pandemic preparedness: surfing the next wave · 2020. 6. 18. · •gregory h. botz, md, fccm, is a...

1 © 2020 TMIT Global TMIT Global

June 18, 2020 CareUniversity Webinar #140

For resource downloads go to:

www.MedTacGlobal.org

Pandemic Preparedness:

Surfing the Next Wave


Charles Denham, MD Chairman, TMIT Global

Founder Med Tac Bystander Rescue Care

Med Tac Bystander Rescue Care June 18, 2020 CareUniversity Webinar #140

Welcome


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Our Purpose Statement

Our Purpose:

We will measure our success by how we protect and enrich the lives of families…patients AND caregivers.

Our Mission:

To accelerate performance solutions that save lives, save money, and create value in the communities we serve and ventures we undertake.

CAREUNIVERSITY ®

EMERGING THREATS

COMMUNITY OF PRACTICE


Speakers

& Reactors

Dr. Charles Denham

Marian E. Von-Maszewski Dr. Gregory Botz

Jennifer Dingman

Heather Foster RN

Chief William Adcox


Disclosure Statement The following panelists certify that unless otherwise noted below, each presenter provided full disclosure information; does not intend to

discuss an unapproved/investigative use of a commercial product/device; and has no significant financial relationship(s) to disclose. If

unapproved uses of products are discussed, presenters are expected to disclose this to participants. None of the participants have any

relationship medication or device companies discussed in their presentations.

• Marian E. Von-Maszewski, MD, is Emergency Readiness Officer and Assistant Professor, Department of Critical Care, Division of Anesthesiology and Critical

Care, at The University of Texas MD Anderson Cancer Center, in Houston, TX. She has nothing to disclose.

• Gregory H. Botz, MD, FCCM, is a professor in the Department of Critical Care at the UT MD Anderson Cancer Center. He received his medical degree from George

Washington University School of Medicine in Washington, DC. He completed an internship in internal medicine at Huntington Memorial Hospital and then completed

a residency in anesthesiology and a fellowship in critical care medicine at Stanford University in California. He also completed a medical simulation fellowship at

Stanford with Dr. David Gaba and the Laboratory for Human Performance in Healthcare. Dr. Botz is board-certified in anesthesiology and critical care medicine. He

is a Fellow of the American College of Critical Care Medicine. He has nothing to disclose.

• Jennifer Dingman has nothing to disclose.

• Heather Foster has nothing to disclose.

• Chief Adcox has nothing to disclose.

• Charles Denham, MD, is the Chairman of TMIT; a former TMIT education grantee of CareFusion and AORN with co-production by Discovery Channel for Chasing

Zero documentary and Toolbox including models; and an education grantee of GE with co-production by Discovery Channel for Surfing the Healthcare Tsunami

documentary and Toolbox, including models. HCC is a former contractor for GE and CareFusion, and a former contractor with Siemens and Nanosonics, which

produces a sterilization device, Trophon. HCC is a former contractor with Senior Care Centers. HCC is a former contractor for ByoPlanet, a producer of sanitation

devices for multiple industries. He does not currently work with any pharmaceutical or device company. His current area of research is in threat management to

institutions including conflict of interest, healthcare fraud, and continuing professional education and consumer education including bystander care. Dr. Denham is

a collaborator with Professor Christensen at Harvard Business School.


Jennifer Dingman Founder, Persons United Limiting

Substandards and Errors in Healthcare

(PULSE), Colorado Division

Co-founder, PULSE American Division

TMIT Patient Advocate Team Member

Pueblo, CO

Voice of the Patient


Charles Denham, MD Chairman, TMIT Global


Med Tac Bystander Rescue Care June 18, 2020 CareUniversity Webinar #140

In the News

May 2020 Survey Results

© 2006 HCC, Inc. CD000000-0000XX 10 © 2020 TMIT

In The News …

10

Patient Safety and COI Stories Being Followed

Nearly 200 investigations are underway at major academic

centers. Critics fear that researchers of Chinese descent are

being unfairly targeted.

The N.I.H. and the F.B.I. have begun a vast effort to root out

scientists who they say are stealing biomedical research for

other countries from institutions across the United States.

Almost all of the incidents they uncovered and that are under

investigation involve scientists of Chinese descent, including

naturalized American citizens, allegedly stealing for China.

Seventy-one institutions, including many of the most prestigious

medical schools in the United States, are now investigating 180

individual cases involving potential theft of intellectual property.

The cases began after the N.I.H., prompted by information

provided by the F.B.I., sent 18,000 letters last year urging

administrators who oversee government grants to be vigilant.

Vast Dragnet Targets Theft

of Biomedical Secrets for China 11-09-19

© 2006 HCC, Inc. CD000000-0000XX 11 © 2020 TMIT

In The News …

August 20, 2018

Unfortunately, threats to the integrity of U.S. biomedical research exist. NIH is aware that some

foreign entities have mounted systematic programs to influence NIH researchers and peer

reviewers and to take advantage of the long tradition of trust, fairness, and excellence of NIH

supported research activities. This kind of inappropriate influence is not limited to biomedical

research; it has been a significant issue for defense and energy research for some time. Three

areas of concern have emerged:

1. Diversion of intellectual property (IP) in grant applications or produced by NIH supported

biomedical research to other entities, including other countries;

2. Sharing of confidential information on grant applications by NIH peer reviewers with others,

including foreign entities, or otherwise attempting to influence funding decisions; and

3. Failure by some researchers working at NIH-funded institutions in the U.S.

to disclose substantial resources from other organizations, including foreign

governments, which threatens to distort decisions about the appropriate use of NIH funds.

“We recently reminded the community that applicants and awardees must disclose all forms of

other support and financial interests, including support coming from foreign governments or-

other foreign entities.”

“We also expect and encourage your institution to notify us immediately upon identifying new

information that affects your institution's applications or awards. Lastly, we encourage you to

reach out to an FBI field office to schedule a briefing on this matter.”

DEPARTMENT OF HEALTH

& HUMAN SERVICES

Public Health Service

National Institutes of Health

Bethesda, Maryland 20892

LETTER TO THOSE ORGANIZATIONS RECEIVING FEDERAL GRANTS

11

© 2006 HCC, Inc. CD000000-0000XX 12 © 2020 TMIT

In The News …

12


Tampa Bay Times Reports:

• Deaths of children in 1 in 10

undergoing CV Surgery at

JH All Children's

• Mutilation of children in

burn unit in Maryland

• Cover up of harm

• Retaliation against

whistleblower MD

• Patient Safety Issues in all

Johns Hopkins hospitals

• Whistle blower law suit

• Multiple malpractice suits.

• Regulatory problems

• Oversight letting team of

doctors make unannounced

visits

NYT & Propublica Reports:

• Conflicts and large payments

to Chief Med Officer – resigns

• CEO with conflicts, vote of

non-confidence – resigns

• Board Members own equity in

start up with special deals.

• Revision of conflict of interest

policies.

• Top executives barred from

serving on corporate boards

or investing in start-ups

Propublica &

Houston Chronicle Reports:

• Cardiac Complications

• Undeclared financial conflicts

of interest

• Allegations of exaggerated

quality program to lure

patients.

• Transplant program shut

down based on reporting.

• Leadership restructuring

• State and federal officials

enforcing safety standards.

• 08-08-19 Feds Cease Greater

Oversight Of Baylor St. Luke’s

Medical Center Initiated After

Patient Death

New York Times &

Washington Post Reports:

• Falsification of research in

cardiac stem care.

• Scientific misconduct

• 31 Articles Retracted

• Many patients treated

• Unknown impact of product

used in patients treated.

• Hospital paid to settle

allegations.

• Hospital pays $10M to settle

Tennessean & Beckers Hospital

Review Reports:

• Nurse medication error during

imaging with patient death

• Electronic medication

dispensing cabinet

safeguards overridden.

• Nurse indicted for reckless

homicide for fatal error.

• State Health Officials decided

no reason to discipline or take

action against nurses license.

© 2006 HCC, Inc. CD000000-0000XX 13 © 2020 TMIT

In The News …

13

Medscape Reports:

• Duke Settles Doctored Data

Lawsuit for $112.5 Million

• Duke Whistleblower Gets

More Than $33 Million In

Research Fraud Settlement

• William Foster, who ran the

lab where the data were faked,

studied the effects of

pollutants on the lungs of

mouse models.

• Thomas alleged that Duke had

won some 50 grants from the

NIH

The Washington Post Reports:

• Baltimore Mayor Pugh involved in

self-dealing book scandal for

hundreds of thousands of dollars.

• UMMS Board Chairman announced

the board's unanimous decision

March 21 to have CEO Robert

Chrencik take a leave of absence.

• Resignations of three UMMS,

including Baltimore Mayor Pugh.

• Hours before Mr. Burch notified the

public of Mr. Chrencik's leave of

absence, the Maryland House of

Delegates unanimously fast-tracked

bill to overhaul UMMS' 27-member

board of directors.

• Kaiser Permanente paid Pugh more

than $100,000 for 20,000 copies of her

books during a period when the

company was seeking a lucrative

contract to provide health benefits to

city employees.

Medscape Reports:

• Between 2011 and 2019

William Roper, failed to

disclose his seats on the

boards of major corporations.

• At the same time, those

corporations did business

with the state, records show.

• Roper has served on the

board of directors of DaVita,

Inc.

• Roper also a member of the

board of directors of three

successor companies in the

pharmacy benefits

administration industry.

• None of his corporate board

service was disclosed on

state ethics forms.

Tampa Bay Times Reports:

• Johns Hopkins All Children’s

faces record state fines.

• The planned $800,000 penalty is

the latest fallout from problems

in the hospital’s heart surgery

department.

• State regulators intend to hit

Johns Hopkins All Children’s

Hospital with some of the largest

fines levied against a Florida

hospital in recent memory,.

• The Times found that surgeons

in the hospital’s Heart Institute

made serious mistakes and their

procedures went wrong in

unusual ways. It also found that

the hospital continued to

perform heart surgeries for

years after frontline workers

raised safety concerns to their

supervisions.

New York Times Reports:

• Director of M.I.T.’s Media Lab

Resigns After Taking Money

From Jeffrey Epstein.

• M.I.T. official, Joichi Ito, left

the boards the MacArthur

Foundation, the John S. and

James L. Knight Foundation,

and The New York Times.

• He “stepped down after the

disclosure of his efforts to

conceal his financial

connections to Mr. Epstein,

the disgraced financier who

killed himself in a Manhattan

jail cell last month while facing

federal sex trafficking

charges”. acknowledged last

week that he had received $1.7

million from Mr. Epstein,

including $1.2 million for his

own outside investment funds.


© 2006 HCC, Inc. CD000000-0000XX 14 © 2020 TMIT

In The News …

14


Beth Israel COI & Theft:

• Chinese cancer researcher,

confessed that he had

planned to take the stolen

samples to Sun Yat-sen

Memorial Hospital, and

publish the results under his

own name.

• Customs officers officers

found what they were looking

for: 21 vials of brown liquid —

cancer cells.

• The researcher admitted he

had taken the samples to

publish the work under his

own name.

June 12, 2020

Fifty-four Scientists Have Lost Their Jobs As

A Result Of NIH Probe Into Foreign Ties By Jeffrey Mervis

Some 54 scientists have resigned or been fired as a result of an ongoing

investigation by the National Institutes of Health into the failure of NIH grantees

to disclose financial ties to foreign governments. In 93% of those cases, the

hidden funding came from a Chinese institution. There are 399 scientists

“of possible concern” to NIH, and the FBI has fingered 30% (121) of them.

An additional 44 have been flagged by their own institutions. Of that pool,

investigations into 63%, or 256 scientists, came out “positive.”

Harvard Chemistry Dept:

• Jan 29, 2020 Harvard

University professor arrested

and charged with lying to U.S.

authorities about taking

millions of dollars from the

Chinese government is

considered one of the fathers

of a specialized field in

nanotechnology.

• Charles M. Lieber has led a

research lab at Harvard for

nearly 30 years and generated

in excess of $15 million in

grants from government

agencies since 2008.

Source: https://www.sciencemag.org/news/2020/06/fifty-four-scientists-have-lost-their-jobs-result-nih-probe-foreign-ties

https://www.sciencemag.org/news/2020/02/us-prosecutor-leading-china-probe-explains-effort-led-charges-against-harvard-chemist

https://www.sciencemag.org/news/2020/02/us-prosecutor-leading-china-probe-explains-effort-led-charges-against-harvard-chemist


Meaningful Use is dead. Long live something better! In the News

As Cities Move Toward Reopening,

How to Manage Risks

Consider how vulnerable you and your loved

ones are and weigh these factors Dr. Darria Long and Dr. Davld L. Katz

Source: https://medium.com/@drdarrialonganddrdavidkatz/as-cities-move-toward-reopening-how-to-manage-risks-1834a264f9d1

June 10, 2020

Along with securing the requisite data,

we propose two tactical priorities. The

first is infection risk stratification; the

second is exposure dose

management. Together, these can

inform the policies, programs, and

personal behaviors of Phase Two, even

with the limited data we now have.


Meaningful Use is dead. Long live something better! In the News

Source: https://medium.com/@drdarrialonganddrdavidkatz/as-cities-move-toward-reopening-how-to-manage-risks-1834a264f9d1

As Cities Move Toward Reopening, How to Manage Risks

Infection Risk

Stratification

© 2006 HCC, Inc. CD000000-0000XX Med Tac Bystander Rescue Care CareUniversity

Source: New Yorker Magazine May 13, 2020

Atul Gawande

Survive & Thrive Guide: Keeping Your Family Safe


Meaningful Use is dead. Long live something better! The 4 P’s to Address Emerging Threats

CAREUNIVERSITY ®

EMERGING THREATS

COMMUNITY OF PRACTICE

Global Patient

Safety Forum

SAFETYLEADERS ®


Cardiac Arrest

Meaningful Use is dead. Long live something better! High Impact Care Hazards to Patients, Students, and Employees

Opioid Overdose

Common Accidents

Bullying

A Medical-Tactical Approach undertaken by

clinical and non-clinical people can have

enormous impact on los of life and harm

from very common hazards:

• High Impact Care Hazards are frequent,

severe, preventable, and measurable.

• Lifeline Behaviors undertaken by anyone

can save lives.

Choking & Drowning

Anaphylaxis

Major Trauma

Transportation Accidents

Med Tac

Story Article

Active Shooter

Healthcare Article

AED & Bleeding

Control Gear Article

Rapid Response

Teams Article

Battling Failure to Rescue

Automated External

Defibrillator

& Bleeding Control

Gear Placement

20 © 2020 TMIT

Meaningful Use is dead. Long live something better! In the News: Med Tac Updates

Source: Campus Safety Nov/Dec Issue - https://www.campussafetymagazine.com/public/med-tac-training-bystanders/

Nov/Dec 2018 Issue

21

21


Bystander Rescue Care

for Failure to Rescue

22

22

Coronavirus Care

Community of Practice


CareUniversity Series

23 © 2006 HCC, Inc. CD000000-0000XX Med Tac Bystander Rescue Care CareUniversity

Ann Rhoades

Dr. Charles Denham Chief William Adcox Dr. Gregory Botz

Randy Styner Dr. Chris Fox Tom Renner David Beshk

Dennis Quaid John Nance JD Beth Ullem

John Little

Dr. Casey Clements

Dr. Steve Swensen Perry Bechtle III Fred Haise

Nancy Conrad

Dr. Mary Foley

Heather Foster

Dr. Chopra

Betsy Denham Becky Martins

Debbie Medina

Preston Head III

Charlie Denham III

Dr. McDowell

Tyler Sant Avarie Pettit Bob Chapman

Dr. C Peabody

Coronavirus Care




24 © 2006 HCC, Inc. CD000000-0000XX Med Tac Bystander Rescue Care CareUniversity

Heather Foster RN Dr. Gregory H. Botz William Adcox, MBA

Coronavirus Survive & Thrive Guide

TM


Meaningful Use is dead. Long live something better! Essential Critical Infrastructure Workers


Meaningful Use is dead. Long live something better! Essential Critical Infrastructure Workers

40% of

Work

Force

No Family

Training

Provided


Meaningful Use is dead. Long live something better! Survive & Thrive Guide: Protecting Your Family

Survive & Thrive Guide: Preparing for Care at Home


Meaningful Use is dead. Long live something better! Survive & Thrive Guide: Protecting Your Family

Survive & Thrive Guides


Meaningful Use is dead. Long live something better! Survive & Thrive Guide: Keeping Your Family Safe

Understand

the Basics

The Basics

Form Family Team &

Health Security Plan

Care of Your

Loved Ones

Leadership Practices

• Why Checklists?

• Setting up Care Room

• Protecting Caregivers

• Protecting the Family

• Family Health Security Plan

• The Family CFO

• Engaging Family: Head,

Heart, Hands, & Voice

• Critical Concepts

• Prevention, Preparedness,

Protection, & Performance

Improvement – The 4 P’s

• How the Virus Spreads

Putting Supplies

& Gear to Work

Technologies

• Supplies & Gear

Checklist

• Seniors & At-Risk Care

Checklists to be Safe

• Innovating Solutions

Preparing for Care at Home



Understand

the Basics

The Basics

Form Family Team &


Care of Your

Loved Ones


Putting Supplies

& Gear to Work

Technologies


• Critical Concepts

• Prevention, Preparedness,

Protection, & Performance

Improvement – The 4 P’s

• How the Virus Spreads



Understand

the Basics

The Basics

Care of Your

Loved Ones


Putting Supplies

& Gear to Work

Technologies


• Family Health Security Plan

• The Family CFO

• Engaging Family: Head, Heart,

Hands, & Voice

Form Family Team &




Understand

the Basics

The Basics

Care of Your

Loved Ones


Putting Supplies

& Gear to Work

Technologies


Form Family Team &


• Why Checklists?

• Setting up Care Room

• Protecting Caregivers

• Protecting the Family



Understand

the Basics

The Basics

Care of Your

Loved Ones


Putting Supplies

& Gear to Work

Technologies


Form Family Team &


Putting Supplies

& Gear to Work

• Supplies & Gear Checklist

• Seniors & At-Risk Care Checklists to

be Safe

• Innovating Solutions

Coronavirus Care




Convene

Connect

Celebrate

Create

Change the World

CAUSE

Family Centric

• General Public

• Critical Essential Workers

• Professional Caregivers

• First Responders

• All Faiths Volunteers & Staff

• Educators & School Staff

• Scouts, Teams, and

Membership Organizations


SOURCE: Centers for Disease Control

Social

Distancing

Hand

Washing

Disinfecting

Surfaces

Use of

Masks

CDC Guidelines

Survive & Thrive Guide: Protecting Your Family


Survive & Thrive Guide: Protecting Your Family

Quarantine Isolation

Isolation & Quarantine

Testing, Tracing, and Treatment



Coronavirus Care Community of Practice

Med Tac Bystander Rescue Care: CareUniversity Series

Family Survive & Thrive Guide: The Latest Best Practices

When: Thursday, July 2, 2020

Time:

(check your time zone)

01:00 PM to 2:30 PM Eastern

12:00 PM to 1:30 PM Central

11:00 AM to 12:30 PM Mountain

10:00 AM to 11:30 AM Pacific

Where:

This is an online event.

Register Now!

I can't make it

Dear Charles "Chuck",

We are launching a monthly webinar specifically for families

from the general public and critical infrastructure worker families from 16 industry sectors. They include medical and security

volunteers for faith-based organizations and community

membership organizations such as scouts. In this first webinar

we are addressing the latest science for practicing social

distance, hand hygiene, high contact surfaces, and use of

masks.

You will hear from emergency medicine, critical care, security

leaders, and infectious disease experts from leading medical

centers. We will present video and resources provided on the web that may be used to help care for COVID-19 patients. Our

speakers will be supported by a reactor panel of leading

experts.

This emergency response initiative is part of the Global Med

Tac Bystander Rescue Care program for the public.

SPEAKERS:

Charles R. Denham, MD


Chairman, TMIT Global

Gregory Botz, MD

Professor of Anesthesiology and Critical Care

UT - MD Anderson Cancer Center

Adjunct Clinical Associate Professor,

Stanford Medical School

Heather Foster RN

Hospital Infection Preventionist

You will be invited.

Spread the word

and invite all

Families and

Colleagues.

38 Med Tac Bystander Rescue Care

May 21, 2020 CareUniversity Webinar #139

For resource downloads go to:



for Caregiver & Critical Worker Families

39 © 2019 TMIT

97% May 2020

*Source: TMIT High Performer Webinars, Post-Event Surveys

94%

Ave.

*NPSBenchmarks. 2020 NPS® Benchmarks Survey Report, Part 1. US Data. Available at: https://www.npsbenchmarks.com

70%

60%

50%

96%

75% USAA

Banking

61%

89%

59%

100% 100%

94% 98%

100%

87%

94%

88% 89%

96% 92%

100%

97% 94%

100%

94% 93% 95% 95% 97% 96%

97%

88%

97%

80%

*TMIT average score calculation is based on

NPS scores for June 2018 through May 2020.

Sept Nov Jan Feb Mar Apr May June July Aug Sept Oct Nov Jan Feb Mar May June Aug Apr July Oct Dec Dec

2018 2019

90%

2020

40 © 2019 TMIT

71%

16% 12%

2% 0% 0% 0% 0% 0% 0%

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

Very

Strongly

Agree

10

Strongly

Agree

9

Agree

8

Agree

7

Very

Strongly

Disagree

1

Disagree

3

Strongly

Disagree

2

Neutral

6

Neutral

5

Negative to

Neutral

4

100% Agreed and 86%

Strongly or Very Strongly

Agreed, and 71% Very

Strongly Agreed

Anonymous Survey Questions

Source: TMIT High Performer Webinar Series; Coronavirus Survive & Thrive Guide for Caregiver & Critical Worker Families – May 21, 2020

I would like to attend the

CORONAVIRUS CARE & SAFETY Webinar Series

41 © 2019 TMIT

• Any flexible topic

• Availability of ppe for home and how to get it

• Back to work, safety for families,

• Best immune system prophylaxis to fight it off best

• Caring for second wave, return to schools

• Covid in the future

• Emotional and mental health support for both the affected individual and

caregivers

• Getting the people to understand how bad this virus is

• How do we isolate an individual when there is no space to really isolate

them?

• How do we share this with the communtiy

• How scouts bsa troops can help.

• Intensive care treatment alternative protocols - how to pivot safely with

drug shortages

• Lessons learned, "re-opening" plans and precautions imperative to the

prevention of a "second wave"

• Mental health and resiliency

• Ppe for certain situations, testing of patients for elective procedures

• Preparing for the next wave (individuals and families); caring for family

members who are sick while keeping yourself and other family members

safe

• Preventing transmission

• Safety, prevention and treatment

• School recommendations

• Special populations that have to travel for treatment.

• You have covered most topics i was looking at

• Your content seems great. Best source for the real straight info.

The topics I wish to have covered in the

CORONAVIRUS CARE & SAFETY Webinar Series


42 © 2019 TMIT

65%

6% 3%

12%

6% 3%

0% 3% 3%

0%

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

Very

Strongly

Agree

10

Strongly

Agree

9

Agree

8

Agree

7

Very

Strongly

Disagree

1

Disagree

3

Strongly

Disagree

2

Neutral

6

Neutral

5

Negative to

Neutral

4

85% Agreed and 71%



Strongly Agreed



I would like to invite individuals or groups to

CORONAVIRUS CARE and SAFETY Series

43 © 2019 TMIT

76%

12% 8%

4% 0% 0% 0% 0% 0% 0%

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

Very

Strongly

Agree

10

Strongly

Agree

9

Agree

8

Agree

7

Very

Strongly

Disagree

1

Disagree

3

Strongly

Disagree

2

Neutral

6

Neutral

5

Negative to

Neutral

4

100% Agreed and 88%



Strongly Agreed



I believe there is value in

Locally Led Coronavirus Safety Programs


For resource downloads go to: www.MedTacGlobal.org

Marian E. Von-Maszewski, MD Emergency Readiness Officer

Assistant Professor, Department of Critical Care

Division of Anesthesiology and Critical Care

The University of Texas MD Anderson Cancer Center

Houston, TX


June 18, 2020

Pandemic Preparedness: Surfing the Next Wave Maintaining Safe Patient Care during the Endemic Phase of COVID-19

MD Anderson

Marian Von-Maszewski, MD

Emergency Readiness Officer

Office of the Chief Operating Officer

Associate Professor

Department of Critical Care

[email protected]

No financial disclosures

46

47 Overview

• Preparations for the first wave

• Lessons learned

• Preparations for the “next wave”

• What to prioritize / how to prioritize readiness efforts

48 Preparations for the first wave – Situational Awareness

https://coronavirus.jhu.edu/map.html

https://coronavirus.jhu.edu/map.html

49 Preparations for the First Wave

• Pandemic Plan

50 Preparations for the First Wave - Supplies

• Pandemic Inventory



PPE



PPE PAPRs



PPE

Respiratory Supplies

PAPRs



PPE

Respiratory Supplies

Hand Sanitizer Pharmacy Laboratory Supplies

PAPRs

55 Preparations for the First Wave - Facilities

• Airborne Infectious Isolation Rooms

• Hospital survey

• Identification of spaces beyond surge capacity

• Conversion of patient care spaces

• Ventilators

• Standard ICU ventilators

• Anesthesia machines

• Other machines

56 Preparations for the First Wave - Staffing

• COVID Care teams

• PPE training

• Basic protocols

• Emergency response

57 Preparations for the First Wave – Patient Care

• Screening based on CDC guidelines and State Department travel advisories initiated in late 1/2020

• Screening questions on arrival

• Algorithms for risk stratification management

• Signage regarding travel and symptoms

• Business travel restricted for employees

58 Preparations for the First Wave - Leadership

• Security – UTP-H

• PPE, transport routes, limiting entry points

• Incident Command system

• Activated in late January for two weeks

• Transitioned to hospital leadership

• Texas Medical Center Collaborative

• SouthEast Texas Regional Advisory Council

59 Lessons Learned – National

• Specific metropolitan areas were overwhelmed quickly

• Nursing homes were at high risk of rapid spread

• Supply shortages became moving targets

• Rush to publish

• Fear of medical facilities

• Medical workforce decreased due to school closures

• Information flows through social media

60 Lessons Learned – Regional / Local

• Standardized bed reporting developed

• Limited testing and long turn-around time led to decreased engagement

• Capacity Capability

• Other supplies limited, but not absent

• Changing PPE guidelines led to safety concerns among medical teams

• Decreased healthcare activity and revenue led to staff furloughs, decreased pay and lay-offs

61 Lessons Learned – Institutional Patient Care

• Outpatients encouraged to include family caregivers in visits via electronic communication

• Inpatient rounding / communication processes changed to engage patient families & caregivers via electronic interactions

• Inpatients provided with means to maintain contact and educated in use of electronic devices

• COVID-diagnosed patients discharged with instructions for continued infection control practices – hand hygiene, use of masks, social distancing

• Dedicated ambulatory units established for continued care of patients with COVID diagnosis to avoid harm from delayed or cancelled appointments and procedures

62 Lessons Learned – Institutional Staff

• Changing PPE guidelines led to concern and required face-to-face reassurance by leadership and Infection Control practitioners

• Care teams with potential exposure needed closer engagement with Employee Health

• Addressing providers’ families concerns for exposure

• Communications

• Institution intranet site with resources, policies and algorithms due to evolving guidelines

• Daily Coronavirus Briefing for ~600 institution leaders with updates on statistics, supplies, hospital status

• Administrative workforce moved to “work from home” to decrease footprint in the hospital thereby limiting potential exposure of patients

63 Lessons Learned – Institutional Practices

• Daily Safety Briefing led by Patient Safety Officer includes review of COVID-related events

• Email account for COVID-related questions and concerns

• Core Leadership Team formed for daily evaluation of institution operations

• Guided reduction of operations and subsequent re-opening, screening guidelines, testing strategies

• Social gatherings in work areas halted

• Supply chain needed clinical input – contacted by multiple “vendors”

• Adoption of Protected Code Blue response based on AHA Interim Guidelines

• Avoid delays in response by using consistent practices for all

64 Preparations for the Next Wave

• Encourage patients to continue mask use and social distancing

• Continue decreased footprint of administrative staff

• Maintain entry screening and hygiene practices

• Establish social distancing parameters in staff areas, waiting rooms and public areas

• Pandemic supply usage monitored and modeled to predict needs

• Initiation of PPE security practices

• ICU capacity models changed to reflect staffing capabilities

• Facilities Resilience to close down or divert operations as needed

• Scientific review of patient management to optimize therapy

65 Prioritization of Readiness Efforts

• Maintain bi-directional regional reporting efforts

• Collaboration of hospital systems to optimize bed capacity

• Maintain / increase pandemic supply processes

• Develop consistent treatment algorithms

• Continue staff monitoring

• Develop tiered staffing models for ICU surge


• Maintain readiness plans

• Natural disasters

• Social unrest

• Information Technology failures

• Financial uncertainty


• Continue patient & family education

• Ongoing staff training

• Maintain pandemic stance

• Translate scientific data into best practice

• Attention to supply chain

• Sustain data-driven safety & quality initiatives

• Focus on caregiver well-being

• Assess resiliency regularly

68 Conclusions

• Endemic phase operations

• Visitation

• Staffing challenges

• Evolving guidelines

• Routine medical care

• Medical education & training

• Have vigilance, not vertigo

• Utilize proven patient safety approach



Response

Rescue

Recovery

Resilience

Readiness

Activate

Mobilize

Care Monitor

Family Health Safety Plan

© HCC Global

70 © 2020 TMIT

National Survey Questions

My family is ready to take care of a loved

one with Coronavirus in our home

Very

Strongly

Agree

10

Strongly

Agree

9

Agree

8

Agree

7

Very

Strongly

Disagree

1

Disagree

3

Strongly

Disagree

2

Neutral

6

Neutral

5

Negative

to Neutral

4

What READINESS information

would you like to have?

70

71 © 2020 TMIT


My family knows what actions to take if a loved

one becomes infected with Coronavirus.

Very

Strongly

Agree

10

Strongly

Agree

9

Agree

8

Agree

7

Very

Strongly

Disagree

1

Disagree

3

Strongly

Disagree

2

Neutral

6

Neutral

5

Negative

to Neutral

4

What information would help you RESPOND

when a loved one becomes infected?

71

72 © 2020 TMIT


My family knows what do when someone

develops severe COVID-19 symptoms.

Very

Strongly

Agree

10

Strongly

Agree

9

Agree

8

Agree

7

Very

Strongly

Disagree

1

Disagree

3

Strongly

Disagree

2

Neutral

6

Neutral

5

Negative

to Neutral

4

What information would help your family

react if someone develops severe symptoms (Rescue)?

72

73 © 2020 TMIT


My family has a safety plan to return to work and play

when the Coronavirus social restrictions are relaxed

Very

Strongly

Agree

10

Strongly

Agree

9

Agree

8

Agree

7

Very

Strongly

Disagree

1

Disagree

3

Strongly

Disagree

2

Neutral

6

Neutral

5

Negative

to Neutral

4

What information would help your

family return to the new normal (Recovery)?

73

74 © 2020 TMIT


My family has a plan to make them less

vulnerable to epidemics in the future

Very

Strongly

Agree

10

Strongly

Agree

9

Agree

8

Agree

7

Very

Strongly

Disagree

1

Disagree

3

Strongly

Disagree

2

Neutral

6

Neutral

5

Negative

to Neutral

4

What information would help you

become more resilient in the future?

74


Speakers

& Reactors

Dr. Charles Denham

Marian E. Von-Maszewski Dr. Gregory Botz

Jennifer Dingman

Heather Foster RN

Chief William Adcox


Jennifer Dingman Founder, Persons United Limiting

Substandards and Errors in Healthcare

(PULSE), Colorado Division

Co-founder, PULSE American Division

TMIT Patient Advocate Team Member

Pueblo, CO

Voice of the Patient


RESOURCES


Meaningful Use is dead. Long live something better!

Flattening the Curve: Avoid the Surge

www.GlobalPatientSafetyForum.org Emerging Threats Community of Practice

http://www.globalpatientsafetyforum.org/

Readiness for Epidemics including preparedness for testing and

volume surges


Meaningful Use is dead. Long live something better! Threat Safety Science: The Context of Emerging Threats

81

Emerging Threats

•Threat Velocity: The speed of new threats challenging us are appearing much faster

than ever before.

•Threat Spectrum: The range of different threats challenging us are increasing as well.

• Invisible and Visible Threats: Many of the threats are invisible to us until they are

upon us. The Coronavirus COVID-19 is an example of a threat that is invisible. Many

who are infected with the virus are asymptomatic AND contagious.


Meaningful Use is dead. Long live something better! The Security Leader’s Perspective

Major Medical Centers – What you might expect to encounter:

1. Limited access points

2. Exterior access screening for everyone

3. Lines and delays

4. Limiting patient visitors and access to only patients and person

involved in direct patient care of the support of direct patient care.

5. No visitors under 18 years of age

6. Reducing and cancelling of elective surgery

7. Off-site screening and testing for COVID19

8. Public areas limited with social distancing recommended

9. Limited food services within the hospitals for visitors

10. Limited or eliminated valet services

11. Crowding and delays



Hospital Challenges for Security

1. PPE, Sanitizing and cleaning supplies are now in greater demand

and harder to obtain. The value of these has gone up and now

must be protected in ways not previous done.

2. Reduced access point while controlling access into the hospitals

3. Limiting visitors

4. Utilization of PPE

5. Patient surges

6. Reduced staffing

7. Fear

8. Added responsibilities



Police and Security – Changes occurring:

1. Non-violent crimes and misdemeanors not being accepted by jails and Juvenile centers

2. Diversion programs for habitual trespassers, alcohol intoxication, etc. closing

3. Some reporting of problems with Emergency Commitments due to illness

4. Setting up alternatives to first responders' homes for quarantine

5. Establish “drive up” testing and prioritized first responders and health care workers

6. Enhanced Sanitizing of police buildings, prisoner holding areas and vehicles

7. Staffs supplied with additional disinfecting wipes and hand sanitizer

8. PE deployments and testing (Nationwide shortages) 9. Communication Centers asking screening questions of

callers to better inform responding personnel and establish social distancing.

10. Limiting police responses to non-life threatening or crimes in progress calls

11. Taking more Reports over the phone instead of a police officer response.

12. Performing “Doorway Triage” at the scene of all 911 calls and asking complaints to come outside on calls.

13. Modified and reduced staffing plans 14. Civilian employees working from home where

possible 15. Repurposing of police officers assigned to special

assignments 16. Require social distancing inside police facilities to

include modified roll calls 17. Recommending officers sanitize their duty belts

and equipment, changing out uniforms at work or immediately upon reaching home to avoid contact with family



What we all can do:

1. Understand the virus and obtain information from credible sources only

2. Educate our children. Answer their questions. Understand their fear.

Establish new routines and expectations

3. Explain basic hygiene practices to our families and everyone’s responsibility

to practice good hygiene and help more frequently clean the most touched

surfaces

4. Support each other, their families and your community

5. Don’t try to over stock thus emptying out grocery stores

pandemic preparedness: surfing the next wave · 2020. 6. 18. · •gregory h. botz, md, fccm, is a...

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