Trial runs allow hospital to fine-tune preparedness procedures

Prepared.

Diane Carlin, chief executive officer of Antelope Memorial Hospital, used the word to describe staff members' efforts to be prepared if the health care facility in Neligh is faced with an influx of COVID-19 patients.

"We've done a lot of good work here at the hospital to be prepared. That's been a best part of this - the coming together of staff," Carlin said during a telephone interview Monday afternoon.

She said the hospital has had several trial runs with testing patients and have not had a positive COVID-19 result.

"Our process has been tested over and over. When we found a weakness in an area, we retrained, we retaught."

Typically, isolation patients are not moved around the hospital.

Carlin said, "You run a COVID-19 test (on a patient) and then they need an x-ray. How do you get them to x-ray and back to their room? What staff takes them? How do you work through that? How is everything cleaned from where they left to where they ended?"

These experiences have put the facility's isolation techniques to the test.

"We've had opportunity to make changes and do adjustments without a COVID patient here yet," Carlin said.

Some of the adjustments include cross-training staff, especially since elective procedures and outpatient clinics have been halted.

Individuals who work in billing have learned the ropes in housekeeping and registration.

Physical therapy staff have assisted with transferring patients on the floor and using lifts, "so we keep nursing for the higher level of their license."

"We can all pitch in and actually help and be protected and confident in the process," Carlin said.

All 150 employees have been retained.

Carlin said hospital staff have had an opportunity to observe guidelines at area hospitals since the beginning of the pandemic.

Doctors Osborne, Dawson and Rudloff have been valuable resources, researching best care practices, according to Carlin.

Daily, she meets with two providers, infection control, the director of nursing, disaster preparedness and department supervisors from lab, radiology, respiratory therapy and housekeeping, to review new information and update supplies on hand, especially for personal protective equipment.

"We have been very proactive since the first of March, checking with sources, placing orders for supplies as needed," Carlin said, nothing many supplies have been backordered and arrive in small amounts.

Staff members have worked hand-in-hand with the North Central District Health Department to order supplies and communicate several times a week with Faith Regional Health Services personnel in Norfolk.

The primary concern: masks.

Non-patient-care staff wear homemade masks when they are not in the patient care area.

All others are wearing surgical masks.

If an employee wants a higher level of protection, the hospital makes sure it is there.

"Keeping our staff protected is one of my biggest priorities," Carlin said, "along with making sure everyone hears the same message. We're constantly communicating with our employees and physicians, to make sure we're all on the same page."

For every person, there is a different scenario when it comes to comfort level.

"We're sensitive to employee needs and requests at this time. It is a very stressful time for employees in the healthcare field," Carlin said.

The hospital houses 23 beds. Six additional beds have been received from Rural Region One Medical Response System, which will be utilized if the number of hospitalized cases would push the facility to maximum capacity.

If a worst-case scenario would occur, and the additional beds put into use, Carlin said those nursing care would expand into other areas of the hospital that offer associated needs, including oxygen, proximity to supplies, medication and staffing.

"I want to be very cognitive,

"If our numbers get to that, the people we're taking care of, we can definitely take care of them," she said.

The hospital works with area hospitals to provide a daily bed count.

Keeping the bed count updated daily allows hospitals to know what is available so if, and when, beds are needed, they know who has room.

Carlin said if hospital census reaches capacity, AMH could look at sister facilities, including CHI Plainview, Avera Creighton or Boone County Health Services, and could transfer patients to those facilities.

She is also aware of the number of ventilators and rooms available at FRHS.

"We could take their lower level patients and give them our higher level needs patients," Carlin said.

Hopefully, by implementing precautionary measures now, potential positive cases of COVID-19 will remain low.

Extra precautions have been introduced to keep patients safe.

All patients who enter the facility are given a mask to wear.

Carlin said it has alleviated a lot of concerns.

Individuals with respiratory and coronavirus concerns use the new Antelope Family Practice clinic adjacent to the hospital.

The former clinic facility at the top of the hill, recently remodeled, is utilized for services including well baby checks, blood pressure checks and monitoring of cardiac levels.

Everyone who enters the hospital or clinic areas is screened. Temperatures are taken also.

If anyone exhibits any symptoms or signs, "we're scooching them on down to the other clinic," Carlin said.

Whether someone who tests positive for COVID-19 is hospitalized will depend on the level of illness.

Someone who tests positive and exhibits mild respiratory issues and little to no temperature will quarantine at home, as long as the individual can care for themselves.

Anyone struggling with symptoms of the virus will be hospitalized.

"It depends on other co-morbidities," Carlin said. "Every individual will be different based on health needs."

Carlin said she cannot underscore the importantance of social distancing.

"People are already itchy to get out and about," she said, urging everyone to contain throughout Gov. Ricketts' 21 days of staying home.

The hospital has seen an uptick in the use of telehealth, especially since President Donald Trump relaxed Health Insurance Portability and Accountability Act rules on March 17.

The Centers for Medicare and Medicaid Services expanded coverage for telehealth visits, including the use of Facetime.

Stipulations of the change in law include not recording the session and identifing who may be in the room during the session.

"We provided it right away after it came out with assisted living and nursing home patients. Now we're able to provide that to the public," Carlin said.

Screening information for COVID-19 is included on the hospital's website, amhne.org, and includes links to information for the Centers for Disease Control and Prevention, Nebraska Department of Health and Human Services and NCDHD.

Preparing for uncertainties have taken a team approach.

"Small town loyalty and dedication show through at times like these," Carlin said. "I cannot say enough positive about our nurses, doctors, housekeepers, and dietary staff. They're all out there and ready to do what they have to do. They're being heroes and I am proud of all of them."