G-WEST APRIL 2022 SUGGESTED ALGORITHM SCENARIO: ROUNDS OF DOCTORS / VISIT OF ANCILLARY *SEPARATE COVID AND CLEAN NURSE STATIONS COVID ROUNDS CLEAN ROUNDS DOCTOR / PERSONNEL ENTERS G-WEST CLEAN AREA DOCTOR / PERSONNEL ENTERS G-WEST CLEAN AREA PROCEED TO DONNING AREA REVIEWS CHART AT CLEAN NURSE STATION REVIEWS PATIENT CHART AT COVID NURSE STATION : WARM ZONE (PREVIOUSLY MANAGER’S OFFICE) *ALL PERSONNEL AT THIS AREA SHOULD BE WEARING LEVEL-3 GOWN, MASK, HAIR CAP, FACE SHIELD, GLOVES AND BOOTIES. PROCEED TO PATIENT ROOMS PERFORM PROPER DOFFING AND DECONTAMINATION MAY GO BACK TO THE NURSE STATION WEARING PRO-GOWN, GLOVES AND MASK IF PATIENT’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’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’ KARDEX AND ACTIVE PROOFLISTS WILL BE KEPT IN THE COVID STATION CLEAN PATIENTS’ KARDEX AND ACTIVE PROOFLISTS WILL STAY IN THE CLEAN STATION QUESTIONS: 1. SEPARATE STATIONS-->CAN THE KARDEX BE KEPT IN THE CLEAN STATION? -TRASNSCRIBING ORDERS THRU ACCESSING THE SCANNED DOS IN MMS? 2. 3. SCENARIO: SEPARATE CHARGE NURSES FOR COVID AND CLEAN STATIONS COVID CHARGE NURSE COVID MD TO WRITE DOCTORS ORDER COVID CHART WILL STAY AT THE COVID STATION (STEEL CHART RACK) QUESTIONS: 1. 2. 3. 4. 5. 6. 7. 8. CLEAN CHARGE NURSE IM RESIDENT TO WRITE DOCTORS ORDERS CLEAN CHART WILL STAY AT THE CLEAN STATION ( WALL-MOUNTED CHART RACK) COVID CHARGE NURSE / WARD CLERK TO SCAN, TRANSCRIBE AND CARRY OUT ALL COVID-RELATED ORDERS CLEAN CHARGE NURSE / WARD CLERK TO SCAN, TRANSCRIBE AND CARRY OUT ALL CLEAN DOCTORS’ ORDERS SAFEKEEP ALL PROOFLISTS, KARDEX, CHART AND IMPORTANT FORMS IN THE COVID STATION SAFEKEEP ALL PROOFLISTS, KARDEX, CHART AND IMPORTANT FORMS IN THE CLEAN STATION SCENARIO: BEDSIDE NURSE DUTY SEPARATE COVID STATION DONNING PERFORMS CHART AND 8AM MEDICATION ENDORSEMENT AT THE COVID NURSE STATION or PERFORMS CHART AND 8AM MEDICATION ENDORSEMENT AT THE HALLWAY MAKE-SHIFT NURSE STATION CHART AND MEDICATIONS REMAIN AT STATION, THEN BEDSIDE WILL MAKE ROUNDS 1ST ROUNDS CHARTING TO BE DONE AT THE COVID STATION OR MAKE-SHIFT HALLWAY DOFFING PICK-UP SUPPLIES/MEDS FROM THE CLEAN STATION DONNING CONTINUE ROUTINE TASKS ASK HELP FROM CLEAN STATION TO: DELIVER MEDS AND FOOD BREAK AT CLEAN PANTRY DOFFING DISPOSE TRASH BEDBATH, DIAPER CHANGE PREPARE FOR END-OF-SHIFT ENDORSEMENT SCENARIO: BEDSIDE NURSE DUTY COVID NURSE IN A MIXED COVID AND CLEAN STATION SET-UP ENDORSEMENT AT CLEAN NURSE STATION DONNING OF COVID NURSE BRING 1ST 2 HOURS DUE MEDS 1ST ROUNDS ROUTINE ACTIVITIES ASK HELP FROM CLEAN STATION TO: DELIVER MEDS AND FOOD DOFFING DISPOSE TRASH BREAK AT CLEAN PANTRY BEDBATH, DIAPER CHANGE CHARTING TO BE DONE AT THE CLEAN STATION OR MAKESHIFT HALLWAY STATION PICK-UP SUPPLIES/MEDS FROM THE CLEAN STATION CONTINUE ROUTINE TASKS DOFFING QUESTIONS: 1. 2. DONNING PREPARE FOR END-OF-SHIFT ENDORSEMENT WIPE WITH CLINELL BEFORE RETURNING TO CHART RACK OR SUBMITTING TO CN/WC SCENARIO: ADMISSION PROCESS SEPARATE COVID STATION : ADMITTING COVID PATIENTS ADMISSION OFFICER WILL CALL THE UNIT TO DECK A PATIENT BEDSIDE NURSE ER DEPARTMENT WILL ENDORSE THE PATIENT VIA PHONE CALL *MAY GIVE ESTIMATED TIME OF ARRIVAL HOSPITALIST **POSSIBLE SECOND CALL OF ER G-WEST COVID NURSE AND NURSING AIDE ON STANDBY NEAR HOTZONE MARKER ER TRANSPORT TEAM WILL WHEEL-IN THE PATIENT UP TO THE COVID HOT ZONE FLOOR MARKER (RED LINE) ER TEAM AND G-WEST TEAM TO WHEEL-IN PATIENT UP TO THE DESIGNATED PATIENT ROOM FOR SAFE PATIENT TRANSFER BEDSIDE NURSE MAY PROCEED WITH USUAL ADMISSION PROCESS AND ROUTINE CARE **G-WEST TO MAKE SURE THAT NO CLEAN PATIENT IS ALONG THE HALLWAY AND ER TEAM MAY PERFORM DOFFING INSIDE THE G-WEST DOFFING AREA QUESTIONS: 1. WILL ER DEPARTMENT ALLOW ER TRANSPORT TEAM TO ENTER THE G-WEST HOT ZONE? **GWEST MANPOWER PROBLEM 2. SCENARIO: ADMISSION PROCESS SEPARATE COVID STATION : ADMITTING CLEAN PROGRESSIVE PATIENTS ADMISSION OFFICER WILL TALK TO THE RELATIVES/PATIENT AND EXPLAIN THAT THE UNIT IS NEAR COVID PATIENT ADMISSION OFFICER WILL CALL THE UNIT TO DECK A PATIENT ER DEPARTMENT WILL ENDORSE THE PATIENT VIA PHONE CALL *MAY GIVE ESTIMATED TIME OF ARRIVAL ER TRANSPORT TEAM WILL WHEEL-IN THE PATIENT UP TO THE PATIENT’S DESIGNATED ROOM BEDSIDE NURSE SENIOR MROD **POSSIBLE SECOND CALL OF ER **G-WEST TOMAKE SURE THAT NO COVID PATIENT IS ALONG THE HALLWAY AND COVID RENAL DOOR IS CLOSED G-WEST CLEAN NURSE AND NURSING AIDE TO ASSIST ER IN BED TRANSFER QUESTIONS: 1. 2. 3. BEDSIDE NURSE MAY PROCEED WITH USUAL ADMISSION PROCESS AND ROUTINE CARE SCENARIO: DURING RAPID RESPONSE TEAM OR CODE BLUE SEPARATE COVID STATION : RRT OF COVID PATIENT ACTIVATION OF RRT/CODE BLUE DONNING OF COMPLETE PPE FOR ALL PERSONNEL **BUNNY SUIT AND FACE SHIELD INCLUDED CHARGE NURSE TO COORDINATE WITH AROD FOR AIRWAY, IPM FOR ABG AND MACHINE, XRAY DEPARTMENT FOR POST-INTUBATION SCAN RN1 - BEDSIDE NURSE RN2 - ANOTHER BEDSIDE NURSE RN3 - SENIOR NURSE/CHARGE NURSE AROD - ESTABLISH AIRWAY PFOD - MV SETTINGS HOSPITALIST - INFORM MDS AND RELATIVES **WAIT FOR AROD TO INITIATE INTUBATION COMPLETE SEDATION: (UNOPENED - C/O BEDSIDE) (PREPARATION AND ADMINISTRATION - C/O AROD) NURSING AIDE/PORTER TO RUN ERRANDS LIKE SECURING CMAC, INTUBATION CLEAR BOX, NEEDED CSS SUPPLIES AND MEDICATIONS NURSING AIDE : ASSIST IN POST-EVENT PATIENT CARE +USED E-CART AND CMAC HOUSEKEEPER: POST-EVENT CLEANING USE OF INTUBATION BOX AND PLASTIC COVER, ADEQUATE IV LINES, INSERT FOLEY CATHETER, INSERT NGT, RRT FORM / CODE BLUE FORM BEDSIDE NURSES, NURSING AIDE, HOSPITALIST PFOD, AROD, XRAY TECHNICIAN, RESPIRATORY THERAPIST, HOUSEKEEPER CONTINUE ROUTINE CARE POST - INTUBATION OR POST - ROSC DOFFING TRANSFER TO INTENSIVE UNIT OR CONVERT TO CRIT - EXTENSION MAKE SURE NO CLEAN PATIENT IS ALONG THE HALLWAY DURING TRANSPORT PROPER INFECTIOUS AND SHARPS DISPOSAL ACCESS CHART AT NURSE STATION SCENARIO: DURING RAPID RESPONSE TEAM OR CODE BLUE SEPARATE COVID STATION : RRT OF CLEAN PROGRESSIVE PATIENT ACTIVATION OF RRT/CODE BLUE CHARGE NURSE TO COORDINATE WITH AROD FOR AIRWAY, IPM FOR ABG AND MACHINE, XRAY DEPARTMENT FOR POST-INTUBATION SCAN RN1 - BEDSIDE NURSE RN2 - ANOTHER BEDSIDE NURSE RN3 - SENIOR NURSE/CHARGE NURSE AROD - ESTABLISH AIRWAY PFOD - MV SETTINGS HOSPITALIST - INFORM MDS AND RELATIVES **WAIT FOR AROD TO INITIATE INTUBATION COMPLETE SEDATION: (UNOPENED - C/O BEDSIDE) (PREPARATION AND ADMINISTRATION - C/O AROD) NURSING AIDE : RUN ERRANDS AND ASSIST IN POST-EVENT PATIENT CARE HOUSEKEEPER: POST-EVENT CLEANING USE OF INTUBATION BOX AND PLASTIC COVER, ADEQUATE IV LINES, INSERT FOLEY CATHETER, INSERT NGT, RRT FORM / CODE BLUE FORM CONTINUE ROUTINE CARE POST - INTUBATION OR POST - ROSC TRANSFER TO INTENSIVE UNIT SCENARIO: MORTALITY SEPARATE COVID STATION : UPON DEATH OF A COVID PATIENT DEATH OF PATIENT POST RRT / CODE BLUE PRONOUNCE TIME OF DEATH BY MD NOTIFY ALL MDS AND IMMIDIATE RELATIVES POST-MORTEM CARE HOSPITALIST: HOSPITAL MORTALITY, NOTICE OF DEATH, CF4, CLINICAL SUMMARY BEDSIDE NURSE: COMPLETE CHART, INITIATE DISCHARGE PROCESS CHARGE NURSE: OFFICIAL UNIT SMS TO MDS, COLLECT PF, COMPLETE IMPORTANT DOCUMENTS ALL LEFTOVER BELONGINGS FOR DISPOSAL *IF WITH IMPORTANT BELONGINGS--> SUBMIT TO IN-HOUSE SECURITY AFTER 1 MONTH TRANSFER TO MORGUE: IN-HOUSE SECURITY ADMISSIONS OFFICE PATHOLOGY MAKE SURE NO CLEAN PATIENT IS ALONG THE HALLWAY DURING TRANSPORT INSTRUCT RELATIVES REGARDING ISOLATION BEFORE SENDING HOME IN-HOUSE SECURITY QUESTIONS: 1. 2. SCENARIO: WARD CLERK DUTY SEPARATE COVID AND CLEAN NURSE STATIONS DUTY FOR MIXED COVID AND CLEAN PATIENTS STAY AT CLEAN NURSE STATION HELP CLEAN CHARGE NURSE CARRY OUT DOCTORS’ ORDERS ANSWER CALL BELL AND RELAY TO COVID CHARGE/BEDSIDE NURSE PREFERRABLY VIA PHONE CALL HELP BEDSIDE NURSE IN TURN-IN/CMRN, CLERICAL TASKS NOT ENCOURAGED TO ASSIST IN DIRECT PATIENT CARE HELP COVID CHARGE NURSE CARRY OUT DOCTORS’ ORDERS DUTY FOR STRICT COVID PATIENTS STAY AT COVID NURSE STATION ANSWERPHONE CALLS AND RELAY TO COVID CHARGE/BEDSIDE NURSE PREFERRABLY VIA PHONE CALL HELP COVID CHARGE NURSE CARRY OUT DOCTORS’ ORDERS AND OTHER CLERICAL TASKS REMIND PERSONNEL TO DOFF FIRST PRIOR TO ACCESS ON CHART HELP BEDSIDE NURSE IN TURN-IN/CMRN, CLERICAL TASKS NOT ENCOURAGED TO ASSIST IN DIRECT PATIENT CARE PERFORM DONNING DOFFING, DECONTAMINATION ⚫ ⚫ ⚫ ⚫ QUESTIONS: 1. 2. 3. LOW VOLUME OF PATIETNTS: AM-PM SCHED: CATERS BOTH COVID AND CLEAN ALTERNATE DAYS 9-5 SCHED: CATERS BOTH COVID AND CLEAN HIGH VOLUME OF COVID AND CLEAN PATIENTS: SAME DAY 9-5 SCHED (1 WC FOR COVID AND 1 WC FOR CLEAN) *WEEKLY ALTERNATE DESIGNATION ALTERNATE DAYS 9-5 SCHED: CATERS BOTH COVID AND CLEAN SCENARIO: WARD CLERK DUTY MIXED COVID AND CLEAN NURSE STATIONS STAY AT CLEAN NURSE STATION ANSWER CALL BELL / PHONE CALLS AND RELAY TO CHARGE/BEDSIDE NURSE HELP CHARGE NURSE CARRY OUT ALL DOCTORS’ ORDERS REMIND PERSONNEL TO DOFF FIRST PRIOR TO ACCESS ON CHART **MAY WEAR CLEAN GLOVES WHEN HANDLING COVID CHART / SPECIMEN FOR SUBMISSION WIPE WITH CLINELL ALL PATIENT CHARTS AT THE END OF DUTY QUESTIONS: 1. 2. 3. SCENARIO: HOUSEKEEPING ON DUTY MIXED COVID AND CLEAN NURSE STATIONS STAY INITIALLY AT CLEAN AREA AS NEEDED / ON-CALL MAINTENANCE SCHEDULED/ ROUTINE MAINTENANCE HOUSEKEEPING CART: KEEP CLEANING SET FOR CLEAN AREA IN THE UTILITY ROOM AND CHANGE TO COVID SET DONNING BRING THE SAME HOUSEKEEPING CART INSIDE THE HOT ZONE BUT WITH THE COVID CLEANING SET IN PLACE MAINTENANCE DISINFECT HOUSEKEEPING CART PROPERLY DOFFING PROPERLY CLEAN AND STORE COVID CLEANING SET IN THE UTILITY ROOM AND REPLACE IT WITH THE CLEAN AREA SET MAY DO SHOWER DECONTAMINATION POST-DUTY OR IF WON’T GO BACK INSIDE THE HOT ZONE QUESTIONS: 1. CHEMICAL DECONTAMINATION PRIOR TO GOINGBACK TO THE CLEAN AREA SCENARIO: NURSING AIDE ON DUTY AM DUTY (CLEAN) 9-5 DUTY (COVID) RECEIVE ENDORSEMENT FROM NIGHT SHIFT LINEN CHANGE MONITORING, LINEN COUNT SHEET PRIMARILY FOR CLEAN PATIENTS MAY HELP REFILL PPES IN DONNING RUN ERRANDS RECEIVE ENDORSEMENT FROM AM SHIFT REFILL PPES AND DROP LINEN PATIENT CARE DONNING DO ERRANDS AND DIRECT PATIENT CARE HELP REHEAT FOOD FOR COVID PATIENTS SINCE THE MICROWAVE OVEN IS IN THE CLEAN AREA ASSIST COVID NURSES IN GETTING NECESSARY SUPPLIES OR MEDICATIONS FROM CSS/PHARMA +LINEN DOFFING DECONTAMINATION POST-DUTY SCENARIO: NURSING AIDE ON DUTY PM DUTY (CLEAN) NIGHT DUTY (MIXED PATIENTS) RECEIVE ENDORSEMENT FROM AM SHIFT PRIMARILY STAYS AT CLEAN AREA PRIMARILY FOR CLEAN PATIENTS REFILL PPES AND LINEN MAY HELP REFILL PPES IN DONNING RUN ERRANDS HELP REHEAT FOOD FOR COVID PATIENTS SINCE THE MICROWAVE OVEN IS IN THE CLEAN AREA PATIENT CARE ASSIST COVID NURSES IN GETTING NECESSARY SUPPLIES OR MEDICATIONS FROM CSS/PHARMA DONNING DO ERRANDS AND DIRECT PATIENT CARE +LINEN DOFFING DECONTAMINATION POST-DUTY **NIGHT SHIFT NURSING AIDE: SCHEDULED HOT ZONE ENTRY 3-5AM **PM SHIFT NURSING AIDE: SCHEDULED HOT ZONE ENTRY 7-9PM QUESTIONS: 1. 2. 3. SCENARIO: ANCILLARY PERFORMING PROCEDURES BOTH FOR CLEAN AND COVID VERIFY ORDERS AND ENCODED ITEMS AT NURSE STATION AND CHARTS PERFORMS PROCEDURE TO CLEAN PATIENT FIRST CHARTS FINISHED PROCEDURE DONNING PERFORMS PROCEDURE TO COVID PATIENT NEXT DOFFING CHARTS FINISHED PROCEDURE DISINFECTION AND DISPOSAL OF USED MATERIALS / EQUIPMENT C/O ANCILLARY TECHNICIAN
