COVID-19 Daily Update - Nov. 23
The Centers for Disease Control and Prevention recommend not traveling or visiting other households for Thanksgiving celebrations. If that cannot be avoided, they advise you to take the following precautions to prevent the further spread of COVID-19 and the flu:
- Get your flu shot
- Limit the number of guests (In Michigan, the maximum is 10 guests from two households)
- Wear a properly fitted mask with two or more layers
- Stay at least 6 feet away from people you don’t live with
- Wash your hands often with soap and water for at least 20 seconds; use hand sanitizer with at least 60% alcohol when you’re unable to wash
- Bring your own food, drinks, plates, cups and utensils
- Stay outdoors when possible, or open windows and turn on fans to keep fresh air circulating indoors
- Clean and disinfect frequently touched surfaces and items between use
Get more tips on safely celebrating the holidays that you can share with friends and family on social media on Beaumont.org: Avoiding high-risk holiday activities.
Antibiotics aren’t always the answer: How Beaumont is combating antibiotic resistance during COVID-19
Over prescribing antibiotics for infections commonly caused by viruses has led to resistance to the life-saving medications.
COVID-19 is a new disease. Initially, clinicians found it difficult to differentiate between coronavirus and bacterial community-acquired pneumonia. COVID-19 patients often develop a hyperinflammatory phase, which can be difficult to distinguish from a secondary bacterial infection. In Michigan, using antibiotics before knowing what was causing the illness ranged from 27% to 84% across hospitals. The variation in prescribing might be attributed to the infrastructure of stewardship programs across the hospitals.
“Clinicians are probably initiating antibiotics out of concern for bacterial co-infections in patients with COVID-19,” said Lama Hsaiky, PharmD. “It is a new disease, and we are learning new things and concepts every day. Data so far has not shown an unusual association between COVID-19 and bacterial co-infections at the time of admission to the hospital.”
Antibiotics may be useful when a patient’s blood pressure is unstable and has an elevated white blood cell count. Clinicians concerned for health care associated infections during prolonged hospital stays may also prescribe antibiotics.
The Beaumont COVID-19 Treatment Taskforce consists of infectious diseases/immunology/hematology and critical care physicians as well as infectious diseases and critical care pharmacists from across the system. The taskforce discourages the routine use of antibiotics when patients present with pneumonia and are confirmed to be COVID-19 positive.
Beaumont Health’s Antimicrobial Stewardship team plays a significant role in reducing unnecessary antibiotic use and educating providers about the potential harm of prescribing or treating with antibiotics that won’t help the patient. In 2020, the stewardship team had a significant role managing the COVID pandemic treatment choices. Interventions focused on leading the COVID-19 treatment taskforce, supporting providers in the continuous, evolving treatment approach, managing medication shortages, enrolling patients in emergency use and investigational medication programs, participating in multidisciplinary rounds and ensuring the optimal use of antimicrobials to minimize the risk of super infections and resistance among COVID-19 patients.
“One of our main focuses is to increase reach,” said Dr. Paul Chittick, who, with Lama Hsaiky, PharmD, are corporate program leads for Antimicrobial Stewardship.
The physicians and pharmacists in the Antimicrobial Stewardship Programs at Beaumont evaluate antibiotic use on a day-by-day basis to see what’s appropriate and what’s not. They then offer recommendations and education to prescribers to provide the best, most effective therapy for their patients.
How can you protect yourself, your patients and your family?
According to the CDC, practicing hand hygiene and staying up to date on vaccinations are two of the best ways to prevent infections in the first place. Read more on the CDC’s website.
Always STRIVE for proper use of antibiotics to help prevent antibiotic resistance. Visit our Antimicrobials Stewardship Program Website, COVID-19 Clinical Resources site and the following links below:
Be antibiotics aware: Bacterial co-infections in COVID-19
STRIVE for the proper duration
Symptom free pee, let it be!
Voices from home: Recorder helps patient through COVID-19
During the first COVID-19 surge, health care workers from across Beaumont Health found themselves in new roles. One of those people was Mary Ellen Welling, RN.
Typically, Mary Ellen is the director of Sleep Evaluation Services, and to keep her skills sharp, she’s a nurse practitioner on the weekends in Pulmonary. But after COVID-19 postponed sleep evaluation appointments, she was assigned to Beaumont, Troy.
Watch Mary Ellen's story and share on social media
“I was trying to triage phone calls because the floors were getting pummeled with people visiting. It was pretty stressful on the health care team. I had the advantage of being able to help in engaging and creative ways,” she said.
One of those creative ways made a huge impact.
Mary Ellen was on the phone with a patient’s wife. The patient, who was in his 40s, was on a ventilator battling COVID-19 and wasn’t responding well. The situation was starting to look dire. The patient’s wife told Mary Ellen she wished her husband could hear her and their family. She wanted to pray with him, and for him, to hear the sounds of home he was missing.
“I asked if she had a voice recorder. Luckily, their son, who was just about to graduate from nursing school, had one. I told her to talk to him, let him hear the sounds of the house. This patient was really deteriorating. They were throwing out every trick to get him to turn around,” recalled Mary Ellen.
The next day, Mary Ellen met the patient’s wife at her car outside to retrieve the recorder.
“I remember telling the nurse, ‘here, try this.’ There’s just something to be said about healing the soul,” said Mary Ellen. “That evening, the nurse emailed me to let me know that she turned the recorder on, and a few hours later he had tears running down his face, so we knew he was in there.”
Melissa Steiner, RN, is one of the nurses who cared for the patient.
“At first he seemed anxious and he was breathing heavier. We got nervous,” said Melissa. “I think it’s very hard for patients to be so isolated. So to have that recording comforted him in a way that medication and staff never could. It was encouraging and gave us hope. Prior to that, we were only seeing the worst possible outcome.”
Three days later, the patient was off the ventilator and in a step-down unit. The medical team was on to something.
That week, Mary Ellen mentioned to Naomi Ishioka, RN, what had happened. Naomi found 20 more recorders to use, plus Administration was going to buy more.
“During that whole crisis, we all became unintentionally callused, because we were so lost from not having those connections. We’re so used to learning who our patients are through families,” recounted Mary Ellen. “I was just working to create a familiar environment and closing those gaps. That’s the healing art of nursing. I didn’t think it was going to blow up. I just thought I was helping somebody out, like MacGyver.”
Another nurse relayed to Mary Ellen something the patient had said: “I thought I was dead until I heard my wife yelling at my dog.”
The sounds of home clearly resonated through the haze of COVID-19.
“It’s the little things, the touches, the caring, that allows folks to have hope,” said Mary Ellen. “I’m really proud that Beaumont has taken this seriously. This is wonderful. It’s that mind, body, soul — looking at the whole picture.”
Teen center staff supports 1,000 grieving families with bereavement call project
Some family members cried, some expressed gratitude and some had numerous questions, making the 1,000 or so phone conversations challenging. Whatever their grieving process has been, family members of Beaumont Health patients who passed away during the first COVID-19 surge this year received support from the Beaumont Teen Centers’ Social Work team through the bereavement call project.
Earlier this year, due to the pandemic and social distancing restrictions, the teen centers were limited in the services they could provide. The Social Work team wanted to contribute, hoping to help families who had suffered the loss of family members during the pandemic. Linda Caurdy-Bess, manager, Advance Care Planning, designed a bereavement call project to provide grieving families with support and resources.
Linda provided the Social Work team with the list of deceased patients from the acute care campuses. They spent time reviewing the charts to become familiar with them before calling the next of kin to provide support and resources.
“The calls our social workers made supported our patients’ families and fostered an ongoing positive relationship with Beaumont,” said Erin MacLeod-Smith, a social worker at Adams Child & Adolescent Center.
During the conversations, the team provided information on local therapists and support groups, as well as Beaumont contact information for questions related to the deceased family member’s medical records, billing and patient experience.
“I found that families wanted and needed the resources we provided. They wanted someone to listen, and truly appreciated hearing from us,” said social worker Dylan Feil. “Families wanted someone to bear witness to their experience and their emotions, because the emotions that come with grief — anger, sadness, guilt, shame and confusion, among others — are an indescribable amount. It’s a delicate time for families.”
The team is grateful for the positive impact they have made on these families and look forward to additional means to provide support.
“Having the opportunity to give clarity significantly aids in the grieving process,” said Erin. “A vast majority of the families are interested in gathering with Beaumont to honor their loved one. Our team will be honored to share in the systemwide memorial that is being coordinated by the Remembrance Steering Committee for early next year.”
The Beaumont Teen Centers are supported by donations and grants obtained by the Beaumont Health Foundation and is one of the top funds team members choose to support through the Spirit of Giving Campaign. To make a donation through the campaign, log in to your PeopleSoft HR account by the end of November and choose “Teen Health Centers” from the drop-down menu. Campaign donations will be accepted through the end of the year.
New documentation and coding practices in oneChart effective Jan. 1
Changes to the Evaluation and Management guidelines for new and established patient offices and other outpatient visits will take effect Friday, Jan. 1. This change is part of the Patient over Paperwork Initiative, which the Centers for Medicare and Medicaid Services, along with the American Medical Association, have developed and released changes to CPT code definitions for office and outpatient service codes to reduce administrative burden. At Beaumont Health, documentation and coding practices for providers will change, along with the workflow team members use in oneChart to comply with these revisions.
In addition, changes to the Level of Service Calculator in oneChart are currently being tested. Training and reference materials for the new documentation requirements, coding changes and new oneChart workflow updates are being developed for Beaumont team members and employed physicians. Watch for more information coming soon.
An update on the Microsoft windows operating system mitigation strategy
All servers and devices that are no longer maintained or supported must be upgraded to new operating systems, or become compliant, by the end of the year. Strategies have been approved by Cybersecurity to provide enough time and protection so that long-term remediation plans can be carried out in 2021.
Plans for Desktops and Laptops:
- Restricted access for all non-Windows 10 devices to Server Messaging Blocks/Shared drives, SQL servers and Remote Desktop Protocol, except those identified and approved exceptions that require access by a key software application.
Plans for Servers:
- Installation of Cylance to all non-WinServer 2012-2016 servers to stop new executables by potential "bad actors" from installing malware.
Invitations will be sent this week and next week to application owners and designated key users for testing sessions that will take place between now and the end of the year. During these meetings, invitees will be expected to help ensure that there are no issues with access and application performance as these mitigation strategies are applied.
We appreciate invitees’ availability and participation to keep Beaumont safe. For questions, email Win10Remediation@beaumont.org.