Lessons learned through a COVID-19 nursing home outbreak

Wendy Dunn is one of the 60 nurse practitioners (NP) working in Ontario’s nursing homes as an Attending NP. Some of the readers will recall this is a role RNAO negotiated with government years ago and one we insist must expand to each nursing home in Ontario. As I spoke with Premier Ford early this afternoon, a lot needs to happen in nursing homes post-COVID-19 and the premier reinforced to me again that RNAO must and will be involved. Be assured that RNAO will insist on this.   

For now, let me share about Wendy’s work during the pandemic at two long-term care homes, Greenwood Court, Stratford, and Knollcrest Lodge, Milverton. Wendy shared with us her experiences at RNAO’s weekly webinar with NPs on the management of an outbreak at Greenwood Court. She has kindly put together some of the lessons learned through this challenging experience: 

• Teamwork – This is the one time when all must be flexible with routines and roles and must respect the high levels of anxiety that everyone is carrying.
• Communication – We have provided families or the resident’s assigned power of attorney with a “daily update” of what is happening within the Home, specifically commenting on swabbing (of both residents and staff) and our PPE supply. Kept track of frequently asked questions and addressed them for the whole group. Our Executive Director sends out her “One Call” daily. We share all the good news that are happening within the walls as the community support has been overwhelming. These updates are also shared with staff.
• I also recommend making one or two people the communicators for the families – our home is small so I have been that person; in a bigger home you would likely need more. Then the message is consistent and trustworthy for families.
• Staffing – We have been surprised by the number of staff who have not filled their shifts because of multiple issues. These include childcare, their own health issues, or issues within their family (children, spouse) that increase their risk of acquiring COVID-19. This could be other family members who will lose their job, or not be able to go to their work, if they were to have a positive COVID-19 swab or other respiratory symptoms. Staff in health care need to have a plan for how they are going to come to work and keep their families/home safe before an outbreak is declared. Would encourage employees to speak with their employers about this so there are no surprises.
• Do not let your guard down – Continue to don and doff PPE as if it is the first time; do not have staff come to work if they are symptomatic (even if it will cause chaos with staffing…); be on the watch for changes/new symptoms with residents. We made the decision to swab our residents who were positive and symptom free and past the 14 day isolation requirement and found they were still positive… reinforces the need to do that. We will be swabbing again.
• Need to remember that “we can do this” – LTC homes are very good at managing outbreaks. Draw on your past successes and do it even better!

RNAO: Thank you Wendy for sharing your expertise. We learn that there haven’t been any additional confirmed cases among Greenwood residents for two weeks. Huron Perth medical officer of health Dr. Miriam Klassen said on Thursday afternoon: “What we’re surmising is, because the staff have been using universal masking and more aggressive isolation and personal protective equipment and cleaning, etc., cases haven’t been transmitted to the residents,”. You can see and hear Wendy sharing her experience in a panel on Health Care Stories from the Front Lines here.