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Are you seeing actual H1N1 cases or 'worried-well'? Be ready for both
Off-site screening could be a possible solution
In addition to all of the sick and injured patients you normally see, you are probably caring for a significant number of people in your ED with no complaint other than anxiety over H1N1.
"Our ED was getting hammered with panicked patients even before we had any confirmed cases reported in Connecticut," says Nancy Bennett, RN, MSN, ED educator at The Hospital of Central Connecticut in New Britain. Bennett says of 299 patients seen on the ED on a single day recently, 70 of them had flulike symptoms.
At Abington (PA) Memorial Hospital's ED, "Many people have entered our facility requesting that they be tested. Some have no symptoms at all and are not inclusive of the criteria for testing," says Karen Sylvester, RN, CEN, clinical coordinator for the emergency trauma center.
Bennett says "any potential pandemic is of great concern to us, but we can't overflow the ED with everyone who has a cough and sore throat running to the ED to be cultured. The rest of the public needs attention, too."
Bennett worked with her ED's medical chief and the hospital's director of plant operations and maintenance to set up an off-site flu clinic just for screening of H1N1. The plan is that the clinic will temporarily occupy a nearby vacant medical facility, which will be staffed with physicians or midlevel practitioners and nursing and clerical staff.
"We're working fast and furiously to unburden the ED with the off-site clinic," she reports. "In addition, the hospital's public affairs department is working to start a campaign to the public with the message, "If you have these symptoms and think you night have the flu, don't go to the emergency room first. Go to the flu clinic."
The goal, says Bennett, is to be "prepared as best we can for the worst-case scenario with opening the temporary flu clinic. That hopefully will take pressure off of the ED. Emergency departments can't be any more overburdened then we already are."
Protect your patients
At Providence Hospital in Southfield, MI, "our triage nurses are on high alert for any patient presenting with fever, cough, sore throat, body aches, headaches, chills, and fatigue," says Rosemary M. Lowry, MSN, APRN-BC, ED manager/nurse practitioner. "Any patient that presents with a cough and fever will be immediately given a surgical mask."
Any patient suspected of having H1N1 is placed in an appropriate treatment area, with standard precautions and strict hand washing with soap and water for 15-20 seconds required. "Using alcohol-based hand sanitizer is also acceptable," she says. "These actions are instrumental in the prevention and the spread of disease."
At Barnes-Jewish Hospital in St. Louis, ED nurses place surgical or isolation masks on any suspected patients. "Nursing staff should be donning N95 masks, goggles, gown, and gloves prior to room entry," says Keith Outlaw, RN, assistant clinical manager of emergency services.
If a patient fits the criteria for H1N1 at The Hospital of Central Connecticut's ED, he or she is given a face mask to wear until they are cultured and cleared by an ED physician. "Constant hand washing between patients or the use of [hand sanitizer] is a must," says Bennett. "Our triage nurses are also trying to minimize any panic and educate the public as to modes of transmission and prevention."
Lynn Ring, RN, ED clinical manager at Spectrum Health Butterworth Hospital in Grand Rapids, MI, says if H1N1 is suspected, ED nurses immediately place a mask on the patient, bring the patient back to a negative pressure room, and place him or her in an "airborne plus contact isolation." However, Ring acknowledges that the volume of suspected cases might far exceed the number of negative pressure rooms in many EDs. "In this case, place the patient in a private room and leave their mask in place, continuing the additional airborne-plus-contact isolation precautions," says Ring. These actions are consistent with recommendations from the Centers for Disease Control and Prevention, she says. (See checklist for screening and confirmatory testing of H1N1.)
How ED nurses are getting the word out about H1N1
Updates are coming fast and furiously
When the first cases of H1N1 hit, Nancy Bennett, RN, MSN, ED educator at The Hospital of Central Connecticut in New Britain, e-mailed nurses and put notices in the triage area on exactly what to look for and what questions to ask. Weeks later, though, ED nurses still require continual updates from the state health department and the Centers for Disease Control and Prevention (CDC), provided to them by the chief and nursing director of the ED.
Karen Sylvester, RN, CEN, clinical coordinator for the Emergency Trauma Center at Abington (PA) Memorial Hospital's ED, says she is "hypercommunicating" information to ED staff on a daily basis. She is using several ways to convey the latest developments. "Daily postings are placed on our web page, newsletters are distributed, blast e-mails are sent, and verbal exchanges are all utilized to keep our staff informed," she says.
Keith Outlaw, RN, assistant clinical manager of emergency services at Barnes-Jewish Hospital in St. Louis, says ED nursing staff are being given daily updates from himself, ED physicians, the ED's clinical nurse specialist and the hospital's environmental health and safety and infectious disease departments. "We are emphasizing to all of our staff the importance of using universal precautions and hand washing," says Outlaw. "Our ED is very concerned, but well prepared to deal with any H1N1 patients."
Rosemary M. Lowry, MSN, APRN-BC, ED manager/nurse practitioner at Providence Hospital in Southfield, MI, briefs ED nurses with information from the CDC, the Michigan Department of Community Health, and Oakland County Medical Control Authority.
Imelda Prado, ED clinical care coordinator at Swedish Covenant Hospital in Chicago, says ED nurses were given a memorandum regarding H1N1 from the state department of health on tests and treatment for suspected cases. "We were also given an inservice from the director of the laboratory on how to collect the culture/swab for swine flu virus," she says. "For confirmed or highly suspected cases of swine flu virus, antiviral medications/chemoprophylaxis are prescribed, either oseltamivir or zanamavir." [Steps taken by ED nurses for H1N1 screening and confirmatory testing are included.]