Notes from the Pandemic Front Lines - Oregon Veteran’s Home & the COVID-19 Pandemic
November 24, 2020
Earlier this year, when the first positive result for COVID-19 was reported at the Edward C. Allworth Veterans’ Home in Lebanon, OR, its staff was ready. They had already spent significant time putting policies and procedures in place, everything from specific treatment plans for infection-control measures to keep staff safe, general operational policies, and more.
Those were the takeaways from a recent Nursing Stand-Up webinar, where three staffers from the facility shared their experiences and offered best-practices, tips, and advice. The facility, which opened in 2014, is owned by the Oregon Department of Veterans’ Affairs and is a 154-bed, small-house model that has created four neighborhoods, one dedicated to memory care, on a 12-acre site, says Valerie Weaver, Director of Nursing.
“We have a very unique design that's special for infection control, because if COVID breaks out in one home, we can contain that home and close its doors,” Weaver explains. “Even when we thought in February that there was still a low likelihood of COVID-19 coming into Oregon, we went ahead and began turning our wheels. We started gearing up for what could possibly happen. We reviewed our pandemic policy, making sure that it would cover COVID-19. We also went ahead and reviewed our disaster preparedness policies as well: PPE, staffing, the whole works. And of course, we looked to the CDC and the Oregon state health authorities for guidelines around infection prevention.”
“As a nursing facility, we are constantly training staff,” adds Monica Claflin, LPN, Infection Preventionist. “It's constant, for both new issues and reminders. We go over hand washing, we go over PPE on a regular basis, so it's on the forefront of our minds at all times.”
The facility team worked with a nearby hospital, as well as local and state health departments and anyone else they could think of, including medical schools, to secure additional PPE and other equipment that might be needed.
Moving from Laying the Groundwork to Infection Prevention and Control
From those initial preparations, the facility’s staff was able to create a plan that involved trigger points to different stages. From an initial outbreak to access and control, everything was covered in such a way that any eventuality wouldn’t be a surprise.
“We have a four-tiered approach,” Claflin says. “Our first tier went into effect immediately and meant putting signs on all of the access doors and creating screening stations where we could ask about symptoms, if they’d been out of the country, things like that.”
From there, the facility began letting potential visitors know they might not be able to access the site, in order to protect patient safety. Then staff training ramped up, and the move into the second tier was triggered if a confirmed case was noted within 60 miles of the facility — the length of some employees’ commute.
Tier three activated when those confirmed case numbers rose to at least two, and tier four was launched when a confirmed case occurred on the campus. At that point, everything was locked down, with no visors, full staff screening, and limited movement between the residents’ homes.
“We were already on high alert, so we picked up fairly quickly the pattern of several veterans having the same symptoms,” Claflin recalls. “We had these COVID-19 standing orders protocols in place prior to ever even suspecting COVID, so as soon as somebody was noted to have any signs and symptoms, they were placed on droplet precautions,” which were then followed by testing and treatment. Those early catches, and the ability to isolate residents, was key because the facility was full—no room to shuttle people around.
And in the ensuing weeks and months, facility staff worked to not only provide vital care to its residents, but also to support staff as they dealt with the pandemic in their own lives. Constant contact with local, state and federal officials has also been a key factor in staying alert and aware of changing regulations and other news. And through it all, the team continued to innovate.
“Monica developed her very own colorful tracking sheet,” Weaver says. “It contains just the information that we needed to meet the reporting guidelines. That was very helpful. Our plans evolved, and we got amazing support from the Oregon Department of Veterans’ Affairs in terms of notifying families and helping us be transparent with them and the public.”
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