INDEX

COVID-19

Table of Contents:

• Evaluation & Management

• COVID Testing

• Code Blue Protocols

• PPE, Donning & Doffing

• Discharge & Follow-Up

• Vaccinations

• Monoclonal Antibodies

Cross References:

• Admissions

• Telemedicine

• Psych

• Sick Call

Due to the ever-changing situation with COVID19, updating this page with all the latest hospital-wide information is not practical. There is a specific regularly-updated UAB One page dedicated to hospital-wide information.

Admissions:

• Patients with a primary diagnosis of COVID should be admitted to a general medicine service (Hospitalist/TH) or the MICU based on severity of illness.

• Patients with a different primary diagnosis who happen to also be COVID+ will go to the most appropriate service for the primary diagnosis.

• We are testing symptomatic patients being discharged. For these patients, order the antigen test. If the test is preliminary negative, a reflex PCR test will be ordered and swabbed. The patient should not wait for the result. They will be called with results.

• All admissions should have a COVID-19 test ordered. Please follow the flowchart below to determine the type of test.

• PCR/RNA Test

  • Cepheid - aka. “STAT” - TAT: 60-90 minutes (Level 1 OR, IR, or ICU)

  • Panther - aka. “ASAP” - TAT: 3-4 hours

  • COBAS - aka. “ROUTINE” - TAT: 6-8 hours

• Antigen Test

  • Sophia - aka. “RAPID” - TAT: 30-45 minutes

Urgent Follow-Up Pathway & Home Pulse Ox

• For moderate PUI/COVID-like illness (eg. O2 sats 91-95%), an expedited follow-up pathway is available.

• This is a telemedicine appointment setup through UAB Family Medicine.

• Order the “Post ED Follow-Up” order found on the ED Quick Orders page. This will send a message to a scheduler to contact the patient and setup an appointment within 24-48 hours and possible outpatient COVID test.

• We may have a limited supply of home pulse ox finger monitors to give to these patients if they don’t already own one. Ask the charge nurse for one and include the COVID Home Pulse Ox patient education in the Depart.

Discharge Prescription for Paxlovid (as of 01/10/2022)

• Be sure to enquire about contraindications (HIV on active therapy, severe CKD)

• Be sure to check against FDA EUA severe drug/drug interactions (Checker)

• Be sure to dose according to renal function

• Be sure to counsel patients regarding EUA (not FDA approved)

• Not approved for PrEP or PEP, not approved for admitted patients

• Use only for symptoms less than 5 days.

• Counsel patients it may be very hard to find: Allocations in Alabama are through Walmart pharmacies to maximize equity of distribution. (Store locator)

Discharging with Home Oxygen

• A select patient population may qualify to be discharged with home oxygen in effort to reduce unnecessary admissions during high surge conditions.

  • Must have confirmed COVID19 positive test

  • Must have limited or no co-morbitities

  • Must have documented O2 sat of less than 88%

  • Must have O2 sat above 93% on 2LNC

  • Must have good social support

• Process for Providers:

  • Consult social work and request that they place a home O2 order, which you will electronically sign.

  • Include “Home Oxygen Use, Adult” in the depart as well as the standard COVID19 discharge paperwork.

  • Order the specific “Post ED Follow-Up” order on the ED Quick Orders page, which as “High Priority Home O2 COVID patient” detailed.

• Patient undergoing this process will have both 24-hr telemedicine follow-up, daily RN care transition calls, and a 3-5 day COVID clinic follow-up.

• Steroids may be considered in these patients. The recommendation, if there is no contraindication, is dexamethasone 6 mg daily for 10 days.

UAB Post-COVID Treatment Program

• There is a clinic follow-up option for patients experiencing COVID symptoms for 3-4 weeks after being diagnosed with COVID19.

• The information for this clinic is available in the Depart patient education under the name “COVID - UAB Medicine Post COVID Treatment Program”

Vaccinations are available for ED patients during limited time frames. Discuss with the charge RN if you have a patient interested in receiving their initial vaccine dose.

Monoclonal antibody therapy is currently available at GED for patients that quality. Please see the attachment below for treatment criteria.

KEYWORDS: coronavirus