Zoom Logo

ACOG SMI & NYSDOH NYSPQC Webinar: Managing COVID-19+ Pregnant Patients - Shared screen with speaker view
Patricia Newcomb
36:53
Test
Kristen Lawless
37:02
Hello, everyone. Welcome to today’s webinar. Please feel free to submit your questions via the chat function.
Pamela Scurry
37:07
hello
Kim Kenyon-Berry
38:24
should be be wearing n95s for all pt encounters?
Chanel Porchia-Albert
39:15
Greetings, Ancient Song has been made aware that at two public hospitals newborns are being separated from their parents immediate postpartum for 14 days even when no signs of COVID-19 is present. What is the current policy on immediate postpartum care of pregnant people and newborns? Give Thanks Chanel Porchia-Albert
martiel stoecker
40:58
should babies be a nursery together with other babies or stay in mothers room together knowing some patients are asymptomatic and may develop symptoms/disease later? what are other facilites doing?
Kristen Lawless
46:25
Please feel free to submit questions through the chat.
Casey Forde
47:53
Anyone considering early discharge for healthy mom/baby with uncomplicated pregnancy and delivery?
Paula crevison
48:07
Are there any guidelines around the pregnant patient needing or requiring a ventilator?
Dena Goffman
50:27
We are discharging women when medically and socially ready but including PPD1 for NSVD and POD2 for CD
Lindsay Gennari
50:37
NYS stays that a support person is allowed but can not be a PUI or COVID+ but what if the patient themselves is a PUI or covid. then is the support person allowed to be a PUI or covid? my hospital is inclined to let a covid + support person in if the patient themselves is.
Pamela Scurry
51:22
once we have determined that we have a mom that is Covid-19 what would be standard of care for postpartum regarding the newborn?
Jessica Barrett
52:31
Are there any RN staffing changes being made to handle the covid pts??
whitney hall
54:57
are any other hospitals doing any simulations as I saw in the ACOG Covid preparedness manual
Jonathan Oliva
56:01
test
Susan Vandervoort
56:14
on the ambulatory side, I have RNs working telephonically working from home to preserve the work force. I provide my nursing director with a list of RNs that could be reassigned to inpatient
Chanel Porchia-Albert
57:53
are there any limitations that doulas need to be aware of in supporting clients virtually within the labor room?
Adriann Combs
58:15
Hi this is Adriann Can you unmute me?
Kristen Lawless
59:00
Hi, Adriann. Will do.
Kristen Lawless
59:11
You should be all set now.
luat le
01:01:34
How do we know second stage of labor is not aerosol generating?
Patricia Heinrich
01:01:46
http://www.ihi.org/communities/blogs/covid-pandemic-conserving-personal-protective-equipment?utm_source=hs_email&utm_medium=Feature&utm_campaign=2020_TW_Test&utm_content=Recs_PPE&_hsenc=p2ANqtz-_MfVCVTjCxYh-4s6OqQYT_yKGAc0SgG3rW30-yTmb6ir39rdh2YNibsiAN41iN3TAmXLXpPaUOlcOh058v4LWMmTQRZA&_hsmi=85425648
Jonathan Oliva
01:03:50
To address second question, I have struggled to reassure my department regarding PPE, particularly N95 use. Nurses and Docs have continually expressed dissatisfaction with the CDC guidelines, claiming safety is not at the forefront of such guidelines. Our hospital insists on keeping with CDC recs before releasing N95s. How do I reconcile these two parties?
Patricia Newcomb
01:04:25
Is anyone masking patient and support person -- either homemade, surgical, or n-95?
Jackie Montgomery
01:04:57
is this for ALL patients in the second stage, or specific to only PUIs/positive COVID patietns?
Casey Forde
01:05:10
masking birth partner with procedural mask
Dena Goffman
01:05:35
All patients and support individuals masked with surgical facemask
Patricia Newcomb
01:05:41
since not enough tests -- asking re -all patients/support people
whitney hall
01:06:06
we are also masking all patients and support people with surgical masks
Jenn Carey
01:06:18
This feels unfair to the rest of hospitals in NYS who are being told there are not enough to start; that we need to preserve them for the positives- and then to hear that other hospitals are using them all the time.
neila hernandez
01:07:28
I agree with Jenn Carey; we are currently preserving for only RT (med neb, intubation, etc) + COVID pts
Jessica Barrett
01:08:11
Agreed Jenn Carey. We have a lock box with 5 masks of each size for a entire floor of RN's
Marino Poliseno
01:08:36
Please comment on testing all patients in labor and delivery with rapid turn around tests in effort to preserve scarce PPE and plan the postpartum period with the neonate?
Francesca Grillo
01:09:24
How do you manage the newborn of a positive patient on postpartum ?
Casey Forde
01:10:01
are all patients on full PPE until you get resuts
neila hernandez
01:10:14
Obtaining swabs for ALL L&D admitted patients?
Kim Kenyon-Berry
01:10:24
Yesterday Pres Trump stated "millions of masks" are being distributed to NY hospitals. Any idea where those are being sent? He even suggested they are being hoarded in NY somewhere.
Michael Lewis
01:10:39
Majority of our patients have been completely asymptomatic on presentation. All patients are tested on admission but our results come back over 24hrs.
Marino Poliseno
01:10:49
Yes all admitted L&D patients
Eva Pressman
01:10:55
Are you concerned about false negative results with swabs on asymptomatic patients?
Natasha Fievre
01:11:27
Are the babies of PUI roomed in with the mom while hospitalized?
neila hernandez
01:11:30
Thank you Marino Poliseno. Can you tell me if this is a recommendation from CDC?
Edmund LaGamma
01:11:40
Mom enters w/ fever but w/o URI signs? Test or not?
Dena Goffman
01:11:59
We are seeing fever as the only or first sign. Would swab for fever
Monica P Anderson
01:12:14
We have a room designated for all newborns of PUIs and positive patients staffed with NICU nurses.
Casey Forde
01:12:29
Dr Goffman Do your patients stay on full isolation while results pending?
Justin To
01:13:07
Hi Dr. Goffman, what has your positive rate been for the universal screening to date?
Shilpi Mehta-Lee
01:13:09
We are also swabbing for fever in labor/postpartum.
Jenn Carey
01:13:13
What level of PPE do you use for support person of PUI or positive patient
Dena Goffman
01:13:46
Asymptomatic women are placed in a low suspicion group. Mom, partner and providers masked. Eye shield added for NP swabs and full gown/eyeshield for delivery.
Kim Kenyon-Berry
01:14:10
How would you handle a mother who is covid + and refuses to have her baby isolated away from her?
Lindsay Gennari
01:14:17
I thought DOH said you have to allow a support person?
Laurie Fegley
01:16:09
DOH did say allow support person, but not if sick
whitney hall
01:16:43
Yes
Deborah Jones
01:17:15
where are the support person's screening values recorded?
Casey Forde
01:17:32
for COV19+ patient support person must stay in the patients room
Camille Clare
01:17:53
We are recording support person's values in patient's chart.
kathleen Dermady
01:19:01
This is Leah at upstate-we have limited to 2 nurses and 2 docs to conserve PPE
Kim Kenyon-Berry
01:19:37
what type of oxygen delivery system is best for mother during labor? nasal canula or nonrebreather mask?
whitney hall
01:19:39
rooming in with separation by curtain
neila hernandez
01:19:40
We have a log that screens support person's responses and temperature q 12 hours, place pt's ID label on sheet and this gets included in pt's paper chart for scanning in HIM
Tracy Johnson
01:20:25
DOH 3/27 document last paragraph states... L&D support person MUST be asymptomatic, not suspected, nor recently confirmed.
Patricia Newcomb
01:21:06
Evidence is weak on effectiveness of oxygen -- so our hospital is not doing oxygen as routine response to labor events - minimizing droplets, disposal of tubing etc.... cleaning time
Robert Silverman
01:21:15
How about the use of nasal prong oxygen in the OR’s during cesarean sections or while pushing? Better to use rebreathers?
Camille Clare
01:21:24
Not using oxygen and not using nitrous oxide anymore
susan sippel
01:21:42
Are you separating PUI babies form babies of COV. + moms?
Barbara Maier
01:21:47
We are not using oxygen or nitrous oxide either
Camille Clare
01:21:52
question about doula support virual came up earlier
Chanel Porchia-Albert
01:22:10
are there any virtual restrictions to providing support in the labor room that in the case someone does not have support or if the laboring person is getting virtual doula support?
Dena Goffman
01:22:20
No oxygen for fetal indications
Camille Clare
01:22:34
how are you keeping track of covid results?
luat le
01:22:47
No oxygen for all laboring patient or COVID pt?
whitney hall
01:22:53
should Covid + patients be Inductions at 39 weeks?
Jonathan Oliva
01:23:00
There has been ongoing discussion at our hospital about discontinuing elective non-medically indicated inductions at 39+ weeks. Rationale: reducing length of stay (and to reduce risk of depleting resources during surge).
Robert Silverman
01:23:32
I think limiting elective inductions is a wise move.
Kim Kenyon-Berry
01:23:44
Are we continuing to practice delayed cord clamping?
whitney hall
01:23:50
one great use of Doulas should be with the patient at her home to keep her in the home until in active labor.
Elizabeth Igboechi
01:24:00
the IPAD initiative is an excellent idea !
Chanel Porchia-Albert
01:24:15
thank you
Camille Clare
01:24:24
you are welcome
Laurie Fegley
01:25:45
Stopping elective inductions also helps to conserve staff (1:1 ratio for Pitocin)
whitney hall
01:26:23
what about IOL for AMA?
Camille Clare
01:26:24
very creative with iv pumps. do you have central fetal heart rate monitoring?
whitney hall
01:27:45
12 hour discharge?
Chanel Porchia-Albert
01:28:34
what about 12 hour discharge?
kathleen Dermady
01:28:50
Please address recommendations for AP visit in low and high risk setting. What are recommendations for fetal monitoring , (ie DM, HTN third trimester)
Jenn Carey
01:29:25
So are you discharging babies to the home of covid positive mom?
Justin To
01:29:29
How are you following mothers who are Covid positive, but remain pregnant, as outpatients?
Frederick Friedman
01:30:31
baby must be tested for NYS screening at 25 hours of life - Peds Team has to buy into that if done as outpatient
Dena Goffman
01:30:45
Covid positive outpatients being followed closely with Virtual visits by dedicated team.
Justin To
01:31:02
Thanks Dr. Goffman
neila hernandez
01:31:43
Our pediatricians are performing repeat NYS screening for those infants requiring this
Camille Clare
01:32:07
we have also stopped oxygen as well a while ago
Christa Christakis
01:32:26
As a reminder, if you have questions after this webinar, please contact me at cchristakis@ny.acog.org
Camille Clare
01:33:03
are you using VNS or home nursing for patient follow-up or your own nursing staff?
Daniel Lasser
01:33:40
Category 2 tracing can be secondary to worsening maternal respiratory function
Patricia Newcomb
01:34:28
Is anyone talking with their ethics or ventilator allocation planning teams about plans for when ventilators are not sufficient for patients needing them? What are you advising?
Lynn Simpson
01:34:34
We are not using VNS -- uncertain whether they would do this follow-up during this crisis.
Barbara Bromley
01:34:36
Does the decision to give or not give oxygen differ for units that have a surgical suite on the labor unit and those that don't and need to transfer the patient to the OR?
Kristen Lawless
01:36:31
Feel free to send algorithms to NYSPQC@health.ny.gov and we will compile and share.
Camille Clare
01:37:13
Where are those simulation information available?
whitney hall
01:37:22
its so not intuitive! :)
Deborah Campbell
01:38:05
NYS TaskForce on Life and Law published ventilator allocation guidelines in 2015. Not sure OB patients were specifically addressed in the allocation guidelines
whitney hall
01:38:10
covid-19 obstetric preparedness manual
whitney hall
01:38:41
has simulations
Patricia Newcomb
01:39:17
NYS Guideline 2015 built on flu -- doesn't address this specific issue -- seems covid + need more than 48 hours on vent usually to have effect
Casey Forde
01:39:34
On a recent transfer in, I noticed that management of the actual patient chart was a problem. it was in the stretcher with the patient, then ended up in theroom
Michael Lewis
01:40:04
i would avoid use of cautery during cesarean section unless a smoke evacuator present
maria smilios
01:41:13
We would like to test all women as they present to L&D but we do not do our own testing and have a limited number of viral media from DOH. Reserved for symptomatic patients throughout hospital.
Dena Goffman
01:41:19
Can share ACOG simulation working group simulations we developed
Frederick Friedman
01:41:20
yesterday we started screening all Ob admissions
Peter Bernstein
01:41:24
We are only testing symptomatic patients
Kim Kenyon-Berry
01:41:30
Only testing patients with symptoms
Lynn Simpson
01:41:33
We screen all admitted OB patients at Columbia.
neila hernandez
01:41:52
Will a summary regarding this webinar be emailed or posted on the website?
Camille Clare
01:42:00
Thanks for allowing me to participate. We screen symptomatic women. We don't have the faster screening available for testing.
Kim Kenyon-Berry
01:42:10
THANK YOU ALL SO MUCH!!
Kristen Lawless
01:42:24
The webinar has been recorded and will be made available following the webinar. We will also disseminate algorithms we receive and other resources.
Christa Christakis
01:42:30
cchristakis@ny.acog.org
whitney hall
01:42:35
Thanks so much!
Patricia Newcomb
01:42:49
Grateful to participate
neila hernandez
01:43:07
thank you!!
Susan Smith
01:43:10
Results for our testing take 5 to 7 days for turnaround
Marino Poliseno
01:43:15
We are considering testing all pregnant patients but resources are limited
Erin Gretzinger
01:43:17
thank you. this was wonderful
Marino Poliseno
01:43:21
Thank you
Jennifer Paletto
01:43:35
thank you