June 2020
8 COVID-19: "The Art of Preparation"
Team members of the Belvoir Hospital's 7 Medical/Telemetry Unit prepare for the start of a new day on April 20, 2020.
10 DoD Launches Effort to Collect
COVID-19 Convalescent Plasma
Patients who have recovered from COVID-19 may hold treatment in their veins that could help others who are critically ill with the respiratory infection.
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14 DoD Experts Address COVID-19 Effects on Mental Health
The COVID-19 pandemic has changed how people live, interact, and cope with new stressors. However, military psychological health experts emphasize making small changes to address problems early can have a big impact.
17 'Home Sweet Home' Leaves a Sour Taste for Some Quarantine-Weary
As physical distancing continues in efforts to avoid the spread of COVID-19, the old saying "there's no place like home" might be sounding bittersweet.
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)
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 22, 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 click here 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
CHAPLAIN'S CORNER: OVERCOMING ANXIETY As we manage our way through a pandemic and society unrest, calm and peace may be greatly desired yet seemingly difficult to obtain. I recommend unplugging for periods of time to center as necessary. Anne Lamott said, “Almost everything will work again if you unplug it for a few minutes, including you.” Remember who is ultimately in control. The Psalmist writes in 46:10 “Cease striving and know that I am God. I will be exalted among the nations, I will be exalted in the earth." -Pastoral Services Fort Belvoir Community Hospital
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June 2020
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COVID-19: "The Art of Preparation" By: FBCH Office of Strategic Communications Team members of the Belvoir Hospital's 7 Medical/Telemetry Unit prepare for the start of a new day April 20, 2020. The unit recently converted many of its daily operations to care for admissions and care of patients admitted for COVID-19 infections. To date, largely due to the flexibility and diligence of the staff, zero staff infections on the ward have been reported since the onset of the pandemic. To view more, click here. (Department of Defense photos by Reese Brown)
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June 2020
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DoD Launches Effort to Collect COVID-19 Convalescent Plasma By: Military Health System Communications Office
Patients fully recovered from COVID-19 are the only ones who qualify to be a COVID-19 convalescent plasma donor, said Army Col. Audra Taylor, chief of the Armed Services Blood Program. DOD personnel and their families, as well as nonDOD civilians with access to collection facilities on installations, are welcome to donate. "Our goal as a lifesaving program is to always provide a safe and ample supply of blood products. The need is now,” Taylor stressed. “We are calling for all who are healthy, able, and eligible, to donate today to help us all stand mission ready and save lives." Why Convalescent Plasma is Collected
Donald Perry, a Fort Bragg civilian employee, recently recovered from COVID-19 and donated his plasma at the Fort Bragg Blood Donor Center May 7. (Photo by Twana Atkinson)
Patients who have recovered from COVID-19 may hold treatment in their veins that could help others who are critically ill with the respiratory infection. The Department of Defense has begun an effort to collect 8,000 donated units of plasma from patients who have recovered from COVID-19 to support the development of an effective treatment against the disease. “We may want to ask you to stick your arm out and donate blood,” Joint Chiefs of Staff Chairman Gen. Mark Milley said in a May 28 virtual town hall. “What that can then do is help others who are severely ill, and if we can do that, then we’ll be on a good path toward getting some really powerful therapeutics.” Donations will be accepted at 15 Armed Services Blood Program centers across the continental United States, and in Hawaii, Guam and Germany. (A complete list of centers accepting donations appears at the end of this article, and is available online.) 10
When a person contracts SARS-CoV-2, the virus that causes COVID-19, their immune systems create antibodies to fight the virus. These antibodies are found in the plasma—the liquid part of blood, Taylor explained. Plasma with infection-fighting antibodies is called convalescent plasma, she said. Through the blood donation process, this plasma is collected from a donor who has recovered from COVID-19 and may be transfused into a sick patient who is still fighting the virus, if they qualify for this type of treatment. The procedure may boost the immune system of the patient and help with the recovery process, Taylor said. The collection process for this type of plasma is the same as standard apheresis collection, she noted. It is being investigated for the treatment of COVID-19 because there is no approved treatment for the disease at this time, and there is some indication that it might help some patients recover from COVID-19. Several COVID-19 patients in the Military Health System have received convalescent plasma transfusions as part of their treatment, Taylor
June 2020 said. The treatment, which must be carried out under an approved protocol, is used for those hospitalized and severely ill with the disease.
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Benning, Georgia •
Eligibility Requirements Donating CCP is the same as a standard platelet or plasma donation and must meet specific requirements set by the Food and Drug Administration. Donors must be at least 17 years and older, weigh at least 110 pounds, and be in good health. Women who have ever been pregnant may need additional testing for specific human leukocyte antigen antibodies that may be present in their blood. In addition to these standard requirements, those who have fully recovered from COVID-19 must be symptom-free for at least 14 days. Donors must also produce documented laboratory test results proving they tested positive for the virus, Taylor explained.
Sullivan Memorial Blood Center, Fort Blood Donor Center, Keesler Air Force Base, Mississippi
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Lackland Air Force Base Armed Services Blood Bank Center, Joint Base San AntonioLackland, Texas
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Robertson Blood Center, Fort Hood, Texas
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Akeroyd Blood Donor Center, Fort Sam Houston, Texas
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Fort Bliss Blood Donor Center, Fort Bliss, Texas
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Naval Medical Center San Diego Blood Donor Center, San Diego, California
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Armed Services Blood Bank Center – Pacific Northwest, Joint Base Lewis-McChord, Washington
“If a donor believes they meet these requirements, they must first contact the local blood donor center before coming in, and if they qualify, set up an appointment,” said Army Col. Jason Corley, Army Blood Program director. “Once set up, the donor must bring the required documentation and undergo the standard donation procedure. Final determination will be made by the medical director or designee.”
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ASBP Centers Collecting Convalescent Plasma
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Armed Services Blood Program
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ASBP COVID-19-specific page
Armed Services Blood Bank Center, Walter
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Blood Drive and Donor Registration
Reed National Military Medical Center,
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Bethesda, Maryland
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Twitter: @militaryblood
Naval Medical Center Portsmouth Blood
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Instagram: @usmilitaryblood
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Tripler AMC Blood Donor Center, Tripler Army Medical Center, Hawaii
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Naval Hospital Blood Donor Center, Guam
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Armed Services Blood Bank Center Europe, Landstuhl Regional Medical Center, Germany Links to More Information
Donor Center, Portsmouth, Virginia •
Fort Bragg Blood Donor Center, Fort Bragg, North Carolina
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Kendrick Memorial Blood Center, Fort Gordon, Georgia 11
The Shift Report
Inpatient Visitation Policy To Protect the Health of our Staff and Patients, the National Capital Region Market will Implement a COVID-19 Visitation Policy Inpatient Visitation Policy Guidelines: •
Visiting hours will be limited to 10 a.m. to Noon and 6 to 8 p.m.
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No visitors under the age of 18 including infants and siblings will be allowed in the inpatient units.
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Labor/obstetric patients may have one visitor for the entire length of hospital stay. Visitor must be over the age of 18 (visitor will remain in patient’s room).
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No visitors for labor/obstetrics persons under investigation (PUI) or patients testing positive for COVID-19.
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Visitors are not allowed to accompany a PUI or patients testing positive for COVID-19.
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Visitors will be screened for illness prior to entry. When appropriate, visitors will be provided a face mask to wear during the visit.
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Due to increased risk of severe infection with COVID-19, visitors over the age of 65 are strongly discouraged.
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Visitation is limited to one visitor per patient at a time.
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All visitors must check in at the nursing station of the unit they are visiting.
Exceptions to NCR MTF COVID-19 Inpatient Visitation Policy: •
Visitors for Special Care Nursery (SCN) patients will be limited to mother and the second banded person for the duration of the inpatient stay.
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No visitors will be allowed in the SCN for the infant of a mother/father PUI or persons testing positive for COVID-19.
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Labor/obstetric patients exceptions: Stillbirth, end-of-life, previable delivery, expected-life limiting or life threatening condition for the newborn, or mother with significant co-morbidity potentially limiting her ability to care for newborn. A single designated visitor over the age of 18 will be allowed; must wear PPE with just-in-time PPE training provided by care team.
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Patients undergoing procedure or surgery may have one visitor who must leave the hospital as soon as possible after the procedure/surgery.
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Guests who meet an exception will be allowed inside the hospital, but will be restricted to the patient’s room. Once a guest leaves a patient’s room, they must depart the hospital.
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No guest will be allowed entry to visit a patient with a pending positive COVID-19 test.
01358-04-22-2020-InpatientVisitation • Current as of April 22, 2020
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June 2020
Outpatient Visitation Policy To Protect the Health of our Staff and Patients, the National Capital Region Market will Implement a COVID-19 Visitation Policy Outpatient Visitation Policy Guidelines: • All patients and visitors entering the facility will be screened for illness prior to entry. • Face masks will be provided to patients and visitors with symptoms consistent with common cold, cough, etc. • Due to increased risk of infection with COVID-19, visitors over the age of 65 are strongly discouraged from entering the hospital facility for visitation. • You must have an appointment or be conducting official business when entering a clinic. • Visitors may not accompany those with an appointment unless one of the following applies: a) Patients under the age of 18 years may have one parent, guardian or caregiver to accompany. b) Elderly patients or those with a disability requiring assistance may have one caregiver to accompany. • If unable to follow visitation guidelines, we request that you reschedule your appointment by calling the appointment line at 1-(855) 227-6331.
01358-4-22-2020-OutpatientVisitation • Current as of April 22, 2020
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The Shift Report
DoD Experts Address COVID-19 Effects on Mental Health By: Military Health System Communications Office
As the country begins to reopen and facial coverings become part of the “new normal,” many beneficiaries feel heightened anxiety and mental distress due to the COVID-19 pandemic. However, DoD psychological health experts offer tools and advice for managing those feelings. (U.S. Air Force photo by Senior Airman Christian Conrad)
The COVID-19 pandemic has changed how people live, interact, and cope with new stressors. However, military psychological health experts emphasize making small changes to address problems early can have a big impact. “Aside from worrying about the contracting the virus, we worry about the many ways it impacts our lives and for how long,” said Dr. Holly O'Reilly, clinical psychologist at the Defense Health Agency’s Psychological Health Center of Excellence. “Taking small steps to address problems early on can make a big difference, especially during the current pandemic.” O’Reilly and three other Department of Defense experts on psychological health discussed the mental health effects of COVID-19 and tools to address them during a media panel May 27 as part of May’s national Mental Health Awareness Month observance. Each year, the Military Health System joins the nation to raise awareness of psychological health concerns. This year’s MHS theme of “Need a Little Help” is especially important, because “sometimes a little bit of help is all we need to improve our mental health 14
and stay mission ready,” O’Reilly said. O’Reilly says that one of those small steps is to “bright side” anxieties during the pandemic. “Instead of catastrophizing and imagining that this will be terrible forever, take a step back and think about how you will successfully navigate this situation, even though it's difficult,” she said. For example, bright siding can help health care workers with the growing anxiety they may feel due to the ambiguity of the novel coronavirus and limited medical knowledge of its impacts. Dr. Stephen Cozza, associate director of the Center for the Study of Traumatic Stress at the Uniformed Services University for Health Sciences, encouraged senior clinicians and medical leaders to frame expectations for their workers and help them understand the limits of what they can do in the challenging environment that COVID-19 presents. This also extends to families of health care workers. “Many of the families of health care workers are both faced by long and extended absences of their loved ones who are working under varying circumstances and putting themselves at risk by being at close exposure to the virus,” Cozza said. “That can also lead to concerns for the health and safety of the health care providers as well as…the family members.” Army Col. (Dr.) David Benedek, chief of Psychiatry at USU, encourages everyone to engage in continuing self-care habits to promote resilience and a more healthy response to the challenges their confronting. These include getting good sleep, maintaining good nutritional and hydration habits, and remaining devoted to appropriate exercise. “The things that we consider self-care are really important, not just for hospital workers and healthcare workers and other front liners, but all of our society … things that we can do to promote our general physical health and also promote our mental health,” Benedek said. His includes staying socially connected through physical distancing and staying in touch with loved ones. “Families should talk honestly about fears and worries, but also share in positive family experiences,” he said.
June 2020 While looking at things from the bright side is a start to addressing mental health issues, seeking care from a mental health professional is always encouraged for anyone who feels that they need a little bit of help. Benedek noted a national increase in patients making appointments for mental and physical health, which decreased significantly in the early stages of the pandemic. He attributed that increase to changes in the worries that people are having, and also to the increase in telehealth or virtual health services for mental health care. “One can make a phone call and get a tele-mentalhealth appointment and not have to worry about coming into a higher risk environment,” Benedek said, “and people are starting to take advantage of that. So I think we will see increased utilization in the weeks and months ahead.” Although May offers opportunities to emphasize and reinforce resources and programs, mental health is a year-round focus with the DoD, O’Reilly said. “We constantly advance our research and analysis to improve prevention and treatment for the beneficiaries of the Military Health System.” The MHS offers a number of mental health tools and programs to help patients, service members, and health care providers address their mental health concerns. From free mobile applications to expansions in telehealth capabilities, access to mental health care is always a priority for MHS. Under one program, the Real Warriors Campaign, Dr. Nicholas Polizzi, Ph.D., with the Psychological Health Center of Excellence, leverages social media and other forms of multimedia to provide mental health materials to patients no matter where they are. The Real Warriors Campaign encourages the military community to reach out for help dealing with stress and anxiety. “If you're looking for evidence-based, self-guided interventions that one can do, be they be a frontline worker, a medical professional, or family member, I would encourage folks to check out the Real Warriors Campaign,” Polizzi said. “Real Warriors is cellphone compatible and has tons of information
in a variety of formats for people to digest on their own and learn more if they're dipping their toe into the self-care psychological health world.” The long-lasting mental effects of the pandemic, like heightened anxiety and potential post-traumatic stress disorder, remains uncertain, according to the experts. Returning to the workplace can add another layer to both conditions. However, all of the experts agree that measures can be taken to promote resilience and a healthy response to the challenges of COVID-19. Mental health is essential not only to mission success, but to quality of life. The Military Health System will continue to prioritize mental health and combat threats to mental health like the COVID-19 pandemic. For more mental health resources, visit the MHS website.
FBCH Pharmacy Curbside Services Update As the hospital evolves based on the current COVID crisis so has pharmacy operations. For a more optimal experience pharmacy customers are encouraged to activate their prescriptions using the phone activation line or the online request form rather than activating via the curbside service. Called in requests will be processed for immediate curbside pickup whereas the internet form can be used for less urgent requests. Continue to request refills via Tricare Online or the automated refill line for pickup at the exchange. Visit the pharmacy internet page for future updates. Refill Line: 800-377-1723 Phone Activation Line: 571-231-3224; opt 2, opt 2
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June 2020
'Home Sweet Home' Leaves a Sour Taste for Some Quarantine-Weary
clinical social worker. That's why it's important to focus on the positive aspects of your particular living situation, mental health experts say, and use available resources to stay connected to sources that help relieve stress.
By: Military Health System Communications Office
"Being confined with others is beneficial because it's a collective experience," said Keller, who lives with his wife and their 17-year-old daughter. "You have the ability to commiserate, and to understand this isn't something that's happening only to you. You can focus on taking care of each other, remind one another of positive memories, and create new shared experiences."
Army Col. Nathan Keller and his family have enjoyed group activities during the COVID-19 pandemic, but they also schedule solo time. (Courtesy photo Army Col. Nathan Keller)
As physical distancing continues in efforts to avoid the spread of COVID-19, the old saying "there's no place like home" might be sounding bittersweet. Whether people live alone or with others, they may be experiencing fear, anxiety, and frustration over restricted movement. The Centers for Disease Control and Prevention recently released guidance about businesses and workplaces reopening. But health care experts say until there's widespread testing and a vaccine for the contagious virus, staying home as much as possible remains the safest course of action. So how can people cope with the continued challenges of being largely confined to home? "Human beings are social creatures and need to maintain connections through a variety of relationships that offer social support and a sense of security," said Army Col. Nathan Keller, Ph.D., director of the student counseling center at Uniformed Services University of the Health Sciences in Bethesda, Maryland. "When we're unable to do that, we can become frustrated and anxious," said Keller, who's also a
For those who live alone, "Maybe there's a sense of relief or gratitude that you can focus on what you need to do without any disruptions," said Navy Lt. Cmdr. Tarah Lewis, a psychiatric mental health nurse practitioner and assistant professor in USU's Graduate School of Nursing. "And you can devote as much time as you want on personal projects," said Lewis, who lives alone in what she describes as a tiny one-bedroom apartment in downtown Bethesda. "I don't even have a pet," she said. "And I don't have a car. I'm used to being outside, walking around and going to restaurants and shops, and that kind of thing." Lewis said people who live alone may be particularly vulnerable to feeling lonely, "maybe even envious of others," she said. "You go on social media and see families going camping, or roommates cooking brunch together." Reaching out to others helps. For Lewis, that means online fitness challenges with friends, and playing games such as "two truths and a lie" during after-work video conferences with co-workers. "That was really fun because I learned things about my colleagues that I never knew," Lewis said. "I actually felt more connected with some of them than I ever did before, even though I went into... 17
The Shift Report ...the office every day" pre-pandemic.
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People who live with others need to find time alone, "even in a crowded house," Keller said. "Focusing on yourself when you live with others may sound selfish, but you need that self-care time so you have the patience and energy to support others." Alone time might mean listening to music, dancing solo, reading, going for a walk or run, or meditating. "Think of those things that you find joy in, and put those in your toolbox," Lewis said. Whether on your own or with others, Keller and Lewis suggest the following: •
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Stick with a schedule. "Having a routine provides structure and some sort of normalcy," Lewis said. Keller said his family created a plan so they're getting up at the same time, working the same hours, and eating meals together. Their schedule also allots personal and family fun time. Move your body. Exercise helps you feel better physically and mentally.
Do you know your pharmacy options?
Cut yourself some slack. "There are days where you're not going to feel as productive as you usually are, or you're not going to be the perfect parent or spouse," Keller said. "It's OK to have those moments." "It's OK to not feel OK," Lewis added. "There's no shame in saying, I'm feeling off, and I need to talk to somebody." The Department of Defense's Psychological Health Center of Excellence offers information on mental health resources including call centers and mobile apps. •
Keep your eye on the prize. "Eventually, this will pay off, and we're going to come out of it more resilient," Keller said. "We're not going to be stuck like this forever."
Lewis said, "The way I see it is, we're at war. And the boots on the ground are the health care providers and front-line workers. And my role? I'm going to practice physical distancing. I'm going to wash my hands. I'm going to cover my face if I have to be around other people. I'm going to do my part. Those are things that I have control over, and I take great comfort in that."
Mail Order/Home Delivery
Secure Messaging Online/Phone Activation
01358-04-16-2020-Pharmacy_Options-Tabloid
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Curbside Pick-Up
eScript
June 2020
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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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