Kaweah Health Employee Huddle

February 12, 2021

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@kaweahhealth.org.

EMPLOYEE HUDDLE QUESTIONS AND ANSWERS FEBRUARY 12, 2021

Employees understand that no merit increases will occur in FY21. However, when merit increases do resume in future fiscal years will the rating received in the performance evaluations that occurred in FY21 be considered?

• We wouldn’t be able to apply the FY21 merit percentage because if earned for FY21, we would have had to pay it timely. However, we can look at the percentages we apply for FY22 as we consider the workforce, market data, market adjustments we’ve applied in FY21 and the budget and financials. This is a great question and we’ll discuss at the Executive Team and Board.

Is there any way we could get our senior family members vaccinated?

• Vaccine supply and distribution continues to ramp up and there will be more availability to the public through the County, pharmacies, etc. Our clinics will be able to provide vaccines to approved groups as well.

For those of us who received the 1^st vaccine dose this Wednesday, there were no time slots to schedule the 2^nd dose. What is the plan for the 2^nd dose? Will we still be able to get it on the 21^st day?

• Yes, we have reserved vaccine for the 2^nd dose clinics. Employees will need to go into ClockWise to schedule that 2^nd dose. We currently have 183 registered for the 2^nd dose on March 3.

If we have had the vaccine, and if someone else in our household has not, is it possible for us to transmit the virus to them?

• Yes, you can transmit the virus even if you have had the vaccine. Some people may fall into that 5% where the vaccine was not effective. Or they may get a mild case of COVID even after the vaccine so it can still be spread.

When will we be able to wear surgical masks instead of N95s?

• We are not changing this at this time, even with vaccinations. We will move back to N95s when we have more of our health care team vaccinated and more of the community is vaccinated. This will also likely tie into decreased tier levels in our county from purple to a lower level. We have had about 3200 of our 5700 people on our health care team who have elected to take the vaccine, so not enough people to ensure the slow of the spread.

Has or will the self-quarantine protocol change for vaccinated employees that have been in close contact?

• Yes, this just came out as a recommendation yesterday, 2-11-2021. The CDC announced that individuals who have completed the vaccine series (defined today as 14 days past the second dose) do not have to quarantine if they live with someone who is COVID positive, as long as they are asymptomatic.

What was the point of getting the vaccine if they are now saying we are still not safe around people and we still have to mask?

• A mask is always going to give you added safety and security with this virus. While people are being vaccinated, only10-15% of people have had it. The virus can still spread in the infection chain. The masks are another layer of protection so we can keep each other safe, our patients safe and slow the spread in the community. As we mentioned in an earlier question, some people may fall into that 5% where the vaccine was not effective. Or they may get a mild case of COVID even after the vaccine so it can still be spread. We have to be patient with our movement from one protection to another as we reach the 330 million people in our country. We will get there though.

Can we implement a more reasonable, cost effective way to sustain proper hand hygiene practices, as BioVigils are not user friendly, not accurate, and impede in nursing care?

• We will review the BioVigil the process and look for inconsistencies that need to be addressed.

I was told nursing assistants cannot give CHG bath without nurse because CHG baths wipes are considered medications. Why are CHG Prep wipes considered a medication, and why are NAs not allowed to do such a bath alone?

• CHG wipes are considered medications by the FDA. I have asked Risk Management to look into the risk associated with the wipes and then we can make an educated decision on whether or not they need to continue to be administered by Registered Nurses only.

Are we still experiencing a glove shortage? We also seem to be out of precaution signs on the floors.

• We are no longer in a glove shortage as we have 75 days on hand of gloves. It sounds like this is an issue of getting the gloves up to the floors. We will follow up on this.
• We print our own precaution signs so we will work with the teams to get those up to the floors.

Can you give an update on double masking?

• I think some of it has to do with the new COVID-19 variants we are seeing in the U.K., South Africa, Brazil and now the U.S. Scientists and others are concerned that they are much more contagious, more-easily spread and can better elude COVID vaccine antibodies. Single masks are generally made of porous layers of material that allow you to breathe but each layer is offset slightly so that the “holes” don’t line up exactly and create a web that prevents micro-molecules from reaching your mouth or nose. If you add a second mask on top of a first, usually a cloth mask over a surgical or medical mask, you create an additional barrier. Dr. Fauci and the CDC are recommending double masking for the general public who does not have access to N95 masks or is reserving them for healthcare workers. According to the CDC, they are most concerned that single cloth masks and general medical masks do not fit tightly enough against a person’s face to prevent aerosolized virus from slipping into openings. A second mask over a general, three-ply mask helps close these gaps; the CDC’s website also provides guidance on how to tie knots in the ear-loops to create a tighter fit.

Given the CDC guidance toward double masking, will Kaweah Health consider N95 masks for all staff as a solution?

• I don’t think so. While N95 masks are more available on the market these days and we have been able to build up our inventory of them, they really are designed and intended to be worn by employees who are providing direct patient care and benefit from the added protection provided by an N95 mask. We will carefully evaluate this recommendation just recently announced by the CDC and determine if we will require those employees who don’t qualify to wear an N95 mask to now “double-mask”. What is most important is that masks are worn properly and are of the right size to best fit a person’s face.

Are you following the Eli Lilly COVID Antibody Cocktail that has just been cleared for use? Is our facility going to start using that treatment?

• On Tuesday, the FDA authorized administering the monoclonal antibodies Bamlanivimab and Etesevimab together to treat patients 12 and older with mild-to-moderate COVID-19 who are at high risk for progressing to severe disease but not hospitalized or on oxygen therapy. Issued to Eli Lilly and Co., the emergency use authorization also authorizes the treatment for patients 65 or older with certain chronic medical conditions. In a clinical trial involving 1,035 non-hospitalized adults, a single infusion of the two antibodies reduced hospitalizations and deaths related to COVID-19, although its safety and effectiveness are still being evaluated. The combination therapy also reduced the risk of resistant viruses developing during treatment when compared with Bamlanivimab alone, which received an EUA last November. Our Medical Staff and Pharmacy Department leaders are currently evaluating the clinical data and will make a decision shortly regarding our use of this treatment for eligible COVID-positive patients.

Have the January financials been released yet? Can you give us an update on how the District is doing financially?

• Just released yesterday by Malinda Tupper, our Chief Financial Officer. Unfortunately, and as expected, January financial results were not good, largely because of our high volume of resource-intensive COVID inpatients and our need to shut down most elective surgeries and procedures. For the month of January, we only performed 528 total inpatient and outpatient surgeries—our lowest level since April 2020 when we performed 506 surgeries; for January 2020, we performed 929 total surgeries.
• For the month of January 2021, Kaweah Health posted an operating loss of $5.5 million, before recognizing any federal CARES Act stimulus funds. Net patient revenue of $49.9 million came in $2.1 million below budget at the same time that total operating expenses of $69.5 million were $3.8 million over budget. Fortunately, we were able to recognize $5.8 million of supplemental stimulus funds for the month which pulled our operating margin from a big loss to a modest gain of $278,000.Year-to-date for the seven months ended January 31, 2021, we have a “pre-stimulus funds” cumulative operating loss of $25.3 million. After recognizing $23.0 million of cumulative stimulus funds, we now have a year-to-date operating loss of $2.3 million, slightly better than the $1.7 million operating loss we budgeted for the first seven months of the fiscal year.

Are the vaccines becoming more readily available to community members?

• The County has reported they have received 49,000 doses and have administered 33,500. A lot of vaccinations are occurring, just not as fast as we need them to. The State has made the decision to contract with Blue Shield to take over the distribution and administration of the vaccines and they are wanting vaccinations to be done through the provider network. We are preparing ourselves to vaccinate patients of Kaweah Health and will most likely be working with Blue Shield for mass vaccination events.