(Free template for adaptation by inpatient psychiatric units)
A. SOCIAL DISTANCING
General
- All staff should wear face masks while at work.
- Offer all patients face masks and encourage them to wear them when in common areas; masks should be evaluated for ligature or other risks before using.
Visitor distancing
- Visitors allowed only when critical for patient care or discharge planning.
Patient distancing
- Evaluate all common areas and redesign as needed to maintain 6 feet of separation
- Dining options
- Option 1: Create two or more dining times for each meal in order to decrease density.
- Option 2: Split patients into groups, with some groups dining in common areas and other groups dining in their rooms.
- Option 3: All patients dine in their rooms
- Congregating/meeting areas
- Evaluate each common room and determine maximum capacity to comfortably maintain 6 feet of distance.
- Remove furniture as needed
- Mark floor with tape to ensure that chairs and tables can be easily repositioned if moved
- Group programming
- Evaluate group programming areas for interior re-design to maintain distancing. If rooms cannot accommodate enough patients to maintain the current schedule of groups, you may have to decrease the number of groups offered. Make sure to carefully document that you are limiting group programming for patient safety reasons, that it is due to the COVID pandemic, and that the change is temporary.
- Dining options
Staff distancing
- Nurse’s station
- Remove furniture/work stations as needed to maintain adequate spacing.
- If more work stations are needed, obtain Workstations on Wheels (WOWs) so that staff can document in another area of the unit. (Note that WOWs must be supervised or locked up at all times to prevent unit safety issues.)
- Staff meetings
- All staff and interdisciplinary treatment team meetings should take place via teleconference
Telehealth
- Create a telehealth policy (see Sample Telehealth Policy)
- Telehealth may be used by MDs/NPs/social workers who are at high risk of COVID complications due to age or underlying conditions.
- Consider using telehealth to “cohort” or “platoon” vital staff
- Create two teams (team A and team B) of providers, who would use telehealth on alternating weeks. If team A is exposed to COVID and requires treatment or quarantining, team B would be available, and unit could continue to function.
Signing forms/consents
- Avoid having patients sign admission or discharge paperwork, in order to decrease viral transmission through use of pens.
- Use staff attestation statements, either on the relevant form, or in notes, eg. “Because of the COVID pandemic, verbal consent from patient was obtained.”
B. OTHER STAFF ISSUES
- Allow all staff (including social workers and MDs/NPs) to wear scrubs for ease of laundry/changing clothes after work.
C. PATIENT EDUCATION
- Incorporate teaching into the groups about hand hygiene and provide handouts for patients with information on COVID-19 to reduce anxiety about the pandemic.
- Develop a packet of worksheets/mental health info as group alternatives for those that are either quarantined or being isolated as they await test results.
D. COVID PATIENT CARE ISSUES
- Preadmission screening
- Patients must be tested by admission source and only COVID negative patients are admitted.
- Ongoing clinical screening of patients
- During hospitalization, all patients are screened for new COVID symptoms daily via twice daily vitals and nursing clinical assessments.
- Patient scenarios
- Patient develops suspicious symptoms on the unit, not yet tested.
- Patient will be COVID tested and placed into isolation, preferably on a medical floor if rooms are available.
- Patient already on unit learns about positive test results, and has either no symptoms or minimal symptoms.
- Patient should be isolated and preferably transferred to another area of the hospital.
- Patient develops suspicious symptoms on the unit, not yet tested.