Thread by @JaimeAPRN

Update thread on COVID at SNF

If you have not ever worked in a SNF it can be hard to imagine the realities we face each day, on a normal basis.

1. Nurses have between 20-40 pts each, differs shift to shift & acuity levels of patients. /1

2. C.N.A.'s have between 9-20 patients each, again varies based on shift & acuity of patients.

3. There is, in an ideal situation, a RN facility supervisor on each shift.

4. M-F 8-430p there are a lot of admin nurses: DON/ADON/UM/Clinical Ed./Infection Cntrl/Risk Mngr /2

5. The SNF nurses are often thought of as "morons, too stupid to work at a hospital, neglectful, lazy, uncaring, etc." - we are treated w/condescending attitudes by other members of the #healthcare team. /3

6. We are restricted by more regulations than most other healthcare settings, for instance in FL we have: AHCA, CMS, DOH, JC, FHCA, CDC, OSHA, DCF-All which guide/regulate our care, can fine us large amts of money, or simply cut funding. That is w/o attorney's & Corp. Policy /4

7. I often joke that SNFs are "the redheaded step children of healthcare" - yet it can be a very rewarding environment & the longterm patients become extended family. We have tried VERY hard w/ #coronavirus to keep it out of the facility /7

...My facility has been on "lockdown" since the first week of March, no visitors except at end of life. We have used telemedicine for all visits, and lab & mobile x-ray have to put on jumpsuits, face shields, and masks before they are allowed in. ... /8

All employees are screened at beginning of shift & midway through their shift...

We kept COVID out (had one scare) until June 2nd (asymptomatic employee) & June 8th...we had + pts

/9

The 10th of June we got our results back from the June 8th testing of all employees & patients.

13+ patients with 10+ employees.

All of the cases are on the same unit...good, right?

Unfortunately that unit is a dementia unit... /10

DOH comes in, we transfer all + to local hospitals. For the most part they are asymptomatic.

Immediately retesting occurs and we have 10 additional + cases...same unit.

DOH states, they can stay at facility. /11

Those 10pts are left in their rooms, on their normally secured unit, w/goal of keeping them in their rooms as much as possible. We cannot close their doors and we cannot restrain them, its against regulations.

/12

If you are familiar w/dementia then you know wandering, pacing, repetition is very common.

The patients are not easy to keep apart...DOH says, "they stay unless they have symptoms"

And more patients are spiking fevers.

Another batch of testing was done Friday...
/13

Over the weekend, when I worked...we had a few who were "negative" as of Friday develop resp. Sx & after cxr be Dx w/PNA....

We had 3 employees sent out via ambulance, high fevers & symptoms came out of nowhere.

No test results from Friday arrived over weekend

/14

As you can imagine, this is not an ideal situation and on top of this, there were HUGE issues getting staff for the weekend.

Remember 10 of the units employees are off with COVID, 3 were sent out, one nurse quit bcuz she didn't want to work with COVID pts.

/15

We did the best we were able too...weekday admin team did not offer to come help. The already overburdened nurses and CNA's had to take increased patients, and we had to do it all without adequate PPE. /16

They had one size n95 mask, and if it didn't fit we were told to "make it work" FIT testing was a joke.

Not enough isolation gowns, so use one over and over...

Flimsy face shields...

That is the PPE provided when working w/active COVID pts. /17

Remember, the entire unit is contaminated. However, the Sani-Wipes are also limited.

Everything is locked up in an area nobody on the weekend has access to. /18

This is a HUGE corporation that owns this SNF... they have Hospitals, SNFs, Out Patient Clinics, and Home Health companies in 10 states.

Yet, this is how we are asked to work with an infectious disease. /19

When I left this morning they were starting to retest all employees and patients again...

So, thats the update for all to read. sorry I went all over the place, people are saying "oh a SNF - well they are old anyways" or "you guys must not have tried" - I can say, we truly did