OUR NURSING HOME PROTOCOL FOR PUI AND CONFIRMED COVID-19 CASES

PUI (COVID-19 SUSPECT) STANDING ORDERS

* IF STABLE, follow the standing orders below:

1. Isolate based on Airdroplet precaution guidelines

2. Test for Covid-19 RNA PCR (nasopharyngeal/oropharyngeal swabbing) send out to contracted lab. DO NOT SEND antibody tests IgG/IgM

3. Stat CXR

4. Stat labs: cbc. Cmp. Lactic acid. Ddimer. PTT/INR, CRP, BNP

5. Tylenol 650mg PO or PR q6 prn fever

6. Albuterol MDI 2 puffs + Atrovent MDI 2 puffs Q6q6 with spacer

* Nebulizer is now not advise apparently because this could potentially aerosolize the airdroplets.

* Empiric Antibiotics to be started for symptomatic Patients pending work-up if HCAP or other bacterial infection suspected - Pls inform provider of any new or worsening symptoms.

CONFIRMED *COVID-19 BY PCR TEST

If the Pt is full code and critically ill, CALL 911 or transfer to nearest ER or urgent care.

• Acute respiratory distress

• Altered mental status

• Hypoxemia

• Hypotension

I. SEVERE SYMPTOMS BUT UNABLE TO HOSPITALIZE (e.g. DNR, No hospital bed). Persistent high grade fever, RR> 20 HR> 100, O2 sat <92% on room air or persistent hypoxemia despite O2

1. (HYDROXYCHLOROQUINE FDA APPROVAL HAS BEEN REVOKED.)

2. Solumedrol 80 mg IV / IM q8 or decadron 4 mg iv or po tid x 1 wk

3. Heparin 5000 units sq q12 ( or Lovenox 40 mg sq qd)

4. Protonix 40mg IV or PO qd

5. DC NSAIDS. start tylenol 650 mg po q6 prn fever

6. ACE inhibitors may potentiate severity of Covid-19 infection (controversial). Continue if on it

7. Albuterol MDI 2 puffs q6 (if HR >100, or Xopenex MDI 0.6mg 2 puffs q6) with spacer

8. Atrovent MDI 2 puffs Q6 with spacer

9. Additional labs: G6PD (quantitative), RSV, influenza A & B, procalcitonin

10. O2 2 liters NC and titrate up as needed keep O2 >92

11. cont IVF 1/2 NS 100 cc/hr

12. To preserve PPE and avoid staff exposure: DC non-essential meds.

13. Consolidate or decrease med dosing frequency. Use long acting QD dosing if possible

14. (Pharm to Review drug to drug interaction)

15. (Social worker or staff to initiate discussion of code status with family)

16. Consider referral to palliative Care and reassess code status

II. CONFIRMED *COVID-19 BUT STABLE PATIENTS:

1. Albuterol MDI 2 puffs q6 (if HR >100, Xopenex MDI 0.6mg 2 puffs q6) with spacer

2. Atrovent MDI 2 puffs Q6 with spacer

3. RSV, influenza A & B

4. O2 2 liters NC and titrate up as needed keep O2 >92

5. cont IVF 1/2 NS 100 cc/hr (optional)

6. DC NSAIDS. start tylenol 650 mg po q6 prn fever

7. To preserve PPE and avoid staff exposure: DC non-essential meds. Consolidate or decrease med dosing frequency. Use long acting QD dosing if possible

8. (Pharm to Review drug to drug interaction)

9. (Social worker or staff to initiate discussion of code status with family)

** if the pt is full code and becomes unstable e.g. persistent for hypoxemia and resp distress, transfer via 911

** keep Family updated

(Get the healthcare staff abreast on minute by minute status by creating a Patient Hub on Hubchart App. Team Care coordination and Telemed Apps. www.hubchart.io )