Caring for COVID as visiting/hospice nurse

[anashenwrath, ASN, RN]

Hi all, hope everyone is taking care out there. I am a hospice nurse, so normally have a mix of home patients, SNFs, ALFs. My county has a little under 1,000 positive cases; we are in our surge, not yet peaked. We hadn't had any confirmed positive cases at my hospice, but there was recently an outbreak at a nursing home and my company asked if I would see patients in this building and any subsequent positive cases. Essentially, I'm the "covid" nurse for the time being (no, I'm not seeing my routine patients at this time!)

Any other visiting or hospice nurses in my situation? I am having kind of a hard time bcs I can't really do anything bedside. I use the facilities equipment for vitals (but can't always find it), and I bought a very crappy stethoscope that I can disinfect after use. I carry a small pile of recommendation forms in a clear plastic bag that I leave at the nurse's station so I can write out recs after my visit. Most of what I do is deal with family members who are freaking out bcs they can't be bedside. Normally I would help them facetime, etc, but I don't want to bring my tablet or phone into patient's rooms, even with plastic bags.

I don't know. It just feels very surreal, and I want to make sure I'm doing everything right for myself and for my patients. I'm just wondering if there are any visiting/hospice nurses who have been caring for COVID patients in LTC settings for longer and maybe have developed a good routine?

Thanks all and please take care!

[vampiregirl, BSN, RN]

I'm a hospice nurse with what sounds like a similar case mix to yours. I'm also the designated nurse IF we get any Covid positive patients or suspected positive. As of now, we do not have any COVID positive or suspected positive.

Have you checked with your quality, infection control or educator at your agency? They may have some recommendations or specific workflow changes for this. I know this entire thing is new (and overwhelming) but at least at my agency, our infection control nurse and educator have done extensive research/ networking with other agencies and is a great resource. We had an in-person inservice, we've had several procedures/ memos etc and demonstrations of donning/ doffing PPE are available for review. They also have made sure we have appropriate PPE, hand sanitizer and disinfectant available. Everyone entering the office is temperature screened and hand hygiene must be performed upon entering the office. We are responsible for taking temps and texting them to our supervisor if we leave from home for a visit.

Currently we are performing a COVID screening for every visit and have a procedure if any risk factors identified. I've been arranging my schedule so my patients that I have a higher index of suspicion (multiple caregivers, lax attitude towards covid risk etc) are later in the day. I take the minimum equipment/ supplies in to each visit and maintain 6' social distancing unless needed for hands on assessment. We wear masks to every visit. The outside of my vital sign equipment bag and my computer get disinfected after I leave every visit (vital sign equipment itself disinfected prior to replacing in bag after use). I keep a bag in my vehicle for waste (disinfecting wipes, alcohol preps and wrappers). Upon arriving home, my uniform goes straight in the washer and I go in the shower. Shoes get sprayed with disinfectant and vehicle touch points get sprayed as well. Now a month in, this has just become routine for me.

I'd love to hear what other hospice/ home care nurses are doing to protect themselves and their patients.