TO:Long-term Care Physicians and Nurse Practitioners
FROM:Dr. Margaret Manville, Medical Director Long-term Care
RE:LTC update
DATE:April 3, 2020
- Many questions have been asked about essential physician/NP visits. LTC homes, in collaboration with our medical leads in our four geographies, have come up with different solutions to this issue. Most LTC homes have limited the number of physicians who provide in-person visits, some to just the medical coordinator. Some have altered their on-call structure to reduce the number of physicians available to the facility. To protect our LTC residents from contracting COVID-19, we must:
- Reduce the number of physicians attending at LTC homes
- 参加LTC家的医生应该参加最少的网站
- The attending physician should be of ‘ lowest risk’ to patients for COVID-19
- 任何完全的基本访问都仅限于访问对医学决策至关重要的访问
- 目前没有主动入住的访问 - 请使用电话或远程医疗选择以获得主动访问。LTC结段0114
- 你的医疗领导和医疗协调员geographies are working with LTC homes to come up with the safest and most resource-efficient plans for your communities.
- Most LTC homes are still contacting the MRPS for faxes, phone calls and telehealth visits.
- On-call physicians – there are also questions about whether on-call physicians can or should visit a LTC facility. If a visit is deemed基本的to the medical or comfort care of the patient, especially if a visit can help with a decision to transfer or keep the resident in the LTC facility for care, that visit would be deemed essential. A good assessment from nursing and excellent communication are paramount for all to feel that they have enough information to make a good decision. The medical coordinator should only get involved if there are issues that cannot be resolved between the on-call physician and the nursing staff.
- Please see theNew England Journal of Medicine articleandCDC发病率和死亡率每周报告上周末出版华盛顿州的养育家庭住宅上的Covid-19。这些报告支持减少医疗工作者和其他人将Covid-19带入护理家庭的能力的建议（加强筛查，仅限于必要的访问，限制在不同地点的HCW，自我监测症状，使用PPES）。他们还讨论了Covid-19的无症状和争论普及。
- 护理谈话的大多数/目标。在Covid-19的背景下拥有这些谈话是挑战的，具有如此多的未知数。但是，如果最近尚未审查，它会对我们的随叫随到的同事们对我们的关注同事们来说，这让我们在决定处置时。在必须在决定转移之前，这些谈话更好地与家庭更好。如果在过去的6个月内已经完成，请审查您的M3-C2患者以适应ER转移和急性护理入学。
- E-MOST: here are some instructions about how to put the MOST into Powerchart.
- 药物评论：药物评论也非常重要，此时也完成了。请尽量安全地减少药物的数量和药物需要给予患者的次数。如果药物不是绝对必要的，这会减少患者暴露于HCW相互作用。请瞄准维生素和补充剂，以及效果不确定的药物。如果您认为家庭不同意，请说明药物可以“持有”（例如4周），一旦大流行威胁减少了一次。
- Charting progress notes for telehealth visits (0114 or 14077). Many LTC facilities use an EHR (eg. Point Click Care, Powerchart) and many physicians are now charting progress notes in the facility’s EHR. The local site administration can help you with access if you are interested in charting electronically. Using your own office EHR is acceptable as long as your progress note is sent to the facility where your patient resides, and it should have 3 patient identifiers (Name, PHN, DOB). Dr. Bekker can help if you are interested in charting remotely in Powerchart. If you are not using an EHR, please use a template for recording your encounter (see the attached as an example) and send it to the facility. Templates also need 3 patient identifiers as stated. All progress notes should be sent into the facility as soon as possible after the telehealth encounter is completed so that documentation can be reviewed by staff and filed. Please type your notes if at all possible so they are legible for the staff. For this time, Island Health facilities will accept dictated progress notes, instructions in the memo below:
Sincerely,
Dr. Margaret Manville, Medical Director Long Term Care
Geography 1: Dr. Kathleen McFadden, Medical Lead, LTC
Geography 2 Dr. Erfan Javaheri, Medical Lead, LTC
Geography 3 Dr. Stacey McDonald, Medical Lead LTC
地理3埃里克博士医疗领导LTC
Geography 4: Dr. Ian Bekker, Medical Lead LTC