Ebola Update: "Facts Not Fear"
Tuesday, December 16, 2014
Posted by: Deb Taylor
Information on Nurse Safe Harbor
Click here for a summary of SAFE HARBOR for Texas nurses.
School of Medicine | The University of Texas Health Science Center Offers New Online Course
Ebola Virus Disease: What Should You Know?
Update and Demonstration of Donning and Doffing of Personal Protective Equipment
October 31, 2014 - October 31, 2017
Go here to connect and learn with this course today!
Texas Department of State Health Services (DSHS) has a website that includes all of the Department’s Ebola-related information. Please visit it for DSHS guidance for health care professionals, schools, labs, and more: texasebola.org.
TNA Executive Director Cindy Zolnierek, PhD, RN served as an expert witness at the first public hearing of the Texas Task Force on Infectious Disease Preparedness and Response at the Texas State Capitol in Austin.
The Governor has charged the Task Force with the development of a comprehensive plan to ensure we are prepared for the potential of infectious diseases, such as the Ebola virus, and can provide the rapid response needed to effectively protect the safety and well-being of Texans. A critical area of focus is the level of preparedness of our health care system, particularly in the early identification of potential threats.
TNA partnered with the Texas Medical Association (TMA) to host a special Tele-Town Hall on the Ebola Response on October 20, 2014.
Featured panelists were:
- Lisa Cornelius, MD, MPH, DSHS infectious disease medical officer
- Michael Fischer, MD, MPH & TM, DSHS epidemiologist
- Jessica Ross, CIC, DSHS epidemiologist
- Cindy Zolnierek, PhD, RN, TNA Executive Director
- Phil Huang, MD, Medical Director and local Health Authority for Austin/Travis County Health and Human Services
Click here to access this one hour informational audio file
Updated CDC Guidelines
The following guidance in the linked documents below reflect lessons learned from the recent experiences of US hospitals caring for Ebola patients. And emphasis on the important of training, practice, competence and observations of heath care workers in correct donning and doffing of PPE.
CDC Guidance for Healthcare workers on PPE
Updated CDC Fact Sheet (As of 10/20/14)
"Texas Nurses Have Concerns & Confidence About Ebola"
TNA Executive Director Cindy Zolnierek, PhD, RN, spoke to Dallas KERA reporter Lauren Silverman about Ebola and nurses' role in treating patients safey. Broadcast this morning on NPR.
"After two of the nurses who treated Thomas Eric Duncan became sick with Ebola, their colleagues across the state are expressing concerns about preparation for handling Ebola..."
Click here: Listen to NPR interview.
Watch "Facts Not Fear" Town Hall Meeting in Dallas (WFAA)
WFAA anchor John McCaa hosted a town hall meeting the evening of 10/15/14 at the Lakewood Theater in Dallas to discuss the facts about Ebola with a panel of recognized medical experts, including TNA Executive Director Cindy Zolnierek, PhD, RN.
Message to Nurses, 2nd Nurse Infected
A message to our nursing colleagues:
From Texas Nurses Association Executive Director Cindy Zolnierek, PhD, RN
"We are alarmed that a second nurse has contracted the Ebola virus and hope for her full recovery. The transmission of Ebola to care providers should raise concerns among us all – particularly nurses who are on the frontline and spend the most hands-on time with patients. Ebola has presented us with a new challenge. We appreciate efforts of the CDC to continuously improve our response, the Texas Health Presbyterian Hospital in Dallas, and most of all, to the brave health care workers at Presbyterian.
"This is an anxious time. This is why I am personally concerned that nurses are recognized as the highly-qualified professionals that we are. We read reports that unidentified nurses have had concerns about their ability to provide safe patient care and that those concerns began when the first Ebola patient was admitted to Presbyterian Hospital in September. Nurses who have such concerns have an obligation to raise those concerns at the time, all the way to the chief nursing officer if necessary. We expect hospitals to provide effective training and equipment. We are pleased that the CDC is sending special teams to help if and when new cases are discovered.
"TNA has fought for 25 years to ensure that nurses have solid legal protections when advocating for safe patient care. If nurses make their concerns known in good faith, they are legally protected against retaliation and have right to “safe harbor.” There is a specific process for nurses to follow.
"TNA is ready to help educate and assist nurses to understand their rights. Please contact us directly or visit our website for additional resources: texasnurses.org."
Watch TNA's Ebola & Nursing Press Event
Cindy Zolnierek, PhD, RN, Executive Director Texas Nurses Association; Stacey Cropley, DNP, RN, Texas Nurses Association Practice Director; and Joyce Batcheller, DNP, RN, NEA-BC, FAAN address public concerns about Ebola.
Click for biographies of presenters and press statement.
(Please forgive the beeps -- we'll do better next time!)
TNA Statement, 10/13/14
"We wish a full recovery to the nurse diagnosed with Ebola in Dallas. Nurses are on the front line of health care delivery and their work can be inherently risky. This fact is generally under-appreciated until a tragedy like this occurs. With proper vigilance and rigorous application of safety protocols, we can minimize these risks. In the meantime, we have a nurse who deserves our full support.
"The Texas Nurses Association is collaborating with the Emergency Nurses Association to make sure that nurses have the tools they need to identify and care for all patients. Here’s how the public can help: If you visit an emergency department, be sure to tell a nurse upfront if (1) you have a fever and (2) if you have recently traveled outside the United States. This will help us to deliver prompt, appropriate care.
"Hospitals must help by providing nurses with ready access to appropriate personal protection equipment (PPE). An informal poll of our members suggests that they have this access, but we are prepared to respond if we learn otherwise.
"It’s worth underscoring that particular care must be taken when donning, securing, removing, and safely disposing of PPE after each use. Refresher education and training sessions are important ways hospitals can help protect their staff and the public. Hospitals – our metropolitan hospitals in particular – should assign resources to observe the proper use of PPE and infectious disease control protocols when dealing with a possible Ebola patient. This double check on safety protocol can help protect everyone.
"The facts are not known about how the nurse in Dallas was exposed. It is incorrect to assume that the nurse failed to follow protocols. Nurses work collaboratively within a complex healthcare environment. Just like in the case of Mr. Duncan, it is critical that we approach these cases objectively and learn from a full account of what happened. Only this way will nurses and all healthcare workers be equipped to safely care for patients and themselves."
"Certainly nurses need to have access to appropriate PPE and know when and how to use it. Hospitals should be checking and rechecking their readiness, including conducting training based on the latest information available from the CDC. Nurses are educated professionals who care for persons with infectious diseases on a daily basis. Nurses who identify potential problems in their ability to provide safe patient care are responsible for raising those concerns so they can be addressed.
"TNA has been invited to provide information to the governor's Ebola taskforce and will be helping as much as possible to ensure nurses' needs and ability to provide safe patient care are addressed."
TNA is following developments regarding the Ebola virus and will periodically update this page with pertinent information. Please let us know, by commenting below or email, suggestions for content. Thank you!
TNF Establishes Fund to Support Ebola Caregivers
Ready to help? The Texas Nurses Foundation (TNF) has established a fund to help equip caregivers in West Africa with much needed personal protective equipment and other medical supplies. Learn more and donate!
Nursing Role in Ebola, Improving EHR Use
TNA has received several inquires from media asking about Ebola, the role that electronic health records play, and the role of nurses. TNA Executive Director Cindy Zolnierek, PhD, RN, has released the following statement:
"The public wants to know why the system failed Thomas Eric Duncan, the individual diagnosed with Ebola in Dallas, and placed people at risk. Many of our association’s members, coworkers, and friends work at Texas Health Presbyterian Hospital – our support goes out to them and to Mr. Duncan, whose condition we hear remains critical.
"The Texas Nurses Association cannot speak for the hospital and we wouldn’t try. Like everyone else, we have to wait until all the details are known before understanding exactly what went wrong. We can assure the public that nurses, as the first responders in emergency departments across the country, are qualified and dedicated to respond to the Ebola threat. Nurses know how to identify and treat infectious diseases – it’s an essential part of our job and we’re ready.
"Electronic health records (EHRs) play an important role in handling the volume of patients we see at our hospitals, especially in busy emergency departments, and can help alert clinicians to follow the guidelines the Center for Disease Control is issuing. Even so, we must take care to support clinicians' ability to speak face-to-face. There can be too much emphasis on technology and not enough on people.
"TNA is working to identify recommendations for improving our use of EHRs – including elevating nurse involvement in their design – to improve patient care and learn from bad outcomes. Our efforts include a survey designed to represent nurses throughout Texas on how EHRs are used.
"Also, I have advice for a concerned public: Talk to a nurse. Very likely, you have nurses in your own family or as friends. Nurses are a great resource for information and a calm voice of reason. We hope you care for nurses as much they work to care for you."
Waiting to Hear Nurses' Side of the Story?
The explanation for why Dallas's Ebola patient was sent home last month despite reporting that he had recently traveled to Liberia continues to evolve. At first, the media filled in the blanks in hospital statements and inferred that a nurse was at fault. Then, the hospital said its EHR system flow failed to communicate pertinent information to doctors.
On October 3, the hospital amended its explanation:
"As a standard part of the nursing process, the patient's travel history was documented and available to the full care team in the electronic health record (EHR), including within the physician’s workflow. There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event."
The impression that the nurse(s) involved with the case failed somehow has yet to be adequately addressed, much less dispelled. This is unfortunate because nurses are among the most trusted and qualified professionals in our country – the public must know that their trust is warranted, especially when an infectious disease such as Ebola is involved.
The healthcare culture, sadly, hasn’t entirely evolved past scapegoating nurses when, in fact, everything that happens in a busy hospital is dealt with in a team setting, with highly qualified nurses working on the front line and shoulder-to-shoulder with doctors. Modern healthcare works or breaks down as a system – not by the misstep, alleged or actual, of a single individual. This is why studying the record, determining the cause and contributing factors of any mistake, is essential to making sure these kinds of errors are not repeated.
TNA Featured on Live MSNBC
Cindy Zolnierek was interviewed live on October 3's MSNBC's Reid Report. Check here to view the show on TNA's YouTube channel -- Cindy appears at about the 6-minute mark. TNA is also giving interviews with other media outlets. If you spot us, let us know!
EHR Not Responsible for Error
Reports and statements issued Oct. 2 by the Texas Health Presbyterian Hospital reveal a critical flaw in the electronic health record system, which contributed to a Dallas patient with ebola being sent home.
"Protocols were followed by both the physician and the nurses. However, we have identified a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case. In our electronic health records, there are separate physician and nursing workflows," the hospital statement said.
TNA's is proud to stand by nurses and is happy to see the focus now turning in a more productive direction.
TNA Preparing Webinar Troubleshooting EHRs, Improving Communication
TNA is busy collaborating with the TNA-Texas Organization of Nurse Executives Health Information Technology Committee to produce a free webinar to help nurses and others assesses their EHRs and put in place better protocols for effective communication among healthcare team members. We'll announce more when we have details. The webinar will be live, but available in recorded form, too.
Additional Ebola Resources Posted
Check out these resources in addition to the ones posted earlier (below):
Keep an Eye Out for Our EBOLA Webinar!
The Texas Nurses Association/ Texas Organization of Nurse Executives Health Information Technology Committee is preparing a webinar for next week to address the systems issues surrounding the recent Ebola exposures. Topics covered will include:
- An Ebola Update
- Examining workflows in clinics and Emergency Departments related to capturing foreign travel history
- Utilizing EHRs and the Clinical Decision Support Systems within EHRs to trigger high alert protocols as outlined by the CDC if the patient indicates foreign travel to West Africa and high risk areas for Ebola exposures
- Adjunct communication in addition to EHR
- Appropriate infectious disease protocols and communications in the event any patient presents a significant public health risk
Date To Be Announced- Webinar will be recorded.