By Lin Grensing-Pophal, contributor
January 17, 2013 - The increase in seasonal flu cases this year has had an impact on many--not the least of whom are the nurses who are caring for affected patients. Penny Conner, RN, BSN, and Janet McGruder, RN, MBA, nurse consultants for the immunization office of the Georgia Department of Public Health, note that an increase in patient load impacts nurses’ practices due to more time spent assessing, educating and documenting patient visits.
They urge nurses to take a proactive approach in order to get through this busy time.
Creative approaches to stem the tide
The unexpected increase in flu activity this season has caught many health care providers off guard. So how are they coping? Many organizations are living by the adage that necessity is the mother of invention, and working with their staff to develop innovative approaches that can meet demand. At Lehigh Valley Hospital-Cedar Crest in Allentown, Penn., for instance, a mobile “surge tent” is being used to treat patients with flu-like symptoms; this is helping the staff to treat the additional patients, while keeping them away from others to avoid spreading the virus.
Overlook Medical Center in Summit, N.J., is one of the first hospitals in the state to install a hand hygiene scanning device. Currently in the pilot phase, the hospital is using the scanner to monitor for hand washing compliance for those entering and exiting patient rooms. “This new system has increased our compliance and will be phased onto all units,” said Janina Hecht, a spokesperson for Overlook Medical Center.
And, because influenza is spread by people interacting with other people, Children’s Healthcare of Atlanta (CHOA) has taken steps to minimize the need for patients to come to the facility to seek care; they have created a flu protocol tool--available online and via a flu hotline--that walks patients and parents through a series of questions designed to provide a recommendation about whether it’s time to see a physician or not. If a physician visit is not indicated, it includes information on how to treat symptoms at home.
An important step in addressing the upsurge in influenza, stresses Renee Watson, RN, CIC, an epidemiologist at Children’s Healthcare of Atlanta (CHOA), is prevention. “In order for us to be able to continue taking care of patients, we have to remain well ourselves,” she said. At Children’s that means requiring all staff, without contraindications, to be vaccinated against influenza.
A next step is making sure that the impact of people coming in to access care, who may have the flu or some other respiratory illness, do not impact others. To address this, she explained, Children’s has respiratory hygiene stations stocked with alcohol hand sanitizers, tissues, masks for both adults and children, and a poster to remind people to cover their coughs.
While Children’s is proud of its family-centered care environment, during flu season, the facility modifies its visiting rules--starting on October 1--and visitors under the age of 12 are not allowed in critical care or other high-risk areas of the hospital. Pop-up wipes are prominent throughout the facility, and disinfectant wipes are located strategically around the organization. These are especially useful to wipe down the wagons that are used to transport children around the hospital.
Ongoing education and awareness
Barb Dehn, RN, MS, NP, a nurse practitioner and health expert in the San Francisco Bay Area, known to the local TV audience as “Nurse Barb,” reported that she is seeing many cases of various kinds of flu this season--“from patients with severe GI upset that quickly leads to dehydration, to the persistent cough, achy joints and the ‘I’ve been run over by a truck’ feeling. People are miserable.”
Nurses, she notes, are often on the front lines when it comes to addressing issues like the uptick in flu cases this season. “Many nurses and nurse practitioners work in urgent care settings and pharmacy-based walk-in clinics. Not only have these professionals been on the forefront of encouraging flu vaccines, they’re also seeing many people who would normally be walking into emergency rooms,” she said.
Importantly, she added, nurses know when and how to leave emergency slots open for those who need to be seen urgently. “We also provide a lot of telephone triage and advice, since most people should stay at home and recover there.”
Dehn offers the following tips for nurses, and their health care organizations, hoping to have a positive impact for patients this season:
- Have information available to patients through pre-printed handouts
- Direct people to credible online sites for information on how to manage symptoms
- Make sure waiting room signs are be posted with large print so they are easy to read--and translated for those who speak other languages
- Have a supply of masks and alcohol-based hand sanitizer in waiting rooms
- Consider cordoning off areas for people who are at risk from the flu
- Continually remind people of best practices: hand washing, getting the flu vaccine and encouraging others to get the flu vaccine
Watson agrees that awareness and education are important. Her advice generally covers four key points:
- Get vaccinated against the flu;
- Be vigilant about hand hygiene;
- Cover your cough; and,
- If you’re not feeling well, stay at home!
Tracking the worst flu outbreaks
Conner and McGruder report that some of the worst influenza outbreaks so far in 2013 have occurred in school settings and long-term care facilities, and certain areas of the country have been hit harder than others.
According to the Centers for Disease Control and Prevention’s (CDC’s) FluView Report for the week between December 30, 2012 and January 5, 2013:
- Twenty-four states and New York City are now reporting high influenza-like illness (ILI) activity; these states include: Alabama, Colorado, Delaware, Georgia, Illinois, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, New Jersey, New Mexico, North Carolina, North Dakota, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, and West Virginia. Sixteen additional states are reporting moderate levels of ILI activity, up from 9 states in the prior week.
- Forty-seven states reported widespread geographic influenza activity for the week ending January 5, 2013, up from 41 states in the previous week. Geographic Spread data are based on assessments made by each state health department and show how many areas within a state or territory are seeing flu activity. The assessments made by each state health department are based on the detection of outbreaks of flu, increases in the percent of people visiting the doctor with flu-like symptoms, and patients with laboratory-confirmed influenza.
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