Physician-in-Chief's Message
March 20, 2020
Dear Colleagues,
 
Thank you for your continued dedication to the children and families we treat at UNC Children’s! We have included updates below as well as our approach to NSAID treatment in patients who are positive for the 2019 coronavirus.
 UNC COVID Updates
 Inpatient Care
  • Rule outs continue to come into the Children’s Hospital. To date, no admitted patients undergoing the pediatric COVID rule-out have been COVID-19 positive.
  • Please remember to use the PED COVID ID pager for questions regarding whether or not a patient should be tested. Do NOT use the PED COVID ACUTE pager or contact the Pediatric Admitting Coordinator (PAC) as they will not be able to assist and will refer you to the ID pager.
  • For low risk COVID-19 rule out patients, we are allowing the use of HFNC up to 2 L/kg/min. This can occur on the floor or in PICU.
  • We are standing up new processes for our low-risk rule out patients. In brief, we are going to allow admission to the primary team for our low risk patients. Please see attached process description for details, also on the Peds COVID Clinical Resources site
  • Also, as an FYI, there are 2 new teams created in EPIC for our COVID inpatients: Ped Surge Acute (PSA) and Ped Surge ICU (PSI). 
  • As always, thank you to our teams for their tremendous work in such uncertain times. As we see people stepping up it makes me proud to be a colleague.
Emergency Department
  • Things are stable in the PED.
  • Shout out to the residents who are coming up with streamlined processes to minimize number of times in and out of rooms to save PPE. 
  • Teletriage with iPad on arrival to ED coming soon
  • Continuing to work with inpatient teams to smooth transitions from PED to floor.
Dan Lercher and Dan Park
Upstairs/Downstairs working in harmony to develop & simulate COVID intubation response plan
Pharmacy
As the situation with COVID-19 evolves, the Department of Pharmacy is committed to providing high quality service to our customers and care to our patients. In an effort to do our part to decrease exposure risk, individual teams have made changes to operations and staffing models to allow team members to work remotely. Please review the high level plans below and do not hesitate to reach out with questions or concerns. 
 
... Acute Care Operations and Distribution
  • Ensuring nurses, respiratory therapists, and other healthcare team members have safe access to the right medications continues to be our top priority.
  • At this time, we are not making significant changes to our staffing model and will maintain our onsite presence. 
  • Medications will continue to be available in Pyxis, delivered to the nursing unit, or sent through the tube system.
  • We may make changes to when and how often medications are delivered; however, we will ensure medications are available on time and will communicate more specific changes with local leaders if and when those changes occur.
 
... Acute Care Clinical Services
  • While we will continue to have staff onsite, the acute care teams (Medicine, Surgery, Heart and Vascular, Pediatrics, Hematology/Oncology) are moving to a reduced in-house staffing model. 
  • We will maintain a core group of pharmacists onsite, similar to weekend staffing, to complete responsibilities in-house. This includes emergency response, assisting with patient home medications, and other patient care responsibilities as needed. 
  • All other pharmacists will be working remotely. Patient care activities, which include order verification, documentation, patient profile review, counseling, and other activities as needed will continue but will be handled remotely.
  • Please continue to contact your service pharmacist for patient care related needs before contacting the Pediatric Pharmacy. The most efficient way to contact your service pharmacist, both onsite and working remotely, is via the paging system in WebExchange or Epic Chat

NSAIDs & COVID in Children
Regarding the information / concerns for use of NSAIDS for COVID patients in pediatrics:
  •  The Lancet commentary explains some of the reasoning behind some recommendations AGAINST the use of NSAIDs for COVID patients.
  • There is no quality data to date (beyond some relayed personal experiences and the hypotheses noted above) to give guidance for recommendations (for or against the use of NSAIDs for COVID patients)
  • This may be less relevant in a population that has minimal / mild disease with COVID (most children)
One approach may be to:
  • Suggest the use of acetaminophen over NSAIDs, if possible, for control of fever in children with an acute respiratory infection and/or fever during this time period, but
  • Give the message that use of NSAIDs is acceptable if fever is not sufficiently controlled or the family only has an NSAID at home
  • Recommend anyone on chronic NSAIDs for any disease state to NOT stop their medication
We need to recognize that adults may be given a different recommendation by providers, but the reason is these risks are likely greater in certain individuals at higher risk for complications from this infection


Telehealth
Everything is shifting quickly but the good news is that Epic, Coding and Compliance are moving very fast to keep up. There is a real urgency at the Medical Center to shift as many appointments as possible to later or virtual. Only patients who absolutely need to be seen
in-person now should be coming to visits.
Please review the following for more details.
Key Information on Behalf of Tom Ivester
We have been asked to share this key information with all Faculty, APPs, and Residents.
UNC Health Atypical Provider Deployment Plan
Below is the slide deck presented at yesterday's Chair's meeting regarding plans to c onsider activating reduced staffing for Core Business functions and engaging Departmental Leaders to provide contingency plans, rosters, and action plans.
SOM Emotional Support Services
Here are NEW EMOTIONAL SUPPORT SERVICES including Telehealth and hotline info. Linked above and attached HERE from Dr. Samantha Meltzer-Brody.
Universal Use of Occupational Health
As more and more of our faculty come in contact with infected patients, the universal use of the services of our Occupational Health Office is imperative.
  •  Please encourage your faculty to use the COVID-19 Hotline for employees which will connect them to our professionals who staff the Occupational Health Office. The Occupational Health COVID Hotline is now available 24/7 for UNC Medical Center and University healthcare employees: 984-215-5668
  • Please refrain from circumventing or countermanding the recommendations and directions from our Occupational Health Office. The delays and confusion that result from this interference can be deleterious to our faculty.


Childcare Options
Babbysitting
On Behalf of Julie Byerley -
Dear Clinicians,
We appreciate your service to patients in this time of need. Recognizing that because of daycare and school closures some of you might lack childcare you need, a group of volunteers compiled a list of college age students interested in babysitting .

While we do not know all of these individuals and have not “screened” or credentialed them in any way, we wanted to make this list available to you for your convenience. If you choose to take advantage of contacting someone one the list, please recognize that no one has checked the background, travel history or other COVID-19 risks, or anything else about the individuals who have volunteered in this manner. We are distributing this list simply as a convenience in facilitating connections. You will need to make your own judgments about using this resource and are responsible for any arrangements you make with those on the list you choose to contact. We recommend starting with someone who’s first name starts with the same letter as yours. We don’t want the first person to get all the phone calls simply because they’re at the top. Once you have spoken to the available babysitter, please write your name in the "Resident" column to ensure the babysitter is not contacted multiple times. For any questions, please contact patrick.oshea@unchealth.unc.edu or amanda.sanders@unchealth.unc.edu . 
 
Urgent Childcare Options for Essential Workers
Under the direction of Governor Cooper, the NC Department of Health and Human Services, the NC Department of Public Instruction, the North Carolina Child Care Resource and Referral Network and our partners across the state are working together provide these vital child care options. Please see flyers in English and Spanish below and share with anyone you know who may need this service.
Finally, we had a wonderful match today! It is exciting to see all the new future residents!
 
I continue to be so impressed with the incredible commitment to child health. Next week, we will plan to have a virtual 1 hour faculty and staff update focused on what we know in children who are impacted with COVID-19 as well as our approach to management at UNC Children’s.
 
Please take care of yourself and your family!
 
Gratefully,

Stephanie
Cell: 919-417-3130