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Keeping patients, staff safe in a pandemic

Six months in, screening a big part of precautions at Van Diest Medical Center

It’s been six months since the COVID-19 pandemic arrived. Since that time, health care systems have been put to the test. Hospitals, clinics, public health agencies and others organizations concerned with the well being of Iowans, formed collaborations to prepare for a possible influx of coronavirus patients.

In March and April, Van Diest Medical Center was working with other area health care professionals to prepare for the COVID-19 pandemic. They developed plans in the event of a surge of cases, along with procedures to keep patients and staff safe as they interacted in the clinic and hospital settings.

While some of the restrictions implemented by the state in March and April have been rolled back, the clinic and hospital are still utilizing screening procedures developed in the early days of the pandemic.

Leigh Miller, director of clinics at Van Diest Family Health Clinic and Van Diest Medical Center, said screening of patients starts when the patient initially calls in for an appointment. The staff runs through a list of questions to determine what type of visit the patient needs. For many, it might just be for medication refills or routine follow-ups. If the patient says they are ill, the schedulers transfer their call to the COVID line where the nursing staff begins to triage the patient.

“The staff will then try to determine if this is a COVID-19 patient or are they sick with other conditions,” she said. “For some, they may need to go to the ER if they are too sick to be seen in the clinic.”

“If it is an acute needs visit, those patients are given appointments with the ‘sick provider,'” Miller said. One clinic provider takes all of the sick patients each day and the providers rotate that duty throughout the week.

“We try to keep those patients all in one area of the clinic with that one provider,” she said. The staff then further triages symptoms to determine if they are suffering from a cold, coughs, an infection or other common conditions, or if the symptoms might be related to COVID-19.

The clinic and hospital continues to ask patients to wear masks while in the building and the patient’s temperature is taken as they arrive. For those who don’t have a mask to wear, the staff provides them with one, Miller said.

Patients who are ill with respiratory symptoms or those suspected of having COVID-19 are segregated from the rest of the patients in a different waiting room, but Miller said in most cases, a nurse will quickly take the patient to an exam room.

To protect the staff members, those who have direct contact with patients wear a procedure mask and a face shield.

“That extends from the registration staff at the front desk to the nurses and the providers,” Miller said. The staff also has full personal protection equipment — including gowns and gloves — should they be needed.

The exam rooms are cleaned and sanitized between each patient appointment, which is something the staff has always done, according to Miller. If there is a suspected COVID-19 patient that has been in the room, Miller said the room will be shut down and the environmental services crew will come in to do a thorough cleaning before reopening the space.

In the past few weeks, there have been a few patients hospitalized at VDMC with COVID-19. Those patients require enhanced isolation, sectioned off from other patients, according to Amy McDonough, chief nursing officer.

“We try to keep it to one nurse taking care of those patients,” she said. “We’ve had up to three patients at one time. That nurses use the N95 masks and the hood, gloves and gowns to keep themselves safe. The doors are kept shut for the negative isolation.”

McDonough said that while inpatient census regularly fluctuates, VDMC hasn’t been inundated with COVID-19 cases.

“Our skilled program is really running great and we see a lot of those types of patients. So our census goes up for other reasons,” she said.

Patients who are getting ready for surgical procedures at VDMC also receive the same in depth screening as clinic patients.

“We’re calling you before the procedure, we’re screening you on site and right before the procedure,” said McDonough. For certain procedures, a COVID-19 test may be given with 72 hours of the procedures.

All admissions to the hospital are also tested for the coronavirus, McDonough said, including those that are transferring in from another facility.

Lisa Ridge, chief executive officer of VDMC, said in a board of trustees meeting Tuesday night, that the hospital had administered about 70 tests in the past week.

“Here at VDMC, we continue to use the state hygienic lab, MercyOne and our own intern biofile for testing. Like Hamilton County, the hospital has seen an increase in testing and positive cases,” she said. The tests are given in the clinic, in-patient or emergency department as well as at the no-contact site on the east side of the hospital.

Restrictions for visitors are still in place, according to McDonough, but in one particular instance, restrictions have been eased. Patients in the emergency room can have one person with them.

“That’s the same as in the clinic,” she said. “One person can come in with the patient, provided they don’t have any of the COVID symptoms.”

And as the pandemic reaches its sixth month, health officials are also looking ahead to fall and winter and the inevitable seasonal influenza.

Carla Johnson, infection prevention nurse at VDMC, said it’s important get a flu shot this year.

“Get your flu shot and continue to do the social distancing and wear a mask in public. Those same things you’re doing for COVID, will help with influenza,” she said. “I’m hoping we’ll see lower numbers with influenza.”

VDMC is ready, should a surge in COVID-19 cases occur, McDonough said. The hospital developed a surge plan back in March and April so if an influx of cases are admitted, that can been revisited, she said.

“We have everything in place that we can to keep patients and staff safe,” she said.

Ridge praised her team for all of their work on the plans and procedures around the pandemic.

“Our team of leaders and our frontline heroes continue to show their strength and nimbleness through these ever-changing times.”

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