THPG Operations

THPG Safe Return to Care Reference Guide


Cleaning Procedures

Aerosol

  • These procedures should only be done in order to save a life.
  • Consider administering treatment in a room used the least
  • Following a nebulizer treatment, close the door. The room should be left dormant until the next day and cleaned before use. Staff who must enter the room during the treatment should wear N95 respirators and eye protection. Stethoscopes, if not disposable, should be thoroughly cleaned after use.

Office

  • The Environmental Protection Agency (EPA) recommends the below guidance to ensure you are using an appropriate disinfectant.
  • At the end of the day clean all exam rooms, check-in & check-out counters and waiting room furniture. All areas where patients would have come into contact. 
  • Clean with the recommended disinfectant such as Citrace. Clean the exam table, cabinet countertop, cabinet and doorknobs, mayo stand, chair handles, jar tops, hot/cold water facets if you have a sink in the room and any other thing the patient may have touched.
  • A recommendation is to remove the jars of cotton swabs, tongue blades, etc. into a central area of the clinic to maintain your level of supplies. You could place those items in something like a shower caddy to carry with you to an exam room, so those things are not in the room. Supplies may go missing. Patients do go through drawers and cabinets, so we want to remove opportunity where possible. Do not leave a speculum on a mayo tray prior to an exam It can be carried into the room if a vaginal exam is necessary.

Post COVID Patient

  • After the patient leaves the exam room, close the door. The room should be left dormant until the next day and cleaned before use.
  • Clean the exam room with the recommended disinfectant such as Citrace. Clean the exam table, cabinet countertop, cabinet and doorknobs, mayo stand, chair handles, jar tops, hot/cold water facets if you have a sink in the room and any other thing the patient may have touched.

Coding and Reporting Guidelines for COVID 19


Test Result Notification for COVID 19

  • Following testing, please check in with patients frequently (daily if possible) to ascertain their status. Symptoms can change rapidly, and patients must be counseled to seek a higher level of care when symptoms are worsening.
  • COVID-19 test results will flow into MyChart for those orders placed in the practice setting. When speaking with patients regarding their results, the following information regarding self-isolation should be explained:
  • Persons with positive COVID-19 results who have symptoms and were directed to care for themselves at home may discontinue home isolation under the following conditions:
    • At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath)
    • And at least 7 days have passed since symptoms first appeared.
  • Persons with negative COVID-19 results should be advised as follows:
  • If they have had close contact with an individual known to have tested positive for COVID-19, they must remain in isolation until 14 days from their last contact with the individual.
  • If they did not have contact with an individual known to have tested positive for COVID-19, they must remain in isolation until 72 hours have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath)

EDS Triage Documents in 4 Languages

  • Please refer to 4/07/2020 (9:59am) Operations Update Email from Jennifer Stephenson

Employee Resources:

EAP

  • Phone Number: 877-MyTHRLink (877-698-4754), select prompt 4, then select 4 again OR call 682-236-6861 to speak to a representative who can help you schedule an appointment or connect you to a counselor.

Childcare


Ordering Chest X-rays

  • Our imaging partners are working to protect their staff and most have made the decision to not perform imaging on patients with cough or fever. Where clinically acceptable, guidance is to treat empirically for pneumonia and follow the patient closely for deterioration of symptoms. Only send those patients to the hospital emergency department that warrant emergency care.

Plasma Donations

  • Contact Clinical Nurse Leader: douglasjohnson@texashealth.org or 214.345.5926
  • Email with the word ‘PLASMA’ in the subject line or leave a voicemail with your name and phone number

PPE Requirement:

All Staff:

  • All employees and providers will now be required to wear face masks (formerly referred to as surgical or isolation masks) continuously while any building that provides patient care.
    • Mask should be changed daily, or when it is wet or soiled
    • Wash/foam hands before and after changing face masks
    • Remove and discard face masks after leaving an exam room of a patient suspected for COVID-19 and replace with a new mask before entering the next patient room.

Front Desk Personnel:

  • Email sent by THPG Leadership on 3.24.20 -1p
  • All employees and providers will now be required to wear face masks (formerly referred to as surgical or isolation masks) continuously while in any building that provides patient care. This includes caregivers, administrators, Food Services, Environmental Services and all other staff. Everyone has an important role in controlling the spread of the virus and keeping our employees and patients safe.
    • Wear gloves and use hand sanitizer (on the gloves) between patients at reception. Gloves should be changed daily or as soon as they torn or soiled.
    • Minimize exchange of items (Ex. Allow patient to insert credit card in the machine when possible)
    • Encourage patients to use hand sanitizer before handing objects to an employee and after taking the object back.
    • Always perform hand hygiene before and after glove use.

Patients and Guests:

  • All patients and individuals with patients are to be masked. As a reminder, there should be no more than one individual with each patient.

Reporting COVID 19

County Health Departments According to Patient’s Residence


Return to Work Letters in Epic

  • There are two THPG COVID-19 letters for patients available in the letter’s activity in Epic.
    • AMB THPG COVID-19 RETURN TO WORK (ID#58225)
    • AMB THPG COVID-19 WORK FROM HOME REQUEST (ID#58280)

  • Contact DL for further assistance: DLCareConnectTHPGtraining@TexasHealth.org

RL Tool for COVID-19

  • Reporting in the RL tool for COVID19 patients is only when there is a gap in procedure (PPE) for patients who are suspect or known positive for COVID19. 

Temperature Check Procedure for COVID-19

  • Employees 2x day: >100.0:
    • Send home to self-isolate
    • Notify Employee Health and follow next steps
    • Employee to get tested at THPG testing center
  • Patients and visitors upon office entry
    • Wear face mask provided by clinic

Testing Orders for Healthcare Workers and First Responders for COVID-19

  • Lab order, in the comment field, must state healthcare worker or first responder for priority service

THPG Office Workflow for COVID 19


THPG Office Staff Script for COVID 19


Treatment for COVID-19

  • There have been many references to the use of azithromycin and chloroquine for treatment of COVID-19. There are studies in support of this for hospitalized patients, although the studies have been small. Due to the emerging nature of this disease, the studies are not randomized controlled trials. Furthermore, the studies indicate reduction in viral load but there is no clear correlation with clinical outcomes. The risk of prescribing these medications as empiric treatment or prophylactic and “just in case” treatment for concerned patients is that supplies of these medications will be diminished and unavailable for acutely ill hospitalized patients. Patients will ask/demand for these prescriptions and it is incumbent upon each provider to be good stewards of our precious resources.
  • Should you or your patients be interested, there is a trial seeking research volunteers who are:
    • Health care workers or household contacts with known exposure to someone with COVID-19 within the last 4 days and who are currently asymptomatic.
    • People who are symptomatic with confirmed PCR+ COVID-19 diagnosis within the first 4 days of symptoms starting.
    • Health care worker with compatible symptoms with exposure to known PCR+ COVID-19 case within 14 days AND compatible symptoms of fever, cough, or shortness of breath and no available testing or pending testing for the individual.

Virtual Visits

  • Video virtual visits can be conducted to complete HCC forms
  • For primary care providers using Skype, do not direct patients to the call center (682-236-6700) for Virtual Visit invite issues. If an invite is needed for an appointment in the next hour, or the patient is getting an error with the invite, the PM and only the PM should contact Kathy Lindler.

Visitor Policy for COVID-19

  • In an effort to reduce community spread, individuals accompanying patients to THPG practices must be limited to one person who is needed to assist the patient, either due to mobility or communication concerns.
  • Additionally, please discourage children less than the age of 16 from accompanying their adult parents or guardians to the office.

Vendor/ Pharm Visits for COVID-19

  • Pharmaceutical or sales representative are not allowed in the clinic nor are outside vendors.
  • Vendor partners who provide clinical care to our patients are allowed to be in the clinic such as Airrosti, Quest, etc.

Lunches Provided by Vendors

  • May be provided, must be individual lunches, not buffet style. The company representatives are not allowed to come to the clinic.




THPG Safe Return to Care Checklist