Covid-19 Update Practical tips for a DMEPOS day to day operations - - PowerPoint PPT Presentation

Covid-19 Update

Practical tips for a DMEPOS day to day operations………

Sandra Canally RN Founder & CEO April 2020

The Compliance Team Process in all we do!

Simplification leads to clarity and clarity allows the provider to focus on what matters most……to your patients & families Safety, Honesty, Caring !

The Compliance Team Wishes you Happy Holidays during this crisis

What Matters Most to you!

➢ Your Employees ➢ Your Patients/customers ➢ Your community

3 Important traits influencing daily practices as a Leader that have carried over throughout my healthcare career to use in time of need ➢ Organization ➢ Observation ➢ Anticipation

Organization

Assess your Risk ➢Type of Provider –DME, Pharmacy ➢Type of services –Bracing, Respiratory, Complex rehab, supplies ➢In what environment – Retail, Mail order, Home Delivery

Every type of provider is at risk and must do what is necessary to prevent the spread of infection!

Organization – Training What is COVID-19?

➢ A large family of viruses ➢ This version from China suggests a likely single, recent emergence of this virus from an animal reservoir. ➢ From there it spread people to people which we call community spread. ➢ Mild for the most part but severe in 16% of the cases, mostly

• lder people or those with other conditions or immune

suppressed. ➢ Declared a Pandemic on March 11, 2020 ➢ Meaning an outbreak of a disease that occurs over a wide geographic area and affects an exceptionally high proportion

• f the population

Symptoms

Develop 2-14 days after exposure

• Fever 83.9% of patients
• Cough 76.82 % of patients
• Shortness of Breath 11.44% of patients

The scientists found that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detectable in the following: ➢ In aerosols for up to three hours, ➢ Up to four hours on copper, ➢ Up to 24 hours on cardboard ➢ Up to two to three days on plastic and stainless steel.

People may acquire the virus through the air and after touching contaminated objects. https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours- surfaces

New coronavirus stable for hours on surfaces

How to Deal with this Pandemic????

Don’t Panic or overbuy!!

Power of Social Distancing

How to Deal with this Pandemic?

The 4 Ps

✓ Protect yourself ✓ Protect your staff ✓ Protect your patients ✓ Prevent spread First: prepare and be ready Second: detect, protect and treat Third: reduce transmission Fourth: innovate and learn

➢ Review your infection control/prevention policies ➢ Review and update your emergency preparedness policies ➢ Perform Training of all staff on all of the above

DME/Pharmacy

Quality improvement plans serve vital roles at times like these. If you don’t know where you are today operationally, your chances of acting fast and thoughtfully in time of a crisis are compromised. During normal business cycles, your QI plan will help you identify areas in need of improvement, and then fix them. Every DMEPOS provider needs to have a written Quality Improvement Plan which is developed and implemented by key personnel of the organization representing management, the warehouse and service delivery. The plan should include the following:

• Plan for new products/services if appropriate.
• Goals for improving patient outcomes (e.g. patient satisfaction and equipment

failure as appropriate)

• Operational areas identified in need of improvement.
• Monitoring of human resources including staff development & training
• Patient satisfaction and dissatisfaction

Quality Improvement -DME/Pharmacy

➢ Determine Staffing levels necessary to operate and who has higher levels of risk ➢ Perform Training of all staff ➢ Any non-essential employees should work from home when possible

• If staff need to work in setting other than home, then

social distancing should be applied.

DME/Pharmacy

Recommendations for an Infectious Disease Outbreak Response Plan:

➢ Identify possible work-related exposure and health risks to your employees. OSHA has more information on how to protect workers from potential exposures external icon to COVID-19. ➢ Review human resources policies to make sure that policies and practices are consistent with public health recommendations and are consistent with existing state and federal workplace laws (for more information on employer responsibilities, ➢ Identify essential business functions, essential jobs or roles, and critical elements within your supply chains (e.g., raw materials, suppliers, subcontractor services/products, and logistics) required to maintain business operations. ➢ Plan for how your business will operate if there is increasing absenteeism or these supply chains are interrupted.

➢ Altering business operations (e.g., possibly changing or closing

• perations in affected areas), and transferring business knowledge to

key employees. ➢ Work closely with your local health officials ➢ Plan to minimize exposure between employees and also between employees and the public, if public health officials call for social distancing. ➢ Establish a process to communicate information to employees and business partners on your infectious disease outbreak response plans and latest COVID-19 information. Recommendations for an Infectious Disease Outbreak Response Plan:

Put the plan into action!

““A bend in the road is not the end of the road … Unless you fail to make the turn.” ― Helen Keller”

Providers with walk in Patient Access

If you are experiencing any of these symptoms: Cough Fever Shortness of breath Please go back to your car and call us. Enter Phone Number We will come OUTSIDE to you. Please place on your door!!

DME, Pharmacy

Staff should be screening calls

➢Do they have symptoms ➢Have they been exposed ➢Is their visit to your operation a MUST! ➢If not, they should not come in person

Hand Hygiene for All

• Staff should perform hand hygiene using ABHS before and after all

patient contact, contact with potentially infectious material.

• Hand Sanitizers must be at least 60% alcohol.
• Staff should preform hand hygiene before putting on and upon

removal of PPE, including gloves.

• Hand hygiene can also be performed by washing with soap and

water for at least 20 seconds. If hands are visibly soiled, use soap and water before returning to ABHS.(sing the alphabet)

• All providers should ensure that hand hygiene supplies are readily

available in every care location.

➢ Do Not let them in your retail operation ➢ Instruct them to go home and call their primary care provider

Patient with symptoms

➢ Eye Protection ➢ Isolation Gowns ➢ Facemasks ➢ N95 Respirators hcp/ppe-strategy/index.html

Strategies for Optimizing the Supply of PPE

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html

Clean and Disinfect

• Alcohol solutions
• Ensure solution has at least 70% alcohol.
• Other common EPA-registered household disinfectants.
• Products with EPA-approved emerging viral pathogens pdf icon [7

pages]external icon claims are expected to be effective against COVID-19 based on data for harder to kill viruses. https://www.epa.gov/pesticide-registration/list-n-disinfectants- use-against-sars-cov-2

• Follow the manufacturer’s instructions for all cleaning and

disinfection products (e.g., concentration, application method and contact time, etc.).

MASKS

➢ CDC states mode of transmission is droplet so technically any coverage

• f the nose and mouth protects you.

➢ Home made masks can provide SOME protection, better than nothing. ➢ They do not protect the eyes but by strictly maintaining the 6 ft social distancing you would technically safe from any droplets ➢ Yesteryear masks like this were used

Important sources for PPE

https://www.ahrmm.org/ahrmm-covid-19 advancing healthcare thru supply chain excellence https://www.cov.care/surgical-masks https://www.hnmmedical.com/medical-supplies/

DMEPOS Provider

Assess your risk ➢ Products/services offered ➢ Retail, Mail order, Homecare

DMEPOS Low risk ➢ No direct patient contact ➢ Products are shipped ➢ Do tele-instructing ➢ e.g.via facetime, check with manufacturer for video/web instructions

Questions to address that would then increase

Your risk

Patients return used equipment ➢ You then must have cleaning & disinfectants and segregate dirty ➢ Also need personal protective equipment

Wash-Glove-Wash

DMEPOS High Risk

Homecare ➢ Perform screening prior to delivery ➢ Use good hand hygiene ➢ Use PPE (Gloves) if touching equipment ➢ Use mask if entering patient’s home and coming close to patient’s air space ➢ Bag and tag equipment for delivery as well as pick up ➢ Ensure you use disinfectant ➢ Utilize telehealth measures in place of delivery if appropriate ➢ To keep number of deliveries down evaluate your ability to Give additional supplies, portables etc. Do more follow-up calls to stay in touch with patients

Equipment Management

Homecare ➢ Bag and tag equipment for delivery as well as pick up ➢ Ensure you use disinfectant registered by the EPA ➢ Follow manufacturer guidelines including but not limited to: ➢ cleaning, storing, handling, preventive maintenance and repairs as well as proper use and set up of equipment and tracking of the

• equipment. This ensures that every piece of equipment that is

delivered is in good working order prior to delivery. ➢ To keep number of deliveries down evaluate your ability to Give additional supplies, portables etc. Do more follow-up calls to stay in touch with patients

Discharge from Hospital

Homecare- Post acute ➢ CMS has stated that communication in the circle of care needs to be shared if patient had covid-19 ➢ Have conversation with discharge planner prior to taking the order ➢ For verification if additional measures are needed Do more follow-up calls to stay in touch with patients

DMEPOS High Risk

Use of PPE

Donning of PPE……Taking off the gear

Training and practice using your healthcare facility’s procedure is critical. 1. Remove gloves. Ensure glove removal does not cause additional contamination of hands. 2. Gloves can be removed using more than one technique (e.g., glove-in- glove or bird beak).

• 3. Remove gown. Untie all ties (or unsnap all buttons). Some gown ties can be broken

rather than untied. Do so in gentle manner, avoiding a forceful movement. Reach up to the shoulders and carefully pull gown down and away from the body. Rolling the gown down is an acceptable

• approach. Dispose in trash receptacle.*
• 4. HCP may now exit patient room.
• 5. Perform hand hygiene.
• 6. Remove face shield or goggles. Carefully remove face shield or goggles by grabbing the strap

and pulling upwards and away from head. Do not touch the front of face shield or goggles.

• 7. Remove and discard respirator (or facemask if used instead of respirator).* Do not touch the

front of the respirator or facemask. » Respirator: Remove the bottom strap by touching only the strap and bring it carefully over the head. Grasp the top strap and bring it carefully over the head, and then pull the respirator away from the face without touching the front of the

• respirator. » Facemask: Carefully untie (or unhook from the ears) and pull away from face

without touching the front.

• 8. Perform hand hygiene after removing the respirator/facemask and before putting it on again

if your workplace is practicing reuse

Community Pharmacy with DME

➢ Use Stop for safety on front door, ➢ Use good hand hygiene ➢ Ensure you use disinfectant in pharmacy ➢ Utilize telehealth measures in place of delivery if appropriate ➢ To keep number of deliveries down evaluate your ability to

• Give additional supplies
• Perform screening prior to delivery
• Assess inventory for potential supply shortages

Anticipation What’s Next?

• Stay Prepared
• Stay vigilant
• Take control where you can
• Above all else, use commonsense!

Adapt, Improvise and Overcome!

Questions from our providers

As a DME we are required to post our hours on the door. Can we list that we currently are closed now due to the pandemic and be exempt from the 30 hours per week standard as placed by CMS?

You should post your business hours of operation Post name and contact number

Questions from our providers

If our state requires a complete shutdown what do we do regarding our patients? (DME Mail Order Company) You are essential personnel are shipping medical supplies Take proper precautions at your place of business Stagger employees hours Maintain social distancing Use good infection control practices Wipe all surfaces down

Questions from our providers

Who Needs PPE: Patients with confirmed or possible SARS-CoV-2 infection should wear a facemask when being evaluated medically. Healthcare personnel should adhere to Standard and Transmission-Based Precautions when caring for patients with SARS-CoV-2 infection. Recommended PPE is described in the Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings. Who Does Not Need PPE: CDC does NOT currently recommend the general public use face masks. Instead, CDC recommends following everyday preventive actions, such as washing your hands, covering your cough, and staying home when you are

Questions from our providers

Is there any way we can get more information from our local governments

• n the local situations. We are a DME suppling nursing homes and in home

patients? We also have very little in the way of personal disinfection supplies, gloves etc. https://www.nga.org/coronavirus/#glance (Governors assoc) https://www.naccho.org/membership/lhd-directory Local Health departments

More Resources

Public Health Legal Preparedness: Select Authorities Isolation, Quarantine, and other Social Distancing Powers Primary authority for isolation and quarantine lies with the states as an extension of their police powers. Isolation and quarantine are sometimes used interchangeably but have distinct functions in protecting the public from contagious diseases: Isolation separates sick people with a contagious disease from people who are not sick. Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick. A table of state statutes for isolation and quarantine authorities is available here. https://www.ncsl.org/research/health/state-quarantine-and-isolation-statutes.aspx

Websites for Resources

Remember every red light eventually turns green

Here’s wishing you all good health and all green lights ahead!

The Compliance Team, Inc Exemplary ProviderTM Accreditation Program

Founded by Sandra Canally RN, 1994 ➢ The first Exemplary Provider™ accreditation programs were launched in 1998, prior to the Medicare Modernization Act 2003 ➢ The only for-profit accreditation organization to be Approved and granted “deeming authority” ( for DMEPOS) from the Centers for Medicare and Medicaid Services in 2006 and Rural Health Clinics July 2014 ➢ The Only Certified woman-owned business enterprise as an Accreditation Organization

Thank you, Sandra Canally RN Founder & CEO The Compliance Team, Inc. scanally@thecomplianceteam.org www.thecomplianceteam.org 215-654-9110

We will continue to bring you all weekly webinars on this ever-evolving topic Please submit your questions to: notifications@thecomplianceteam.org