Full Scale Testing...

[Rocky]

Many people have said if it breaks into a full scale pandemic it will overwhelm hospitals with patients coming in for testing and treatment.

How hard would it be to get approvals for Pharmacies for them to hire nurses that could relieve the hospitals by handling the tests? If it is positive allow the Pharmacists to prescribe the right medicine and get the patient back home for recovery?

If the goal is to prevent hospitals from being overwhelmed, wouldn't this be a good way to do it?

Wouldn't it be cheaper for everyone compared to filling up the emergency rooms?

 

[Chyna]

Re: Full Scale Testing...

It wouldn't be difficult, in that pharmacies already hire nurses to do things like give vaccines and run clinics (influenza vaccine clinics were done by a nurse at the pharmacy I worked at, as well as vaccines not covered by our public health program for travel or additional to routine childhood ones)

The problem would be DOING it. Getting funding, getting organised, getting the test kits. Getting someone "in charge" to ok it, getting past preparing to be prepared to plan to be prepared and actually DOING it.

And then of course, as we've already seen, there's the politics of what results get reported, when and how. That probably wouldn't change, because those nurses would have to report somewhere "official", and could likely not rx anti-virals (although I noted some states included lifting the pharmacist certification requirement for anti-virals in their emergency plan)

 

[the doctor]

Re: Full Scale Testing...

If we could get past the politics etc we would still not be able to overcome the fact that there are just not enough nurses. In the US, the nursing shortage has need severe for the last few years. On average, most places have only 85% of the nurses required.

GW

 

[Lizw]

Re: Full Scale Testing...

The problem would be DOING it. Getting funding, getting organised, getting the test kits. Getting someone "in charge" to ok it, getting past preparing to be prepared to plan to be prepared and actually DOING it.

Amen. I don't see any reason why EMT's couldn't be drawn into this as well. Anti-virals can be given sub-q as well as IM, so that wouldn't be any more difficult than injecting insulin, something that a large number of people already know how to do. EMT's certainly have sufficient training to quickly learn to perform the tests. But as you say, getting anyone to actually OK the idea and move on it is the biggest obstacle.

 

[Tea]

Re: Full Scale Testing...

Just curious, but if they do testing at pharmacies, wont that just endanger those going in to pick up regular prescriptions?

If it gets that busy later, wouldn't the goal be to keep those who are ill out of public places as much as possible? Or will it be, if you are well.. stay home?

Maybe it would be better if teams could go hit homes like a postmans route.. Or more like a Fedex route. Swab n go?

Vaccines I could see in pharmacies, but actual flu testing?

 

[Rocky]

Re: Full Scale Testing...

So maybe they could set a tent up outside of the pharmacy for the testing to take place, and have the local fire emergency crew on hand during the process.

I already know local hospitals are swamped, if this continues to grow at the rate it is, we might be talking two weeks before needing something like this in place.

Maybe local firestations could be set up as testing/treatment centers.

the EMTs will be involved one way or another, whether it is treatment before it's severe, or after its critical and they are hauling people from their homes towards hospitals that have no room to hold them...


I'm just brainstorming, so anyone with ideas please hop in and join us.

 

[Rocky]

Re: Full Scale Testing...

And then of course, as we've already seen, there's the politics of what results get reported, when and how. That probably wouldn't change, because those nurses would have to report somewhere "official", and could likely not rx anti-virals (although I noted some states included lifting the pharmacist certification requirement for anti-virals in their emergency plan)

well the simple way to count is by the number of prescriptions given out.

At a certain point, even the CDC won't be able to keep up with samples testing, the confirmation that can be given within 2 hours counts as a positive and on to the next.

as far as funding, we've already seen how fast congress can write a 100 Billion dollar check, I think that and politics can happen overnight.

So for now let's drop that part and just concentrate on the best way to put it together.

It doesn't take a doctor to do the test, sliding a tube down the nasal passage to get a swab sounds like something that could be taught with very little training.

EMTs running door to door, spreads them out too far compared to concentrating the patients at a certain location so they can just move from one bed to the next.

 

[Laidback Al]

Re: Full Scale Testing...

If we could get past the politics etc we would still not be able to overcome the fact that there are just not enough nurses. In the US, the nursing shortage has need severe for the last few years. On average, most places have only 85% of the nurses required.

GW

Let me emphasize the doctor's comments. It is not simply a question of hiring minimally trained personnel to do testing at a local pharmacy. There is simply a shortage of trained nurses. If the need for critical care increases even marginally during this pandemic there will not be enough HCW to manage the patient load.

The bad news does not stop there. In fall of 2007, Goju started a thread at Allnurses.com inquiring whether nurses would work during a pandemic. Allnurses.com is probably the largest online forum for nurses in the world with more than 250,000 members. The poll indicates that less that half of the respondents (48%) would absolutely agree to work during a pandemic.

You can see the poll results and view the comments at this thread:
http://allnurses.com/pandemic-flu-forum/will-you-work-258506.html

Even if only the 30% of the nurses fail to show up for work, the damage to the health care system would be catastrophic.

 

[Rocky]

Re: Full Scale Testing...

well the good news is, the local nurses I've been speaking with aren't afraid of what is going around right now, but they are stretched as far as they can and getting busier by the day. None of them are planning on walking, if this was a deadly virus, that would be a different story. These nurses say they aren't even wearning masks to handle patients right now.

They are afraid of the numbers continuing to grow, by moving the initial testing treatment out of the emergency room, it would allow them to concentrate on the most serious cases...

 

[Rocky]

Re: Full Scale Testing...

remember Al, nothing is impossible if the planning starts early enough, The Doc is an expert and knows the answers I am trying for. He has already shared with me the worst case scenario, now I'm trying to find a way to soften the blow and quick.

If the case loads keep growing at 1-2000/week at each local hospital, the system will break, the people that really need help won't be able to get it. So what is the answer we can put in place within a week or two?

 

[Blue]

Re: Full Scale Testing...

Let me emphasize the doctor's comments. It is not simply a question of hiring minimally trained personnel to do testing at a local pharmacy. There is simply a shortage of trained nurses. If the need for critical care increases even marginally during this pandemic there will not be enough HCW to manage the patient load.

The bad news does not stop there. In fall of 2007, Goju started a thread at Allnurses.com inquiring whether nurses would work during a pandemic. Allnurses.com is probably the largest online forum for nurses in the world with more than 250,000 members. The poll indicates that less that half of the respondents (48%) would absolutely agree to work during a pandemic.

You can see the poll results and view the comments at this thread:
http://allnurses.com/pandemic-flu-forum/will-you-work-258506.html

Even if only the 30% of the nurses fail to show up for work, the damage to the health care system would be catastrophic.

I think that you are correct. Perhaps that is why most of our facilities have not included informing the nursing staff of their pandemic plans. My facility certainly has not. They did just send us a letter this week promising to keep us updated but with very little information.

To me the fact that they told us that we need to conserve N95 masks was very telling. They said that it was OK to reuse the N95 mask when working with TB patient for a shift, but not OK to reuse masks when working with flu patients.

I was left with the feeling that we could run out of PPE if we started to receive many flu patients. I don't know how many we have if any at this time. The letter did not tell us.