This article was published on June 1st, 2020 in the Journal of the American Medical Directors Association (JAMDA). A group of medical directors from several New York skilled nursing facilities (SNF) give detailed consensus policy recommendations on COVID-19 management. Key recommendations include:
Measures Regarding Staff and Residents
- Employees should be screened for COVID-19 symptoms at beginning of shift. Screen all residents for symptoms of COVID-19 twice daily. Facemasks should be provided to both staff and residents.
- N-95 masks and eye-shields should be given to staff when in direct patient care/contact.
- COVID-19 testing should be done only if: testing is performed on staff/residents without a history of COVID-19, testing occurs with at least 3 rounds of testing 1 week apart, up to date technology to ensure quicker results, and a plan for if staff/resident test is positive.
Management of COVID-19 Positive/Presumed Positive Cases
- If a resident tests positive, a designated unit should be created to cohort positive patients, with specific staff assigned to unit.
- Management of positive patients:
- Provide antipyretic therapy with acetaminophen as needed.
- Provide supplemental O2 if pulse oximetry is <90%. Advance to venti-mask if hypoxia not improved.
- Consider prophylactic anticoagulation therapy as COVID-19 is found to be procoagulant. Consider Antibiotics if a concern arises for bacterial pneumonia.
- Consider h2 blocker as a treatment for reflux disease.
- Transmission based precautions can be discontinued if:
- At least 3 days have passed without a fever (without use of antipyretics), improvement in respiratory symptoms, and at least 14 days have passed since COVID-19 symptoms started.
OR
- Lack of fever (without use of antipyretics), improvement in respiratory symptoms, and negative results on at least 2 consecutive COVID-19 tests at least 24 hours apart.
Admissions
- Hospitalized patients who are COVID-19 positive should be admitted to positive unit in the SNF. Hospitalized patients who are COVID-19 negative can be admitted to transition unit for 14 days while symptoms are monitored.
Lester PE, Holahan T, Siskind D, Healy E. Policy Recommendations Regarding Skilled Nursing Facility Management of Coronavirus 19 (COVID-19): Lessons from New York State. J Am Med Dir Assoc. 2020;21(7):888-892. doi:10.1016/j.jamda.2020.05.058
This review was posted on behalf of Spencer Hofschulte-Beck, medical student at Marian University, and approved by Dr. Kathleen Unroe, IU School of Medicine Associate Professor, geriatrician, and IU Center for Aging Research Scientist
