Dealing with COVID-19 in Hospice

August 15, 2020

You want to protect your patients and staff from COVID-19. To limit exposure, the CDC recommends avoiding contact with other persons. But your patients are relying on you to relieve their suffering and distress and most likely will require an in-person visit. How can you do this safely? The following are steps supported by the CDC, Health and Human Services, and other agencies.

Fortunately, in healthcare and especially home-based care, hand hygiene has always been a top priority even before COVID-19. The virus appears to spread mainly from person to person through respiratory droplets, therefore in addition to hand hygiene, wearing a mask when around other persons is paramount to reducing exposure.

At all times, provide patient care using standard precautions and prevention strategies, including:

Perform proper hand hygiene before and after all patient contact, contact with potentially infectious material, and before putting on and after removing Personal Protective Equipment (PPE), including gloves, by washing hands with warm water and soap for at least 20 seconds, or using alcohol-based hand sanitizer that contains 60-95% alcohol.
Appropriate usage of PPE should be followed, including a face mask.

Now with that out of the way. Here are the steps to take based on the flow chart provided by the Accreditation Commission for Health Care (ACHC). Here is the flow chart.

ALL STAFF: Every day self-monitor for a fever (higher than 100.3 degrees) or new respiratory symptoms, such as a cough, shortness of breath, or sore throat? Have you had close contact (lived with or been within 6 feet for over 15 minutes) with a person with COVID-19 in the past 14 days? If you answered "yes" to any of these questions, contact your agency for further directions.

ALL PATIENTS (new and existing): Each day before any visits occur, call and ask the patient/caregiver if they or anyone who lives with them:

Has a fever (higher than 100.3 degrees) or new respiratory symptoms, such as a cough, shortness of breath, or sore throat?
Has had close contact (lived with or been within 6 feet for over 15 minutes) with a person diagnosed with COVID-19 in the past 14 days?
Has been diagnosed with COVID-19 or told by a healthcare provider that they might have or have COVID-19?

If they answer "no" to all of these questions, then visits may be made using standard precautions outlined above. If they answered "yes" to any of the questions, the Healthcare Provider is contacted for further guidance.

The most significant action is communication. This is where using an Electronic Health Record (EHR) can help. Staff needs to know which patients have been contacted and the results. Using Digital Physician's Hospice EHR, each contact made to screen for COVID-19 can be documented and included in the chart.

FIRST STEP: add a chart document label for COVID-19 Screening.
Go to the "Settings" icon drop-down menu in the top right, and select "Organization Settings." Then select "Chart Document Labels" and click "Add" located near the bottom right. Select a chart category, then add the label "COVID-19 Screening." Next select "Yes" for "Result has value" and enter "Completed" for the default value, then save.

SECOND STEP: create an audit trigger with a reminder message.
From the "Settings" icon drop-down menu, select "Care Paths/Reminders," and a list of existing reminders will display. Click "Create New Reminder" at the bottom right and fill in the questions, then save. The "Reminder Item" must be selected from the autocomplete drop-down list that matches the label you just created (COVID-19 Screening). Make sure to set the interval/frequency to "Daily." The "Chart Alert" should be set to "Yes" to ensure that the patient's chart prominently displays if the "COVID-19 Screening" is not complete.

THIRD STEP: add a notification for the responsible staff member.
From the "Care Paths and Reminders" list, select the reminder "COVID-19 Screening" to make changes or add a notification. Select the "Notifications" tab, click on "Add Notification" and complete the form, then save.

FINALLY: as the staff member calls the patient or representative, enter the result in the patient's chart. From the patient's chart, click on "Action" located in the bottom left and select "Result." Type in the label "COVID-19 Screening," select it from the drop-down list, and then complete the remaining questions and save.

If this solution sounds useful to you, sign up for a free trial of Digital Physician's Hospice Telemedicine and Electronic Health Record (www.digitalphysician.com/signup).