Coronavirus (COVID-19) Update

Source: TxANA
Date: March 16, 2020

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In light of a new wave and increase of COVID-19 cases in Texas, state officials are working closely with the Centers for Disease Control and Prevention (CDC) and local public health departments in monitoring and mitigating the current outbreak of the novel coronavirus 2019 (COVID-19) to protect public health.

TxANA is actively monitoring state and federal agencies such as the Texas Department of State Health Services (DSHS) and the CDC for any updates related to the virus. TxANA will continue to share the latest guidance related to the outbreak with our members.

The current guidance from DSHS for health care providers regarding COVID-19 is as follows:

  • Remain vigilant and monitor the situation in your local community.
  • Preventing and mitigating the spread of the virus is everyone’s responsibility.
  • Work closely with your local health department if you suspect your patient is suffering from COVID-19, they can provide guidance on testing.
  • Review your facility's infection control strategies.
  • Practice and encourage a personal regimen of washing hands, coughing into the crook of your elbow, disinfecting surfaces and staying home when you feel sick.

TxANA will remain in close communication and coordination with the American Association of Nurse Anesthetists (AANA) and other stakeholders to provide our members with the most up-to-date recommendations and information regarding COVID-19.  

The following resources may be helpful to you, your colleagues and your local health care facilities in Texas as we all work together to mitigate the spread of this virus and address cases of COVID-19 in communities:

CRNAs as advanced practice providers in critical care settings handout.

 

Governor Abbott Updates Elective Surgery Ban:

On June 25, 2020, Governor Greg Abbott has issued an Executive Order suspending elective surgeries at hospitals in Bexar, Dallas, Harris, and Travis counties due to significant increases in people being hospitalized due to COVID-19. This is a preemptive measure to ensure there are enough beds and resources to treat COVID-19 patients.

On June 30, 2020, the Executive Order was amended to include Cameron, Hidalgo, Nueces, and Webb counties.

On July 9, 2020, the Executive Order was amended to suspending elective surgeries in hospitals in all counties located within 11 Trauma Service Areas (TSAs) in Texas.
The following counties are included in the Governor's Proclamation:
 
All counties within TSA J—Andrews, Brewster, Crane, Ector, Glasscock, Howard, Jeff Davis, Loving, Martin, Midland, Pecos, Presidio, Reeves, Terrell, Upton, Ward, and Winkler counties;
 
All counties within TSA K—Coke, Concho, Crockett, Irion, Kimble, Mason, McCulloch, Menard, Reagan, Runnels, Schleicher, Sterling, Sutton, and Tom Green counties;
 
All counties within TSA M—Bosque, Falls, Hill, Limestone, and McLennan counties;
 
All counties within TSA O that are not already covered by Executive Order GA-27—Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano, San Saba, and Williamson counties;
 
All counties within TSA P that are not already covered by Executive Order GA-27—Atascosa, Bandera, Comal, Dimmit, Edwards, Frio, Gillespie, Gonzales, Guadalupe, Karnes, Kendall, Kerr, Kinney, La Salle, Maverick, Medina, Real, Uvalde, Val Verde, Wilson, and Zavala counties;
 
All counties within TSA Q that are not already covered by Executive Order GA-27—Austin, Colorado, Fort Bend, Matagorda, Montgomery, Walker, Waller, and Wharton counties;
 
All counties within TSA R—Brazoria, Chambers, Galveston, Hardin, Jasper, Jefferson, Liberty, Newton, and Orange counties;
 
All counties within TSA S—Calhoun, DeWitt, Goliad, Jackson, Lavaca, and Victoria counties;
 
All counties within TSA T that are not already covered by Executive Order GA-27—Jim Hogg and Zapata counties;
 
All counties within TSA U that are not already covered by Executive Order GA-27—Aransas, Bee, Brooks, Duval, Jim Wells, Kenedy, Kleberg, Live Oak, McMullen, Refugio, and San Patricio counties; and

All counties within TSA V that are not already covered by Executive Order GA-27—Starr and Willacy counties.

Texas is divided into twenty-two regions called trauma service areas (TSAs), provided for the formation of a regional advisory council (RAC) in each region to develop and implement a regional trauma system plan, delineated the trauma facility designation process, and provided for the development of a state trauma registry. For more information about TSAs, visit the Texas Department of State Health Services website.

The list of counties affected under the Executive Order may change to “address surges in hospitalizations that may arise in other parts of the state”. Please note, “this prohibition shall not apply to any surgery or procedure that, if performed in accordance with the commonly accepted standard of clinical practice, would not deplete any hospital capacity needed to cope with the COVID-19 disaster.”

View the June 25, 2020, Governor’s Executive Order here.  

View the June 30, 2020, Governor’s Executive Order here.  

View the July 9, 2020, Governor’s Executive Order here.  

AANA Resources Page:

https://www.aana.com/practice/covid-19 

Anesthesia Care Of The Patient With Coronavirus Disease 2019 (COVID-19) – Infographic

For Anesthesia Professionals:

 

Texas Board of Nursing:

Governor Abbott waives regulations to allow APRNs a 6-month grace period for licensure renewal.

Continuing Education During COVID-19:
"The Board of Nursing will consider extenuating circumstances on a case-by-case basis regarding the completion of continuing competency requirements for licensure renewal during the COVID-19 Disaster Declaration Period. For more information about continuing competency requirements, please visit the Board’s Frequently Asked Questions for Continuing Education & Competency at:

http://www.bon.texas.gov/faq_education_continuing_ed_and_competency.asp

If a licensee needs to request a waiver of continuing competency requirements, please email a request to the following address: Mark.Majek@bon.texas.gov

In the request, include your name, date of birth and license number. Once received, the BON will allow an online renewal."

Pain Management:
On Monday, June 6, 2020, the emergency amendment to Board Rule 217.14 (e)(1) that allows APRNs the ability to issue prescriptions for chronic pain via telemedicine during the COVID-19 emergency declaration provided certain criteria are met. The provisions of the emergency rule will be posted on the BON website at: https://www.bon.texas.gov/COVID-19announcements.asp

Volunteer Options:

Centers for Medicare & Medicaid Services:

The Centers for Medicare & Medicaid Services (CMS) has temporarily suspended physician supervision requirements for CRNAs providing anesthesia services to Medicare and Medicaid patients. This suspension of burdensome and unnecessary physician supervision requirements means that CRNAs can contribute their skills and expertise when and where they are needed the most.

Texas Coronavirus Website, Information for Hospitals and Healthcare Professionals:


DSHS is the main state website dedicated to providing the most up-to-date information about COVID-19: https://www.dshs.texas.gov/coronavirus/healthprof.aspx 

DSHS has added a communication tools section to their website with a social media tool kit, video and printable materials that are shareable: https://www.dshs.texas.gov/coronavirus/tools.aspx#toolkit

Contact Information:
DSHS COVID-19 Call Center:
1-877-570-9779
Hours (call center hours now extended): 7:00 am – 8:00 pm CST, Monday – Friday
Email: coronavirus@dshs.texas.gov

Local Health Entities:
For local assistance, see the listing of Coronavirus Disease 2019 (COVID 19) Local Health Entities.

CDC Coronavirus Website:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/

Case Counts
State: https://www.dshs.texas.gov/coronavirus/#casecounts
National: https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

Recommended Disinfectants
Take care to wipe down all surfaces with products that have been approved by the U.S. Environmental Protection Agency for use against emerging, enveloped viral pathogens. This is a critical step in keeping individuals protected. A list of appropriate cleaning products is being kept by the Center for Biocide Chemistries, which can be found at https://www.americanchemistry.com/novel-coronavirus-fighting-products-list.pdf

Notice Regarding Testing and Submission of Specimens for COVID-19
As of March 5, 2020, the Texas DSHS Laboratory is accepting specimens per the criteria outlined in the COVID-19 Specimen Collection and Submission Instructions found on the DSHS Laboratory website.

ALL specimens for COVID-19 virus testing require preapproval. Contact your Local Health Department or DSHS Public Health Region to ensure patient meets Person Under Investigation (PUI) criteria for testing and to obtain DSHS approval to test. Specimens MUST meet PUI criteria for testing prior to shipping and WILL NOT be tested without prior approval. Please DO NOT ship specimens prior to receiving this approval.

DSHS Distributes Additional Medical Supplies for COVID-19 Response
“At the request of the Texas Department of State Health Services, Texas has received a share of personal protective equipment from the Strategic National Stockpile. DSHS is distributing the medical supplies to hospitals and health care providers across the state through the state's Hospital Preparedness Program.”
https://www.dshs.texas.gov/news/releases/2020/20200315.aspx 

 

Frequently Asked Questions:

How can CRNAs be utilized during the COVID-19 crisis?
TxANA and the American Association of Nurse Anesthetists (AANA) urge hospitals and facilities to utilize CRNAs as Advanced Practice Registered Nurses (APRNs) who can provide life-saving critical care management for patients impacted by the COVID-19 virus.

In their role as APRNs, CRNAs can function in various areas of the hospital, including emergency room and critical care units. CRNAs can be leveraged for their expertise in rapid systems assessment, airway management, ventilatory support, vascular volume resuscitation, triage, emergency preparedness, and resource management to support their facilities. 

TxANA and the AANA encourage CRNAs to work directly with their facility administrator to determine how their skills as APRNs can be directly utilized to help address the COVID-19 crisis. 

 

We hope you and your colleagues will utilize TxANA’s online resources to help keep yourself, family and patients safe. Please contact TxANA with any questions.