Kaweah Health Employee Huddle

January 22, 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 FROM JANUARY 22, 2021

1. We have several discharges that are held because patient does not have IV access and needs to go home with an IV Therapy. Is the hospital trying to address this need?

• We had recent change over and orientation of our PICC nurses so the reduction has been due to our onboarding and competency development. We actually still have one unfilled position we are trying to recruit for to support the team and the volume. We can also use interventional radiology for insertion when our PICC nurses are not available. Appreciate that our PICC nurses are valued and will explore some back up teams who maybe could help with these procedures.

2. If we have had both doses of the vaccine and we are directly exposed to somebody with COVID do we still quarantine?

• A quarantine is required if living in the home with someone who is COVID positive. The CDC has not provided any guidance yet on changing this due to being vaccinated.

3. Can we use Lifestyle Center staff or other labor pool employees to help with FaceTime communication for patients in isolation? The nursing staff is busy providing care but the separation/isolation of these patients due to no visitor policy is devastating.

• This is a great idea and Ed Largoza has made arrangements to start having labor pool staff on our limited visitor units from 1200-1400 today, Friday 1/22 to help with just this. We actually do not have that many labor pool team members on a daily basis so he is working to identify people for this role. If you are someone who would like to help with this each day, reach out to labor pool and sign up.

4. Now that the census has been so high for some time, will KD be able to review the ability to do the matching for the 401K as before? Are there conversations around unfreezing the annual raises?

• The Executive Team talks about this often and will continue to do so. While the census is high, the surgical volume is very low and this is the area where hospitals receive the most positive revenue. Nevertheless, we will continue to watch this closely and discuss with our Governing Board.

5. Is there a way there could be a lullaby or a tune played over the intercom each time a baby is born? It would be a great morale booster during this hard time for all of us.

• Ed Largoza checked on this for us and the prior process is still there, so we will check in with Labor & Delivery to resume starting the process when a baby is born.

6. An employee recently switched to Per Diem status. Can she be put on a list to be called for the labor pool if there are not enough full or part time employees available?

• Yes, per diem employees are eligible for the labor pool. Please reach out to Raleen Larez or Rebekah Foster.

7. Is there is a plan for vaccinated employees not to have to wear masks?

• We will move to removal of masks for vaccinated employees when given the okay from the CDC and OSHA.

8. Can clinical staff wear surgical masks instead of N95s once they have been vaccinated?

• We will reassess that with the PPE committee and weigh the pros and cons for protection of our staff.

9. Kaweah Health needs to assign roles for CODES and have a CODE teams, so that the CODE teams hones their skills at assessing critical situations and can provide safe, swift, and appropriate actions for positive outcomes. I have seen several infant codes and adult codes and the amount of staff in the rooms is dangerous, 20 plus people in one room is not ideal in any situation. Add inexperienced staff and high tensions, and it is a recipe for a disaster. I am hoping this will be taken seriously and that hopefully Kaweah can look into adopting some other hospitals models for CODE teams and attempt to retain or hire staff with experience in this area.

• I was actually at a code on 2S last week and saw this exact thing with a lot of people in the room and area. Sometimes the room is overwhelmed with people as the transition happens from unit staff to code team. We do have code teams with individuals’ assigned to specific roles each shift. There are seven people who need to be in the room and transport close by to help with compressions and changing out every two minutes. There is a team for each wing and this list is sent via fax to every inpatient unit and the house supervisors and operators at the start of each shift. The code team roles are assigned to experienced nurses and RTs but it does sound like we have some opportunities for running drills to expand comfort and experience with the nurses who are calling the codes on the units and the response while the team arrives. I also think we have an opportunity to revisit the roles and responsibilities to make sure that the person in charge is directing people out of the room who are not necessary. Our RRT/Code Blue team actually meets on Wednesday next week so I have shared this concern with that group already. We would also be open to additional insight into this committee if anyone is interested in joining the team and bringing improvement ideas to them. It is always good to have different perspectives and new ideas.

10. Why aren't the therapy staff members receiving extra shift bonuses?

• We continue to evaluate the need for the extra-shift bonus on a bi-weekly basis for all disciplines. The areas that are currently getting extra-shift bonus have typically been 24 hour departments that were in dire need of staffing either due to a number of openings, LOAs, and with no options of contract staff.

11. You mentioned last week that we would ration care first to those who need it the most. What about rationing care to those who need it the most but have the least likelihood of surviving? Do we have a threshold in place to where resources are removed from that individual? Do we figure in years of life left when rationing care? Do we ration care based on insurance coverage? Before we move to rationing care are there other nearby hospitals that can help with our overflow or is this something that all hospitals in our region are going through?

• Last week I said if we came to a point where we have to ration care then we would be triaging patients off of care. This would mean we would review patients and remove care for the patients who have the lowest likelihood of survival to put critical care resources into the care for people who are likely to survive. Age is not an initial factor in triaging care but life cycle does become a factor if there are two patients who tie in review of survivability. We absolutely do not consider insurance, economics, race, gender, sexual preferences or any other discriminating factor like that. That would be completely unethical and against any code or value for a health care professional. We are highly sensitive to the impact rationing care would have on the lives of our patients, their families and our team members. We would not move to rationing care without first moving to asking our ICU nurses to take up to 3 patients, transferring patients out to other hospitals, bringing in more staff and physicians from our other areas of the hospital, reaching out to our staff to see if they have the capacity for extra shifts, asking the state for emergency resources and bringing on travel and locums providers ourselves. At this time, we have successfully increased nursing staff from state emergency resources. We have on boarded 29 nurses for ICU and ED. We are awaiting approval on a request for 10 more med/surg nurses. We also have seven CNAs who arrived this week. We have requested two more critical care doctors and are still waiting for that request to be filled. Our staff have significantly increased the numbers of hours and shifts they work, our providers are working more hours, and our teams with critical care experience are pushing themselves in moving to higher level of care and taking care of the increasing number of critical care patients to help us avoid rationing care. Before we make the decision to move to triaging care we would reach out to the region and the state, let them know our situation that we are out of resources, and they would then start to assist with facilitating transfers or sending in resources. Our goal is to stay ahead of the requests as well. Our staffing requests from the state started in the first week of December but our increased staffing actually began in the summer. We increased open positions and asked our inpatient patient care departments to over hire and overstaff on their schedules in anticipation of increased volumes and potential LOAs on our teams. We continue to hire as well as identify ways to retain. I have been meeting with all my patient care managers to identify most prominent challenges and concerns they have with retention and supporting them with initiatives and changes that need to occur in their areas to promote retention, education, development and satisfaction within their teams.

• We spent three weeks on the precipice of having to triage care and that has taken a toll a lot on people. But, at this point, everything is standing down. We have turned a corner for the better even though we still have a lot of sick people in our facility.

12. The national tribute to those who died from COVID was very moving. Will Kaweah Health consider doing something to memorialize those we’ve lost?

• The loss of a Kaweah Health employee or provider is devastating. About a year ago, we started working on a memorial initiative that will start in April, 2021. We will include a fence along the Kaweah Park Creek, have a master plaque honoring employees and providers we’ve lost since 2018, and then individual plaques. We have lost about 10 staff members in that timeframe. We want to involve the families for permission and recognition and will invite our staff to participate. We’ll continue this into the future.

13. I recently walked into a location where a staff member was receiving a service unmasked. I was later told by the person performing the service that the KD staff member in question had already had COVID and she was comfortable in a close proximity environment without a mask. What is KD’s view on this type of situation?

• I would have to better understand the situation to speak specifically to that. Overall I still want to see people wearing masks, regardless of previous COVID status or vaccination status at this time. Of course, a person’s specific situation may vary so I would not comment on that issue exactly but if there is a concern that needs more investigation let me know.

14. Is KD going to be moving vaccine, not used/needed for staff, to patients or the community? When, how, etc.?

• We have received permission from the County to vaccinate our Skilled Nursing, Mental Health, and Dialysis Clinic patients. We do not have permission for any other inpatients at this time, but we are working very hard to start vaccinations in our various clinics. We will communicate the process to vaccinate new hires, employees returning from leave, post pregnancy employees, and new Medical Staff members.

15. Will Kaweah administer the Moderna vaccine to employees and the community?

• The Moderna vaccine lot that we have has been approved for use. At this time we have not administered any Moderna vaccine.

16. I took the first vaccination on my second day back from being out with COVID. The nurse giving me the shot said I didn’t need to wait 10 days. Will the first dose still have the desired affect?

• Yes. It will give the body the antibodies it needs to be effective.

17. What do you think the timeframe would be for physician offices to be able to provide this to their patients?

• We have not heard of plans for physician offices to access the vaccine but I guess if a PCP wanted to be a vaccination site they would apply to be a vaccination site and then ask for an allocation from the County as the vaccine comes in. Like we saw early on with the tests, the shortage makes allocation the only option for accessing the vaccine. I think we are 8-10 months from vaccine being plentiful enough for providers to order it like the flu vaccine. In the meantime, the primary population able to access the vaccine from the county allocation are those over 65 years old.

18. It has been said that the vaccine will be available in Phase 1C to persons aged 16-64 years with high-risk medical conditions. What conditions are they referring to? Is there a list of conditions we can reference for this?

• Throughout the pandemic this has most often referenced people who are immunocompromised or with respiratory diseases. The CDC has identified certain diseases in people as putting them at higher risk of need for hospitalization or intubation if they contract COVID. These are listed here: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html and include Cancer, CKD, Down syndrome, heart conditions, organ transplant related weakened immunity, obesity, Type 2 DM, smoking. Check out the CDC link for more details.

19. Is there any chance that KD will vaccinate our families in the near future?

• The County is really strict about the tiers so we can’t. The vaccine is their vaccine and we have to follow the guidelines they give us.

20. Are we testing specimens for the new strains of the virus? Is that strain getting closer to our area?

• Our County is watching for this strain and sending samples for further scrutiny to the State lab. We have not identified any in our County yet.

21. An employees’ daughter had COVID-19 in July – lost taste and smell – and it came back fully after 2 months. Now her ability to smell is “acting up” out of the blue. If there is smoke she can’t smell it but instead smells rotten garbage. Is the loss of smell neurological?

• No, it is not neurological in the sense that it is impacting the central nervous system or brain; but there is evidence of a more localized issue at our olfactory or smelling neurons. The damage from the virus binding to the proteins in those areas is resulting in damage to the neurons. Neurons can heal. A process called plasticity in our bodies gives us the ability to adapt and shape new ways to achieve what we need. So, the sense of smell may not come back entirely, may be altered, or it could return completely but it can take a long time. It might take months or even years for that system to rebuild.