BAPTIST HOME OF SOUTH JERSEY/RIVERVIEW ESTATES COVID-19 OUTBREAK RESPONSE PLAN
Baptist Home of South Jersey/Riverview Estates
Lessons learned from the response to and experience with COVID-19
Effectiveness of Screening and monitoring of residents each shift for signs and symptoms of COVID-19 as new symptoms were identified. Importance of including vital signs and pulse oximetry to this process each shift.
Surveillance monitoring of staff and visitors prior to entering the facility for symptoms and pertinent history related to potential exposures to mitigate spread of infection in the facility.
Need for extended supplies of PPE available for Emergency Usage
Developing and Implementing Policies and Processes for Isolation and Cohorting of Residents with like phases of infection to mitigate the spread of COVID-19 Virus. Attempts to keep staff in specific assignments and phases through shift as possible, to keep infection from spreading (mitigating movement through facility) to the best of our ability. (copy of cohorting plan was shared with Residents, Families and Resident Representatives via weekly email communication and Staff has been educated to this plan and continued to be in-service ongoing)
Revising Infection Control policies to include extended education and training of staff on Infection Control, proper use of PPE and donning and doffing techniques, cleaning and disinfecting, proper use of facemasks and various types, proper use of face shields or eye protection.
The need for new ways of Communication between Residents, Families and Resident Representatives for notice of positive cases, updates to changes and general wellbeing of the facility.
Developing ways of communication with staff, residents, families and resident representatives on notification of a positive COVID-19 test result. Staff receives notification either verbal, written, text or email. Families and responsible parties/POAs are notified via email with “Urgent Notification of Positive COVID-19 test Result”. This letter explains actions taken by the facility without disclosure of personal information or identities. This communication also includes guidelines for visitation, and ways to obtain an appointment for a Duo, Facetime or Skype visit with loved ones. Letters are distributed as per NJ Department of Health and CMS Guidance, before 5pm the following calendar day. Residents receive written “Urgent Notice of Positive COVID-19” letter and also receive verbal notice by staff. The email of our Executive Director/Administrator, Director of Nursing and Infection Prevention Nurse, Social Worker and Resident Life Director are included on these emails to ensure anyone who has questions or concerns may reach out to any of the Team. Our Residents, Families and Resident Representatives have embraced this communication well through the pandemic and offer responses of appreciation for keeping them current with Riverview Estates.
Communication and Visitation
Visitation is permitted at all times. Policies and Processes for visitation are communicated via our COVID update letters to Residents, Families/Resident Representatives.
Alternative visitation includes: Window visits, Duo, Facetime, Skype visits, Outdoor visits, Essential Caregiver and End of Life/Compassionate Care Visits. Guidelines and Policies and restrictions have been sent to our Residents, Families and Resident Representatives. We encourage anyone with questions or requests for these visits to contact our Resident Life or Social Services Director (email addresses and phone numbers are attached in this plan)
Strategy for Securing Staffing during an Outbreak
- Encouraging Safe Infection Control Practice to keep workers healthy and safe to enable them to continue their assigned duties. Ensure proper PPE is worn at all times to mitigate the spread of virus.
- Identify through surveillance each shift and testing employees. Employees are tested weekly or bi-weekly based on local positivity rate and/or outbreak status. Employees with signs and symptoms of COVID-19 are tested immediately to decrease spread of illness.
- Encourage staff who are sick and isolating at home to communicate daily for continued surveillance and progression of any signs or symptoms.
- Continuous assessment of current staffing needs with current census and care needs
- Hiring of additional staff.
- Providing education opportunities for employee in good standing for c.n.a class
- Riverview Estates has contracts to procure additional staff through three agencies. They are able to provide nurses and certified nursing assistants.
- Incentive bonuses to encourage coverage of shortages to staffing needs
- Utilize Hero Bonus and incentive bonuses
- Cross training staff to other duties and assignments
- Discouraging vacations/time off requests during staffing crisis with consideration to need for rest and mental health of staff.
- Utilizing Waivers for C.N.A/Nurses out of state if needed
- Utilizing job board postings to assist with recruiting new staff (LinkedIn, NJUE job posts, Leading Age job posts, Schools of Nursing and C.N.A Certification Graduates)
- Encourage Team Approach and All Hands-on Deck
Testing of Residents and Staff for COVID-19
Fully vaccinated staff do not have to be routinely tested (except as provided in Section (1)(o), when a facility must engage in outbreak testing of all staff, regardless of vaccination status). Fully vaccinated staff must still be tested if they present symptoms consistent with COVID-19.
The frequency of testing for unvaccinated staff is based on the extent of the virus in the community (weekly regional CALI level).
Staff exhibiting and signs or symptoms of the virus are also tested with new onset of symptoms regardless of vaccination status.
Staff is immediately notified of Positive test results and encouraged to call their physician and remain on isolation at home. They are also sent an isolation surveillance tracking form to write their symptoms such as temperature, body aches, cough, diarrhea, nausea, vomiting, shortness of breath. Information on this tracking form is communicated with the Infection Control Nurse or Director of Nursing to help determine a safe return to work. Staff with min/mod symptoms may return in 5 days if symptom free and no fever for 48 hrs. Returning staff will re-continue with surveillance and monitoring before entering the facility and wearing proper face mask and face shield at entry.
Residents are not tested weekly unless they are symptomatic. If there is a positive result in one staff or in the event of a COVID-19 Outbreak, all residents will be tested bi-weekly until there are no positive results for 14 days and two rounds of testing are met in that 14-day period and all are resulted negative.
Riverview Estates reports all new positive test results to the Burlington County Local Department of Health and New Jersey Department of Health. Surveillance Line Lists are utilized for maintaining and reported as appropriate with guidance and instruction of these Departments.
Reporting to through the NJHA PPE portal is done daily, 7 days per week. This portal asks for case counts, census, suspect and positive cases for both residents and staff. Testing numbers are submitted daily as well as positive, negative and pending results. PPE counts are submitted daily to track supply. We also use a Burn Rate Calculator to track consumption of PPE and how much is on hand. Testing materials are reported to ensure there is sufficient supply for weekly testing and prn testing.
CDC/CMS portal is through NHSN. We report 5 times per week in this portal. This portal also asks for census, positive cases in residents and staff, suspect cases in resident and staff, availability of PPE and staffing shortages.
Positive results are also reported to our Staff, Residents, Families and Resident Representatives’ no later than 5pm next calendar day of positive result. A positive in a Resident would be reported to Family/Resident Representatives and physician via telephone as soon as possible.
Daily Monitoring and Screening:
Riverview Estates actively screens everyone entering the facility. The only exception is for EMS personnel who must move quickly to assist in an emergent situation. Staff is monitored at the Employee entrance with oncoming shifts. Visitors or other HCP entering the facility are monitored at the lobby entrance. Both staff and visitors have temperatures checked. Fever greater than 99.4 are suspect and asked not to enter. This questionnaire includes symptoms, any potential exposures, travel to countries or states in high risk areas as per guidelines of State of New Jersey, and confirmed diagnosis of COVID-19 or recovering from COVID-19.
Symptoms of COVID-19 Virus Might Include:
Temperature, chills, cold like symptoms, runny nose, congestion, recent loss of smell or taste, body aches, headache, cough, shortness of breath, sore throat, fatigue, confusion, nausea, vomiting, diarrhea.
Not meeting this Surveillance Screening and Monitoring Criteria would deem the person at risk and therefore will not be permitted to enter the facility.
When a visitor is able to enter the facility, the following will be implemented prior to entry:
Screening and monitoring process
Signage of informed consent by the visitor and resident, stating the visitor and resident are aware of risks to both visitor and resident and rules for safe visitation. Resident Representative would have to sign for resident that is not able. This also gives the Resident’s consent to have the visitor.
Proper hand hygiene and donning of PPE required for the type of visit.
Maintain social distancing of at least 6ft from residents and staff (avoid touching, hugging, handshakes, kissing.) Avoiding contact with any resident other than the one you are visiting. And also, do not wander through the facility or to any other area of the facility during your visit. Visits will be limited to Resident’s room if a private room or another area designated.
Residents are assessed and monitored for signs and symptoms of respiratory infection and COVID-19 symptoms 3 times per day. Residents with symptoms are put in surveillance isolation and physician and family are notified.
Residents and Staff will be tested for COVID-19 at onset of new symptoms.
Cohorting, PPE and Training Requirements
- Facilities shall train and provide staff with all recommended COVID-19 PPE, to the extent PPE is available, and consistent with CDC guidance on optimization of PPE (https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html), if applicable. All staff must wear all appropriate PPE when indicated.
- Facilities shall implement universal source control for everyone in the facility. All residents, whether they have COVID-19 symptoms or not, must practice source control when around others (surgical mask if supply is available) in accordance with CDC guidance at :https://www.cdc.gov/coronavirus/2019-ncov/prevent-gettingsick/cloth-face-cover-guidance.html. A face covering must NOT be worn by children under the age of two (2) or anyone who has trouble breathing, is unconscious, incapacitated, or otherwise unable to remove the mask without assistance. Source control may be provided with cloth face coverings or facemasks.
iii. Facilities shall separate COVID-19 positive and negative residents in accordance with NJDOH guidance at: https://www.nj.gov/health/cd/topics/covid2019_healthcare.shtml. A resident is considered recovered from COVID-19 only after they have met the criteria for discontinuation of isolation as defined by the NJDOH at: https://www.state.nj.us/health/cd/topics/ncov.shtml, and CDC guidance at https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalizedpatients.html.
Facilities must continue to follow current NJDOH orders, guidance and directives on admissions and readmissions. Facilities may receive residents who were tested prior to admission transfer or shortly thereafter, in accordance with NJDOH Guidance: https://www.nj.gov/health/cd/documents/topics/NCOV/COVID_Cohorting_PAC.pdf, Orders: https://www.state.nj.us/health/legal/covid19/4-1320_EmergencyCurtailmentOfAdmissions.pdf and Directives. Facilities shall take appropriate action on the results including, but not limited to, the guidance below:
- Sending Facility: COVID-19 diagnostic test results must be provided (in addition to other pertinent clinical information) to the receiving facilities for any transferred residents upon receipt of lab results.
Receiving Facility: Upon identification of a case of COVID-19 in a resident who was recently admitted (within 14 days), the receiving facility must provide these results back to the sending facility to allow for the appropriate response and investigation.
Communication, Calls or Concerns
Baptist Home of South Jersey/Riverview Estates
We are here to assist. Email addresses for the Executive Director, Director Nursing and Social Services Director are included in the emails weekly to our Residents, Families and Representatives. They are also included in every “Urgent Notice of Positive COVID-19 result” Letter.
We have encouraged communication regarding any questions or concerns to these key Directors
Email contact list:
Executive Director, firstname.lastname@example.org
Director of Nursing, Long term care: email@example.com
Director of Social Services: firstname.lastname@example.org
Director of Resident Life: email@example.com
Resident Life Dept: firstname.lastname@example.org
Assistant Administrator/HR, email@example.com
Facility telephone number: 856-829-2274
Compliance and Privacy Hotline: 1-800-211-2713