UEHC Team
July 2020
University Employee Health Clinic Staff
University of Iowa Hospitals & Clinics
Iowa City
,
Iowa
United States
We were asked by Epidemiology to take on a larger role than we had ever before in being the content experts.
The year 2020 started out as most years do, with the bright promise of new adventures. The University Employee Health Clinic (UEHC) was settling into new leadership, some open positions, and the normal routine of daily visits from employees for onboarding, vaccines, respirator mask fits, and audiometry/spirometry yearly appointments as well as monitoring the bloodborne pathogen call line and the latent Tuberculosis program. A very successful Flu Campaign had just ended. We knew there were changes on the horizon as is inevitable with a new manager. Never did we imagine what was in store for us as a newly emerging pathogen was making its way around the world. UEHC would be thrust to the forefront of staff preparation and health in the coming months.
In January 2020, Epidemiology brought to our attention the virus that is now known as COVID-19. This virus was just starting to make a name for itself in Wuhan, China. There was much concern over how to treat university employees, both healthcare and non-healthcare, who were returning to Iowa from travel to China. With the assistance of Epidemiology, a spreadsheet was created to keep track of these employees, as well as a monitoring form for use by the employees. An instruction sheet was developed for UEHC nurses to follow using the Centers for Disease Control (CDC) and the Iowa Department of Public Health (IDPH) guidance. We also worked with Human Resources, both healthcare, and non-healthcare as there were different criteria regarding the ability to work on-site depending on the employee's job and location.
In addition to seeing these employees in the clinic and fielding phone calls from them, UEHC nurses monitored the Employee Health shared mailbox daily for email regarding the self-monitoring forms. Employees were instructed to provide temperatures and symptoms twice daily for 14 days upon return to the United States. UEHC nurses placed this information in the spreadsheet, contacted employees who reported symptoms, and shared information with managers and Human Resources as needed.
During this time, the Bio-Emergency Response Team (BERT) began meeting. UEHC was brought into many conversations on how to protect the health of employees, especially as it pertained to exposures. We were asked by Epidemiology to take on a larger role than we had ever before in being the content experts.
In March 2020, the BERT meetings transitioned to the Hospital Incident Command Structure (HICS). This was in keeping with UIHC working to ensure safety for staff, patients, and visitors as COVID-19 was now community spread. It was requested that UEHC house a call line for employees to answer questions/concerns about travel and symptoms, giving advice on whether the employee should come to work or needed to self-quarantine. This request was made at 1400 on a Tuesday. To set this up required working with housekeeping to clean out a storage space and outfit with tables and chairs, having IT install four computers, and getting Telecom to turn on four phone lines and a call tree message. We started the call line at 0700 the very next morning, staffing it 24/7 for several days. We did decrease the hours to 0600 - 2200 within the first week, staffing the line with a mix of UEHC nurses and medical assistants and borrowed ambulatory staff and medical students. The call line has operated 7 days/week since, well beyond our clinic hours. In mid-May, the weekend/holiday coverage was transitioned to the Integrated Call Center.
Very quickly, it was asked that we order the visit to the Influenza-Like Illness Clinic for employees who met Centers for Disease Control and Prevention (CDC) criteria. This required building a dot phrase and creating the order. UEHC rarely uses EPIC, instead of documenting in ReadySet as we are required to keep the employee health record separate from the employee's hospital record. A document guide was created for the call line staff to use as well as Epic training and access from Identity Management for several of the UEHC Medical Assistants. Recently, it was requested that UEHC order the testing as well. More education was done.
A spreadsheet was developed for documentation of the calls. Multiple tabs have been added as needed to address new issues as they have arisen. COVID positive employees who self-report are tracked as well. This information is shared every weekday in the Noon News. We also track localized outbreaks on units, assisting with contacting employees, and arranging for testing.
In the meantime, it was recognized that personal protective equipment (PPE) was in short supply. Particularly concerning was the lack of some N-95 respirators and CAPR supplies. UEHC had already increased the number of respirator mask fits performed daily to meet the need of staff caring for COVID- 19 patients. In doing so, we stopped requiring appointments, allowing staff to come on a walk-in first come/first serve basis.
As more and more staff were identified as needing a respirator, UEHC decided to set up pop-up clinics. This is something we had never done before. To be able to accommodate this, we needed to change from quantitative testing to qualitative testing. Qualitative testing uses saccharin or Bitrix in solution, spraying either into a hood as the employee makes movements to ensure a tight fit of a respirator. UEHC had not performed qualitative testing since 2012 and only one staff member had been trained on this technique. In addition, necessary testing supplies were limited and unable to be purchased. We reached out to the Environmental Health and Safety (EHS) staff on campus to assist in training UEHC staff on this technique. They were also able to assist in the first few pop-up clinics, augmenting UEHC staff. EHS and Student Health sent over hoods and atomizers so more stations could be set up in the pop-up clinics as demand increased. Engineering Services was contacted and asked if they could make more hoods. Within a few days, we had an additional 12 hoods. The pharmacy was a huge help as well. Not only did they find some atomizers, but they were able to make the saccharin and Bitrix solutions.
Armed with enough supplies, we requested more staffing help from Ambulatory Nursing and Iowa River Landing (IRL). Several staff members were sent to us for the next two weeks. UEHC staff trained them in qualitative testing and ReadySet documentation. We then set up our first of many pop-up clinics. This one was solely for the Main Operating Room staff as it is difficult for them to get to the clinic. In three days, we test fit nearly 400 staff members. Prior to COVID-19, on an average day, we would test fit around 10 staff members.
The pop-up clinic was so successful, we extended it another week. This enabled us to test fit many frontline staff from the first areas to treat COVID patients - Emergency Department, MICU, SNICU, Respiratory Therapy, 4 South, and 5 South, to name a few. We borrowed more staff, this time from 3RC, training them to ReadySet and qualitative testing. These staff members enabled the pop-up clinic to have extended hours until midnight, reaching even more frontline care providers.
A third pop-up clinic was established a few weeks later, setting up in two different areas. This involved another crew from IRL who were then trained by UEHC staff. In addition, it was requested that a Just in Time team be trained to provide mask fittings for staff in a moment's notice if needed. SWOT and Vascular Access Team nurses were identified as the team members. UEHC staff trained them to perform qualitative testing, medically clear staff members, and document results. In setting up this team, a wire basket on wheels was procured from the surplus pile. One of the UEHC nurses took the cart home, disassembled, cleaned, and painted it, and bringing back to the clinic to stock. The cart now resides in the House Managers' Office and is restocked by UEHC.
UEHC continues to get requests for pop-up clinics. A fourth clinic was held the week of May 18th, relying on UEHC to split its staff between the main clinic and the pop-up clinic with minimal assistance from Ambulatory Nursing and IRL. As the pop-up clinics are popular, we will continue to host as staffing allows. Since March 1, 2020, we have performed over 3000 mask fits. UEHC partakes in the reprocessing program for masks. All masks that are now used for respiratory fitting are sent to be reprocessed up to seven times. This has significantly reduced the number of masks UEHC takes from Processed Stores, which has assisted in protecting this valuable resource.
In attempts to increase respiratory supplies, UEHC has participated in the testing of different masks and fitting tools. We have even assisted the Emergency Department in a research project involving surgical masks and an elaborate system of rubber bands to apply pressure on the mask, hoping to create respirators out of supplies on hand. Since February, we have also onboarded dozens of staff members repurposed from the Veteran's Affairs Hospital and from other parts of the University campus who have been sent to UIHC to assist in operations. We have driven out to other locations such as Linen Services to attend to onboarding needs including vaccines to limit the number of staff entering the hospital. We provided respiratory mask fitting to the College of Dentistry. And we have traveled off-site twice to a UIHC clinic in Muscatine to provide mask fittings.
During all of this, we maintained a full clinic schedule, onboarding new UIHC staff, providing Tuberculosis treatments and annual appointments, and continuing our support of the bloodborne pathogen call line. We faced a great challenge at the beginning of April with the retirement of one of our nurses, who took with him many years of knowledge and expertise. The team has also oriented one clerk and three nurses to UEHC during this time, which is substantial as we only have 3 budgeted clerk lines and 3.5 budgeted nurse lines.
As we head into the summer, with the hospital ramping up ambulatory visits and surgery appointments, we know UEHC will receive less and less assistance with our Call Line and Pop-up Clinics. We are working to incorporate the Call Line into our everyday clinic life, transferring the line into our workroom and developing a rotation for answering it. All nurses and medical assistants are training to do this. We are also making plans to have more Pop-up Clinics in the future in various areas when we return to yearly mask fit requirements as directed by OSHA. This will include changes to the clinic's schedule, yet another innovation not done before in UEHC.
This small team comprised of 3 clerks, 3 medical assistants, and 3.5 nurses have seen many changes, as has the entire UIHC system. Every day they have adapted to the ever-changing policies, increasing demands and innovative ways to assist in a crisis. When a large portion of the institution was having to scale back on patient volumes and procedures, we were seeing our largest increase to date. This team's eagerness to work together and the flexibility that they have shown to make sure that all staff at UIHC and the University of Iowa are safe and well cared for is humbling.
For the stellar way the staff have responded to every change and new event given them the past several months, I am proud to nominate the University Employee Health Clinic for the DAISY Team Award 2020.
In January 2020, Epidemiology brought to our attention the virus that is now known as COVID-19. This virus was just starting to make a name for itself in Wuhan, China. There was much concern over how to treat university employees, both healthcare and non-healthcare, who were returning to Iowa from travel to China. With the assistance of Epidemiology, a spreadsheet was created to keep track of these employees, as well as a monitoring form for use by the employees. An instruction sheet was developed for UEHC nurses to follow using the Centers for Disease Control (CDC) and the Iowa Department of Public Health (IDPH) guidance. We also worked with Human Resources, both healthcare, and non-healthcare as there were different criteria regarding the ability to work on-site depending on the employee's job and location.
In addition to seeing these employees in the clinic and fielding phone calls from them, UEHC nurses monitored the Employee Health shared mailbox daily for email regarding the self-monitoring forms. Employees were instructed to provide temperatures and symptoms twice daily for 14 days upon return to the United States. UEHC nurses placed this information in the spreadsheet, contacted employees who reported symptoms, and shared information with managers and Human Resources as needed.
During this time, the Bio-Emergency Response Team (BERT) began meeting. UEHC was brought into many conversations on how to protect the health of employees, especially as it pertained to exposures. We were asked by Epidemiology to take on a larger role than we had ever before in being the content experts.
In March 2020, the BERT meetings transitioned to the Hospital Incident Command Structure (HICS). This was in keeping with UIHC working to ensure safety for staff, patients, and visitors as COVID-19 was now community spread. It was requested that UEHC house a call line for employees to answer questions/concerns about travel and symptoms, giving advice on whether the employee should come to work or needed to self-quarantine. This request was made at 1400 on a Tuesday. To set this up required working with housekeeping to clean out a storage space and outfit with tables and chairs, having IT install four computers, and getting Telecom to turn on four phone lines and a call tree message. We started the call line at 0700 the very next morning, staffing it 24/7 for several days. We did decrease the hours to 0600 - 2200 within the first week, staffing the line with a mix of UEHC nurses and medical assistants and borrowed ambulatory staff and medical students. The call line has operated 7 days/week since, well beyond our clinic hours. In mid-May, the weekend/holiday coverage was transitioned to the Integrated Call Center.
Very quickly, it was asked that we order the visit to the Influenza-Like Illness Clinic for employees who met Centers for Disease Control and Prevention (CDC) criteria. This required building a dot phrase and creating the order. UEHC rarely uses EPIC, instead of documenting in ReadySet as we are required to keep the employee health record separate from the employee's hospital record. A document guide was created for the call line staff to use as well as Epic training and access from Identity Management for several of the UEHC Medical Assistants. Recently, it was requested that UEHC order the testing as well. More education was done.
A spreadsheet was developed for documentation of the calls. Multiple tabs have been added as needed to address new issues as they have arisen. COVID positive employees who self-report are tracked as well. This information is shared every weekday in the Noon News. We also track localized outbreaks on units, assisting with contacting employees, and arranging for testing.
In the meantime, it was recognized that personal protective equipment (PPE) was in short supply. Particularly concerning was the lack of some N-95 respirators and CAPR supplies. UEHC had already increased the number of respirator mask fits performed daily to meet the need of staff caring for COVID- 19 patients. In doing so, we stopped requiring appointments, allowing staff to come on a walk-in first come/first serve basis.
As more and more staff were identified as needing a respirator, UEHC decided to set up pop-up clinics. This is something we had never done before. To be able to accommodate this, we needed to change from quantitative testing to qualitative testing. Qualitative testing uses saccharin or Bitrix in solution, spraying either into a hood as the employee makes movements to ensure a tight fit of a respirator. UEHC had not performed qualitative testing since 2012 and only one staff member had been trained on this technique. In addition, necessary testing supplies were limited and unable to be purchased. We reached out to the Environmental Health and Safety (EHS) staff on campus to assist in training UEHC staff on this technique. They were also able to assist in the first few pop-up clinics, augmenting UEHC staff. EHS and Student Health sent over hoods and atomizers so more stations could be set up in the pop-up clinics as demand increased. Engineering Services was contacted and asked if they could make more hoods. Within a few days, we had an additional 12 hoods. The pharmacy was a huge help as well. Not only did they find some atomizers, but they were able to make the saccharin and Bitrix solutions.
Armed with enough supplies, we requested more staffing help from Ambulatory Nursing and Iowa River Landing (IRL). Several staff members were sent to us for the next two weeks. UEHC staff trained them in qualitative testing and ReadySet documentation. We then set up our first of many pop-up clinics. This one was solely for the Main Operating Room staff as it is difficult for them to get to the clinic. In three days, we test fit nearly 400 staff members. Prior to COVID-19, on an average day, we would test fit around 10 staff members.
The pop-up clinic was so successful, we extended it another week. This enabled us to test fit many frontline staff from the first areas to treat COVID patients - Emergency Department, MICU, SNICU, Respiratory Therapy, 4 South, and 5 South, to name a few. We borrowed more staff, this time from 3RC, training them to ReadySet and qualitative testing. These staff members enabled the pop-up clinic to have extended hours until midnight, reaching even more frontline care providers.
A third pop-up clinic was established a few weeks later, setting up in two different areas. This involved another crew from IRL who were then trained by UEHC staff. In addition, it was requested that a Just in Time team be trained to provide mask fittings for staff in a moment's notice if needed. SWOT and Vascular Access Team nurses were identified as the team members. UEHC staff trained them to perform qualitative testing, medically clear staff members, and document results. In setting up this team, a wire basket on wheels was procured from the surplus pile. One of the UEHC nurses took the cart home, disassembled, cleaned, and painted it, and bringing back to the clinic to stock. The cart now resides in the House Managers' Office and is restocked by UEHC.
UEHC continues to get requests for pop-up clinics. A fourth clinic was held the week of May 18th, relying on UEHC to split its staff between the main clinic and the pop-up clinic with minimal assistance from Ambulatory Nursing and IRL. As the pop-up clinics are popular, we will continue to host as staffing allows. Since March 1, 2020, we have performed over 3000 mask fits. UEHC partakes in the reprocessing program for masks. All masks that are now used for respiratory fitting are sent to be reprocessed up to seven times. This has significantly reduced the number of masks UEHC takes from Processed Stores, which has assisted in protecting this valuable resource.
In attempts to increase respiratory supplies, UEHC has participated in the testing of different masks and fitting tools. We have even assisted the Emergency Department in a research project involving surgical masks and an elaborate system of rubber bands to apply pressure on the mask, hoping to create respirators out of supplies on hand. Since February, we have also onboarded dozens of staff members repurposed from the Veteran's Affairs Hospital and from other parts of the University campus who have been sent to UIHC to assist in operations. We have driven out to other locations such as Linen Services to attend to onboarding needs including vaccines to limit the number of staff entering the hospital. We provided respiratory mask fitting to the College of Dentistry. And we have traveled off-site twice to a UIHC clinic in Muscatine to provide mask fittings.
During all of this, we maintained a full clinic schedule, onboarding new UIHC staff, providing Tuberculosis treatments and annual appointments, and continuing our support of the bloodborne pathogen call line. We faced a great challenge at the beginning of April with the retirement of one of our nurses, who took with him many years of knowledge and expertise. The team has also oriented one clerk and three nurses to UEHC during this time, which is substantial as we only have 3 budgeted clerk lines and 3.5 budgeted nurse lines.
As we head into the summer, with the hospital ramping up ambulatory visits and surgery appointments, we know UEHC will receive less and less assistance with our Call Line and Pop-up Clinics. We are working to incorporate the Call Line into our everyday clinic life, transferring the line into our workroom and developing a rotation for answering it. All nurses and medical assistants are training to do this. We are also making plans to have more Pop-up Clinics in the future in various areas when we return to yearly mask fit requirements as directed by OSHA. This will include changes to the clinic's schedule, yet another innovation not done before in UEHC.
This small team comprised of 3 clerks, 3 medical assistants, and 3.5 nurses have seen many changes, as has the entire UIHC system. Every day they have adapted to the ever-changing policies, increasing demands and innovative ways to assist in a crisis. When a large portion of the institution was having to scale back on patient volumes and procedures, we were seeing our largest increase to date. This team's eagerness to work together and the flexibility that they have shown to make sure that all staff at UIHC and the University of Iowa are safe and well cared for is humbling.
For the stellar way the staff have responded to every change and new event given them the past several months, I am proud to nominate the University Employee Health Clinic for the DAISY Team Award 2020.