Appendix A.

Basic Staffing Model Recommended for Covid-Positive SNF Units Staffing recommendations for Covid-positive units would be adjusted based on actual patient acuity.

Position Staffing Level

Registered Nurse 1 per 8 patients per shift

Nurses Aid-Certified 1 per 5–6 patients per shift

Respiratory Therapist Available on campus 24/7

PT, OT, and Speech As needed

Social worker/discharge planner 1, day shift

Registered Dietician As needed

Nurse manager 1

Physician-internal medicine 1, with panel of 20 patients

Source: NewYork-Presbyterian Healthcare System

Sample of Clinical Guidance for the Management of Covid-Positive Patients in a Skilled Nursing Facility

Donning Required PPE: Hand Hygiene, Gown,

N95, surgical facemask, eye protection, gloves

Keep hands away from face • Change gloves if torn or heavily contaminated •

Perform hand hygiene before putting on new gloves

Doffing PPE: Gloves, hand hygiene, gown, surgical mask, hand hygiene exit room and remove eye protection, Hand Hygiene

Remove surgical masks before leaving patient room and closing

door

WASH HANDS IMMEDIATELY AFTER REMOVING ALL PPE or

AS NEEDED

Soiled Linen Packaging/Handling • BLUE BAG all soiled linen &

label clothing: COVID-19

Trash/ Waste Packaging/Handling: • Perform management of solid

trash and RMW in accordance with routine procedures (LASTROOM TO BE COLLECTED)

Occupied Room Cleaning • Hand hygiene & don appropriate PPE• Remove trash and all soiled items• Double-bag soiled linen and label COVID (COVID-19

confirmed only)

• Remove cubicle curtain, bag, tie closed• Double-bag soiled linen; label COVID• Discard opened/disposable supplies• Disinfect all movable equipment/pumps• Terminal clean/disinfect all vertical and horizontal

surfaces including walls

Follow routine isolation cleaning process

• Enhanced disinfection of all high-touch surfaces• Clean and disinfect bathroom/restock

NEWLY ADMITTED PATIENTS • Placed on contact/droplet precautions; followroutine contact/droplet protocol FOR 5 DAYS untilcleared• Temperature of all residents once per shift• Placed on 24h reportFollow isolation terminal cleaning process

• Hand hygiene & don appropriate PPE

ALL STAFF: • EYE PROTECTION – Face Shields or Goggles• SURGICAL MASKS - at all times – discard

after contact isolation rooms

• N95• Discard only surgical masks and disinfect eye

protection

ADMISSION OF COVID+ PATIENTS

• LOS – 14 to 21 days• STAFFING: RN, LPN, CNA, OT, PT, COTA• Rehab potential to be determined – LOCATION OUTDOOR• STRICT CONTACT & DROPLET PRECAUTION (PPE + Hair Cover)

• PATIENT TO WEAR SURGICAL MASK (if medically appropriate)

• DOOR IS TO BE CLOSED• NO NEBULIZER TREATMENT – MDI Only• HEPA FILTER (HALLWAY)• Implementation of Respiratory Care Pathway

• All Vital signs twice per shift• SP02 > 92%• Strict Intake and Output• History of Immunization – FLU & PNA Admin• Administrator O2 Therapy Above SPO2 > 92% O2<4L• Incentive Spirometer• Continue drug regimen as recommended• CMP + PLT + DIFF – Upon admission & weekly• Acetaminophen (NO NSAIDS)• Analgesics

CODE STATUS

• Determine Code Status

EQUIPMENT • One medication cart and computer assigned for use• Assigned blood pressure machines for each resident• Single use thermometers• Assigned linen cart• Wall oxygen and suction set up required

Source: NewYork-Presbyterian Healthcare System