Protocols and Risk Management

From The Children’s Care Network: Guidelines for immediate COVID-19 Office Containment Steps The recommended guidance is provided to pediatric healthcare providers as they care for and protect patients and their parents/guardians and to protect healthcare providers and their staffs during the COVID-19 outbreak. These guidelines and recommendations are not exhaustive. All medical decisions remain at the full discretion of each healthcare provider. Click HERE to access the PDF version of the guideline.

Patient Safety/Risk Management & PPE Supply Kids Health First reached out to Ruth Wood, Director of Operations for MAGMutual Patient Safety Institute, regarding the anticipated shortage for personal protective gear. Below are several reference links and recommendations.

FDA responded with a FAQs article regarding shortages of surgical masks and gowns.

Below are the specific Centers for Disease Control guidelines about PPE during this pandemic.

Ruth recommends notifying the Georgia Department of Public Health (Main: 404-657-270) and/or Emergency Management Agency (Main: 404-635-7000) immediately about your decrease in PPE and short supply. At this time, we are not certain who is managing national and state supply chains, but these entities may be able to place your practice on a list or provide additional direction. Also, it’s important to ensure that you have reached out to vendors and have placed orders. There might be alternative suppliers that may have stock. We are including a spreadsheet from ECRI about alternative PPE vendors that might be helpful.

Double click on this link to download the Excel file with several tabs.
Immediate strategies to extend PPE inventory:
- Monitoring PPE supply and control to prevent theft, damage and loss. Track daily usage
- Implement telemedicine services
- Limit current use of PPE, strictly following CDC guidelines
- Designate specific staff to manage sick visits for patients with suspected or confirmed Coronavirus Disease 2019 (COVID-19)

Alternative Sources for PPE: From the Advisory Board -4/1/20 Which businesses should you be asking for PPE? There are a handful of non-health care businesses that regularly use PPE suitable for the hospital setting, particularly masks and gloves, and may have larger amounts of stock on hand. Below is a list of these businesses. We recommend that hospitals complement general solicitation efforts for PPE with more direct outreach to such companies, if sizeable and nearby. Non-health care businesses to turn to for PPE:

Construction companies;
Woodworking, painting, industrial coating companies;
Welding suppliers;
Marine suppliers;
General industrial suppliers (such as Granger, Fastenal);
Automotive stores;
Heavy equipment, worksite machinery rental companies (such as United Rentals);
Cleaning companies (especially fire, water and mold restoration franchises); and
Agriculture companies.

From Children’s Healthcare of Atlanta: Guidance for N95 Mask Use & Disinfection In alignment with CDC recommendations, refer to the following Children’s resources for more information about using N95 masks when completing an aerosol-generating procedure (AGP) for a patient on enhanced contact droplet precautions (i.e., a patient with a suspected or confirmed case of COVID-19). Updated guidance for N95 mask use Explanation of aerosol-generating procedures warranting an N95 mask. Read more about nebulizer treatments. Refer to the following resources for more information about N95 disinfection:

N95 disinfection playbook with rationale, methods, process and references for the disinfection process
Process map
Disinfection guideline for physicians and providers
Disinfection process education (PPT)

Order Respirators from FDA-Approved Suppliers

The FDA has provided a list of authorized respirators manufactured in China, which may be ordered and used in accordance with the CDC’s recommendations.
For the most current CDC recommendations on optimizing respirator use, please read the CDC’s Strategies for Optimizing the Supply of N95 Respirators.

General Patient Safety/Risk Management

MAGMutual 3/13/2020: Safety alert update Covid-19
MAGMutual & The Doctor’s Company: 4/29/20- Practice Resources from Risk Management Perspective for COVID-19 and Post COVID-19

HR Related Concerns

If an employee gets COVID -19 and determined it’s from working at a practice, then workers comp would kick in. Employers in the state of Georgia with 3 or more employees are required to carry workers comp insurance.
- GA WC Page: https://georgia.gov/popular-topic/workers%E2%80%99-compensation

MAGMutual 3/17/2020: Employer obligations under proposed families first coronavirus act hr6201

MAGMutual Telemedicine: Telehealth Practices during Coronavirus (COVID-19) Outbreak

For MAGMutual customers, telemedicine is covered but they must be an established patient, and the provider must also be licensed in the state in which they are providing care.

Updated Payment Terms and Payment Extension Grid- 4/17/20 Payment terms and potential extensions update:

Company	Regular Payment Terms	Potential for Grace Periods	Other Terms
Merck	90 days	Extended to 120 days 2%, net 121 for orders placed 1/7/2020 – 4/6/2020 and new orders placed 4/7/2020 – 5/7/2020	Orders placed through Vaccine Shoppe (Vaxserve): invoices due in April and May 2020, payment terms will have an additional 30 days (including 2% prompt pay).
Sanofi	90 days	4/17/2020: Sanofi is extending payment terms (including 2% prompt pay) on invoices due in April and May out an additional 30 days.	Sanofi Pasteur will waive the 1.5% interest fee on any invoices not paid within the 90-day contract terms so long as the invoice is paid within a reasonable timeframe.
Sanofi Pasteur is also suspending the collections process at least through April 30, 2020 and will reevaluate the need to extend that suspension as needed.
GSK	60 days	No global change. Must be requested individually. Sent message out through TCCN 4/9/2020.
Pfizer	75 Days	Extended to 105 Days

Cybersecurity: Defending Against COVID-19 Cyber Scams The Cybersecurity and Infrastructure Security Agency (CISA) warns individuals to remain vigilant for scams related to Coronavirus Disease 2019 (COVID-19). Click here to download a word document with links on safeguarding cyber security.

Interpreting Diagnostic Test for SARS-CoV-2

Read the Journal of the American Medical Association’s viewpoint on interpreting two types of diagnostic tests commonly used for SARS-CoV-2 infections—reverse transcriptase–polymerase chain reaction (RT-PCR) and IgM and IgG enzyme-linked immunosorbent assay (ELISA).

Please note, this information is based on studies in symptomatic adults. There are ongoing efforts to learn more about PCR positivity and seroconversion in children.

Asthma Care During COVID-19 Pandemic

This guidance sheet was developed by TCCN and Children’s to provide recommendations on caring for asthmatics and addresses concerns over potential MDI inhaler shortages.
Recently, Medicaid has expanded prescription supplies from 30 days to 90 days, and commercial payors are expected to do the same. This document includes sample reminders for your asthmatic patients regarding taking their medications properly, ordering refills, and social distancing.
Click HERE to download the Asthma Care document

‘Child-Friendly COVID-19 Testing’ Training for Providers An interdisciplinary team at Children’s Hospital of Philadelphia has created a free, online training for healthcare professionals on child-friendly COVID-19 testing. This training aims to increase provider knowledge and comfort when testing pediatric patients for COVID-19. Note, you must enter basic demographic information before accessing the training.