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December 18 Employee Huddle

December 18, 2020

Please Note: When time does not allow us to answer every submitted question, we answer questions at the next week KD Huddle. Submit a question now for next week by e-mailing dvolosin@kdhcd.org.

EMPLOYEE HUDDLE QUESTIONS AND ANSWERS

Pfizer vaccine – two dose vaccine taken 21 days apart since that’s how it was tested. It’s only partially effective at the first dose which is why the second dose is encouraged, effective at 95%. It’s been tested in 44,000 subjects who were given either placebos or the vaccine. They then followed the subjects to see how they reacted and their symptoms. There were side effects, more flu-like symptoms which is normal since it’s building antibodies. MRNA is the active ingredient. It’s used to deliver a genetic code to the COVID-19 cell to the spike proteins and generates antibodies. Fats or lipids, salts and sugar. Salts help absorbs the solution and the sugar helps protect it in the freezing process. The vaccine is not required, but we advise you to at least consider it.

  1. What are the plans for adding additional patient care areas as the hospital becomes more full? When would we consider utilizing the convention Center as a patient care area?
  • We have identified spaces in pediatrics and Broderick Pavilion being used for adult Med/Surg patients right now.We have also been moving patients out to the south and west campuses.Our next move would be to the NICU.Our NICU team is prepared to move their patients to the Newborn Nursery and the stepdown NICU in L&D.We will be able to care for ten babies with these beds and then reserve two spaces in the stepdown NICU for patients waiting to transfer to Valley Children’s if we do not have capacity.NICU gives us 23 beds to use.We will need to care for non-COVID adult M/S patients in that area.We will be flowing Medical ICU into 3W if we need more COVID ICU space.We continue to move non-COVID ICU and ICCU to CVICU and CVICCU.We will flow ICCU from 3W who are COVID+ to 2N if needed.We have been sending patients to the alternate care site at Porterville Developmental Center.They are currently filled due to staffing but are reaching out to the area schools to see about nursing student staffing.If we need more beds than NICU we will use ED Zone 6 and Endoscopy as admitted patient units.Right now we have them set up for ED holding.If we continue to need more beds we will assess capacity and capability in Mother Baby areas.Mother Baby and L&D have increasing volumes now so we will need to be cautious with how many beds they have available.To staff these areas we will need to move to team nursing and increase our ratios.We will also have to mandate people into the labor pool to staff our support service areas to keep these patient care areas running with supplies, cleaning, meals, etc.The other side of the surge is trying to decrease the number of patients in the hospital.We are working with community PCPs for quicker discharge follow-up so our hospitalists can discharge patients 1-2 days earlier.We have our CM team able to set up oxygen for patients in the ED so they can discharge home with it.We are requesting retro insurance authorization for dialysis and SNF placements to stop delays in placement.We are looking at admissions and asking the ED providers to connect with PCPs to do monitoring and follow-up instead of admitting too.The convention center is still an option from the city of Visalia but with so many of our staff sick and impacted, we would really stretch to staff that.
  • We have an endoscopy area available for admit overflow, more than for C OVID patients since they are more pods that private beds.Those areas can be patient care area.
  • One piece that has factored in opening these beds is staffing from physicians to nursing, to EVS.Particularly for nursing staff, the ratio would be 8-10 patients and we’ve implemented team nursing.We met with our family medicine and internal medicine physicians, and agreed to not bring patients into the hospital if their PCP can follow up with them and monitor them.That could help us get patients out a day or two earlier.We are also looking at if people need to be admitted in the ED and if they need to be in and be watched or can they go home with special instructions with their PCP following up with them.We do have the convention center as a backup but it still comes down to staffing and would need state intervention.
  1. Regarding employees not on the front lines. How can they and their families get vaccinated? Will there be an option through Kaweah Health?
  • As we are allocated vaccine from the state we are following the state guidance on vaccinating healthcare workers. As the community vaccines become available, we will work with the County on developing the process and helping to administer the vaccine.
  1. Now that the Pfizer COVID vaccine has been FDA approved, can you tell us what populations the vaccine has been indicated for administration?
  • The Pfizer vaccine is indicated for people over 16 years old.It is recommended for people with underlying medical conditions who have not been directed not to be vaccinated in the past. Data is still being collected on the safety and efficacy of vaccine for people with HIV or other immunocompromised conditions.COVID-19 can have severe effects on them.They can still take the vaccine; the data is just not available yet on potential for reduced immune responses after the vaccine.People should still protect themselves.Safety data related to pregnancy and the vaccine is still being collected through ongoing trials.Pregnant women can receive the vaccine but pregnant women should discuss options and risks with their health care providers.
  • CDC does caution people who have had a severe reaction to a vaccination in the past not to take the vaccine until more studies are complete.
  1. How many employees have died due to COVID?
  • We had one provider die after contracting COVID. He passed away in July. We have six team members currently hospitalized right now. 230 total people are on leave with COVID. We also have an additional 70-80 who are home quarantined from a family member who has COVID.
  1. Do we know where most of the current COVID infections are happening?
  • On the County website they have a map of Tulare County and populate the map with number of COVID positive residents by city across the County. They also provide details on the outbreak on the last three weeks. Porterville has had the highest outbreak, 27% of the County outbreak. Tulare is second with 21.6% and Visalia 14.3% and Dinuba with 9.6%. Three Rivers have only had 28 residents test positive, and in last three weeks they’ve had 11. There isn’t a single city that hasn’t had at least one positive COVID case.
  1. What is the rationale for making all employees in patient care wear an N95 when it appears that most employees have been getting sick outside of their work duties?
  • The asymptomatic employees who then come to work risk spreading it to patients who are not wearing their masks and to coworkers if they are not extremely careful with their environment.We still have people who remove their masks when around team members and are not able to distance all the time.We had outbreak on two patient care units and the N95s will help minimize that spread.N95s supply is still strained but we have been stocking up since the spring.The N95s should only be used by people going into patient care rooms or having direct contact with patients in their settings both inpatient and in the clinics.Once you put it on, you use it for the day and then discard it.Departments who do not need to go into patient rooms should not need N95s, they should be wearing the surgical masks and distancing throughout the day.Departments with people who sometimes have to go into rooms should try to limit how many of their team need to go in a room on a certain day to continue to spare masks.Going onto patient care floors or areas does not require an N95.
  1. It came out that the men need to shave their facial hair. Is this mandatory?
  • To wear the N95, it needs to seal to your skin. You can try to fit test, but most likely will fail. Since it’s require equipment right now, facial hair will need to be removed.
  1. If you recently had COVID with moderate symptoms and now are recovered is it recommended you wait to get the vaccine?
    Yes, you should still get the vaccine.
  1. We received 1950 vaccines from the County. When will we get additional vaccines?
  • Tulare County received three cases of the vaccine and there are 975 doses in each box.100% of the 1950 vaccines will go to first dose.In a few weeks, the County will provide the same number for the second dose.
  1. Are we concerned about second shipment coming in?
  • The County made the comment that they were being told they would receive two cases in a couple weeks, but Kaweah could receive a third from the state.Additionally, the Moderna vaccine is imminent.
  1. A few of us in the office saw Gary on the news the other night and he had mentioned that staff was polled regarding the vaccine and the numbers revealed that 1/3 would take it, 1/3 would not and 1/3 was still undecided. None of us were polled so we are wondering where those numbers were from.
  • I was referring to an article that shared results of a nationwide survey of nurses and physicians and the general public.In the article it indicated about 1/3 were excited, 1/3 were hesitant, and 1/3 said no.Physicians came in about 50/50.General populations nationwide has continued to tick up, that about 61% said they would take the vaccine.
  1. Why was the Biometric screening discount not honored this year for our insurance? Without the discount, there was noticeable increase in the premiums. As a medical center, isn’t one of our company goals to promote health and wellness?
  • The simple answer is that it was for economic reasons. This pandemic has caused a devastating financial effect on Kaweah Health.Every month we’ve posted operating losses.Fortunately, we’ve had some federal funds, but we still ended up in the red with those funds.We’re hoping to break even this year and the biometric screening credit was one of the items that was eliminated.We did work hard to provide a rich employee health plan if compared to other hospitals, we still continue to provide one of the most affordable insurances to our employees.
  1. If you recently had COVID, should you get the vaccine?
  • Yes, our antibody test was about 3.5%, for example we had employees who tested positive for COVID, but when they received the antibody test, they had none.It created speculation that maybe the antibodies from the natural virus are short-lived.
  1. How long will the COVID vaccine immunity last or is it expected to last?
  • About two weeks after both doses of the vaccine have been administered, you are expected to have some level of immunity.
  1. Will Kaweah Health organize mass antibody testing again?
  • We will not organize another mass antibody testing, but it is available through your primary care physician.
  1. If we get the vaccine, and we have symptoms due to getting vaccine and have to stay home, do we have to use PTO?
  • PTO/PSL will be the same as for a reaction to a flu vaccination. We will not count a reaction as an occurrence towards attendance. The coding could change IF the government indicates that Supplemental Paid Leave is to be offered for a reaction to the vaccine.
  1. Has anyone reported side effects who took the vaccine this morning? If someone has bad side effects will leaders let staff know?
  • You could feel the symptoms the day of your vaccine, but most likely will be the following day.Yes, transparency is important and we would share this with staff.There have been some cases where the vaccine was given and a strong allergic reaction occurred immediately.We are observing staff for a period of time to monitor any allergic reaction.About 40% of people who received the vaccine experienced symptoms.The second dose has been reported to have stronger symptoms.
  1. If you have cancer and are going through chemotherapy should you take the vaccine?
  • This would be something to discuss directly with your physician to discuss the risk of COVID vs. risk of taking vaccine.They are still collecting data on this.
  1. If you get both doses, do you still need to wear a mask?
  • Yes, this is the recommendation of the CDC and a requirement of Kaweah Health and is out of an abundance of caution.There will be many people who haven’t been vaccinated in the public so to be safe, we will continue to wear masks and PPE.
  1. You mentioned a website for employees to sign up for vaccine? How will we receive this website?
  • When your tier and name comes up, an email will be sent to your director who will then send out to their staff.
  1. Why don’t we send the link out to all staff so they can sign up?
  • This is only going out to staff who are in the phase being offered at that time.
  1. Could we review the guidelines for staff who lives with someone who has tested positive?
  • We have been following the CDC guidelines.Initially the guidelines required quarantining at home for 14-days and you must be symptom free.Recently, the CDC reduce this to 10-days.This week, CDC announced potentially updating return to work without symptoms to 5-7 days.
  1. Is it true that KD received CARES Act funds for PPE and used it to pay off debt?
  • No, we have not used any of the CARES Act funds to pay off debt.