out COVID-19, follow active COVID-19 processes.
    • Otherwise, follow the isolation listed. Use of a negative pressure operating room is not needed.
  • Order asymptomatic test prior to procedure and follow processes based on test result.

 

Surgical Services Guidelines Summary Table
Updated on 11/19/2021 at 2:37 pm

Clinical guidelines and codes

Code blue updates for patients with confirmed or suspected COVID-19
Updated on 10/12/2020 at 11:42 am

A new guideline for code blue for patients with confirmed or suspected COVID-19 has been outlined for our UI Health Care staff to follow, effectively immediately.

Code Blue Guideline for COVID-19 patients or PUI

  1. Cardiac arrest management for patients with either confirmed COVID-19 infection or PUI is a high-risk period for transmission to health care workers.
  2. Providers should proactively address goals of care of COVID-19 patients. In the event of cardiac arrest, the evidence is showing that the probability of a good outcome is poor, especially in critically ill COVID-19 patients. This information should be shared with the patient (or surrogate decision-makers) as it relates to the specific patient’s condition.
  3. If a patient enters cardiac arrest, follow current guidelines for your area (calling a code blue for inpatient and outpatient at main campus & calling 911 for offsite locations).
  4. While you wait for the response team to arrive follow the current American Heart Association Guidance:
    1. Cover your own mouth and nose with a face mask.
    2. Cover the patient’s mouth and nose with a face mask.
    3. Perform hands-only CPR.
    4. Use an AED/Defibrillator if available.
    5. Once the response team arrives, let them assume care of the patient and leave the room.
  1. The response team for COVID-19 cardiac arrest patients should be limited to only necessary personnel. Pharmacists will be available outside the room. Students are not to be allowed in to simply observe.
  2. All code blue response team members, during cardiac arrest, should adhere to airborne and contact isolation precautions. No Code Blue team member should enter the patient’s room without these precautions. The door should remain closed.
  3. Each member of the code team should carry his/her own properly-fit N95 mask.
  4. Limited supply (2 of each size of N95 and 8 face shields) will be brought to the code as back up. One set will be brought by HOM/nursing supervisor and one set will be on the defibrillator/monitor that is brought to the code.
  5. Appropriate donning and doffing procedures may delay routine cardiac arrest care. Providers will work expeditiously as best as they can, without compromising their safety. Isolation precautions and use of PPE are not different in COVID-19 confirmed patients or PUI.
  6. No unnecessary equipment should be taken into the patient’s room during cardiac arrest. The emergency medicine tray should be left outside the room. A pharmacist will assist with preparing and mixing drugs. 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.
  7. For intubated patients in ICUs who are being mechanically ventilated, respiratory therapists should expand alarm parameters and ventilation should continue with the standard mechanical ventilator (10 breaths/min). The ventilator circuit should not be broken unless evidence of equipment malfunction occurs. A viral/bacterial filter will be added to the expiratory arm by the respiratory therapist.
  8. For patients who are being bag mask ventilated (whether intubated or not), a viral/bacterial filter will be added by the respiratory therapist.
  9. After a cardiac arrest event, all equipment (such as defibrillator, etc.) should remain in the room for complete decontamination prior to placing back in service. Any patient who achieves ROSC should be transported to an ICU room using maximal contact and droplet precautions using standard institutional policy for COVID-19-positive patients (including use of security to clear hallways). The code team should discard their PPEs after the code and while in the room, and then wear new PPEs for patient transport.

Code green updates for behavioral emergencies

The Show of Support Team consists of a hospital security officer, BHS nurse leader (M–F, 7 a.m.–3 p.m.), and BHS SWOT/HOM (off shifts). Please see table below as a guide on when to call each team. Staff will dial 192 (on the back of the badge) and request either the Show of Support Team or the Code Green Team (a similar model to medical emergencies).

The Code Green and Show of Support Teams are available to units/services at UI Hospitals & Clinics. Off-site areas should follow their emergency management plan.

Patient Behavior Level of Response
  • Confused/delirious
  • Irritable (easily annoyed/angered)
  • Not following directions
Unit level response:

  • Notify nurse manager and/or charge nurse
  • Notify patient’s provider
  • Verbal threats to harm self or others
  • Impulsive (quick to over react)
  • Staff concerned patient will escalate further
Show of Support Team

  • Dial 192
  • Physical violence seems imminent
  • Property destruction
  • Elopement
Code Green Team

  • Dial 192

Frequently asked questions

What if I don’t need the SOS/Code Green Team but just need a psychiatric consult?

  • Psych Consult Services at pager #3322
  • Psych nurse daytime consult pager #7689
  • BHS SWOT nurse #3498

What if a visitor is having the behavioral emergency?

  • Contact Safety and Security, dial 195

What if my patient needs twice as tough restraints?

  • Call BHS units or HOM to have restraints sent to you:
    • 2JPW: 3-6155
    • 2JPE: 6-7736
    • HOM #3313

More information

COVID-19 NICU Guidelines
Updated on 01/18/2022 at 8:22 am

COVID-19 NNSY Guidelines
Updated on 01/18/2022 at 8:23 am

Pediatric RRT and Code Blue Response
Updated on 05/18/2020 at 7:33 am

1. Resuscitation efforts will be carried out using standard procedures and protocols

2. Care will be taken to minimize the number of staff members and equipment entering the patient’s room.

  • Any provider and staff members (e.g., RT, RN) entering the room during a resuscitation will follow standard, contact and airborne precautions with eye protection given high likelihood of an aerosol-generating procedure. This means wearing a gown, gloves, N95 mask and face shield. Door will remain closed.
  • PICU Charge RN 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.
  • 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. This will be stored in the Resident Workroom on Level 10. Resident must return this to L10 charge nurse who will should inventory, re-stock and replace bag in Resident Workroom on Level 10 after use (directions inside bag).
  • Intubation should be performed by the most experienced provider available. Awake fiberoptic intubation should be avoided.  Perform a rapid sequence induction to avoid manual ventilation.  Laryngoscopes should be sheathed immediately post-intubation and all used airway equipment will be sealed in a zip-locked plastic bag.
  • Medication tray should be left outside the room.
Peds RRT for NON COVID-19 PUI or positive patient

Responders who should enter the room:

  • Senior Pediatric Resident
  • Staff Physician for the patient
  • Bedside RN
  • Additional Floor RN
  • RT
  • PICU Charge RN

** Floor Charge RN to direct traffic but does not need to enter room unless there is clinical necessity

Peds RRT for COVID-19 PUI or positive patient

Responders who should enter the room

  • Senior Pediatric Resident or Fellow or Staff Physician (i.e, the most experienced available clinician
  • Bedside RN
  • Additional Floor RN
  • RT
  • PICU Charge RN
  • Peds anesthesia faculty (#6626) will get the page as FYI

** Floor Charge RN to direct traffic but does not need to enter room unless there is clinical necessity

Peds Code Blue* for NON COVID-19 PUI or positive patient

Responders who should enter the room:

  • PICU fellow / faculty (will serve as team leader)
  • Senior Pediatric Resident
  • Bedside RN
  • Additional Floor RN (this might be the Floor Charge RN)
  • RT
  • PICU Charge RN
  • Anesthesia On-Call for airway
  • Peds anesthesia faculty (#6626)
  • Individuals performing chest compressions, if needed
Peds Code Blue* for COVID-19 PUI or positive patient

Responders who should enter the room:

  • PICU fellow / faculty (will serve as team leader)
  • Senior Pediatric Resident or Fellow or Staff Physician (i.e, the most experienced available clinician
  • Bedside RN
  • Additional Floor RN (this might be the Floor Charge RN)
  • RT
  • PICU Charge RN
  • Anesthesia On-Call for airway
  • Peds anesthesia faculty (#6626)
  • Individuals performing chest compressions, if needed

*Additional responders who are needed for a Code Blue but should not enter the patient’s room include:

  • Floor / Charge RN to direct traffic
  • RN to assist with preparing medications
  • RT Supervisor and CWS House Operations Supervisor (HOM)
  • All other typical Code Blue responders
Hyperbaric COVID-19 Protocol for the Treatment of Emergency Cases
Updated on 06/28/2021 at 1:16 pm

PURPOSE: Description of workflow alterations in an effort to mitigate the spread of infection within the hyperbaric facility when caring for emergent cases and/or incidences involving two or more patients, in addition to suspected COVID-19 patients. This patient population includes those receiving emergency related treatment.

TARGET POPULATION: Hyperbaric staff, patients, physicians, and the physical facility

DEFINITIONS: None

CRITERIA:

CLINICAL ASSESSMENT/SCREENING:

  1. Patients that meet the inclusion criteria to receive hyperbaric treatment will be assessed daily with the following methods.
  2. Upon arrival to the facility and if able, each patient will be screened for new or worsening cough, fever, or sore throat. Clinical presentation will provide a secondary observation if the patient is displaying COVID-19 like symptoms and unable to verbally respond to these questions.
  3. Patient temperatures will be taken daily and documented in EPIC.

DOCUMENTATION REQUIREMENTS:

  • Covid-19 prescreening will be documented in EPIC in accordance with hospital guidelines.

PRECAUTIONS, CONSIDERATIONS, AND OBSERVATIONS:

A. Facility Preparedness

  1. The chamber will be disinfected between each treatment by the hyperbaric staff with an approved disinfecting agent recommended by Perry Baromedical.
  2. Hyperbaric equipment including recliners, chairs, pillows, IV poles, ventilators, and patient monitors will be cleaned with an approved disinfectant agent between each treatment.
  3. The dressing rooms will be disinfected with a hospital supplied approved cleaning agent between each patient use.
  4. Patient equipment in the form of hoods or masks will be disinfected between each treatment and stored separately in a sealed bag on a labeled shelf.

B. Patient requirements

  1. All patients will don a surgical mask upon entering the facility and be asked to wash their hands and/or use hand sanitizer.
  2. As required to participate in a hyperbaric treatment, the patient will change into approved 100% HBO cotton scrubs.
  3. After changing clothes, patients will either wash their hands or use hand sanitizer.
  4. Vital signs will be performed and documented in EPIC. Temperature, heart rate, respiratory rate, oxygen saturation, and blood pressure will be taken before the patient enters the chamber.
  5. The patient will be allowed to use a surgical mask during the compression phase of the dive. This accommodation allows access to their nose to facilitate a Valsalva maneuver to prevent ear barotrauma.
  6. If the patient is intubated, COVID-19 isolation guidelines established by the Respiratory Care department will be followed.
  7. Once treatment depth has been reached, each patient will remove their surgical mask and don their HBO approved oxygen hood.
  8. The hood will remain on the patient for the duration of the treatment including decompression. This action effectively isolates each patient from the chamber environment.
  9. If a patient hood needs to be removed for any reason, the patient will immediately don their surgical mask. Hood breaches will be kept to a minimum.

C. Staff requirements

  1. Each attendant will abide by the Respiratory isolation guidelines established by the hospital, CDC, and the Undersea & Hyperbaric Medical Society during this COVID-19crisis.
  2. A surgical mask must be worn by the HBO attendant at all times.
  3. Hand sanitizer will be used between each patient contact encounter and as per our hand hygiene policy.
  4. Gloves will be donned and doffed between patients

D. Patient load

  1. Up to six patients can be treated at the same time if from the same household.
  2. 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. If one or both patients require a bed for treatment, only 1 will be treated at a time.
  3. Efforts will be made to triage patients based on clinical presentation.
  4. A risk assessment to patient and attendant safety will be made on a case by case basis.

E. Safety

  1. We will continue our regular practice and use of approved dive tables based on the presenting illness of each patient.

REFERENCES:

Dr. Merete Ibsen – Medical Director

Mike Holder – Safety Director

Clinical Care Guidance for Healthcare Professionals about Coronavirus (COVID-19). (2020, May 3). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care.html

Guidelines for infection control, patient treatment, and staff safety considerations related to Hyperbaric Oxygen Therapy (HBO2) in monoplace and multiplace hyperbaric chambers during the novel coronavirus disease (COVID-19) outbreak. March 2020

APPROVED BY: Medical Director and Respiratory Care Director

Source: Department of Respiratory Care

Effective Date: 5/8/2020

Version Number: 1

Hyperbaric COVID-19 Protocol for the Treatment of Elective Cases
Updated on 06/01/2020 at 5:28 pm

PURPOSE

Description of work flow alterations in an effort to mitigate the spread of infection within the hyperbaric facility when caring for elective cases. This patient population includes those receiving scheduled daily treatments.

TARGET POPULATION:

Hyperbaric personnel, patients, and the physical facility.

CLINICAL ASSESSMENT/SCREENING:

  1. Patients that meet the inclusion criteria to receive hyperbaric treatment will be assessed daily with the following methods.
    1. Upon arrival to the facility, each patient will be screened for new or worsening cough, fever, or sore throat.
    2. Patient temperatures will be taken daily and documented in EPIC.

DOCUMENTATION REQUIREMENTS:

  1. Covid-19 prescreening will be documented in EPIC in accordance with hospital guidelines.

PRECAUTIONS, CONSIDERATIONS, AND OBSERVATIONS:

  1. Facility Preparedness
    1. The chamber will be disinfected between each treatment by the hyperbaric staff with an approved disinfecting agent recommended by Perry Baromedical.
    2. Hyperbaric equipment including recliners, chairs, pillows, IV poles, ventilators, and patient monitors will be cleaned with an approved disinfectant agent between each treatment.
    3. The dressing rooms will be disinfected with a hospital supplied approved cleaning agent between each patient use.
    4. Patient equipment in the form of hoods or masks will be disinfected between each treatment and stored separately in a sealed bag on a labeled shelf.
  2. Patient requirements
    1. All patients will don a surgical mask upon entering the facility and be asked to wash their hands and/or use hand sanitizer.
    2. As required to participate in a hyperbaric treatment, the patient will change into approved 100% HBO cotton scrubs.
    3. After changing clothes, patients will either wash their hands or use hand sanitizer.
    4. Vital signs are performed every Monday and Thursday. This includes heart rate, respiratory rate, blood pressure, O2 saturation, and temperature. The remaining days will be limited to checking temperatures only (Tues, Wed, Fri).
    5. The patient will be required to use a surgical mask during the compression phase of the dive. This accommodation allows access to their nose to facilitate a Valsalva maneuver to prevent ear barotrauma.
    6. Once treatment depth has been reached, each patient will remove their surgical mask and don their HBO approved oxygen hood.
    7. The hood will remain on the patient for the duration of the treatment including decompression. This action effectively isolates each patient from the chamber environment.
    8. If a patient hood needs to be removed for any reason, the patient will immediately don their surgical mask.
  3. Staff requirements
    1. Each attendant will abide by the droplet isolation recommendations provided by the hospital during this Covid 19 crisis.
    2. A face shield, surgical mask, and gloves will always be worn by the HBO attendant.
    3. Hand sanitizer will be used between each patient contact encounter.
    4. Gloves will be donned and doffed between patients
  4. Patient load
    1. We will limit our capacity to 2 patients per treatment until social distancing practices subside.
    2. With 2 patients and 1 attendant, the approved 6-foot social distancing recommendation can be effectively implemented.
  5. Safety
    1. We will continue our regular practice and use of approved dive tables based on the presenting illness of each patient.

REFERENCES:

Dr. Merete Ibsen – Medical Director

Mike Holder –Safety Director

Clinical Care Guidance for Healthcare Professionals about Coronavirus (COVID-19). (2020, May 3). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-      care.html

Guidelines for infection control, patient treatment, and staff safety considerations related to Hyperbaric Oxygen Therapy (HBO2) in monoplace and multiplace hyperbaric chambers during the novel coronavirus disease (COVID-19) outbreak. March 2020

 

APPROVED BY: Medical Director and Respiratory Care Director

Source: Department of Respiratory Care
Effective Date: 5/8/2020
Version Number: 1
Date Revised:
Date Reviewed:
COVID-19 management for psychiatric patients
Updated on 12/21/2021 at 3:34 pm

Protocol for Ordering COVID-19 Testing and Retesting for All Inpatient Admissions
Updated on 05/07/2021 at 8:01 am
COVID-19 Visiting and Isolation Guidelines for NICU Inpatients
Updated on 01/18/2022 at 8:24 am

Clinical processes and workflows

Alaris IV Infusion Pumps Located Outside Patient Rooms for COVID-19 Positive Adults
Updated on 04/17/2020 at 9:20 am

PROTOCOL TEMPORARILY CREATED PURSUANT TO AUTHORITY OF HOSPITAL INCIDENT COMMANDER ACTIVATED IN RESPONSE TO COVID-19. EFFECTIVE UNTIL FURTHER NOTICE.

Date Created Per HICS: 4/02/2020                                                             Date Amended Per HICS: (4/16/2020)

Purpose: To minimize personal protective equipment (PPE) utilization, decrease PPE doffing risks and maintain medication infusion safety. The decision to implement this policy will be made by the unit leadership (Nurse Manager and Medical Director) on a unit by unit basis due to staff education requirements and unique circumstances on each patient care unit.

Policy: For patients with a confirmed COVID-19 infection, an Alaris IV infusion pump located outside the patient’s room may be utilized for administration of continuous infusions or intravenous fluids. The decision to use this plan shall be made in conjunction with the treatment team and nursing.

General procedures for inpatient care units and the ILI Clinic:

A. Inpatients should be able to be easily visualized if this process is utilized. This can include glass doors or use of the Video Monitoring Unit (Note- the VMU is to be used as a supplemental monitoring resource dedicated to ensuring the nursing staff is aware of any activity by the patient that may affect the IV infusion, such as ‘picking’ at the lines.)

B. Direct visualization or VMU is not required for patients receiving IV fluids (D5, NS etc…) in the ILI clinic.

C. An Alaris IV infusion pump located outside of the patient’s room may be utilized for peripheral or central administration of continuous infusions or intravenous fluids

D. Extension tubing shall be attached to the Alaris IV infusion pump

  1. If utilizing tubing sets instead of or in addition to extension tubing, ports on tubing sets should not be used to administer medications
  2. IV extension tubing may be used for the same amount of time as other IV tubing
  3. Position patient in the room so that the least amount of IV extension tubing is used
  4. Keep IV tubing off the floor
  5. Care should be taken to secure IV tubing and connection sites

E. Nursing staff shall verify the IV line to be used for a given infusion prior to initiating medication administration

  1. Frequency of site checks (N-07.001)
    • 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

F. A patient specific barcode shall be attached to the Alaris IV infusion pump located outside the patient’s room

G. A dark-colored bag shall be placed over any IV medication hung outside a patient room to protect patient information

H. Care should be taken to ensure that power cords are secured and not a trip hazard and not on the floor

I. The correct electrical connection outlet devices are located on the IV poles used for the Alaris pumps. Extension cords are temporarily authorized for this use and will be extended for the duration of the HICS COVID-19 event.

J. No restrictions regarding which continuous infusions or intravenous fluids may be run by nursing staff using an Alaris IV infusion pump located outside the patient’s room. This including but not limited to:

  1. High-alert medications (MM.7-1)
  2. Titratable continuous infusions

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

M. Ensure that when connected to a central line, that lumens are either infusing or saline locked to avoid occlusion. Don’t shut off the pump and forget to saline lock when you are done with the lumen.

Mechanically ventilated patients who cannot be directly visualized from outside the patient room when the door is closed and are not on video monitoring:

A.Nursing staff may not administer any continuous infusions or intravenous fluids using an Alaris IV infusion pump located outside the patient’s room

B. All IV medications shall be administered using an Alaris IV infusion pump located inside the patient’s room

 Considerations during patient transport

A. Limit the number of disconnections/reconnections of IV extension tubing

B. Check that all medical devices are secure

C. Consider use of a clean disposable chux or clean pillowcase to place IV tubing in patient bed

COVID-19 Positive Patient Discharge Process
Updated on 06/28/2021 at 1:08 pm

The process outlined below is to be used for the discharge of all COVID-19 positive patients.  This process has been developed with collaboration from a multi-disciplinary team and approved through the HICS structure.

  • Once decision to discharge the patient has been confirmed, nursing will work with the patient and/or the responsible party picking up the patient to identify an approximate discharge time.
    • Note: COVID-19 positive patients may have one designated visitor during their admission unless an exception is made. COVID-19 positive patients  are not to be waiting for rides outside of their room. All efforts should be made to prioritize any possible discharge barriers and to complete paperwork in a timely manner to make identified discharge time. 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.
    • It is strongly recommended that patients fill their discharge prescriptions at the UIHC Discharge Pharmacy to minimize community spread. Prescriptions should be sent electronically to the Discharge Pharmacy. Pharmacy staff will call the patient’s room to counsel the patient, and the prescriptions will be sent up to the patient’s room.
  • Nursing staff will perform discharge and documentation per usual method, ensuring patient receives and verbalizes understanding of COVID-19 discharge instructions.
  • Nursing will request “patient transport” via EPIC. Nursing will include “COVID-19 positive”, or similar language in comment section of request to alert transporter to take appropriate precautions.
    • Note: Patient transport request will be placed only after it is determined patient’s ride is on hospital grounds and waiting at designated pickup location.
  • Nursing staff will take wheelchair into patient’s room, prepare patient for discharge (e.g. transfer them into the wheelchair with belongings) while wearing droplet, contact and eye protection PPE.
  • 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 disinfectantper manufacturer’s guidelines* and communicate to transportation staff that patient is COVID-19 positive.
  • Transporter needs to wear a surgical face mask and eye protection; clean gloves should be stored in transporter’s pocket.  Additional PPE is not required unless other medical assistance resulting in physical contact (i.e. Assist in patient transfer) is required.
    • For infants / young toddlers the parent / guardian may sit in the wheelchair and hold onto their child for the transport off the unit.
    • For older children / adolescents then the patient should be in the wheelchair but there may be a parent / guardian present for transport off the unit as well.
  • If assistance or physical contact will be needed, two transporters will accompany the patient.  One transporter will wear a surgical face mask and eye-protection and does not wear gloves.  This person will open doors, activate elevator buttons, etc.  The second transporter will wear droplet, contact, and eye protection PPE; this person will provide assistance to the patient.
  • Under no circumstances should anyone wearing gloves touch door handles, doors, elevator buttons, etc.
  • Patient will be transported to designated exit via mode-of-transportation as identified by Guest Services. If applicable, Guest Services will contact Safety and Security at #6-2658 for access to designated exit.
    • Adult patients – W194 near Ramp 1
    • Adult patients – 1940X near South JPP
    • SFCH patients – SFCH Main Entrance
    • NICU/NNSY patients – 1940X near South JPP
    • MBCU patients- 1940X near South JPP and/or Ramp 4
    • When family members pick up the patient or the patient drives their own vehicle, staff transport the patient to their vehicle using less frequently populated routes.
  • Once transport is complete, transporter will put on gloves and:
    • Place sheet in routine linen hamper
    • Thoroughly wipe wheelchair down with approved disinfectant per the manufacturer’s guidelines*
    • Remove PPE except face shield and perform hand hygiene
    • Return the wheelchair for patient use
    • PPE, linen hamper, and disinfectant will be stored in the Guest Services area near West GH entrance for adult patients
    • PPE, linen hamper, and disinfectant will be stored in the Guest Services area near SFCH Main Entrance for SFCH patients

Note: If transport must hand patient off to valet staff, valet staff need to wear a surgical face mask and eye protection. If providing medical assistance or making physical contact with the patient (i.e. Assist patient to transfer) droplet, contact and eye protection PPE are needed. Valet staff will follow same disposal and cleaning instructions as described above.

*Per Manufacturer’s guidelines, thoroughly wipe the surface with approved disinfectant and ensure the area is wet and allowed to air dry.

** Droplet Precautions PPE: surgical face mask, gloves

** Contact Precautions PPE: isolation gown, gloves

** Eye Protection: face shield, goggles, or mask with fluid shield

Discontinuation of Isolation Precautions for Patients with COVID-19
Updated on 12/15/2020 at 8:44 am
Discontinue COVID-19 Isolation Precautions Asymptomatic, mild, or moderate COVID-19 related symptoms (must meet all criteria):

  1. At least 10 days since symptoms first appeared (or positive test if asymptomatic)
  2. At least 24 hours with no fever (without fever-reducing medication)
  3. Symptoms have improved

Severe COVID-19 related illness or advanced immunosuppression (must meet all criteria):

  1. At least 20 days since symptoms first appeared (or positive test if asymptomatic)
  2. At least 24 hours with no fever (without fever-reducing medication)
  3. Symptoms have improved

Page the Program of Hospital Epidemiology; 3158 with questions or for additional guidance.

Patients who have previously tested positive for COVID-19 in the past 90 days should not be routinely re-tested if new symptoms develop. Re-testing could be considered if symptoms are highly specific for COVID-19 (loss of taste or smell with fever or respiratory symptoms) AND the patient had a recent high-risk exposure (within 6 feet of a person with lab confirmed COVID-19 for more than 15 minutes without the source person wearing a face covering during the source person’s infectious period). Patients with symptoms and a high-risk exposure should be tested ASAP and again on day 7-10 of quarantine if they present on day 1-5 post exposure.  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.

Patients with a previous positive COVID-19 test in the past 90 days who have had a high-risk exposure and are currently asymptomatic do not need to quarantine and retesting is not recommended.

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. Similarly, hospitalized patients without a known high-risk COVID-19 exposure who do not have COVID-19 symptoms and have had a previous positive COVID-19 test in the past 180 days (counted from the first positive test) should not be retested upon admission or routinely throughout their hospital stay.

Adult Overflow into UI Stead Family Children's Hospital During COVID-19 Pandemic
Updated on 06/01/2020 at 5:31 pm

Notary Process for COVID-19 Patients
Updated on 05/21/2020 at 3:50 pm

At this time, notaries will continue in-person visits to UIHC patients as needed.  The current process for notaries in non-COVID rooms will remain unchanged.  The proposed process (below) will go into effect only for COVID positive patients or patients awaiting COVID test results who require notary services.

  1. Notary (or two witnesses) will wear proper PPE to access unit. Notary will sign appropriate form outside the patient room and use window or open door to view patient.
  2. RN staff working with patient will take the signed paperwork from notary and a Voalte phone with Haiku access into the patient’s room.
  3. Patient will sign the paperwork while notary/witnesses observe from doorway.  Paperwork will remain in the patient room and accompany patient when transferred or discharged.
  4. RN staff will take a picture of each page of the signed document using the Voalte phone and Haiku application.
  5. Social Work staff will send email to Health Information Management at brooke-zittergruen@uiowa.edu and karen-r-kelly@uiowa.edu. HIM will ensure all document photos are combined into a single PDF and uploaded into the patient’s file in Epic (in media tab).

Unit Voalte phones are the primary technology for this process.  Any requests for additional applications or usage must go through HICS.

Criteria and workflow to administer COVID post-exposure prophylaxis with monoclonal antibodies
Updated on 09/10/2021 at 9:20 am
Documentation of COVID-19 vaccination
Updated on 06/24/2021 at 5:26 pm

You can show proof of COVID-19 vaccination in either of the two ways listed below. Verbal report of COVID-19 vaccination is not accepted.

  1. Upload photo via Mychart
  2. Bring documentation in-person

Vaccination documentation can be a photo of your COVID-19 vaccination card or documented proof of vaccination from a pharmacy or health care provider.

Note that when a patient checks into an encounter, IRIS is queried and updated COVID-19 vaccination information will be available under both Health Maintenance and Immunizations. Staff can manually query IRIS without an encounter by opening the patient’s chart either by using Patient Station or the Open button, choosing the Immunizations tab and selecting Imm Registry to trigger a query.

Please see the following links for step-by-step instructions in Epic for validating COVID-19 vaccination statusentering historical immunization records, and reconciling outside immunizations.

ILI Clinic/Telemedicine

ILI Respiratory Clinic – Treatment Visit
Updated on 07/19/2021 at 8:28 am

Patients diagnosed with COVID-19 who are undergoing telemedicine home monitoring by the QuickCare Telemedicine team deemed to need in person evaluation (see Ambulatory Monitoring of COVID Patients) will be seen via this workflow and under these clinical practice guidelines.

ILI Respiratory Clinic Treatment Visit Clinical Workflow and Clinical Practice Guidelines

  • Schedulers give patients instructions about location of appointment and who to contact upon arrival.
  • Workflow at Management Check in:
    • Patients will call the number listed on the parking spot sign when they arrive
    • Get the patient’s name and DOB. Ask them where they are parked.
    • The nurse or paramedic will exit the clinic to pick up the patient from their vehicle.
  • Workflow for Providerswith Clinical Practice Guidelines:
    • Vitals obtained and physical exam conducted by nursing staff and provider. Use clinical judgement, but consider these guidelines:
      • If patient is in respiratory distress (RR > 24 or inability to speak in full sentences or persistent O2 sat < 92% on 3 Liters NC) or with unstable vitals (hypotensive) —> ED transfer for stabilization, triage, and disposition decision
      • If 02 on room air is <92% —> Administer O2 via nasal cannula to keep SpO2 > 92% —> If O2 requirement is stable with < 3L O2 NC, and no respiratory distress or tachypnea > 24 RPM —> Direct admission
      • If concern for fluid overload on auscultation —> Consider CXR
      • If wheezing on lung exam or history of asthma/COPD —> albuterol MDI (preferably with patient’s home MDI)
    • Assess for history of heart failure or QTc prolongation
    • IV placed and blood drawn and sent for BMP (Utilize ILI: RESPIRATORY ILLNESS CLINIC ORDERS Smart Set —> Treatment —> IV Fluids)
    • Assess for nausea
      • Zofran 4 mg ODT or IV push
      • Obtain EKG if history of QTc prolongation.  Ensure QTc is <470 ms before administering Zofran
    • Review labs
      • If Cr > 1.8 mg/dL with no history of CKD —> Admission
      • If Cr > 0.5 mg/dL above baseline Cr if history of CKD —> Admission
      • If Na < 125 mEq/L or > 148 mEq/L —> Admission
      • If K < 2.5 mEq/L —> Admission
    • Replace potassium if needed
      • If K 2.5 – 3.4 mEq/L —> 40 mEq KCl liquid
    • Administer IV Fluids (LR or NS) – caution if later in course of illness (Day 7+) and concern for respiratory distress
      • 1000 cc bolus
      • 500 cc and re-evaluate for consideration of another 500 cc if history of CHF or concerns of fluid overload on CXR
    • If patient previously unable to keep down fluids secondary to nausea, can PO challenge with water or clear liquids.  If patient fails PO challenge and has intractable vomiting/nausea precluding adequate home hydration —> Direct admission
    • If patient continues to show signs/symptoms of dehydration after 1 L of IV fluids —> Direct admission

Contact General Medicine Triage Officer (pager 5025) or Family Medicine Resident on call (pager 4070) to discuss direct admission. If direct admission is accepted, provider will place admission bed request order.

Transportation to Main Hospital from ILI Respiratory Clinic

  • Patient is a direct admit to UIHC (determine unit location from ATC)
    • Call Johnson County non-emergency dispatch number (319-356-6800)
  • Patient needs to be transferred to ED non-emergently (319-356-6800)
    • Call Johnson County non-emergency dispatch number
  • Patient is unstable and needing transferred to the ED
    • Call 911
  • If patient declines ambulance transfer and chooses to go by private vehicle then the admitting floor and the Emergency Department both need to be notified prior to the patient leaving the clinic.
    • The patient will check-in through the Emergency Department. The admitting floor staff will be responsible for transporting the patient from the Emergency Department to the admitting floor.
ILI Respiratory Clinic Workflow for COVID Results
Updated on 07/19/2021 at 8:30 am

1. All COVID-PCR test results will be released to MyChart immediately.

  • Includes positive and negative results for LAB8963, LAB9023, LAB8978

2. Positive results-Symptomatic or High-Risk Exposed Patients

  • Discuss release from isolation guidelines: Fever free x 24 hours without the use of fever reducing meds PLUS symptoms improving PLUS at least 10 days since onset of symptoms.
  • ILI Respiratory Clinic nurse reviews result in EPIC Results Inbasket and contacts patient via telephone. Discuss the following and document in EPIC using .COVIDRESULTSPHONECALL:
    • Self-isolation (see .COVIDPTINSTSUSPECTEDORCONFIRMED).
    • Quarantine and post exposure testing for high-risk close contacts.
    • Verify address and delivery instructions for home monitoring kit if applicable (apartment number, floor, access code, preferred door to drop off kit).

3. Positive results – Pre-operative/procedure testing for Asymptomatic Patients

  • Surgical/procedure team to contact patient with next steps regarding upcoming procedure.
  • ILI Respiratory Clinic nurse will contact patient to review self-isolation, quarantine, and telemedicine follow-up information.

4. Negative results- Symptomatic Patients without high risk exposure

  • Recommend self-isolation until fever free x 24 hours without the use of fever reducing medications.
  • ILI Respiratory Clinic nurse reviews results in EPIC Results Inbasket
  • If patient has MyChart, nurse sends patient a letter via MyChart using smartphrase.
  • If patient does not have MyChart, nurse sends a result note to the P ILI RESPIRATORY ILLNESS NURSE pool and documents specific instructions to be communicated.
    • Clinical staff members will make 1 attempt to provide results.  If no answer, will send UIHC: INFLUENZA LIKE ILLNESS RESULTS LETTER COVID Negative (Symptomatic)

5. Negative Results – Symptomatic Patients with high risk exposure

  • Patients with symptoms and a high-risk exposure should be tested ASAP and again on day 7-10 of quarantine if they present on day 1-5 post exposure.  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.
  • Recommend self-isolation until fever free x 24 hours without the use of fever reducing medications.
  • ILI respiratory clinic nurse reviews result in EIPC Results Inbasket
    • If patient has MyChart, nurse sends patient a letter via MyChart using smartphrase.
  • If patient does not have MyChart, nurse sends a result note to the P ILI RESPIRATORY ILLNESS NURSE pool and documents specific instructions to be communicated.
    • Clinical staff members will make 1 attempt to provide results.  If no answer, will send UIHC: INFLUENA LIKE ILLNESS RESULTS LETTER àCOVID Negative (Symptomatic) – Exposed Healthcare personnel, Non-Essential/critical worker OR COVID Negative (Symptomatic) – Exposed; Essential/Critical Worker.
    • If patient answers and is still having symptoms, clinical staff can Order Follow-Up Appointment if needed
    • If symptoms still present, schedule patient follow up video visit depending on severity of symptoms and whether additional work-up is needed.
    • Use FOL159 (FOLLOW UP- ILI Telemedicine).  Return Reason: COVID negative, follow up for symptom resolution or FOL145 (FOLLOW UP PCP), or arrange follow-up in QuickCare or Urgent Care.
    • Instruct patient that if they wish to cancel their appointment to contact scheduling at 1-319-384-9010.
    • If patient answers and symptoms have resolved or are significantly improved, no additional follow up needed

6. Negative Results – Exposed Asymptomatic Patients

  • The Iowa Department of Public Health recommends that persons with a high-risk exposure to a person with COVID-19 complete a 14-day in-home quarantine if possible.  However, if a 14-day quarantine cannot be completed, there are options for early release from in-home quarantine:
    • Early release after 7 days of in-home quarantine may be considered if a person remains without symptoms and has a negative test on or just before the 7th. However, during the remaining 7 days of quarantine, the person must:
      • Continue to monitor for symptoms of COVID-19
      • Wear a face mask at all times
      • Maintain social distance
      • Follow all other safety measures recommended by public health
    • Early release after 10 days of in-home quarantine may be considered if a person remains without symptoms without any testing.  However, during the remaining 4 days of quarantine, the person must:
      • Continue to monitor for symptoms of COVID-19
      • Wear a face mask at all times
      • Maintain social distance
      • Follow all other safety measures recommended by public health
    • ILI Respiratory Clinic nurse reviews results in EPIC Results Inbasket
  • If patient has MyChart, nurse sends patient a letter via MyChart using smartphrase.
  • If patient does not have MyChart, nurse sends a result note to the P ILI RESPIRATORY ILLNESS NURSE pool and documents specific instructions to be communicated.
  • Clinical staff members will make 1 attempt to provide results. If no answer, will send UIHC: INFLUENZA LIKE ILLNESS RESULTS LETTER COVID Negative High-Risk Exposure.
    • If patient develops symptoms during COVID quarantine, they should schedule another telemedicine appointment to determine if symptomatic COVID testing is needed.

7. Negative results – Pre-operative/procedure testing for Asymptomatic Patients

  • Review to MyChart and done result.  Will not communicate result to patient via telephone.

8. Indeterminate Results – Indeterminate results from UIHC lab have been run twice and come back as a “low positive.” Patients with an indeterminate COVID-19 result will be treated as positive and instructed to isolate like any other COVID-19 positive patient. These patients will not be routinely retested.

  • The Iowa Department of Public Health does not consider these results to be positive and will not contact trace.
ILI Respiratory Clinic/Telemedicine Important Contacts
Updated on 07/19/2021 at 8:33 am
Home Monitoring or ILI Respiratory Clinic Direct Admission Guidelines
Updated on 07/19/2021 at 8:32 am

1. Definition of services

  • Ambulatory and home monitoring of COVID positive patients, managed by:
    • Respiratory Telemedicine – home treatment team staffed by Quick Care and Urgent Care providers

2. Determination of appropriateness for direct admission

  • See document Criteria for Escalation of Care from Home Monitoring of COVID Positive or Suspected Patients

3. Protocol for direct admission to hospitalist COVID team via a telemedicine encounter

  • Telemedicine provider will page the general medicine triage officer or Family Medicine resident on-call (patient >18 yo) or appropriate pediatric service to admit the patient to discuss the patient and the indications for admission
    • If both providers agree a direct admission is appropriate:
      • Referring provider places an admission bed request.
        • This can be done by going to Meds & Orders and entering “admission bed request”
          • Select the inpatient bed request
          • Referring clinic: ILI
          • Contact information: Enter your name and pager
          • Isolation: droplet, contact and eye protection
          • Admitting service: internal medicine (patient >18 yo) or appropriate pediatric service to admit the patient (patient <= 18 yo)
          • Attending service contacted: Select “yes” and then enter the accepting provider’s name. This allows ATC to skip the triage process.
          • Complete the rest of the questions
        • This will trigger the admission transfer center (ATC) to find a bed for the patient.
        • ATC will contact the requesting provider for more information and to inform them when a bed is available.
      • If the medicine triage officer or contacted pediatric service provider recommends ED evaluation:
        • Telemedicine provider will then call the ED, identify themselves and ask to speak to one of the ED staff about the patient.
        • The charge nurse will often answer first and take information about the patient to pass along to the ED staff
        • Discuss the patient with the ED staff, indicating why the hospitalist is concerned about admitting to the floor.
      • Protocol for patients arriving by private vehicle to the ED for either admission or evaluation:
        • Patient (and parent/legal guardian(s) if applicable) should be instructed to present to the main ED entrance.
        • Adult patients are not allowed visitors.
        • Instruct patient to arrive wearing a mask if patient is >2 yo. If they don’t have a mask, they should IMMEDIATELY notify screener or security that a mask is needed by calling the ED once they arrive at the main ED entrance.
        • If patient presenting for direct admission:
          • Screener will notify the ED Charge nurse that a patient has arrived for direct admission
          • ED Charge nurse will notify via Voalte the Med/Surg HOM for adult patients or the CWS HOM for pediatric patients
          • HOM will arrange for an escort to meet the patient at the ED an accompany them to the appropriate ward. This escort is responsible to be sure masks are kept on and in place.

4. Protocol for direct admission to adult hospitalist COVID team or appropriate pediatric service via in-person visit at off-site Walk-in Clinics

  • Provider will page the general medicine triage officer or family medicine on-call resident (patient >18 yo) OR appropriate pediatric service to admit the patient to discuss the patient and the indications for admission. See ILI Respiratory Clinic – Treatment Visit.
  • If both providers agree a direct admission is appropriate:
    • Referring provider places an admission bed request.
      • This can be done by going to Meds & Orders and entering “admission bed request”
        • Select the inpatient bed request
        • Referring clinic: ILI
        • Contact information: Enter your name and pager
        • Isolation: droplet, contact and eye protection
        • Admitting service: internal medicine (patient >18 yo) or appropriate pediatric service to admit the patient (<= 18 yo)
        • Attending service contacted: Select “yes” and then enter the medicine triage officer’s name or Pediatric COVID Hospitalist. This allows ATC to skip the triage process.
        • Complete the rest of the questions
      • This will trigger the admission transfer center (ATC) to find a bed for the patient.
      • ATC will contact the requesting provider for more information and to inform them when a bed is available.

See ILI Respiratory Clinic Treatment Visit Clinical Workflow and Clinical Practice Guidelines for patient transportation guidelines.

  • If the medicine triage officer or contacted pediatric service provider recommends ED evaluation
    • ILI Respiratory Clinic or HTT provider will then call the ED, identify themselves and ask to speak to one of the ED staff about the patient.
    • The charge nurse will often answer first and take information about the patient to pass along to the ED staff
    • Discuss the patient with the ED staff, indicating why the hospitalist is concerned about admitting to the floor.
    • See ILI Respiratory Clinic Treatment Visit Clinical Workflow and Clinical Practice Guidelines for patient transportation guidelines.
ILI COVID-19 Results Algorithm
Updated on 12/16/2020 at 8:19 am

ILI Clinical Pathway
Updated on 06/18/2021 at 2:58 pm

ILI Telemedicine Epic Help FAQs
Updated on 11/12/2020 at 7:52 am

Telehealth Visits and COVID-19 Testing Workflows
Updated on 05/05/2021 at 1:06 pm

Home monitoring of COVID-19 positive patients

Ambulatory Monitoring of COVID Positive Patients
Updated on 05/06/2021 at 8:09 am

AMBULATORY PATIENTS (INCLUDING THOSE SEEN IN ED AND DISCHARGED TO HOME)

  1. COVID Risk 0-2 Peds and Adults
    • ILI (FOL159)
    • Asymptomatic or previously symptomatic but now asymptomatic
      • Patient seen in ILI Telemedicine/Respiratory Clinic
        • Encourage patient to call 319-384-9010 if they would like to schedule follow-up. If patient requesting follow-up, schedule them for last day of quarantine.
      • Patient seen in ED
      • Encourage patient to call 319-384-9010 if they would like to schedule follow-up. If patient requesting follow-up, schedule them for last day of quarantine. No kit
    • Mildly symptomatic
      • Definition
        • ILI Results Pool RN/Provider/ED Team judgment, but generally no more than 1-2 relatively benign symptoms (cough, URI sx). No dyspnea, fever, poor PO intake, etc
      • Patient seen in ILI Telemedicine
        • ILI Result Pool RN to place order for 3-5 day follow up depending on symptoms and risk factors.
      • Patient seen in ED
        • ED team member communicating results to place order for 3-5 day follow up depending on symptoms and risk factors.
      • No kit
    • Symptomatic
      • Definition
        • More serious symptoms (fever, dyspnea, diarrhea, poor PO intake, etc)
      • Patient seen in ILI Telemedicine/Respiratory Clinic
        • ILI Results Pool RN to place order for 2 day follow up.
      • Patient seen in ED
      • ED team member communicating results to place order for 2 day follow up.
      • Message pharmacy via email (HomeMonitoringKits@healthcare.uiowa.edu) to send limited kit*:
        1. Name/Initials
        2. MRN
        3. COVID Risk Score
        4. Specify limited kit
        5. Address
        6. Phone
        7. Special Delivery Instructions (such as leave at front door on black bench)
        8. Preferred language

2. COVID Risk 3+ Peds

    • ILI (FOL159)
    • Asymptomatic
      • Patient seen in ILI Telemedicine/Respiratory Clinic
        • ILI Results Pool RN to place order for 5 days post-positive test.
      • Patient seen in ED
        • ED team member communicating results to place order for 5 days post-positive test.
    • Mildly symptomatic or symptomatic
      • Patient seen in ILI Telemedicine/Respiratory Clinic
        • ILI Results Pool RN to place order for 1-day post-positive test.
      • Patient seen in ED
        • ED team member communicating results to place order for 1-day post-positive test.
    • Providers/ILI Results Pool RN/ED Team will determine if kit is necessary on case-by-case basis. (Full kits can only be sent to patients > 5 years old.)
      • If kit is necessary, message pharmacy via email (HomeMonitoringKits@healthcare.uiowa.edu) to send kit:
        1. Name/Initials
        2. MRN
        3. COVID Risk Score
        4. Specify full or limited kit**
        5. Address
        6. Phone
        7. Special Delivery Instructions (such as leave at front door on black bench)
        8. Preferred language

3. COVID Risk 4+ Adults

    • HTT (FOL161)
    •  Asymptomatic
      • Patient seen in ILI Telemedicine/Respiratory Clinic
        • ILI Results Pool RN to place order for 5 days post-positive test. If possible, avoid scheduling follow-up on Saturday/Sunday.
      • Patient seen in ED
        • ED team member communicating results to place order for 5 days post-positive test. If possible, avoid scheduling follow-up on Saturday/Sunday. If possible, avoid scheduling follow-up on Saturday/Sunday and tell patient to call 319-384-9010 to schedule an earlier test.
      • Message pharmacy via email (HomeMonitoringKits@healthcare.uiowa.edu) to send full kit**
        1. Name/Initials
        2. MRN
        3. COVID Risk Score
        4. Specify Full Kit
        5. Address
        6. Phone
        7. Special Delivery instructions (such as leave at front door on black bench)
        8. Preferred language
    • Mildly symptomatic or symptomatic
      • Patient seen in ILI Telemedicine/Respiratory Clinic
        • ILI Results Pool RN to place order for 2 day follow up (if next day follow-up needed, page 7576 to discuss). If possible, avoid scheduling follow-up on Saturday/Sunday and tell patient to call 319-384-9010 to schedule an earlier test.
      • Patient seen in ED
        • ED team member communicating results to place order for 2 day follow up.
      • Message pharmacy via email (Brenda Carmody, Courtney Gent, Lisa Mascardo) to send full kit**
        1. Name/Initials
        2. MRN
        3. COVID Risk Score
        4. Specify Full Kit
        5. Address
        6. Phone
        7. Special Delivery Instructions (such as leave at front door on black bench)
        8. Preferred language
    • Severely symptomatic or worsening
      • Page HTT team (7576) immediately to discuss a plan.

DISCHARGING INPATIENTS

  • Continued symptomatology OR <10 days since initial symptoms or positive test.
    • HTT (FOL161)
    • Discharging provider places order for 1 day follow up.
  • Bedside RN will arrange home monitoring kit to be delivered to the patient’s room prior to discharge.

 

*Limited kit= pulse ox, masks, nurse education packet

**Full kit= blood pressure monitor, pulse ox, masks, nurse education packet

COVID Risk Score Criteria and Stratification
Updated on 05/06/2021 at 8:11 am

ADULT (18+) COVID RISK SCORE CRITERIA AND STRATIFICATION

Medical history

  • Immunosuppression (2 points)
  • Currently receiving chemotherapy, history of bone marrow or solid-organ transplant, HIV
  • Active cancer/malignancy (1 point)
  • Cognitive Impairment or Developmental Disability (1 point)
  • Age (2 points possible)
    • <25 (-1 point)
    • 25-55 (0 points)
    • 55-69 (1 point)
    • >70 (2 points)
  • Congestive heart failure (1 point)
  • Coronary artery disease (1 point)
  • Hypertension (1 point)
  • Nursing home resident (1 point)
  • Chronic kidney disease (CKD) (2 points)
  • Chronic liver disease (1 point)
  • Pregnancy (2 point)
  • Chronic pulmonary disease (2 points possible)
    • Asthma (1 point)
    • Chronic obstructive pulmonary disease, Interstitial lung disease, cystic fibrosis, other chronic pulmonary diseases (2 points)
  • Diabetes (1 point)
  • Active tobacco use disorder (1 point)
  • Congenital hematologic disorders (2 points possible)
    • Sickle cell disease (2 points)
    • Thalassemia and others (1 point)
  • Cerebrovascular disease (1 point)
  • Overweight/obesity with a BMI (body mass index) >25 (2 points possible)
    • BMI 25-29.9 (overweight) = 1pt
    • BMI 30+ (obesity) = 2 pts
  • Race/Ethnicity = Hispanic or Latino, Black or African American, American Indian or Alaskan Native, and Native Hawaiian and other Pacific Islander people (1 point)

Score 0-2: ILI Respiratory Telemedicine Team

Score 4+: Home Treatment Team (HTT)

Criteria for Escalation of Care from Home Monitoring of COVID Positive or Suspected Patients
Updated on 04/17/2020 at 4:40 pm

Disposition options available:

1. Call EMS (911).

  • Use clinical judgement, but generally should be called with:
    • Unable to speak in full sentences.
    • Having concerning chest pain (particularly if non-pleuritic, exertional & relieved with rest, pressure-like).
    • Symptomatic hypotension: systolic BP <90 or a drop of 30 mmHg or more from baseline.
    • Syncope.
    • Cyanosis per family members.
    • Encephalopathy per family members.
    • Hypoxia: SaO2 <88%.

2. Same day appointment with ILI Respiratory Clinic for in-person evaluation. Patient can receive IV fluids, electrolytes, labs, imaging. Does not need direct admission or ED visit.

  • Use clinical judgement, but generally consider with:
    • SaO2 >92, but decreasing over the last few days (ex 98% —> 95% —> 93%).
    • Asymptomatic hypotension, pre-syncope, lightheadedness.
    • Inability to tolerate PO.
    • Profuse loose stools.
  • Place: FOL160 FOLLOWUP RESPIRATORY ILLNESS CLINIC à
    • PAC schedules patient to be seen same day for a 120min appointment .

3. Direct admission to the floor. If concern a patient requires ICU care, call EMS.

  • Use clinical judgement, but consider with:
    • Similar to criteria in 2a, but in clinical judgement warrants admission. The patient must be stable enough to facilitate admission over a few hours time frame.
    • Worsening dyspnea on exertion, but still able to speak full sentences.
    • Mildly increased O2 requirements (if on baseline O2), but again able to speak full sentences.
    • SaO2 88-92% and able to speak full sentences without respiratory discomfort.
    • Hypotension, but not having syncope.
ICC Triage Algorithm for Home Monitoring
Updated on 04/22/2020 at 8:00 am

Home Monitoring Kit Troubleshooting Guide
Updated on 04/30/2020 at 4:00 pm

Download: Patient education materials

What to do if have COVID-19 symptoms, test positive, or are exposed
Updated on 01/19/2022 at 9:59 am
Family symptoms kit
Updated on 04/16/2020 at 4:00 pm

 

Measuring your symptoms patient kit
Updated on 01/18/2022 at 10:03 am
Disinfect Breastmilk Containers for Moms with COVID-19
Updated on 04/23/2020 at 9:10 am

Safely Disinfect Breastmilk Containers at Home and Bring to the Hospital
Updated on 04/23/2020 at 9:12 am

COVID-19 - Neonatal Information Sheet
Updated on 07/23/2020 at 7:58 am

Newborn Going Home with COVID-19 or with a Mom who has COVID-19

  • Babies infectedor whose status is not known due to lack of testing, but with no symptoms of COVID-19, may be go home on a case-by-case basis. Your babies care team will teach you precautions to take. Follow-up contacts (either by phone, telemedicine, or in-office) will be scheduled through 14 days after birth.

Be sure to teach all people who will care for your baby about wearing a mask and gloves, and washing their hands.

People over the age of 60 and those with health conditions should not care for your baby if possible.

  • Babies with a negative COVID-19 test or who have never been exposed can go home when ready. A healthy (non-infected) person should care for baby.

If an exposed or positive mom is in the same house, she should try to stay at least 6 feet away from baby. When mom must be near baby, she needs to wash her hands with soap and water for at least 20 seconds. If possible, she should also put on a face mask before caring for baby.

She should do this until:

  • At least 10 days have passed since symptoms first started and
  • She does not have a temperature of greater than or equal to 38.0° C (100.4° F) for at least 24 hours without the use of medicine that lowers fevers
  • Other people who are being tested or have symptoms, should wash their hands with soap and water for at least 20 seconds and should also wear a mask if they can whenever they are within 6 feet of the baby.

Breastfeeding

Studies have not found the virus in breastmilk.

We strongly suggest mom pump breastmilk. First, they should wash their hands and breast. Then a healthy person can feed baby the milk.

Moms who want to breastfeed should wash their hands and breasts well and wear a mask. An infected mom could give baby the virus by contact when they are close during nursing but not through the breast milk.

When you get home:

  • Do not take your baby outside, except for health care
  • Do not take your baby to businesses, places of worship, or other public places
  • Do not use public transportation, ride sharing, or taxis

People: Keep baby in one room and away from other people in your home.  Do not have visitors.

Animals: Keep your baby away from pets while they are sick. Have someone else in your home care for your animals.

Cover your coughs and sneezes

Cover your mouth and nose with a tissue when coughing or sneezing. Throw used tissues in a lined trash can. Clean your hands right away.

If you do not have a tissue, hold your arm in front of your face. Cough or sneeze into your elbow. Coughing into your elbow instead of your hand is safer. When you cough into your hand, the virus gets on your hand and is easier to spread.

Clean your hands often

  • Wash with soap and water for at least 20 seconds.
  • If you do not have soap and water, clean your hands with an alcohol-based hand sanitizer with at least 60% alcohol. Cover all parts of your or older sibling’s hands and rub them together until they feel dry.
  • Soap and water are best if hands are visibly dirty.
  • Do not to touch eyes, nose, or mouth with unwashed hands.

Do not share items in the home

Do not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets in your home. After using these items, they should be washed well with soap and water.

Clean all “high-touch” surfaces each day

High-touch surfaces are counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Clean any surfaces that may have blood, stool, or body fluids on them. Use a household cleaning spray or wipe. Follow the label instructions for safe use.

Watch for symptoms

Get health care right away if your baby:

  • Has trouble breathing
  • Will not drink or breast feed
  • Does not have wet diapers often
  • Does not wake up
  • Has a fever

Call your baby’s doctor’s office and tell them your baby has been exposed to COVID-19 but can still be ill from other reasons. Keep a light sheet over your baby before going into the building and you should wear a mask. This will help the doctor’s office to keep other people in the office or waiting room from getting sick.

Discharge information for new parent recovering from COVID-19
Updated on 05/06/2020 at 12:47 pm

COVID-19 and Keeping Your Baby Safe After Delivery
Updated on 08/13/2020 at 7:39 am

Cloth Face Covering Instructions
Updated on 04/27/2020 at 4:00 pm

Home exercise program for patients with COVID-19
Updated on 05/15/2020 at 3:17 pm
Pre-Procedural Screening for COVID-19
Updated on 08/20/2021 at 9:49 am

Inpatient Exposure Discharge Instructions
Updated on 11/01/2020 at 8:51 am

Inpatient screening for COVID-19
Updated on 07/07/2020 at 7:30 am

Visitor guidelines for inpatients with COVID-19 or PUIs
Updated on 12/29/2021 at 12:56 pm

 

Adult inpatient

Pediatric inpatient

View this policy on:

PolicyTech

How to reduce risk levels during COVID-19
Updated on 07/10/2020 at 12:52 pm

What to do if someone in your home has COVID-19
Updated on 09/03/2021 at 12:42 pm

 

How mRNA and viral vector vaccines work
Updated on 04/05/2021 at 9:30 am
How to talk with your patients about receiving the COVID-19 vaccine
Updated on 05/03/2021 at 1:42 pm
What you can do after vaccination
Updated on 06/08/2021 at 9:00 am
Vaccinations available for children ages 5 and older
Updated on 11/11/2021 at 8:11 am