Page 136 - COVID-19 Inpatient Training Resources

Inpatient Suspected COVID-19 (PUI) precaution discontinuation at St. Joseph’s and St. Michael’s
Last updated June 8, 2020 by IPAC

What’s changing?
IPAC, in collaboration with the clinical team/MRP, is now reassessing all PUI patients where lab results
are still outstanding/pending to determine in advance whether precautions can or cannot be removed if
a negative result is received.

If they are able to make a decision, they will enter a note in the comments section of the precautions
order in the EHR that says “If COVID(-) and afebrile, can d/c as per IPAC and MRP.”

IPAC proactively assessing and providing instruction on patients charts will allow unit nursing staff to
make decisions in real time and avoid having to contact IPAC and the MRP for each negative result as it
arrives.

What this means for you
If you are caring for a PUI patient and you receive a negative test result, review the comments section of
the precautions order on the electronic chart to see if IPAC order comments are present to support
discontinuation of precautions.

If the precaution order has the comment “If COVID(-) and afebrile, can d/c as per IPAC and MRP,” use
the following protocol to determine if precautions can be removed:
□ Review the patient’s chart to confirm that the patient has remained afebrile and has not
deteriorated clinically with respect to COVID-19 symptoms.
 Once you are able to confirm the above, precautions can be discontinued without further
consultation with IPAC.

If there are no IPAC order comments in the patient’s chart, use the following protocol to determine if
precautions can be removed:
□ Review the patient’s chart to confirm that the patient has remained afebrile and has not
deteriorated clinically with respect to COVID-19 symptoms.
□ Confirm that there are no additional isolation orders or infectious symptoms that would prevent
discontinuation of precautions
□ Confirm that the MRP is not still considering as COVID-19 and planning to repeat COVID-19
testing
□ Once you are able to confirm the above, you can contact IPAC and provide them with the above
information when you consult with them
 In an effort to minimize disruptions to IPAC and physicians afterhours, please make
every effort to consult prior to 10pm.

Broad impact at Unity Health
We are always looking for ways to streamline and decrease the amount of time patients remain in
precautions when they aren’t required. We are also aware that the availability of private isolation rooms
is a barrier to flowing patients out of the Emergency Department to inpatient beds. IPAC proactively
assessing and providing instruction on patients charts will also allow unit nursing staff to make decisions
in real time and avoid having to contact them after hours. In addition, reducing delays in providing
patients with their results and discontinuing their precautions will help reduce anxiety for patients and
families.