Tuesday, April 7 Community Briefing

Drive-thru test collection has increased to an average of approximately 8 daily, with a total of 53 to date since drive-thru testing began.  Test specimen collections are being sent to Quest laboratory in Lenexa, KS due to prioritization of testing at the KDHE laboratory and test results are taking approximately 48 hours.

Respiratory Clinic – patients are advised to call their provider’s office before they go which enables the office to schedule them to be seen in the Respiratory Clinic if their symptoms mimic respiratory illness. Average of 1-2 COVID-19 tests are administered for an approximate 12 patients seen in the clinic per day.  Capability to see 24 patients daily with the increase to 2 advanced practice providers and 4 additional exam rooms.  Patients are being scheduled in the clinic Monday-Friday, 8:00am-12:00pm.

Inpatient volume – total inpatient volume averages 17-21 (ALL hospitalized patients – unrelated to COVID-19).

Total COVID-19 inpatients to date is six.  Two have transferred to Topeka.  One has been discharged home to isolation.  Three are currently inpatients in our COVID-19 unit.  COVID-19 patients are cohorted to one unit which is a negative pressure unit.  The location of the unit is the old ICU area on 3^rd floor.

Opening of CCU (COVID-19 Care Unit) – opened on Friday, April 3, for a total of 8 COVID-19 patients, if needed.  The decision was made to move COVID-19 patients to CCU in order to keep patient rooms available for all other inpatients.  There is a total of 5 isolation rooms within the hospital.

PPE plan/utilization:

• All patient encounters. All the time.  One procedure mask per shift (based on CDC recommendation) to help extend the current supply inventory for all patient care staff.  With this method and use rate, we have an approximate 3-week supply (18 days) on hand.  We anticipate our allocated order arriving mid-April where we may be able to re-evaluate our PPE usage rates.
• Powered Air Purifying Respirator (PAPR) use for PUI/Positives
• PPE assistants/spotters

Sample size of Lyon County is relatively small to compare to the national trend.  Inconsistency of promptness to report – data may be skewed, especially on the weekends where data tends to show a decrease on Saturday/Sunday with a spike on Monday.  Overall country data is currently heavily weighted by 3 states – New York, New Jersey, Connecticut.  Positive inpatient numbers increasing tells us that community spread is happening within Lyon County.

To meet KDHE guidelines and Lyon County Public Health regulations from Friday, April 3, all self-serve stations accessible by the public have been temporarily closed.

Global PPE protocol during the COVID-19 pandemic has slightly changed normal patient care processes with limited ability for staff to interact with patients normally through facial expressions and emotions.

Dr. Alana Longwell and Bethany Frank re: Advance Directives

Overview of hospice – team that works together to focus on working with people with life-limiting illnesses.  Team includes physicians, social workers, registered nurses, hospice aides, chaplains, and volunteer services who are all devoted to patients and family members.  Hand in Hand Hospice serves the Lyon County and surrounding areas.

Social work – advanced planning, advance directives; community education provided at all times and directly with hospice patients/family members

Types of advance directives:

1. Durable Power of Attorney (DPOA):

• Someone appointed to make decisions re: medical care for the best interest of the patient when a patient is unable to verbalize those requests themselves
• Someone that knows the patient’s wishes (medically) – doesn’t have to be a family member, could be a trusted friend
• Not having this in place can often cause turmoil within families with differing opinions

2. Living Will:

• A way to deny medical equipment or life sustaining equipment
• Often used when there is an incurable disease and would enable patient the right to refuse medical equipment that prolongs the dying process if it is not in line with the patient’s wish
• Prolonging the dying process isn’t a matter of choosing life or death – it’s choosing how one wishes to die and allows them the opportunity to die peacefully and naturally

3. DNR (do not resuscitate)

• Chest compressions would not be used at a time when a patient’s heart stops beating or they stop breathing, to allow for a dignified and peaceful death
• An important topic to be discussed with those that have underlying health conditions because people with those conditions have an approximate 2% success rate with resuscitation

Encourage community to begin these conversations – this is not a scare tactic.  It’s an important topic that needs to be discussed so that family members can be coordinated on the decisions for their loved ones. No one plans to be in the hospital, no one plans to test positive for COVID-19, but medical decisions can be planned and having those decisions made is a gift that we can give our family members during that challenging time.

It is understood that these conversations are difficult and can cause discomfort or anxiety, but it’s never too early to have them.  These conversations make a difference, they help our family members, they alleviate stress during a difficult time, and it gives family members confidence that their wishes are fulfilled.

When family members or friends don’t know the wishes of a loved one, it can tear families apart, cause stress, and make a grieving process more difficult.  It is much harder to make these decisions on the backend.  Proactively addressing these topics and making these decisions beforehand is effective.  It’s important to have these conversations now and make sure that loved one’s decisions are honored.  The hospital is not the place to have these conversations – end of life wishes should be known beforehand to give patients the autonomy and care they want and need.

Hospitalist program documents the desires of all inpatients if they want CPR.

Staff have not seen a direct increase of advance directives related to COVID-19 yet in the community.

For more information or guidance with these decisions, please contact Hand in Hand Hospice to make an appointment with a Social Worker – (620) 340-6177.