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Arizona: Nursing Home Tool Kit - Healthcare Quality Improvement Campaign
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The status of Arizona’s policies on Cleaning and Disinfection are as follows:

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  • Use a UV machine to disinfect all face shields, N95 masks, iPads, nurse cart keys, and any other items that are used frequently or need disinfecting.
  • Staff will shower and change at the end of shifts in areas that have been designated within the facility before leaving the unit to reduce the spread of COVID-19 in the community or at homes.
  • Use baby-nursery cameras in COVID-19-positive rooms to monitor patients remotely.

Notable Groups: Haven Health Group and Pioneer Health Group

The status of Arizona’s policies on reporting, guidance, and mandated reporting are as follows:

Notable Groups: Office of the Governor Doug Ducey

Arizona’s testing policies are described below:

  • Along with local public health departments and providers, the state of Arizona has launched an initiative to test all residents and staff in Arizona’s nursing care institutions over a two-week period (May 15 – May 29, 2020). Facilities were given the option of having a lab come to their location to do the testing or to obtain the supplies to do their own on-site testing. Organizations who decided not to participate in the initiative were required to sign an “opt out” notice and send to ADHS.

Notable Groups: Arizona Department of Health Services (ADHS), Arizona Health Care Association, SonoraQuest Lab

The status of Arizona’s workforce and staffing situation during Covid-19:

Notable Groups: Office of the Governor Doug Ducey

The status of Arizona’s nursing home (NH) communications during the Covid-19 pandemic.

  • Launched a statewide COVID-19 Hotline that offers an entry point to field questions and concerns from any residents of Arizona about COVID-19. (Relevant link: https://211arizona.org/covid-19)
  • Hosts weekly calls with key physicians in nursing homes and local nearby hospitals (e.g., hospitalists, skilled nursing facilities (SNFs), primary care providers, and infectious disease physicians) to identify any and all gaps in knowledge, training, and personal protective equipment (PPE) issues as well as provide updates on the current state of operations, and address shortages of staff and general fears
  • Also convenes a weekly call with stakeholders to coordinate efficient communication between hospitals and nursing homes. These calls focus on providers sharing the status of their COVID-19 inpatients, emergency department surges, nursing home capacity, personal protective equipment (PPE) and testing resources, infection prevention training, and use of telemedicine. Participants include hospitals, nursing homes, state agencies, and nursing home trade associations
  • HSAG developed a special SharePoint site that includes a section for Q&As, announcements, and new resources. This site also includes a bed-count tracker for nursing homes to improve the coordination of care between hospitals and post-acute care facilities
  • Holds weekly calls with providers of long-term care to update the community on case counts, guidelines, personal protective equipment (PPE) distribution, and other important issues during the pandemic (Relevant link: https://www.maricopa.gov/5496/Long-Term-Care-Facilities)
  • Facilities will receive a weekly survey, which is then analyzed by county officials. Infection preventionists will then use this survey to target facilities most in need of technical assistance and PPE distribution
  • The Arizona Department of Human Services and Unified Command are both purchasing PPE and are prioritizing the distribution of the bulk of PPE to long-term care facilities for the protection of the most vulnerable (Relevant link: https://www.maricopa.gov/5460/Coronavirus-Disease-2019)
  • Declared a public health state of emergency for the Navajo Nation and created a web page with information, maps, and resources about the COVID-19 response in their local area (Relevant link: https://navajo-nation-coronavirus-response-ndoh-nec.hub.arcgis.com)
  • Governor Doug Ducey established a Task Force on Long-Term Care, which is focused on safely resuming visitation within long-term care facilities. The task force includes public health officials, medical experts, senior advocates, private sector leaders, legislators, and families. The task force develops recommendations and metrics for when and how in-person visitation can safely resume at long-term care and assisted living facilities. The task force also makes recommendations on the best ways to keep families informed about their loved ones (Relevant link: https://azgovernor.gov/governor/news/2020/07/governor-ducey-announces-task-force-longterm-care)
  • Developed an additional hotline to field COVID-19-specific questions and concerns from nursing homes all across the state
  • COVID-19 Hotline: 1-844-542-8201
  • This nursing home encourages the usage of social media (Facebook and LinkedIn) to increase morale, optimism, and to reassure its community about loved ones in their nursing home (Relevant link: https://drive.google.com/file/d/1pRpLD4wLHac4T_gY8D1_aWpHsvdjDNVn/view)

Notable Groups: 2-1-1 Arizona, Health Services Advisory Group (HSAG), Windsor Ridgecrest, Poison Control Hotline, Office of the Governor Doug Ducey, The Navajo Nation Commission on Emergency Management, Maricopa County Public Health Department, Bandera Healthcare

Arizona’s ongoing actions to improve access to personal protective equipment (PPE):

  • To increase the supply of personal protective equipment (PPE) at the nursing home level, it’s advised to visit hardware stores, which carry large supplies of PPE (coveralls to supplement gowns, eye protection, face shields, shoe covers, masks, and gloves)

Notable Groups: Pioneer Health Group

Arizona’s current actions to improving the utilization of personal protective equipment (PPE):

  • AzNG has obtained level II and level III reusable (fabric) gowns. AzNG representatives are calling nursing homes across the state to determine needs and put together a priority list for their distribution. In addition to this, AzNG has created mobile teams that provide training on how to use and maintain the gowns.

Notable Groups: Arizona National Guard (AzNG)

Arizona’s patient transfer policies:

  • Newly developed, centralized 24/7 call line facilitates inter-facility transfer of patients to and from hospitals and nursing homes. This free service is an algorithm based on protocols created by Arizona transfer centers, ADHS, and chief medical officers. In addition, the state has also identified two large alternative sites in the event of large hospital surges. This includes St. Luke’s Medical Center, which recently closed, and a mall department store
  • This system will manage throughput and deter bottlenecks in the emergency department (ED) with four key components:
  • An algorithm for nursing homes and hospitals on accepting admissions and re-admissions from higher acuity facilities that clarifies when patients need to be in isolation or quarantined due to COVID-19 (Relevant link: https://azdhs.gov/documents/preparedness/epidemiology-disease-control/infectious-diseasesservices/coronavirus/guidance-accepting-admissiongs-readmissions-higher-acuity-facilities.pdf)
  • By Executive Order, Arizona nursing homes are required to report bed availability and the status of COVID-19 positive patients daily. To facilitate this, a web-based application, the Post Acute Care Capacity Tracker (PACCT), has been developed. Having a centralized reporting mechanism ensures an appropriate level of care and reduces redundant phone calls from various hospitals to nursing homes (Relevant link: https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-diseaseepidemiology/index.php#novel-coronavirus-surge-line)
  • A statewide centralized call station, Arizona (AZ) Surge Line, has been created through the Office of Governor Doug Ducey to facilitate COVID-19 transfers. To match ongoing patient transfer needs with available Intensive Care Unit (ICU) and post-acute beds, a web-based application was developed to gather data such as centralized bed availability, vents, staffing, personal protective equipment (PPE), etc., from hospitals and nursing homes. This tracker provides data to the AZ Surge Line which arranges COVID-19 transfers from hospitals to nursing homes and from remote rural areas, such as the Navajo County which has COVID-19 hot-spots, to ICUs in hospitals (Relevant link: https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-diseaseepidemiology/index.php#novel-coronavirus-surge-line)
  • On July 9, 2020, Governor Doug Ducey signed Executive Order (EO) 2020-48 that mandates that skilled nursing facilities, assisted living facilities, long term acute care hospitals, medical group homes, hospice, behavioral health inpatient facilities, intermediate care facilities, medical group homes, and home health agencies are to report into the ADHS Post-Acute Care Capacity Tracker (PACCT). Every 24 hours, providers must report the number of COVID-19 residents that require isolation, the provider’s ability to accept new COVID-19 admissions, current COVID-19 admission criteria, the number of beds available, and the number of beds available to new admissions with active or previous COVID-19. This daily data will allow hospital care coordinators to access statewide bed availability across the post-acute care continuum and quickly send patients to locations that can best serve them. The executive order also added Arizona SurgeLine post-acute provider protocols for the transfer and acceptance of patients when it is clinically appropriate and resources will allow for it (Relevant link: https://azgovernor.gov/executive-orders)
  • Innovation Care Partners (ICP), a clinically integrated care delivery system within the HonorHealth health system, has developed an innovative post-acute care collaborative strategy to proactively identify skilled nursing facility COVID-19 outbreaks and lessen the severity
  • ICP provides daily, real-time reports that identify potential outbreaks and direct immediate assistance, including assessment of testing, staff protection, personal protective equipment (PPE), and physician communication
  • ICP actively surveys partners about PPE which has resulted in the delivery of 1,200 isolation gowns, 18,000 surgical masks, and 1,000 N95 masks
  • HonorHealth connects partners through virtual webinars that review national and local data, guidelines, advanced care planning, and PPE
  • ICP updates partners via text messages and developed a website that includes a post-acute care COVID-19 toolkit. These strategies help ICP and HonorHealth strengthen partnerships, hear and assess emerging concerns, distribute information in a timely manner, educate post-acute care providers, and improve quality outcomes

Notable Groups: Innovation Care Partners / HonorHealth, Arizona Department of Health Services (ADHS)

Arizona’s current resources during the Covid-19 pandemic:

  • AHCA has expanded infection control support across the state of Arizona through the use of a new program called Disaster Ready (DR) EPIC (Emergency Preparedness Infection Control). The program is funded by a grant through the Arizona Department of Health Services (ADHS) Hospital Preparedness Program. DR EPIC is an extension of the AHCA’s ongoing Disaster Ready program, which has been in place since 2012. The program’s team includes experts in nursing, infection prevention, and industrial hygiene. All Arizona skilled nursing facilities (SNFs) are eligible for technical assistance. SNFs with any questions are encouraged to email the DR EPIC Online Help Center at EPIC@azhca.org. They can also call the Helpline at [602-241-4644] (Relevant link: https://vimeo.com/448284857/1194ddb244)
  • AHCA developed a program to implement emergency preparedness and incident command training for nursing homes, funded by a grant from the Arizona Department of Health Services
  • AHCA created a COVID-19 web page with information relevant to nursing homes, which includes information on national, state, and local guidelines

Notable Groups: Arizona Health Care Association (AHCA)

Arizona’s ongoing actions to better check visitors for potential Covid-19 and other methods of screening said visitors for family meetings:

ADHS has approved new guidelines regarding visitation in congregate settings, including nursing homes. The guidelines were proposed by the Governor’s Task Force for Long-Term Care and cover the thresholds for community spread of COVID-19 and facility implementation of mitigation strategies. Community spread thresholds set visitation requirements based on number of COVID-19 cases, COVID-19-like illness and the percentage of positive COVID-19 tests. The guidelines call for facilities to allow compassionate care visits regardless of the level of community spread. Mitigation strategies include requiring visitors to present a negative COVID-19 test less than 48 hours old; attestations regarding isolation after testing; limiting contact time and a dedicated visitation space; mask-wearing requirements for residents (when safe), visitors, and staff; hand sanitizing requirements; visitor logs to facilitate contact tracing; and enhanced facility cleaning and sanitation (Relevant link: https://www.azdhs.gov/documents/preparedness/epidemiology-disease-control/infectiousdisease-epidemiology/novel-coronavirus/community/congregate-visitation.pdf)

Notable Groups: Arizona Department of Health Services (ADHS)

Arizona’s Telehealth Inclusion:

  • This corporation facilitated telehealth technician visits for several of the post-acute facilities to test residents (free of charge) for transfer clearance to assisted living facilities during the pandemic. They have also been utilized by physicians and staff in skilled nursing facilities
  • The Arizona Telemedicine Program is conducting virtual webinars to help providers such as nursing homes, all across the state to quickly strengthen their programs for telemedicine (Relevant link: https://telemedicine.arizona.edu)
  • This group created a position dedicated to coordinating telehealth visits. This person arranges a time with the provider and nurse. This helps the nurse stay on task by not having to coordinate these efforts

Notable Groups: United Telehealth Corporation, The University of Arizona

Arizona’s notable organizations that are confirmed nursing home assistance for the pandemic.

  • AzNG has obtained level II and level III reusable (fabric) gowns. AzNG representatives are contacting nursing homes to determine their level of need and creating a priority list for distribution. AzNG has also put together mobile teams to provide training on how to use and maintain the gowns

Notable Groups: Arizona National Guard (AzNG)

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Arizona: Nursing Home Tool Kit

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