Covid-19 Nurse Practitioner

KatieMI, BSN, MSN, RN · Mar 31, 2020

1). There is no such thing as "coronavirus clinic" or "COVID nurse practitioner" so far, AFAIK. Patients who stay at hone are managed by their primary care providers. Those who are in hospitals are managed by hospitalist providers and specialists as needed. There are testing centers but to work there means to simply follow protocol/asking scripted questions. Centers keep a provider available at all time just because there has to be one to officially order the testing, otherwise they can be staffed by nursing students and volunteers.

2). As a hospitalist NP/APRN, I work with COVID patients. Duties are precisely the same as with anybody else: initial exam/history, H&P, initial order set, contacting consultants, daily rounds with orders/results review, duscharge planning, discharge. Those admitted/moved to ICU are treated by ICU care team with standard ARDS protocol sans steroids till the last resort.

We receive regular updates about treatment protocols, etc, and additional training for working with respiratory therapists for using non-invasive respiratory support.

egg122 NP, MSN, APRN · Mar 31, 2020

Hi Barshan!

In NYC and CT some urgent cares have set up testing clinics for COVID-19 and they have hired people (usually on a temp basis) to help staff. The structure depends on each private clinic but a lot of them will have a telemedicine visit first, where the NP assesses if the person is having symptoms consistent with COVID and qualifies for testing, then an in person appointment is made at the urgent care's designated testing site, followed by a telemedicine visit to review the results.

I hope this helps.

Emily

barishan, BSN · Apr 4, 2020

On 3/31/2020 at 9:50 AM, egg122 NP said:
Tuesday by egg122 NP, MSN, APRN
Are you a credible source? Add your Credentials, Experience, etc.
236 Likes; 79 Posts; 793 Profile Views
Hi Barshan!
In NYC and CT some urgent cares have set up testing clinics for COVID-19 and they have hired people (usually on a temp basis) to help staff. The structure depends on each private clinic but a lot of them will have a telemedicine visit first, where the NP assesses if the person is having symptoms consistent with COVID and qualifies for testing, then an in person appointment is made at the urgent care's designated testing site, followed by a telemedicine visit to review the results.
I hope this helps.
Emily

Hi Emily ? thanks for your answer.

There is no APRN in our country, I am asking this question because I am curious and I am trying to inform my surroundings about APRN.

How do nurses provide telemedicine service? Can you enlighten me a bit about this? there is no telemedicine in our country.

On 3/31/2020 at 9:32 AM, KatieMI said:
1). There is no such thing as "coronavirus clinic" or "COVID nurse practitioner" so far, AFAIK. Patients who stay at hone are managed by their primary care providers. Those who are in hospitals are managed by hospitalist providers and specialists as needed. There are testing centers but to work there means to simply follow protocol/asking scripted questions. Centers keep a provider available at all time just because there has to be one to officially order the testing, otherwise they can be staffed by nursing students and volunteers.
2). As a hospitalist NP/APRN, I work with COVID patients. Duties are precisely the same as with anybody else: initial exam/history, H&P, initial order set, contacting consultants, daily rounds with orders/results review, duscharge planning, discharge. Those admitted/moved to ICU are treated by ICU care team with standard ARDS protocol sans steroids till the last resort.
We receive regular updates about treatment protocols, etc, and additional training for working with respiratory therapists for using non-invasive respiratory support.

do you have another experimental treatment? Turkey, led a research team of professor I had my intern will be given to the experimental plasma covid19 patients.

What are the reactions of nurses and your professional opinions? (about the medical progression of the disease and pandemic)

egg122 NP, MSN, APRN · Apr 4, 2020

Hi Barshan!

Generally the clinic or employer either contracts with a company that has a website in order to use it (examples include https://www.doxy.me or https://www.medici.md) or if their company is large enough there will be a team of programmers or engineers to create their own platform. The government here has relaxed rules currently so we are also allowed to use FaceTime at this time. It would be a video conference with patient where we assess them physically (within the limitations of a video) as well as take a detailed history. Currently, the CT department of health is discouraging prescribing plaquenil and azithromycin on an outpatient (they want hospital and nursing home use only. In NY, there are restrictions for the medications but it is possible to prescribe. However, many telemedicine platforms are discouraging this due to shortages and risk for complications that may outweigh benefits in mild to moderate cases. Nurse practitioners in both states can prescribe medications by law. The post testing telemedicine visits focus on providing education on expected and unexpected symptoms with the disease, education on when to go to the emergency room, and education of quarantine and prevention of spread of the virus. For patients who are high risk for complications, some telemedicine services will do follow up phone calls to check in on them after as well.

Nurse Practitioners in the US do go through extra training in assessment, disease management and pharmacology to be able to prescribe. I am not sure of the regulation in Turkey. In some countries, RNs are able to order testing under protocols written by MDs so you may want to partner with your MD colleagues to create a system that works and is within scope of practice for your area.

To answer your question on experimental treatments- it varies a lot by region of the country. Remdesivir is used but very difficult to obtain. tocilizumab is being used in refractory cases, particularly with high IL-6 levels. Mount Sinai is starting to trial plasma donations.

Best of luck!

egg122 NP, MSN, APRN · Apr 4, 2020

Also, this link is a info sheet that is being widely circulated on COVID-19 treatment in hospitals: https://Twitter.com/nickmmark/status/1243365513209638913/photo/1

These are Yale New Haven Health Systems protocols for in-patient:

barishan, BSN · Apr 4, 2020

1 hour ago, egg122 NP said:
1 hour ago by egg122 NP, MSN, APRN
Are you a credible source? Add your Credentials, Experience, etc.
236 Likes; 79 Posts; 793 Profile Views
Hi Barshan!
Generally the clinic or employer either contracts with a company that has a website in order to use it (examples include https://www.doxy.me or https://www.medici.md) or if their company is large enough there will be a team of programmers or engineers to create their own platform. The government here has relaxed rules currently so we are also allowed to use FaceTime at this time. It would be a video conference with patient where we assess them physically (within the limitations of a video) as well as take a detailed history. Currently, the CT department of health is discouraging prescribing plaquenil and azithromycin on an outpatient (they want hospital and nursing home use only. In NY, there are restrictions for the medications but it is possible to prescribe. However, many telemedicine platforms are discouraging this due to shortages and risk for complications that may outweigh benefits in mild to moderate cases. Nurse practitioners in both states can prescribe medications by law. The post testing telemedicine visits focus on providing education on expected and unexpected symptoms with the disease, education on when to go to the emergency room, and education of quarantine and prevention of spread of the virus. For patients who are high risk for complications, some telemedicine services will do follow up phone calls to check in on them after as well.
Nurse Practitioners in the US do go through extra training in assessment, disease management and pharmacology to be able to prescribe. I am not sure of the regulation in Turkey. In some countries, RNs are able to order testing under protocols written by MDs so you may want to partner with your MD colleagues to create a system that works and is within scope of practice for your area.
To answer your question on experimental treatments- it varies a lot by region of the country. Remdesivir is used but very difficult to obtain. tocilizumab is being used in refractory cases, particularly with high IL-6 levels. Mount Sinai is starting to trial plasma donations.
Best of luck!

Thank you Emily ?

For example, a cut occurred in the patient's foot. there is no problem in sense of movement and feeling. no need for sewing. Infection has occurred in the middle of the place, you can write a prescription for this, or can psychiatry increase the dose of your patient's medicine? A service for patients with follow-up.

did I get it right?
Do you provide telemedicine services in emergency situations?

KatieMI, BSN, MSN, RN · Apr 4, 2020

1 hour ago, barishan said:
do you have another experimental treatment? Turkey, led a research team of professor I had my intern will be given to the experimental plasma covid19 patients.
What are the reactions of nurses and your professional opinions? (about the medical progression of the disease and pandemic)

I work in a large tertiary care hospital. We use chloroquine on the majority of moderately or severely sick patients from admission unless there are contraindications (we already had one case of unstable ventricular tach as side effect of this drug) with or without erythromycin. NPs are allowed to prescribe either of them.

Remdesivir is here but very difficult to get. IMHO, when it is ordered and finally there, it becomes just too late.

The hospital system in my state started a trial of chloroquine as possibly preventive for high risk categories. They now enroll healthy first responders, including nurses, as volunteers. The results will take months to be published.

We literally do not have enough recovered patients healthy enough to provide plasma. Most of them are a great deal weakened even after moderately severe COVID19 infection. Most of those who went on vents even for short time will need at least couple of months to recover.

Honestly, I do not understand your second question. I can speak only for myself, and my main question is "when the heck this thing will finally finish???"

egg122 NP, MSN, APRN · Apr 5, 2020

14 hours ago, barishan said:
Thank you Emily ?
For example, a cut occurred in the patient's foot. there is no problem in sense of movement and feeling. no need for sewing. Infection has occurred in the middle of the place, you can write a prescription for this, or can psychiatry increase the dose of your patient's medicine? A service for patients with follow-up.
did I get it right?
Do you provide telemedicine services in emergency situations?

Yes, psychiatry can increase doses of medications on telemedicine platforms and there are a lot of companies with dedicated psychiatric telemedicine or a mixed service with some in person appointments and some by telemedicine. To answer your question about emergency situations, telemedicine can be used if the patient does not need to be seen in person (such as for x-rays or laceration repair as mentioned in your example). I do prescribe antibiotics via telemedicine. You can also do a telemedicine visit and then have them follow up in person in a few days or a week just to be extra safe or if they are higher risk for complications. However, there are times were an exam or diagnostic is needed and if a person calls in that needs that we will coordinate to have them sent to an urgent care center or emergency room.

We can also manage chronic diseases, such as diabetes, hypothyroidism and hypertension via video consult if the company has set up the ability to order labs. The chronic disease management use is usually augmented by an at least once a year in person visit though. Additionally, most reputable telemedicine companies do not prescribe narcotics, benzodiazepines, muscle relaxers or erectile dysfunction medications online given the potential for abuse.

Finally, there are cases where rural hospitals that lack medical staff and contract with telemedicine services in order to provide ICU care or other specialist care. Nursing homes also contract with these companies in both rural and urban areas to provide specialist care as well as after-hours medical coverage as well.

barishan, BSN · Sep 11, 2020

On 05.04.2020 at 16:21, egg122 NP said:

Evet, psikiyatri, teletıp platformlarında ilaç dozlarını artırabilir ve özel psikiyatrik teletıp veya bazıları yüz yüze, bazıları da teletıp ile karma hizmet sunan birçok şirket vardır. Acil durumlarla ilgili sorunuza cevap vermek için, hastanın şahsen görülmesi gerekmiyorsa (örneğinizde belirtildiği gibi röntgen veya yırtık onarımı gibi) teletıp kullanılabilir. Teletıp yoluyla antibiyotik yazıyorum. Ayrıca bir teletıp ziyareti yapabilir ve daha sonra ekstra güvenli olmaları veya komplikasyon riski daha yüksekse, birkaç gün veya bir hafta içinde şahsen takip etmelerini sağlayabilirsiniz. Bununla birlikte, bir muayene veya teşhisin gerekli olduğu zamanlar vardır ve bu ihtiyacı olan bir kişi ararsa, acil bir bakım merkezine veya acil servise gönderilmesini koordine edeceğiz.

Şirket laboratuvar siparişi verme kabiliyetine sahipse, diyabet, hipotiroidizm ve hipertansiyon gibi kronik hastalıkları da video danışmanlığı yoluyla yönetebiliriz. Kronik hastalık yönetimi kullanımı genellikle en az yılda bir kez şahsen ziyaretle artırılır. Buna ek olarak, çoğu saygın teletıp şirketi, kötüye kullanım potansiyeli göz önüne alındığında, narkotik, benzodiazepin, kas gevşetici veya erektil disfonksiyon ilaçlarını çevrimiçi olarak reçete etmez.

Son olarak, tıp personeli olmayan ve YBÜ bakımı veya diğer uzman bakımı sağlamak için teletıp hizmetleriyle sözleşme yapan kırsal hastanelerin olduğu durumlar vardır. Huzurevleri ayrıca hem kırsal hem de kentsel alanlarda bu şirketlerle uzman bakımı ve mesai sonrası sağlık sigortası sağlamak için sözleşme yapar.

OMG ❤️ Thanks for this. You are amazing ?