COVID Testing

• UNLV Medicine is no longer doing the COVID testing test (for now)

• UMC COVID Testing Link

• SNHD COVID Testing Link

Pre-Clinic:

• UNLV Medicine COVID Return to Work Protocol 

• If you are feeling ill, please report to all necessary people as per the resident handbook sick protocol

• If you think you need to be tested for COVID19, contact Kathy

• Everyone who enters the building must be screened with questions and their temperature, and physicians must sign off after evaluation.

  • If a patient or family member is POSITIVE then the patient will be brought to the 1st floor exam area.

• Maintain social distancing in the elevator (wait for the next one if need be).

Personal Protection

• Eye protection is recommended but not required for all patient interactions

• You must wear at least surgical mask at all times in clinic. Sources 1, 2, 8, 9 

• If you examine any patients/parents as persons under investigation/suspicion, you must wear goggles/splash guard, N95 mask, isolation gown. Watch & Read proper PPE Donning & Doffing: Sources: 4, 5

• Please conserve your N95 as much as possible, see the CDC's Guideline on Extended Use: Source: 6.

• Gloves are still stored in the rooms, make sure to bring a pair into the room with you if needed

Patient Care

• Parents are urged to call prior to their visit (scheduled and drop ins)

• Well Visits

  • All well visits are now at least 20 minutes, but as a compromise the pool patients have returned but schedule starts are staggered to avoid getting backed up.

  • The OAE, tympanometry and Audiometry are all in EPIC and can be ordered on patients, currently not a routine/standing order, and the AAP Bright Futures Recommend screening at 4/5/6 years old

  • Both parents are now allowed at visits

  • The Vaccine Room is still on hold, so please use the BLUE ROOM FLAG and remind MAs of the order

  • Other Tips:

    • Some vaccines that can be done earlier (in case a family wants to limit or are unsure of their visits in the future: Hep B vaccine (okay at the 1 month visit), HIB & PCV (okay at the 12 month visit)

    • Administer (and bill) for Fluoride varnish (if not done in the past 3-6 months), many Dentist Offices have put their well visit checks on hold.  UNLV Dentistry may be opening 5/18/20. Source: 7

    • Always ask about food, medication and supplies security.  Many of our patient families may be struggling during this time.

• Sick Visits

  • Respiratory/Febrile patients (cough, sore throat, fever, body aches, vomiting, diarrhea, rash or shortness of breath), will be seen by an attending (when available, residents if there is no open schedule for attendings) in the first floor exam room.  (this room includes any febrile parent/guardian). Residents will staff with a precepting attending or the attending on tele-medicine.

  • this room will be sanitized thoroughly after each visit

  • Non Respiratory/Febrile sick visits will be seen by anyone on the third floor as usual.

  • Nebulized Treatments must first be approved by an attending.

• Clinic Flow

  • Patient rooms have been re-numbered and rooms now end at 29. Keep in mind that Rooms 27 & 29 do not have sinks, so please plan accordingly. 

  • Carmen does not need the referral printouts unless its urgent - in this case, make sure to make it urgent in EPIC, speak with her, and complete the note asap.

• Orders

  • Make sure to use your attending's name as the ORDERING PROVIDER for vaccines (to avoid any insurance conflicts).  This defaults to  your name so make sure to keep an eye out.

  • Please print all LABS and IMAGING for patients to take home with them AND mark in the chart where they will go.  There has been an issue in EPIC lately.

• Billing

  • Always add numbered modifiers before letter ones

  • To be safe, it is best to add a GC (with direct attending supervision) and GE (with indirect attending supervision) to your billing

  • The 25 Modifier IS NOT required for procedures done by the MA/Nurse, e.g. POC-T, NBS

  • The 25 Modifier IS required for procedures done by physicians, e.g. ASQ, MCHAT, EPDS, Nutrition Counseling

  • Add an SL modifier for a patient who will be utilizing the VFC program for their vaccines (medicaid, self pay)

• Logging Hours

  • Do not change the 4 hour already in place on new-innovations

  • for the Community/Lied and Advocacy/Lied rotations you will have your continuity clinic during a MORNING SESSION.

Additional Activities

• • Residents on clinic "back up" or continuity clinic may be assigned/re-assigned to either the COVID Testing Tent, Call Center, or Test Result Call Back

  • Volunteer Opportunities:

    • Three Square Food Distribution

    • Donate Blood

  • Changes to Outside Services

    • Nevada Early Intervention Services is not meeting in person and calling or using SKYPE for any referred patients. Call (702) 486-7670 for updates - Please fill out and fax the referral form for expedited service.

    • WIC Offices - "Local WIC clinics in your neighborhood continue to conduct business either over the phone and mail or in person through appointments. Please contact your local WIC clinic with questions about nutrition education, benefits, EBT cards, or eligibility. New eligibility continues to be processed by your local WIC agency or clinic. For questions about eligibility, please reach out to the WIC Administrative Office through this link: http://nevadawic.org/contact-us/, email: wicgeneral@health.nv.gov  or call 1-800-8-NEV-WIC. "

    • Outpatient Lab & Radiology Services - Quest (and likely other labs & radiology clinics) prefer scheduled visits - encourage families to set up a lab draw appointment to avoid unnecessary COVID exposure and wait times.  

Sources

1. CDC Guideline to Air-Purifying Respirators 
2. BMJ: A cluster randomised trial of cloth masks compared with medical masks in healthcare workers 
3. Turbulent Gas Clouds and Respiratory Pathogen Emissions Potential Implications for Reducing Transmission of COVID-19 
4. CDC PPE Donning & Doffing Video 
5. CDC PPE Sequence Chart
6. CDC N95 Respirator Reuse Recommendations 
7. American Dental Association Recommendations during the COVID-19 Crisis 
8. CDC Infection Control: Minimizing Chances for Exposure 
9. Medium.com The Masks Masquerade: Incompetence and Errors in Reasoning Around Face Covering