April 2020
8 From the Front Lines to the Home
Front, Military Medicine is Always Ready
Who would have imagined this? We’ve stopped almost everything else we were doing and turned our energies toward fighting this pandemic.
10 Possible Changes at MTF
Pharmacies in Response to COVID-19
In response to the current COVID-19 outbreak, military treatment facilities and pharmacies under the Military Health System may need to change or limit access or services available to non-active duty service members, their families, or retired beneficiaries.
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12 Coping with the Stress of Social Distancing
Social distancing recommendations by the Centers for Disease Control and Prevention are now in place across the nation in response to COVID-19. It’s understandable that during this time, people may experience increased anxiety and stress levels as they limit social interactions and spend long stretches of time at home.
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To protect the health of our patients, staff and visitors, as we combat COVID-19, our Visitation Policy has been updated to meet current guidelines, effective March 26, 2020. Thank you for helping us protect the health of our community who we are honored to serve.
Fort Belvoir Community Hospital Command Director Captain Cynthia Judy Chief of Staff Colonel Clinton Schreckhise Command Senior Enlisted Leader
Command Sergeant Major Kristy Cortner
Mission Committed to outstanding patient experience through safe, quality, compassionate care for all we serve.
Vision The premier Community Health System, leading the nation in innovative healthcare and well-being.
Values • • • • • •
Member and Partners Organizational and Personal Learning Patient and Family-Centered Excellence Valuing Workforce Engaged Leadership Stewardship
The Shift Report Staff Editor in Chief
Stephanie Grooms
Editor(s)
Autumn Lombardi and Reese Brown
Digital Art
Stephanie Grooms and Tobias Morelli
Announcements
LaTonya Jackson
“We Lead ... One Team!” The views expressed in this publication do not necessarily reflect the official policy or position of Fort Belvoir Community Hospital, the Defense Health Agency, Department of Defense, or U.S. Government. Discussion of any commercial products within this publication does not create nor imply any Federal/DoD endorsement. Unless otherwise indicated (and except for “by permission” and copyright items), materials may be reprinted provided credit is given to photographer and the author.
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Available Services During COVID-19 Disclaimer: This represents Fort Belvoir Community Hospital's current plan for delivering services as of April 8, 2020. As conditions and circumstances change this list may also be updated. During this time of national emergency, Fort Belvoir Community Hospital is committed to providing timely access to medical care for those who need it the most, while protecting patients and staff from unintended illnesses resulting from exposure to others. To ensure Belvoir Hospital's healthcare professionals are poised to support an increased need for acute patient care and minimize risk to all, certain services and programs have been delayed/reduced or provided through telehealth options at this time. Please see the following list for all affected areas. We will update this list as the situation evolves, so please keep an eye out for additional changes.
• Department of Anesthesia • Audiology Service • Department of Behavioral Health • Chapel Services • Dental Services • Elective Surgeries and Routine Procedures • Family Medicine and Internal Medicine • Hematology/Oncology • Joint Medical Readiness Center (JMRC) • Nutrition Services and Dining • Occupational Health Clinic • Optometry Service • Department of Orthopedics • Department of Pathology
Please visit https://bit. ly/3aTUxE7 to view important information regarding the operations of the various clinics/services listed below.
• Department of Pediatrics • Department of Pharmacy • Public Health Nursing • Department of Radiology • Red Cross • Release of Information • Sleep Studies • Sports Medicine
• Allergy • Cardiology • Dermatology • Endocrine • Gastroenterology • Infectious Disease • Neurology • Pulmonary • Rheumatology 4
If you think you have COVID-19, please stay home and take care of yourself, avoiding contact with others as much as possible. If you have questions or symptoms you would like to discuss with a healthcare professional, call the 24/7 Nurse Advice Line (NAL) at 1-800-TRICARE (874-2273), select option 1, then option 2, visit MHSNurseAdviceLine.com for a web or video chat, or send a secure message through the TOL Secure Messaging function. Beneficiaries also can call the Integrated Referral and Management Appointing Center (IRMAC) at 855-227-6331, which can offer inperson appointments or even virtual appointments from their home.
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Patient Parking Guidance In an effort to protect our patients, staff, and visitors as we combat #COVID19, we continue to implement many necessary precautions to protect our forces and their families while safeguarding our healthcare mission capabilities during the current global outbreak All patient and visitor parking has been limited to the front surface parking lot, and the hospital entrance of the Oaks Pavilion will serve as the primary entry point into the facility. Continued patient questionnaire screening for COVID-19 symptoms will take place at this entry point. Thank you for your patience and for being so understanding with this extra layer of precaution. These efforts are being made to streamline the entry points into the hospital, and to further improve the screening and protection of our staff members and beneficiaries.
E Main Patient Entrance
Staff Garage
Staff Entrance
Patient Parking
Entrance CLOSED
Garage CLOSED
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The Shift Report
Be reminded, This is a marathon, not a sprint. Keep The Faith! Believe in it, rest in it, breathe it in and walk it out. We are praying over you and ARE so thankful for your sacred work! -Pastoral Services Fort Belvoir Community Hospital
“Whoever dwells in the shelter of the Most High will rest in the shadow of the Almighty. I will say of the Lord, “He is my refuge and my fortress, my God, in whom I trust.” - Psalms 91:1-2 6
April 2020
Although sanitizer is good, soap & water is best!
CLEAN HANDS SAVE LIVES! 01358-03-02-2020-Handwashing_Flyer
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From the Front Lines to the Home Front, Military Medicine is Always Ready By: Lt. Gen. Ron Place, Director, Defense Health Agency
Defense Health Agency director, Army Lt. Gen. Ron Place, visited medical personnel at a COVID-19 screening station outside the Emergency Department at Walter Reed National Military Medical Center on Tuesday, March 31, 2020. (MHS photo by Navy Lt. Cmdr. Andrew Benson)
Who would have imagined this? We’ve stopped almost everything else we were doing and turned our energies toward fighting this pandemic. As the specific impacts take shape within the United States, the Military Health System is surging forward, implementing standing plans and showing agility in responding to events that some believed were unthinkable even a few short months ago. Federal and state officials are requesting military medical forces to assist in stemming the spread of infection both directly and indirectly. Hundreds of thousands of professionals who are supported by the relatively young Defense Health Agency are reinforcing our civilian medical capabilities. Just as we’ve done throughout our history, when the U.S. military is called in times of crisis and natural disaster, we answer. Military medicine is providing assistance in unprecedented ways. Already, two hospital ships, the USNS Mercy and the USNS Comfort, are positioned in Los Angeles and New York City, respectively, providing much needed additional medical capability 8
to civilian medical facilities overwhelmed with COVID-19 patients. The Army has also established field hospitals in New York and is increasing bed space elsewhere with the phenomenal work of the U.S. Army Corps of Engineers. It’s the right thing to do, right now. In the best of times, the primary mission of the Military Health System is to maintain a medically ready force and a ready medical force. This means we must ensure American Soldiers, Sailors, Airmen, Marines, and Coast Guardsmen are medically ready to deploy anywhere, anytime to defend the Nation. It also means we must develop and sustain our own medical teams to be trained and ready to support the force. Shifting focus from this primary mission carries risk; however, after two decades of conflict, we are well prepared to both identify risk and develop strategies to mitigate it. This is not theoretical. We’re taking actions with tangible effects. For instance, we are rapidly shifting as many physicians, nurses, and other medical professionals as we can from administrative duties to direct patient care. We’re plowing new ground by graduating new doctors and nurses months early from the Uniformed Services University of the Health Sciences, the military’s medical school, so they can join the fight – now. In our military hospitals and clinics, we’ve limited elective medical and dental procedures, so we can decrease surgical inpatient needs, shift clinical staffing toward COVID response, and conserve medical resources for the COVID fight. Additionally, we’re identifying patient bed space on military installations and planning how to quickly convert – or return to use – unused space, with all of the needed equipment and supplies. That means, in some cases, converting office space once used as patient rooms when our military was twice the size, back to treatment areas. Fighting this pandemic is all-hands-on-deck. No good idea is off the table. The reassuring news is that the Military Health System is, in some ways, uniquely suited for this crisis. Just as every Marine is a rifleman, every medical provider in our system is a generalist. While
April 2020 many of our health care providers normally do focus on specific diseases or specialties, they are trained to treat patients across the range of needs wherever they’re called to serve. Agility is part of what we offer our nation every day. Facing multiple challenges is nothing new for us. Together, across the levels of government, we can do this. At this extraordinary time, we can play a significant part in caring for citizens in need, while still ensuring our military forces are medically ready to defend our Nation. With the support of the 9.5 million beneficiaries who depend on us for their health care, our agile and dedicated Defense health team is surging thousands of service members to the front lines, helping our fellow Americans, and meeting our obligation to the nation’s sons and daughters who have volunteered to defend them.
TRICARE Extends Temporary Telehealth Support for Applied Behavior Analysis Services By: TRICARE.mil
TRICARE is taking new steps to support family members in the Autism Care Demonstration (ACD). From March 31 to May 31, TRICARE will temporarily cover telehealth support for applied behavior analysis (ABA) parent or caregiver guidance services. This is to help support ACD beneficiaries during social distancing and the COVID-19 response. Are you a parent or caregiver of a child diagnosed with autism? Is your child enrolled in ACD? If so, then you can get remote, unlimited ABA parent or caregiver support guidance services at home. Your child doesn’t need to be present. A TRICAREauthorized, board certified behavior analyst or assistant behavior analyst must provide the services. TRICARE also covers other telehealth services for children with autism when clinically indicated.
This may include: • • • •
Physical therapy. Occupational therapy. Speech and language therapy. Most medical care and psychotherapy.
Through secure, two-way video conferencing, ABA providers can: • • •
Teach parents or caregivers ABA techniques. Practice skills with other family members. Review parent or caregiver goals.
“TRICARE wants to give families receiving ABA services additional support during this challenging time,” said Dr. Krystyna Bienia, a clinical psychologist and senior policy analyst at the Defense Health Agency. “We hope this provision will help to reduce stress on parents and help them help their children until regular, in-person services resume.” Ask your TRICARE-authorized provider if they offer telehealth services. Not all providers offer these services. Telehealth services, including ABA parent or caregiver support, aren’t appropriate for all children. Your provider can help you decide if this support is right for your child’s needs. Your provider must use CPT Code 97156, “Family Adaptive Behavior Treatment Guidance.” The provider must submit the claim with the GT modifier. To connect with your provider, you’ll need an audio and video-enabled computer, tablet, or smartphone. Telehealth services don’t include: • • •
Audio-only conferencing. Phone calls. Texting.
Learn more about TRICARE and COVID-19. Stay safe and take command of your health.
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Possible Changes at MTF Pharmacies in Response to COVID-19 By: Military Health System Communications Office
pharmacies in the event that military pharmacy services are temporarily disrupted.” Careful local assessments will determine the status of each individual military pharmacy and may result in temporary measures to adapt to this changing situation. In extreme cases, there may be temporary, partial, or full limitations of military MTF pharmacy services. These will be temporary solutions that will be assessed daily. In the case of a local outbreak or a confirmed case of COVID-19 at military MTF pharmacy, MTF commanders are authorized to limit pharmacy services as necessary. This may include: •
Air Force Staff Sgt. Montea Armstrong, 17th Medical Group pharmacy technician, fills a prescription at the Ross Clinic’s pharmacy on Goodfellow Air Force Base, Texas, March 23, 2020. The 17th MDG activated a drive-in pharmacy to minimize personnel in the clinics and medical staff delivered prescriptions to the patients outside the clinic in their cars. (U.S. Air Force Photo by Airman 1st Class Abbey Rieves)
In response to the current COVID-19 outbreak, military treatment facilities and pharmacies under the Military Health System may need to change or limit access or services available to non-active duty service members, their families, or retired beneficiaries. Military commanders of MTFs will make local determination of which services may be limited, but those decisions will be based on ensuring the health, safety, and security of patients, staff, and beneficiaries. “The health and protection of our patients, health care teammates, and the community is essential as we preserve the fighting force,” said Col Markus Gmehlin, Defense Health Agency Pharmacy Operations Division (POD) acting chief. “We are taking necessary steps to ensure that our teams who are caring for patients and delivering critical medications do so in a safe environment. This may mean temporary limitations to military pharmacy services. We are committed to ensuring that you have access to your prescriptions via home delivery and/or retail network 10
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Alternative pickup options (staggered pickup times, curbside pickup, etc.). The temporary transfer of non-enrolled, non-active duty service members (ADSMs) and/or non-active duty family members to home delivery or retail. The temporary closure of a military pharmacy.
MTF commanders will make a case-by-case determination based on the severity of the spread of COVID-19 at a specific location. If pharmacy services are limited, they will be assessed and reopened as soon as it is safe for personnel and beneficiaries. TRICARE beneficiaries have several options available to ensure continued access to needed medications. TRICARE pharmacy home delivery allows beneficiaries to order up to a 90-day supply of most medications safely and conveniently, with delivery to their home addresses in the U.S. or an APO/FPO address. (Please note that quantity limits apply; laws for mailing certain medications such as controlled substances vary state-by-state; home delivery is not available in Germany; and co-pays apply for non-active duty beneficiaries). To switch to home delivery, the easiest way to transfer your prescription is via the Express Scripts
April 2020 mobile app or online at the TRICARE website. Beneficiaries who need prescriptions urgently can access up to three, 30-day supplies of medications at retail network pharmacies. Copays will apply. Copayments are directed by statute and DoD cannot waive them. Beneficiaries with an active prescription on file at a military pharmacy can ask their retail pharmacist to contact the military pharmacy to make a transfer. In the event the transfer cannot be coordinated, beneficiaries may need to call their prescriber to obtain a prescription that they can take to their pharmacy of choice. For beneficiaries needing to refill their prescriptions, patrons are reminded that standard refill policies
apply. Please wait until only 25% of the prescription remains before submitting a request to refill a prescription. Beneficiaries with questions or concerns should contact ExpressScripts, where pharmacists are available 24/7 to answer questions, offer counseling and support, and assist with prescription orders. Call ExpressScripts at 877-363-1303.
TRICARE beneficiaries can also call their local MTF pharmacy. Visit the TRICARE website to find a pharmacy’s phone number. To find a retail network pharmacy, visit the ExpressScripts website.
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The Shift Report
Coping with the Stress of Social Distancing By: Military Health System Communications Office
such as the CDC and World Health Organization, which often serve as the primary source for media outlets. Sign up for emergency alerts through local governments. • Use technology to connect with others: Talking with loved ones while in isolation can help reduce levels of anxiety and boredom. In today’s digital age, there are a variety of ways to stay in contact with people, including phone, email, text, and social media. Video calling platforms allow face-to-face interactions from the comfort of your home. Playing online games with friends and family can also offer an engaging way to feel connected.
Service members and their families will quarantine at Fort Knox if they come into contact with a person potentially infected with COVID-19. (U.S. Army photo by Eric Pilgrim)
Social distancing recommendations by the Centers for Disease Control and Prevention are now in place across the nation in response to COVID-19. It’s understandable that during this time, people may experience increased anxiety and stress levels as they limit social interactions and spend long stretches of time at home. The Substance Abuse and Mental Health Services Administration or SAMHSA recently issued a tip sheet with advice and resources to support behavioral health during periods of social distancing or quarantine that result from a disease outbreak. Ways to Cope • Limit COVID-19 media consumption: Avoid 24/7 watching of news programming for updates on COVID-19 because it may lead to increased anxiety. • Find credible news sources: Constant media reporting during a public health crisis may create impressions of increased risk and danger to people. Look to credible sources issuing guidelines and recommendations, 12
• Practice self-care: Physical health can play a role in mental health. Take time to relax by stretching, practicing deep-breathing exercises, or meditating. Enjoy fun activities. Keep a journal listing the positive things in life. Anxiety and fear over personal health or the health of loved ones are typical reactions to a global pandemic. Other feelings can include anger, frustration, and boredom over the uncertainty of when life will return to “normal.” Be aware that in situations of high stress and loneliness, some people may experience symptoms of depression or posttraumatic stress disorder. Anyone experiencing a concerning or significant level of anxiety or stress, or if any of these symptoms last for two or more weeks, should call a health care provider or behavioral health professional. For more information, including a helpful list of resources and hotlines, refer to SAHMSA’s four-page publication: Tips for Social Distancing, Quarantine, and Isolation During an Infectious Disease Outbreak.
April 2020
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Stay strong...
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...we're in this together!
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Website: tricare.mil/mtf/belvoirhospital Facebook: facebook.com/belvoirhospital Twitter: @belvoirhospital Instagram: instgram.com/belvoirhospital Flickr: flickr.com/photos/belvoirhospital LinkedIn: linkedin.com/company/fort-belvoir-community-hospital YouTube: youtube.com/channel/UCOSpkMriE4R9Kc1JVqXdDzQ
9300 DeWitt Loop Fort Belvoir, VA 22060 Information: (571) 231-FBCH (3224) TTY: (571) 231-1799 Appointments: (855) 227-6331
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