Influenza Kit Contents 2009

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1 Influenza Kit Contents 2009 A facility flu kit will be assembled prior to the start of the influenza season to enable a timely organized community response. The kit contains the following: Influenza Swabs, with influenza swab policy easily accessible for nurse review Labels containing recommended anti-viral medication for the current year (made in advance based on medical director / CDC recommendations for current year) Signs for community doors and resident rooms (check in at nurses station) Influenza acute temporary care plan Influenza and H1N1 Outbreak Management Policy Glomular filtration rates, calculated using the National Kidney Foundation web-site (GFR calculator) CDPHE Influenza Outbreak Report form for Long-Term Care Facilities Outbreak surveillance tracking form: residents, staff, volunteers, etc. Responsible party notification (telephone) format, for IDT use Droplet isolation precaution supply carts set up with sufficient quantity during flu season. Central supply is responsible for keeping supply carts stocked and readily available. Easily accessible, but usually not in the flu kit: Updated staff information to order anti-viral prophylaxis: Name, age, date of birth, allergies. Updated staff contact information.

2 POLICY EXAMPLE: This must be approved by community internal quality improvement committee processes. Policies and Procedures Subject: Influenza Naso-pharyngeal Swab Effective Date: Revision Date: File Under: Page: Approved by: Your LTC community QA Committee POLICY Rapid diagnostic tests may assist in the diagnosis and management of residents who present with influenza signs and symptoms. Rapid diagnostic testing for influenza should be done when the results will affect clinical decision making. (see influenza outbreak management for additional information to determine frequency and reasons for collecting a naso-pharyngeal swab) Reliability of rapid testing is inconsistent. False negatives can result from incorrectly performing the procedure or be due to types of influenza. Influenza testing is always done immediately and sent out stat, based on an attending physician or medical director order. Equipment Gloves, non sterile Penlight Mask and eye protection Sterile Dacron or Rayon swab Specimen Transport Bag with Biohazard symbol. Completed Laboratory request form Stat physician order PROCEDURE 1. Explain the procedure, including telling the resident that they may gag or feel the urge to sneeze during the procedure, which will take seconds maximum. 2. The resident should be sitting on the edge of the bed or chair facing you or be in bed their back with their head elevated approximately Wash your hands and put on gloves, mask, and eye protection. 4. As the resident to blow their nose if possible to clear nasal passages. 5. Check nostrils with penlight for patency. It may be helpful to ask the resident to occlude one nostril and then the other while exhaling. Listen for the more patent nostril.

3 6. Ask the resident to cough to bring organisms to the nasopharynx. 7. While still in the package, bend the swab into a curve, then open the package without contaminating the swab. 8. Ask or assist the resident to tilt their head back. 9. Gently pass the swab into the selected nostril about 3-4 inches into the naspharynx. Keep the swab near the septum and floor of the nose. Rotate the swab quickly and remove. (Alternative if unable to access naso-pharynx through nostril: Depress the resident s tongue with a tongue blade, passing the bent swab up behind the uvula. Rotate the swab and withdraw it carefully.) 10. Insert the swab into the original paper package and place in specimen transport bag with biohazard symbol. 11. Remove gloves and wash hands. 12. Label the specimen with the resident s name, date, time, and collection site. 13. Complete laboratory request form and arrange for immediate pick up by the laboratory, as a stat specimen. 14. Notify the physician of specimen results, per order. 15. Notify the DON or designated nurse manager if the specimen is positive for influenza.

4 2009 Tamiflu Labels for MARS, if not electronic Avery: clear labels, template 5160 fits most standard MARS Approximately 2.5 X 1.0 Review dosing every year with your medical director. Then, have these pre printed so nurses do not have to hand write MD orders and MARS: Tamiflu Treatment dose: 75mg PO BID x5 days Tamiflu Prophylaxis: 75mg PO every day x10 days after the Last diagnosed case Tamiflu Renal Impairment Treatment Dose: (GFR <30) 75mg PO every day x5 days Tamiflu Renal Impairment Prophylaxis dose: (GFR<30) (Total of 5 doses) 75mg PO every other day x10 days after the last diagnosed case Directions to make labels in Word 2007: Medical records does this for us New Document Mailings (Tool bar at top of page) Labels (Left side of tool bar at top of page) Options Select label brand and size under Options then click ok Type information as it is to appear on label Be sure that Full page of the same label is highlighted Use manual paper tray on printer and load each sheet of labels face up and in the direction indicated on the sheet Click ok

5 PLEASE CHECK WITH THE NURSES STATION BEFORE ENTERING THIS ROOM

6 Sample: Approved by your policy committee Policies and Procedures Subject: Droplet Precautions Effective Date: December 10, 2008 Revision Date: File Under: Page: Approved by: The QA committee at your facility Policy: In addition to standard precautions, droplet precautions will be initiated for residents with documented or suspected infection or colonization which may be transmitted via respiratory droplets, generated by coughing, sneezing, or talking. Confining residents to their room will only occur if an infection is unable to be contained with standard precautions. Psycho-social needs will be addressed in the acute temporary care plan. Residents requiring droplet precautions will be prioritized for private room placement, or placement with a room-mate considered to have the same infection. Common infections include: MRSA Influenza Uncontained secretions when cause may be unknown Requirements: 1. Sign stating Please check with nurse prior to entering room 2. Acute Temporary Care Plan 3. Isolation supplies for droplet precautions (gloves, gown, masks, goggles) Procedure: (In addition to standard precautions, gloves and gown etc) 1. Post a sign instructing visitors to check with the nurse prior to entering room. 2. Initiate acute temporary care plan, including type of precautions 3. Educate resident, family, staff, and visitors as needed to maintain contact precautions 4. Set up isolation supplies outside of room 5. Use a mask upon entry into the resident room, if contact likely within 3 feet or less. 6. Upon completion of visit or care, remove mask, gloves, gown etc. and wash hands 7. Put a mask on the infected resident, if resident is leaving the room. 8. Wash hands prior to leaving room and upon returning to the room. 9. Discontinue isolation when infection is resolved or contained

7 Hello, This is calling from. We are letting families know that we may have influenza, or a virus like influenza here in our community. We are taking every precaution, and starting on Tami flu, which is an anti viral medication. We will be checking for any signs of illness such as a temperature or a cough and let you know immediately if anything changes. We would prefer you not visit, but communicate by telephone or e mail. Please call us if you have any questions. Thank you Good by

8 Problem# Date: Influenza Care Plan CARE PLAN PROBLEM GOAL APPROACHES DISC. COMMENTS Symptoms will resolve in 5 Begin Tami-flu as ordered Nsg days or less Influenza like illness, related to potential exposure. Minimize potential spread of acute illness Minimize sense of social isolation while confined to room Use prescribed supportive medications, such as Tylenol, as ordered and as needed. Do not exceed 4 grams of tyl/ 24 hours from all sources Hydration checks while awake. Offer favorite fluids such as: Encourage bed rest Vital Signs Q Shift and PRN Pulse OX PRN Make Resident as physically comfortable as possible, using pillows, extra blankets, cool wash cloths, etc PRN Monitor for secondary infections, such as pneumonia, and assess respiratory status QS and PRN while awake Nsg IDT/ Nsg Nsg Begin Droplet Precautions: Masks worn when entering IDT resident's room, working within 3 feet of resident. Confine resident to his/her room, as able, until treatment is All completed or 5 days following onset of symptoms If the resident leaves his/her room then a mask is required. IDP Notify family and keep updated SS/Nsg Provide pocket Hand Sanitizer to resident if appropriate. Nsg Provide Hand sanitizer to staff to carry in pockets Nsg DON/ADON to do daily rounds to observe new signs and symptoms of respiratory illness DON/ ADON Housekeeping to clean room & environment daily and PRN Hsk with bleach solution Provide activities of resident choice in his room such as Act reading, books on tape, television, music, etc. Consider co-habiting of confirmed positive residents during IDP acute illness One to One visits with appropriate precautions as tolerated Act RESIDENT ROOM # ADMIT DATE ADMISSION #

9 Influenza Surveillance Log Residents Health Dept Outbreak notification: / / / Name Sex Age Onset Date/Time Date Time By Who spoke with? Symptoms Droplet Tami flu Room mate Illness precautions Started? treated? If not, Duration initiated? Date/Time why? Swab collected / results

10 Influenza Surveillance Log Staff Health Dept Outbreak notification: / / / Name Sex Age Onset Date/Time Date Time By Who spoke with? Symptoms Droplet Tami flu Room mate Illness precautions Started? treated? If not, Duration initiated? Date/Time why? Swab collected / results

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