*(subject to change with new developments)

PRE-VISIT SCREENING

Effective immediately, STAFF must conduct a screening call before care is given by Valeo to our patients for that day.

 The following screening questions must be asked prior to providing care:

• 1– Exposure: In the past 14 days, have you or anyone in your home/facility had close contact with anyone diagnosed with or suspected to have COVID-19? {yes/no} Have you or anyone in your home/facility been to a large gathering where masks were not in use or social distancing was not possible?{yes/no}
• 2 – Symptoms: Do you or anyone in your home/facility have any signs or symptoms associated with Covid 19 including: raspy/itchy/sore throat, cough, fever, or shortness of breath? Fatigue? Muscle or body aches? Headaches? New loss of smell or taste? Congestion/Runny Nose? Nausea/Vomiting, Diarrhea? {yes/no}

Educate your patients on the following 3 visit protocols they must follow:

• 1 – Physical Distancing: Inform patients that anyone else living in the home must leave the room while you are there for your visit. If patients require translation OR need a caregiver in the room, ask that they stand at least 6 feet away from you and wear a mask or some type of cloth covering over their nose and mouth. If needing to teach caregivers, try to do so over the phone or via telehealth after your visit, or maintain distance of 6 feet while doing so.
• 2 – Covering Face: INFORM your patient of the NEED to cover their mouth with a mask (Valeo will provide either a surgical type or cloth mask) during your entire visit, WHETHER or not they have any Coronavirus symptoms.
• 3 – Daily Temperature Checks/Symptom Assessment: Educate your patients and their caregivers to check their temperature on a daily basis. Educate your patients and their caregivers in the signs and symptoms associated with Covid 19 (Coronavirus or Something Else Symptom Assessment Guide).

Once these questions have been answered, include the response in your visit note to document that you conducted the pre-visit screening. If the responses indicated a potential risk or exposure, immediately notify the management team and hold off on your visit until further orders are received by the patient’s doctor.

Please screen your patients on the morning of your visit, prior to driving out to see them. Please put in Qliq, if you are the first staff member out to see the patient for the day, that pre-screening was completed. DON’T forget to also ask the screening questions about anyone else who is living in the home with them or has visited them in the last couple of days. This is another vital, but forgotten, part of the screening process.

Also, if they don’t answer your pre-visit call and you decide to drive to your patient’s home to see if you can do your visit, please ask them the screening questions at the door before entering the home.

Although we may not be able to know for sure if the patient we are visiting has contracted the virus or not, the least we can do is find out if they are exhibiting any signs and symptoms.

 For all patient visits, please ask your patients and their caregivers/family members to use their own hand soap, alcohol hand sanitizer, masks, PPE, etc. for themselves and save your limited supply for your own use. If a patient (and/or a family member/CG) has been tested for Covid-19 or has tested positive, you MUST inform the admin team. Valeo Home Health and Hospice Covid+ Patient Protocol will be initiated.

HAND HYGIENE

The number one way to combat the spread of this virus is through proper hand hygiene. Hand washing with soap and hot water is the best measure to prevent spread of COVID-19.

All clinicians and their patients must wash their hands using soap and hot water for 20 seconds at the start of every visit. Clinicians must also perform hand hygiene at the end of every visit .

When washing your hands, please thoroughly scrub the palms, the top, each individual finger including between fingers, under the nails and around the cuticles.

If there is no soap and running water, or if it is difficult for you or your patient to get to a sink/basin to wash hands, you and your patient may use alcohol hand sanitizer of at least 60% ethyl alcohol or 70% isopropyl alcohol and rub all surfaces of your hands for 20 seconds. You will need to follow the same exact process of scrubbing your palms, the tops of your hands, each individual finger including between fingers, under the nails and around the cuticles when using hand sanitizer.

Use a barrier such as tissues, paper towel or gloves to touch door handles and faucet handles in patient’s homes and don’t touch any surfaces with your bare hands.

PERSONAL PROTECTIVE EQUIPMENT

Effective immediately, we are asking that all clinicians wear at minimum an N95 mask and face shield in high risk situations or where mandated by UDOH (defined as care provided in an ALF, SNF, communal type living situation or where family members/CGs are exhibiting high risk activities that may make them at increased risk of contracting Covid 19). In “low” risk situations, a cloth mask with filter may be substituted. In addition to a mask, gloves, and goggles are to be worn for every single home visit.

 You may reuse your mask from visit to visit by observing the following protocol:

1. Wash/sanitize hands thoroughly as described above before removing your mask or at anytime you touch your mask.
2. After your visit once outside the home, remove your N95 mask/cloth mask, being careful to not touch your eyes, nose or mouth or the INSIDE of the N95 mask/cloth mask. Place your N95 mask/cloth mask in a breathable bag.
3. We are requesting that you bring your used N95 mask(s) into either the SLC Office location or the Orem Drop site location in a breathable baggie with your name on it, so that we may clean it with UV light and return it to you. While your mask is being cleaned, we will provide you with another mask for use so that you have the ability to rotate N95 masks. Cloth masks should be washed

We are locking up PPE in our offices. If you have a need for additional equipment, please let Wendy/Deanne/Rachel know so that we can make it available for you to pick up.

PATIENT SIGNATURES

For the time being, we are suspending signed visit verify. INSTEAD, please pull up the red house in the driveway of the patient’s home to get the gps location and tap, patient unable to sign. The GPS address stamp will serve as your locator.

EQUIPMENT/SUPPLY/NURSING BAG USE

For routine visits: ask your patient if they have a thermometer, BP machine and/or pulse-ox machine you can use for them so you don’t have to use yours. By using their BP cuffs, oximeters, and thermometers, the chances of cross contamination are reduced. In an effort to reduce cross contamination, if a patient is seen by multiple disciplines in a day and are not exhibiting any S&S related to vital sign issues or demonstrates need for VS check due to health issues such as orthostatic hypotension, HTN not controlled, Valeo Home Health and Hospice will implement a once a day vital sign check. Vital signs are to be reported on the patient’s Qliq thread by the first staff member seeing that patient for the day so that other clinicians may record VS based upon these measures.

• USE a barrier in each and every home, throw the barrier away after each use. Make sure that your barrier is large enough to place your bag on, as well as ALL equipment/supplies you may need for your visit. Get supplies out 1 time and zip bag back up until needing to place them back inside when visit is completed. MAKE sure that you clean all needed/used equipment (BP cuff, thermometer, oximeter, etc) BEFORE and AFTER each use/patient contact with an antibacterial cleaning solution and paper towel or with antibacterial wipes. Spray/wipe YOUR bag down with Lysol/Disinfectant  or alcohol spray upon leaving the home, prior to placing on a barrier or in a container in the trunk of your car.
• Supplies in a Disposable Bag: Carry wound care and foley catheter supplies into the patient’s home in a Ziploc or disposable trash bag that you can leave in their home.

In ALL homes, take in ONLY the necessary items needed for your visit. In potential or suspected homes, use double bag technique. Place all necessary/needed items in Ziploc bags inside of a disposable trash bag. Open the trash bag up and use it as a barrier for your other items in the Ziploc bags. Once you have completed your visit, place your patient care items in their Ziploc bag, wipe the Ziploc bag down, and place on a barrier/in a container in the trunk of you car. Throw the trash bag away. Clean patient care items thoroughly prior to the next use with antibacterial solution and paper towel or antibacterial wipes.

PROTECT YOURSELF AND YOUR PATIENTS. Keep in mind, it is better to overdo washing/hand sanitizing/wiping than underdo.

CHARTING IN THE HOME

We highly recommend that you limit the amount of time you are in a patient’s home to only hands-on care and head-to-toe assessment. Instead, complete documentation in your car both prior to and after providing care.

STAFF TEMPERATURE CHECK

Check your temperature every morning before leaving the house to do visits. Qliq your temperature reading to the QLIQ DAILY TEMPERATURE REPORT. We will be tracking daily staff temperatures Mon-Fri. If you are on vacation, please verify that Tyra is aware as we will not expect you to report your temperature while on vacation. PLEASE ALERT the Admin Team to any S&S that you are experiencing that may be related to Covid 19 or any potential chances of exposure to a Covid + individual. We are here to support you and keep our team healthy and safe.

WHEN TO CALL THE DOCTOR

Please contact the doctor for further instructions if any of the following symptoms are present:

• Temperature of 100.4°F; and/or
• New onset of cough that is not a common occurrence and is not allergy related; and/or
• Shortness of breath; and/or
• Loss of sense of smell and/or taste noted

 DO NOT panic and go into a doctor’s office, urgent care or emergency room. All healthcare clinics and facilities are asking that individuals call their doctor first before going into any facility so they can be properly screened and told exactly what to do and where to go.

Avoiding Urgent Cares, Doctor’s offices and Emergency Rooms will protect you from being exposed to COVID-19 in case you don’t have it and it will prevent others from being exposed to it in case you do have it.

Of course, if at any time you feel that you are having a medical emergency, please call 911.

PATIENT/CAREGIVER EDUCATION

Agency staff will need to educate all new and current patients on the following:

• Patients and/or their caregivers will need to check patient’s temperature every day and inform you or the Agency office if they have a temperature of 100.4°F, cough, shortness of breath, or loss of smell or taste.
• Patients/family/caregivers should wear some type of mask (preferably cloth) when out in public per CDC recommendations/county mandate
• Patients/family/caregivers are educated and are exercising hand hygiene techniques as well as social distancing practices to minimize transmission of the disease.
• During the course of our care, if a patient or necessary caregiver (i.e. caregiver who must be present during patient visits) is found to potentially have COVID-19, IMMEDIATELY inform the office. While essential care will continue to be provided, we will limit care and exposure to staff.
• If weather permits, patients should ventilate rooms in their homes with open windows to clear the air and keep it moving.

NEW ADMISSIONS

ALL staff asked to see a potentially exposed, recently tested or confirmed + Covid 19 patient will be mandated to follow strict FULL PPE guidelines including: Face Shields, N95 mask, gown, gloves at all times while in the home. In addition, we will provide you the necessary protective equipment to have the patient/essential caregiver don prior to entry into their home to protect you including a mask. We will maintain strict PPE guidelines for a period of 20 days from onset of symptoms and 24 hours symptom free without the use of medications for all patients/caregivers.

 Patients that are considered high risk are those that are over 65 years old and/or with co-morbidities such as heart disease, lung disease, diabetes, auto-immune disorders, and immune-compromised.

PAPERWORK/PAYROLL PROCESSING

In an effort to limit the potential for transmission of germs/virus, we want to limit paper documentation dropped off to the office. Please email/Qliq Wendy all HH consents, NOMNCS, etc. Please email/Qliq Deanne all Hospice NOE’s, etc. Please email/QLIQ Tyra ALL route sheets. We need your help in completing the majority of tasks in Kinnser/WellSky to ensure proper processing of your documentation to meet payroll deadlines.

AGENCY UPDATE

We are in the process of tracking:

• Patients who have visited the ER, are coughing/sick, have concerns about sick relatives who have visited them, etc. and need follow up phone calls to ensure they are not COVID-19 positive. Please contact the office if you are aware of any of the above so that we may add them to our list to follow.
• Medical supplies inventory.
• PPE inventory and upcoming shipment dates.
• Clinicians who call in sick due to their own illness or that of a family member.
• Staff daily temperatures as a pre-emptive measure, in addition to S&S that may be indicative of Covid 19 infection.
• It is REQUIRED that staff wear masks at all times when out in public or when in the presence of a gathering of more than 10 people, maintain social distancing at a minimum of 6’and continue to perform scrupulous hand hygiene either with soap and water or hand sanitizer of at least 60% isopropyl alcohol and 70% ethyl alcohol as a pre-emptive measure.

 Essential visits will continue to be made to our patient population. Telehealth visits, although not reimbursable to Valeo (but payable to staff performing the telehealth visit), are now allowable per Medicare and other payers. We ask that you utilize this resource to provide care as appropriate to your patients who either cannot be seen due to facility restrictions or due to patient/caregiver concern during this time. The use of telehealth affords us the opportunity to supplement the care we provide and enhance the patient/caregiver learning experience.  For documentation purposes, please request a TELEHEALTH visit be added in Kinnser/Wellsky and document your virtual/telehealth “visit.” For payment purposes, please submit telehealth calls on a route sheet including whom you called and the length of time for the call. Telehealth visits/phone calls must reflect SKILLED NEED for reimbursement by Valeo, to clarify a telehealth visit is not a check in call.

TRAVEL OUT OF THE AREA

Until further notice, all employees requesting time off will need to inform their Supervisor of their destination if they will be traveling out of Utah. We are requesting that all employees heed the guidance provided to “stay in place” as much as possible within the confines of patient care and the necessities to maintain your homes.

 PREVENTION

CDC has reinforced the use of everyday preventive actions to help prevent the spread of respiratory diseases and seasonal influenza. That includes:

• Avoid close contact with people who are sick. For medical professionals required to provide care, proper personal protective equipment, use of protective measures is essential. Close contact is defined as within 6’ of another individual.
• Avoid touching your eyes, nose, and mouth. MAINTAIN SCRUPULOUS HAND HYGEINE either via washing your hands or using hand sanitizer of at least 70% alcohol content.
• Limit wearing jewelry on your hands.
• STAY home if you are sick.
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash. Hands and fingers do not do a sufficient job of covering the droplets of a cough or sneeze.
• Keep surfaces and frequently touched objects (bedside tables, door handles, surfaces in the bathroom, toys for children, etc.) clean by wiping them down with a household disinfectant.
• Avoid direct contact with others including: handshaking/hugging etc.
• Wear a mask when out in public, around unrelated persons or related persons living outside of your immediate home, or when unable to maintain social distancing measures of at least 6’. Avoid large gatherings, crowded indoor spaces and ensure that indoor spaces are properly ventilated when needing to be inside.