UWMC Nurses Lead the Way in Global COVID-19 Pandemic Care

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• The nursing leader’s evolving role in a rapid telemedicine rollout during the COVID-19 outbreak
• Five Hundred Twenty-Five Thousand Six Hundred Minutes
• Containment of COVID in an Adult Psychiatric Unit
• Nursing Communication at an All-Time High During the Pandemic

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The Nursing Leader’s Evolving Role in a Rapid Telemedicine Rollout During the COVID-19 Outbreak

In Ambulatory, as in all areas of healthcare, the COVID-19 pandemic changed our world. The arrival of COVID forced us to reprioritize, moving certain projects along faster than others. Many of these changes will continue to be a part of ambulatory care going forward. One example is telemedicine.

Prior to COVID, telemedicine had been in use in about 40 clinics throughout the system. As of April 2020, it was used in about 180 clinics. Primary Care had been planning to implement an increased use of telemedicine in pilot phases; however, the pandemic required that we ramp up those planned implementations and include all clinical settings that had willing participants.

One such clinical setting was Dermatology. Our initial challenge was to decide which patients could be safely seen and cared for in a telemedicine visit. The Clinic Nurse Manager and the Clinic Medical Director, with input from their teams, engaged in a collaborative approach toward developing selection criteria. We settled on patients already established on Accutane (isotretinoin), those with new rosacea, those with new acne, and some patients needing follow-up after treatment.

Some of our initial challenges in ensuring that patients would receive the care they required were related to whether patients could be seen well enough in a remote setting (especially since we cannot control the quality of the camera the patient would use).

Initially, all staff at UW Medicine were given their own active Zoom Pro account that was later changed to a Protected Health Information account. Staff were provided with Zoom training materials, and, from there, we worked with the Patient Service Specialist staff and providers to develop appropriate visit lengths and templates for the providers.

The Contact Center was instrumental in communicating the type of appointment a patient was going to have by sending them a confirmation email with connection instructions.

The Information Technology teams worked very hard on embedding the telemedicine visits with an active Zoom Protected Health Information link for these visits, ensuring quick access for the patient within the electronic health record. Their assistance in the process was invaluable.

Everyone experienced challenges during this initial period of adjustment. The Medical Assistants and RN staff learned how to engage with patients prior to the provider logging on, which formed part of the rooming portion of the visit. This initial stage of greeting and orienting the patient, then instructing the patient how to use Zoom and MyChart was critical in shaping patient experience during those first several months of the pandemic.

Of course, the specific type of clinic can determine how many telemedicine visits can be done remotely. Between February and May 2020, the number of telemedicine visits conducted at UWMC Roosevelt increased nearly 200%. However, only 8% of current Dermatology clinic visits at UWMC are performed via telemedicine.

Telemedicine will continue to be important to our patients at UWMC. It allows remote access to our specialized areas of medicine and remote monitoring of patients, some of whom may be too sick or financially unable to travel. Telemedicine improves the scope of healthcare for rural areas and is helpful for those with mobility issues when clinically appropriate.

For us, telemedicine reduces cancellation and no-show rates, reduces appointment duration, and increases overall access, allowing us to reach more patients. We also use telemedicine for e-consults, helping us build our referral network.

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Five Hundred Twenty-Five Thousand Six Hundred Minutes
Kim Jackson, Nurse Manager – ICU Float Pool, STAT RNs, & VAT

Five hundred twenty-five thousand six hundred minutes.

For readers familiar with the Broadway rock musical Rent, you’re halfway to “seasons of love” already. (Go ahead – sing it out!)

For readers unfamiliar with Rent, here’s the scoop on the integer – five hundred twenty-five thousand minutes is the number of minutes contained in one year. In 2020, The Year of the Nurse as ordained by the World Health Organization, my sense is that you probably recall a few more minutes than in years past. Which ones do you recall? And what do you remember about the beginning?

Having worked at UWMC since 2003 as a new grad on 5E coupled with nearly as many years in STAT Nursing, I can veritably say there has never been a time at UWMC Montlake like 2020-‘21. I sure hope it is the event of a lifetime, for us all.

As I think back, the beginning is already a stretch. Seventeen months – a lifetime in its own right. I am grateful to be in this present moment. My memories of 2020 are nearly exclusively of the hospital and people working in it. It is difficult to reflect without acknowledging the spectrum of lived experience – no part was all bad, certainly no part was all good, and the impacts were not equal. My reflections rise from what I learned and what I aim to carry forward.

Never have I witnessed a more dedicated response and commitment to each other’s well-being. This, above all, was my experience – a single collective and unifying purpose from person to person and department to department that transcended all other priorities. This purpose expanded across UW Medicine in a way only a pandemic could force. We, in the midst of expansive unknowns, personal fears, family priorities, and relentless change, collectively dug in – with each other. For each other.

We collectively surmounted:

• New protocols and procedures, daily
• Getting each other safely in and out of isolation
• Maintaining a safe PPE supply despite resource constraints
• Social distancing
• Universal masking
• Zoom
• New testing and screening for patients and for ourselves
• Safely transporting and completing procedures for isolation patients
• Caring for patients with a disease we knew very little about
• Not being able to share food and beverages and not being able to say goodbye as we would want
• No hugs
• Hot zones
• Altered care teams & on-site resources
• Communicating and connecting with loved ones despite visitation restrictions
• Visitation restrictions
• Preparing for a census surge, developing alternate care models
• A new vaccine
• Being diagnosed with COVID-19 ourselves

UWMC’s mission statement declares that we “improve health by providing exceptional patient and family centered care in an environment of education and innovation.” Never have we been such a collective force in meeting our mission.

It is difficult to reflect on what we’ve come through as a medical community without additionally acknowledging what we have surmounted outside our hospital doors – social and political upheaval, racial injustice, deeply dividing viewpoints and actions within our own families. There is no doubt each of us has walked a unique path through this troubled time. What binds us is that we have walked it together.

If you haven’t already, take a few of those five hundred twenty-five thousand six hundred minutes to reflect on recent minutes now behind you. It could be a somber reflection, hopefully cathartic, likely healing. Consider jotting some notes, and when the time is right for you, please share your stories – with each other, with your families, with strangers. Your work and perseverance, part of a collective whole here at UWMC, has had tremendous impact. Know that your courage comes not only in the form of saving ill lives, but in sharing your humanity.

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Containment of COVID in an Adult Psychiatric Unit

In March of 2020, the Geropsychiatric Unit (now Adult Psychiatric Unit) on our Northwest Campus faced an outbreak of COVID; nine patients and seven staff members were infected. Immediately, a team of nurse leaders came together with multidisciplinary partners to mount a quick and effective response. The staff were quarantined at home, and the patients were placed under special droplet/contact precautions.

The team continued by employing several strategies to contain the outbreak:

• Patients were placed into cohorts and tested for COVID regularly until they cleared.
• Safe PPE practices were taught to all staff, and trained observers were stationed to safeguard patients and staff alike.
• Outside visitation was limited.
• Care was provided in a Hot Zone.

This team managed to avoid any additional patients becoming COVID-positive, and only one staff person became infected. However, the environment was stressful because the patient population had severe behavioral challenges and frontline staff were initially scared and unsure of their safety.

In the end, the team was successful, and published their story in the Journal for American Psychiatric Nursing in January of 2021. The authors are: Cheri Constantino-Shor, MSN, RN, CMSRN, CRNI, Behavioral Health CNS; Golo Rani, MN, RN, Nurse Manager; Svaya Olin, RN CIC, Infection Prevention Program Manager; and Keri Nasenbeny, Associate Chief Nursing Officer.

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