CMDA monthly meeting - Shared screen with speaker view
Yes, 41 Facilities identified, though quite a few more have possible or probable cases
Are providers using hydroxychloroquine/z-pack? Is this restricted from use in Colorado?
Can we consider as a community establishing consistent guidelines for when to trial using hydroxychloroquine and azithromycin?
Timothy Rodgers, MD
The problem is not how to use PPE. The problem is what to do when all your gear runs out!!!
Any recommendations for ALs with Memory Care Units, on how to handle patients who may be + for COVID?
what is the opinion on governor's speech being so positive and talking about ending quarantine early?
Recently, there has been fingerstick antibody tests available to first responders in Denver. Will this be available to be used in residents at SKL/LTCF facilities. Also, what are the sensitivities/specificities of both the COVID-19 PCR and Antibody test?
LTC Facility has 14 day quarantine for new admits. I wanted to swab for COVID d/t cough and hypoxia (likely 2/2 lung ca and pt is on hospice) but she came from home with unknown exposure. Staff is stressed and I feel this would alleviate some anxiety with staff. However facility would still leave them on 14 day quarantine even if swab is negative. Is the quarantine necessary if swab negative?
I would also love to have guidelines on when to try using the hydroxychlorquine and azithromycin.
Are there current studies for use of these medications in CO? If so can these be posted on CMDA website?
I have a pt that wants to be transferred from a subacute facility to an NF facility. The pt has no COVID screens but the receiving facility wants a negative COVID test, which I can’t get from the local hospital lab as the pt doesn’t meet criteria. Any suggestions?
I recently had a medical director recommend adding Lovenox to the hydroxychloroquine and z-pack. What is the recommendation on using Lovenox?
It seems as if there are a lot of different COVID-19 assays; do we know the sensitivity of each test? Is there one in particular that is being used in most facilities?
Timothy Rodgers, MD
The problem is not how to use PPE. The problem is what to do when all your gear runs out.
Columbine Health Systems
I have heard that hospitals are not utilizing bipap/cpap unless in a negative pressure room due to risk of aerosolization. Has anyone else heard of this, or is anyone changing management of these devices within their facilities in the setting of an outbreak?
What are you thoughts on the management plan of “low occupancy facilities” meaning facilities that are currently <80% census, taking in admissions that are not necessarily proven COVID-19 negative from the hospitals?
Will we see more COVID+ pts discharted from hospitals to our SNFs?
How are facilities handling acceptance of new admissions? COVID positive during hospitalization, COVID unknown, COVID PUI?
Any clinical pearls on supportive treatment for patients dying of Covid-19 in LTC?
I have heard that the providers in the hospitals are told not to do compressions at this point, is this true?
Morphine seems to be the drug of choice
What is the school of thought for admitting a "recovered" COVID patient in a COVID naïve facility? "Recovered" meaning symptom-free, fever-free for >72 hours, > 10 days from onset of symptoms.
Is there evidence that if you get Covid, you will be immune to it in the future? If a staff member gets sick and recovers, should those staff members then be the ones to care for other Covid + cases?
I have also heard pts dying with COVID need higher doses roxanol? What is the typical regimen providers are using?
What is the guidance on ppt who are residing in a facility who are hot bed ( large number of positive pt. + some in hospital either critically ill or are dying) and family of non symptomatic ppt are asking for their loved one to be tested so they can be moved from their current facility.
As a reminder, providers are protected legally and ethically, when they make a decision aligned with “non-beneficial interventions”
Dr. Watson, could you expand on that at some point?
If we are in a Covid 19 negative facility, would you recommend NOT admitting Covid 19 patients even if they test negative before discharge?
UC Health (and many others) have elaborated what is rarely discussed, but commonly practiced -quoted here: Non-beneficial interventions:As always, you are under no obligation to offer treatments without known benefit to a patient even should they or their families request such treatments. We do this with simpler treatments all the time, such as declining to prescribe requested antibiotics when patients have a viral URI. Declining to offer aggressive therapies should be no different. Existing UCHealth, do not attempt resuscitation (DNAR Policy), non-beneficial intervention (Non-beneficial Intervention Policy) and end of life care End of Life Care Policy) policies support the concept that health care providers are not obligated to offer non-beneficial interventions.
Dr. Gaur, how were you able to get universal testing? I can't even get a hospitalized patient re-tested.
Dr Gaur is in Georgia.
Thank you, Dr. Watson!
How do the rest of us get access to the new test Dr. Watson is using?
Firas Saidi,MD Manor care HV
tests are more available but we don’t have swabs
I thought this group would be interested in this:
Big News: Dr. Joseph Ouslander, co-creator of INTERACT, is the Featured Guest on Telligen's April 9th COVID-19 Office Hours!
Does staff need to get new gowns in b/w each suspected COVID pt rooms?
sorry I have to go. thank you everyone. please feel free to reach out to me with questions or concerns!!
Thank you . we will obtain written responses to the rest of the questions and send them out to the CMDA list. Thanks everyone!
Thanks for doing this. Great stuff
Well done CMDA team-awesome
this was so helpful--thank you!
can you put the link in the chat?
I would like that website
Thank you everyone!