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Refusing Care of a COVID-19 Patient Due to Inappropriate PPE

Disasters   (250,403 Views | 266 Replies)

EDboundSN has 5 years experience as a EMT-B and specializes in the Emergency Department.

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You are reading page 9 of Refusing Care of a COVID-19 Patient Due to Inappropriate PPE. If you want to start from the beginning Go to First Page.

Nurselexii specializes in Non judgmental advisor.

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12 minutes ago, MunoRN said:

Z1538253599_IMG_12712.thumb.JPG.1abbab0d24260a6ebc2d914cd66918dd.jpeg.7bed00c9ec6f73731b18dec6ff96de8b.jpegThe "scientific and evidence based criteria" they're referring to is neither of those things.  The state's criteria is that procedure masks is sufficient protection.

Although I dont like what this says I love how you whipped out the information LOL

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CaffeinePOQ4HPRN has 10 years experience as a BSN, LPN, RN.

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12 minutes ago, Nurselexii said:

Although I dont like what this says I love how you whipped out the information LOL

This is... 😳

Edited by CaffeinePOQ4HPRN

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Katillac has 18 years experience as a RN.

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48 minutes ago, MunoRN said:

Z1538253599_IMG_12712.thumb.JPG.1abbab0d24260a6ebc2d914cd66918dd.jpeg.7bed00c9ec6f73731b18dec6ff96de8b.jpegThe "scientific and evidence based criteria" they're referring to is neither of those things.  The state's criteria is that procedure masks is sufficient protection.

Thank you so much for this! I looked into it, and by God Oregon actually has a plan ! The following is from Oregon Crisis Care Guidance:
"The professional “duty to serve” must be balanced with the ethical
principle of reciprocity, as healthcare workers should be assured of the safety resources they need to do their jobs."

Can you tell me where it says that procedure masks are sufficient? I'm not being argumentative, I really want to know where that comes from in light of what they say in their crisis plan.

Edited to say: Never mind, I found it. Minimum PPE for evaluating COVID-19 patients is face mask. AGPs require minimum N95.
Minimum PPE necessary to evaluate patients with respiratory illness, suspected COVID-19, or confirmed COVID-19:•Face mask (I.e., surgical or procedural mask)•Eye protection (face shield or goggles)•Gown•Gloves

Some procedures warrant a higher level of protection. See “Aerosol-Generating Procedures in Hospitals”. Aerosol-GeneratingProcedures (AGPs) in HospitalsAGPs (Appendix I) are much more commonin ED and hospital settings.When conducting AGPs for patientswith fever or respiratory symptoms, or with known or suspect COVID-19, HCP should utilizestandard, contact, and airborne precautions, including:•N95 mask or higher respiratory protection (includes powered air purifying respirators [PAPRs])•Eye protection(face shield or goggles)•Gown•Gloves

Edited by Katillac

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Walti has 52 years experience as a LPN, LVN, RN, EMT-I and specializes in ICU/ER mostley ER 25 years.

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Reading the statement from the board left me a bit confused, I'd be leery of an open ended, nonspecific "etc".

But I did not see where the board is concurring with relaxed rules from the CDC in this statement.

I feel more clarification is needed from the Oregon board.

It will be interesting to see if other boards are going to be killing off their nurses.

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CaffeinePOQ4HPRN has 10 years experience as a BSN, LPN, RN.

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Quote

It will be interesting to see if other boards are going to be killing off their nurses.

This 👆100%

There's a lot of vague language and purposefully unanswered questions here in Canada, too. Just waiting to see how many of us in my home province will be expected to line up to die.

Edited by CaffeinePOQ4HPRN

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On 3/19/2020 at 5:30 PM, MunoRN said:

My state has addressed the issue of whether nurses can refuse to care for these patients, the response was that you're free to permanently surrender your license, but that's the only option.

I would argue that older and immunocompromised nurses should be more of a last choice for caring for COVID patients, although we might already be to that point.

But you could give a 2 week (or required) notice without surrendering your license.

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Pete W. has 1 years experience.

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IF YOU CAN'T GET AN N95 AND MUST USE A SURGICAL MASK ALSO USE A PLASTIC FACE SHIELD, although not equivalent that will be a significant improvement over the surgical mask alone and there are even some Youtube videos on how to make one hour of soda bottled plastic.  This is a very simple device
 

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10 minutes ago, Pete W. said:

IF YOU CAN'T GET AN N95 AND MUST USE A SURGICAL MASK ALSO USE A PLASTIC FACE SHIELD, although not equivalent that will be a significant improvement over the surgical mask alone and there are even some Youtube videos on how to make one hour of soda bottled plastic.  This is a very simple device
 

I like it.  Necessity is the mother of invention.

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On 3/23/2020 at 11:20 AM, Jory said:

So what is your plan if the equipment runs out before it is replenished?  Allow people to lay there and die?  

What is your plan if equipment runs out where you are?  Are YOU going to care for people without adequate protection for yourself?  You mentioned you have children.  Are you going to put patients before your own flesh and blood? 

You talk big, Jory, but I wonder, if push comes to shove, what you will actually do.  

As an NP or whatever APRN role you are, do you work without proper gear or is it only other nurses you think should do that?  (Other nurses who are at the bedside, not seeing patients in Clinics or on the OR table).  

We are sending all over to Italy and Iran.  It's great to help other countries, but what about our own nurses and aides and others at the bedside for prolonged periods of time, day after day after day?

 

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Pete W. has 1 years experience.

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1 hour ago, Kooky Korky said:

I like it.  Necessity is the mother of invention.

Also a face shield could have plastic bag material taped to the bottom edge and either hanging down far and loosely over the neck and upper chest or taped on to the upper chest pinned in the cap. Another piece of such loose plastic taped to the top possibly. At the end of the shift these attached pieces are discarded. Before using motion tested to make sure it's not too tight restricting and has some looseness 

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

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4 hours ago, Walti said:

Reading the statement from the board left me a bit confused, I'd be leery of an open ended, nonspecific "etc".

But I did not see where the board is concurring with relaxed rules from the CDC in this statement.

I feel more clarification is needed from the Oregon board.

It will be interesting to see if other boards are going to be killing off their nurses.

The board is concurring with rules even more relaxed than the CDC.

The CDC recommends N95 or better for HCWs caring for coronavirus patients.  They only support the use of surgical or procedure masks when attempts to provide proper protection have failed, although this has been often misinterpreted.

The Oregon BON is concurring with Oregon Public Health, which has taken the position that even if N95 or better protection is available, the recommended level of protection for nurses caring for Covid-positive patients is procedure or surgical masks, which is not supported by any current evidence.  

They leave the only exception as being when patients are undergoing Aerosol Generating Procedures (AGPs).  The basis of concern for exposure with AGPs is that they may include similar mechanisms that cause droplet aerosolization with a cough, or even worse, they may trigger a cough.  Close proximity transmission through respiratory mechanisms, particularly a cough which is a well known symptom of Covid, is a well established source of infection. 

Backing an employer's intention to not provide meaningful respiratory protection when nurses are caring for Covid patients, even when such protection might be readily available, is a disturbing position for a BON to take.  

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CaffeinePOQ4HPRN has 10 years experience as a BSN, LPN, RN.

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15 minutes ago, MunoRN said:

The board is concurring with rules even more relaxed than the CDC.

The CDC recommends N95 or better for HCWs caring for coronavirus patients.  They only support the use of surgical or procedure masks when attempts to provide proper protection have failed, although this has been often misinterpreted.

The Oregon BON is concurring with Oregon Public Health, which has taken the position that even if N95 or better protection is available, the recommended level of protection for nurses caring for Covid-positive patients is procedure or surgical masks, which is not supported by any current evidence.  

They leave the only exception as being when patients are undergoing Aerosol Generating Procedures (AGPs).  The basis of concern for exposure with AGPs is that they may include similar mechanisms that cause droplet aerosolization with a cough, or even worse, they may trigger a cough.  Close proximity transmission through respiratory mechanisms, particularly a cough which is a well known symptom of Covid, is a well established source of infection. 

Backing an employer's intention to not provide meaningful respiratory protection when nurses are caring for Covid patients, even when such protection might be readily available, is a disturbing position for a BON to take.  

This is excruciating 😥. We're asking for BASICS.

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