May 2020
"Even with a mask, a nurse's smile can be seen for miles."
8 Belvoir Hospital Curbside Pharmacy Rolls into Action
After a month of planning, Fort Belvoir Community Hospital has opened curbside pharmacy service in the now-unused Rivers Garage.
10 COVID-19: Know Symptoms and Next Steps to Help Ensure Full Recovery
Sore throat, aching muscles, stuffy nose – are you feeling sick because of seasonal allergies, a cold, or could your symptoms be a sign of COVID-19?
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12 CDC Maintains Childhood
Immunization Guidelines During COVID-19
Immunizations remain a vital component of pediatric health care, even during the COVID19 pandemic.
16 FBCH Visitation Policies
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)
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 visit https://bit. ly/3aXCsEl 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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BE GENTLE WITH OURSELVES AND OTHERS Times of change and unknown can bring out some strong emotions in folks around us. It's important for us to not take it personally even when the frustration at that moment may be directed at us personally. We also often forget to be gentle with ourselves. Thich Nhat Hanh stated "When a person's speech is full of anger, it is because he or she suffers deeply." The real reasons for someone to lash out many times don't have nearly as much to do with the subject at hand as with what a person is going through personally. We can be peace makers and care for one another by just being present and listening intently. The Proverbial writer penned the words in 15:1 "A gentle answer turns away wrath, but a harsh word stirs up anger." Vs. 4 he states "The soothing tongue is a tree of life." -Pastoral Services Fort Belvoir Community Hospital
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May 2020
TEAM BELVOIR HAS GOT YOU COVERED!
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Belvoir Hospital Curbside Pharmacy Rolls into Action By: Paul Lara, Belvoir Eagle
them in the system, do the queuing correctly, and no other place does that.” After some trial runs, it was decided to have customers drop off prescriptions on the garage’s first floor, wait at the Community Center parking lot until they receive a text, then pickup filled prescriptions on the second floor. The additional distance required adding 20 government service volunteers to help deliver, as teams of runners constantly shuttle new prescriptions from the pharmacy to the garage.
Mark Long, Fort Belvoir Community Hospital pharmacist, takes a prescription in the hospital’s Rivers Garage, Friday. The hospital’s latest action further protects patients and staff by minimizing traffic in the main pharmacy. (Courtesy Photo by Paul Lara)
After a month of planning, Fort Belvoir Community Hospital has opened curbside pharmacy service in the now-unused Rivers Garage, according to Lt. Cdr. Jesse Schmidt, the hospital’s pharmacy chief. Schmidt said the hospital’s design presented challenges, since its pharmacy is in the center of the building, next to the main entrance. “We tried to do a drive-through pharmacy, but there’s no way. The uniqueness of Fort Belvoir Community Hospital’s physical structure makes it really difficult for us to do curbside, because of the distance,” he said. From the pharmacy, Rivers Garage is more than 200 yards away. “It’s taken us a while to figure out how to bridge that logistics gap.” Schmidt said a key implementation was to provide laptops connected to the pharmacy’s software. “What makes our curbside unique to a lot of the others in the National Capital Region or the DHA is that we were able to take our pharmacy windows and bring them outside,” he said. We’ve been able to extend our electronic network out here and be able to use laptops on wheels and intake them the same we would do at the pharmacy window. We can put 8
Navy Capt. Cynthia Judy, hospital director, said the new procedure is for patients’ and staff safety. “The entire pharmacy team has been working really hard, over the last few weeks, to make this experience as seamless as possible. It’s all about promoting social distance and your convenience,” she said, adding that beneficiaries are asked to still wear a face covering when they drive up. Judy suggested activating the prescription before coming in, and go directly to the pick-up location. Prescriptions can be activated by calling the main hospital number, 571-231-3224; Option 2 for pharmacy; then Option 2 again to activate your prescription. The curbside pharmacy is available from 7:30 a.m. to 5:30 p.m., weekdays. Saturday pickups are offered in the main pharmacy. Schmidt said this process will have continuing patient benefits in the future. “After this is over, we’re going to try to keep the phone activation line, if we can,” he said. “We created an internet form patients can access from home, fill out and submit. Then, all they have to do is come to the pickup line. Not the intake line. We’re trying to give them convenience, as best we can,” Schmidt said. “We are also working on long-term solutions with DHA using automated will-call systems, and automated will-call machines in the lobby. We are taking what we’ve learned from this crisis, to figure out better ways to do things.”
May 2020
Do you know your pharmacy options?
Mail Order/Home Delivery
Secure Messaging Online/Phone Activation
Curbside Pick-Up
eScript
01358-04-16-2020-Pharmacy_Options-Tabloid
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COVID-19: Know Symptoms and Next Steps to Help ensure Full Recovery
can occur anywhere from two days to two weeks after becoming infected. Other symptoms may include muscle pain, headache, chills, sore throat, and a new loss of taste or smell.
By: Military Health System Communications Office
Emergency warning signs that require immediate medical attention include trouble breathing, chest pain or pressure, and bluish lips or face. The CDC advises anyone experiencing these symptoms to call 911. If possible, put on a face covering before medical help arrives.
Sgt. Kate Cole, a medic with the 209th Regiment (Regional Training Institute) does a temperature check for Maj. Gen. Daryl Bohac, Nebraska adjutant general, as he enters Memorial Hall for an officer candidate commissioning ceremony March 20, 2020, at the Camp Ashland Training Site, Nebraska. (Nebraska National Guard photo by Sgt. Lisa Crawford)
Sore throat, aching muscles, stuffy nose – are you feeling sick because of seasonal allergies, a cold, or could your symptoms be a sign of COVID-19? Many people may be concerned about catching this new respiratory virus that leads to COVID-19 disease, and that's understandable. Since the first reports in late December, about 3 million people around the world have tested positive. That number includes approximately 981,000 confirmed cases in the United States as of April 28, according to the Centers for Disease Control and Prevention. The good news: Most people who become infected will recover, according to the CDC, and without needing special medical treatment. So there's no need to panic if you get sick. What's important is knowing what to do next to help ensure a full recovery and avoid infecting someone else. The main symptoms of COVID-19 are fever at or above 100.4 degrees Fahrenheit, cough, and shortness of breath. The CDC says these symptoms 10
Some people may become seriously ill from COVID-19 and have difficulty breathing. The virus may be especially dangerous for people who have chronic or long-term health conditions that affect the immune system. Those conditions include heart or lung disease, diabetes, treatment for cancer, and HIV/AIDS. For cases that are not emergencies, experts advise people to stay home. Don't go to a military treatment facility or urgent care clinic because that may expose others to the virus. Instead, contact the MHS Nurse Advice Line. Registered nurses will screen for COVID-19 exposure or infection. They also will offer advice for self-care and, if appropriate, coordinate virtual appointments with health care providers. Nurses also may make a referral to visit a health care provider in person. “Virtual care has become valuable for health care providers and patients during the coronavirus pandemic,” said U.S. Public Health Service Lt. Bobby Taylor, program manager for the MHS Nurse Advice Line. “This resource allows you to practice social distancing and still get the answers to your health questions and concerns.” The CDC offers advice for managing COVID-19 symptoms at home. It includes resting, staying hydrated, and monitoring symptoms to make sure they don't get worse. Sick people also should isolate
May 2020 themselves from others, including family members. That may require staying in separate rooms of the house and using a separate bathroom, if possible. Health care providers can offer guidance for when sick people can stop isolating. Typical guidelines include at least seven days since symptoms first appeared, improvement of symptoms, and at least three days with no fever while staying off feverreducing medications. TRICARE beneficiaries can sign up for email updates and get the latest information on COVID-19, including emergency and urgent care options and pharmacy home deliveries.
the Defense Health Agency, said Army Col. (Dr.) Jennifer Kishimori, director of chemical, biological, radiological, and nuclear medical countermeasures policy in the Office of the Assistant Secretary of Defense for Health Affairs. "We are working to communicate current CDC guidance for public health, hospital preparedness, patient evaluation, infection control, laboratory testing, and health risk communication, in coordination with the Joint Staff," she said. This guidance ensures any patient with a risk of infection receives the proper care and testing, and that public health authorities are notified of all cases.
Health care providers and military families at MTFs receive CDC-based guidance on COVID-19 through
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CDC Maintains Childhood Immunization Guidelines During COVID-19 By: Military Health System Communications Office
U.S. Air Force Senior Airman Tamika Bradley, 20th Medical Operations Squadron allergy and immunizations technician, prepares to administer a vaccine to a child at Shaw Air Force Base, S.C. National Infant Immunization Week is April 25 - May 2, 2020. (U.S. Air Force photo by Airman 1st Class Destinee Dougherty)
Immunizations remain a vital component of pediatric health care, even during the COVID19 pandemic. Immune systems are still developing in children and infants. Vaccinations result in the production of antibodies to protect people from potentially deadly diseases, explained Ann M. Morse, a family nurse practitioner at the North-Atlantic Regional Vaccine Safety Hub, Naval Medical Center Portsmouth. “Immunizations allow the immune system to recognize that germ, virus, or bacteria and fight off that disease, or limit the severity of complications if exposed to the real disease,” continued Morse. Immunizations also protect public health through herd immunity by preventing a widespread outbreak of highly infectious diseases, like measles or whooping cough. Despite the current climate of social distancing, vaccine-preventable diseases continue to circulate. Individuals who have not been vaccinated and contract the disease could spread it to susceptible individuals because those infected can be contagious up to a week before developing 12
any symptoms, explained Morse. She added that if children stop receiving necessary vaccinations, herd immunity decreases, increasing the likelihood of other potential viral outbreaks, like measles. “If multiple individuals developed one or more different vaccine-preventable diseases, hospitals could again have decreased number of isolation rooms, critical care (ICU/CCU) beds, ventilators, protective coverings (masks, gowns, gloves, boots) and more,” Morse explained. She added there are a variety of infant or childhood respiratory illnesses that show similar symptoms of COVID-19, such as fever, cough, and body aches. The Centers for Disease Control and Prevention continues to encourage childhood immunizations during the COVID-19 crisis, but recently updated its recommendations for health care providers to manage patient visits. The way health care providers schedule immunization appointments may vary according to social distancing standards, said Morse. It is also possible that depending on the influx of COVID-19 cases in a local community, some health care providers may not schedule inperson wellness visits, but will continue to offer immunizations, noted Air Force preventive medicine physician Lt. Col. (Dr.) Ruth Brenner, deputy chief of the Immunization Healthcare Division. “Due to the pandemic, there is a strain on medical resources, so some clinics may not be able to support a full complement of immunization services or at the same location where immunizations may normally be received. I recommend contacting your primary care manager or clinic to ask what is available as well as community options,” Brenner said. As a mother of young children, Brenner has had to navigate the medical system for important immunizations during the COVID-19 pandemic with the help of the Pediatric Clinic at her military treatment facility. For parents who choose not to immunize their children during the pandemic, there are "catch up" schedules provided by the CDC
May 2020 so that children don’t need to start over or repeat doses already received, explained Brenner. Many child care centers are allowing a grace period for childhood immunizations at this time, she noted. “Each family should balance the risks and benefits before going to the clinic,” she said, adding that MTFs are adhering to CDC recommendations of social distancing and separating sick children from well children. Amid the COVID-19 pandemic, the strain on health care systems is obvious, said Brenner, adding, “Pediatric immunizations remain an important aspect of the health of our children and our communities. Military treatment facilities
are working hard to continue to offer pediatric immunizations during the current health crisis.” Morse said military families should call their clinics to arrange times for their visit and ask about precautions they will need to follow upon entering the facility, such as wearing a face mask. “It will be important to ask about normal vaccine side effects and take home the vaccine information sheets,” she said. Concerned parents can also call the IHD’s 24/7 Immunization Healthcare Support Center at 877438-8222 and select option 1 to speak with an oncall nurse or provider.
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DHA Leaders Visit Fort Belvoir Community Hospital Review COVID-19 Response and Best Practices By: FBCH Office of Strategic Communications On April 24, 2020, Belvoir Hospital received an early morning visit from U.S. Navy Rear Adm. Mary Riggs, Assistant Director for Healthcare Administration of the Defense Health Agency, and from U.S. Air Force Brig. Gen. Shanna Woyak, the Director National Capital Region's Medical Directorate, and Air National Guard Assistant to the Chief of the Nurse Corps, Office of the Surgeon General. The two joined Navy Capt. Cynthia Judy, Director of the Belvoir Hospital, as they visited the staff and reviewed current COVID-19 response best practices. (Department of Defense photos by Reese Brown)
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May 2020
"After hearing news reports and personally caring for COVID patients in isolation, nurses at Walter Reed and Fort Belvoir decided to do something about it. The end result was an initiative where the unit makes videoenabled tablets available to patients to help them stay in touch with loved ones in addition to posting full facial photos of themselves in the patient room so the patient can “see� the care team behind their masks. These immeasurable acts of compassionate care will assuredly impact the lives of our patients and their loved ones. This is a moving testament to how deeply our staff care for the well-being of our patients and their families." U.S. Air Force Brigadier General Shanna Woyak Director, National Capital Region's Medical Directorate 15
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.
•
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.
•
No visitors will be allowed in the SCN for the infant of a mother/father PUI or persons testing positive for COVID-19.
•
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.
•
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.
•
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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May 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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THANK YOU, SOPHIA!
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May 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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