Peer Questions

• We use the InTemp Data Loggers by Onset (purchased from MicroDaq). https://www.onsetcomp.com/intemp/
  1. These loggers send a notification via text note or email when temperatures are out of range.

• We use the VFC 300 wifi from Control Solutions. You can set up email and text notifications. I have it text the manager, the VFC primary, and the medical director.
  1. Here is the link to it: https://www.vfcdataloggers.com/vfc-300-wifi/

• We use Fridge Tag-L2 and do not have a phone alert.
• The brand we use is Senoscientific. It is cloud-based. The business office supervisor and the clinical supervisor get texts when there is a temperature variance. Usually it means a door was left open.
• We use Tag3 data loggers and buy the data plan so we get text messages if the frig/freezer goes out of range. We buy the loggers and the data plans from Berlinger.
  • We only use Tag3 and data plans for the devices that store vaccine overnight and weekends. For the ones that only house vaccine during the day and are not storage units, we only use Tag2 loggers.
  • We used InTemp/TempAlert previously, but the state didn’t like their reports so we just eventually switched to the ones that the state preferred – it was just easier at audit time.

• We have made changes to our policy about masks for patients.  Staff were already wearing masks.  We posted a sign on the door that is pretty clear about the need for a mask.  All of our reminder calls and texts for appointments and when an appointment is made get the information that a mask is required.  However, if a patient comes without one, we are not going to refuse to see them at this point.  We have discussed putting them in a different room if they are here for a well check.  This way they do not potentially infect the “Well” room for the next patient.  Some staff are not happy with having to work up a patient in an exam room if they do not have a mask.

• Pros – Families and employees are thankful that we are doing our best to keep everyone safe.
  • Cons – 1. Change! 2. We’ve had 2 parents refuse to wear masks. We offered one the opportunity to reschedule the well visit and the other chose to wait in the car for her teenager.
  • New policies – Yes. All employees and doctors must wear masks at all times. All parents and patients ages 2 years and older must wear a mask in the office, including exam rooms. We used the mayor’s mandate for guidance in our communication to staff and families.

• We have not since the new mandate. However, we have required employees to wear them everyday since April. We have been requiring patients to wear them in the clinic if they do not have one we give them one.

• We require our workers to wear masks. We have not required the patients/parents to wear masks. We have moved all “sick” visits to the afternoon. We ask them to call us from the car. A nurse will meet them at the car to begin the assessment.

• We are primarily doing telehealth visits. For the summer we have implemented a one-week-on, one-week-off policy where we are only seeing patients in office every other week.  For those patients being seen in office, they are required to wear a mask the entire time they are in the office, and we are also wearing masks.  If a patient does not have one, we do provide a surgical mask.  So far, we have had zero push-back on this policy.  We have had a few patients who misunderstood and believed it was okay for them to take off the mask once in the exam room, but we asked them to put it back on without issue. We do not currently utilize the waiting room and ask patients to arrive at their scheduled appointment time, to call or text the office letting us know they have arrived, and the provider gets them from their car and takes them straight back to the exam room.

• We have mandated masks for everyone and majority of our patients are understanding and appreciate the precautionary steps taken.

• We began requiring masks for all patients and guests a couple of weeks prior to the mandate.  The thing that made the difference was our ability to get PPE from TEMA.  Without the additional PPE, and with so many patients coming without their mask, we needed more PPE than we were able to purchase ourselves.  Now that the mask mandate came out, at least more patients are arriving with their own masks, which helps us not deplete our mask supply so quickly. No other process changes were required.

• We currently request that all patients and parents wear a mask to appointments if over 2 years of age. When booking appointment we tell them to bring and wear mask to appointment. If they still arrive without a mask we will provide one for them.

• While our county has not yet implemented a mask mandate we encourage our patients to wear masks.  When scheduling their appointment our staff asks several questions which help us determine if the patient needs to wait in their car and be given a mask before entering. Anyone with a cough, fever, or exposure to any sickness are required to wear a mask upon entering our facility.  So far patients have been compliant.

• For their initial 90 day and annual eval we send 5-6 focused questions out to their peers for feedback.  It is done by e-mail.  Not a rating system by peers…just subjective feedback on key job functions and code of conduct.
• As part of our annual evaluation at Vanderbilt, we must submit the names of three individuals that we would like to give feedback regarding our work performance. In our case, this feedback is reviewed with us by our director anonymously at the time of our evaluation (i.e. I will not know who said what, but my director will). There is not a specific format to follow but it is generally based on the Vanderbilt Credo and how well the person represents these behaviors. We can also ask people outside of our organization that we have worked with to give feedback. The behaviors are:
• I make those I serve my highest priority
• I respect privacy and confidentiality
• I communicate effectively
• I conduct myself professionally
• I have a sense of ownership
• I am committed to my colleagues

We also review ourselves on these behaviors and give specific examples for each.

• As a norm, we meet once a month for about 30 minutes. If there is a definite issue to talk about, we do have an extra meeting to address it. For the most part, we pick issues like consistency of well visits and ask those involved in talking to the patients and ask what hurdles they are experiencing and how we can get better at it. We have everyone give opinions and at the end of the meeting we decide “as a group” the steps we will be taking. It is not only approaching the patient, but also how the employee needs to tackle the task in a way it would be comfortable for him/her. If this new way is a problem with the individual, we talk about is as well.
• We use an MD peer review process. We have also allowed staff to evaluate MDs. Both have been received well. We do not do co-worker peer reviews.

• We will do it in their vehicle outside the clinic if absolutely necessary.  We have transitioned to MDI in office for albuterol.

• If we need to give a nebulizer treatment, we have a portable one that plugs into car and will give to them in the car.

• We are not doing nebulizer treatments in the office at all during COVID.  The risk of aerosolized disease is too great (even with a HEPA filter). The patient most likely already has a nebulizer at the house and we just ensure they have their medication. If the patient does not have a nebulizer, we can dispense a DME nebulizer to them and instruct on home use. Alternatively, if medically appropriate, we can prescribe an inhaler…but not always medically appropriate.

• We have a treatment room, where the nebulizer is set up at.  We use a different mask and tubing for each patient.  At this time, the room is sanitized and not used for 2 hrs.

• Administrator and Clinical Manager with direction from the MD
• We are doing most of our testing curbside. We have protocol for who is allowed in our building. We have our walk in NPs taking care of all curbside testing. They must have full PPE before leaving the building and it is placed in a biohazard bag before returning to the building.
• Our Nurse Manager keeps track of all exposures as well as reporting to the state.
• We are still wearing full PPE gear and seeing potential or exposed COVID patients in our drive-thru so we don’t have to notify anyone. We are still not allowing sick children in our well side. We also have separate office space and entrance for sick kids. Any COVID symptoms go into those rooms only and employees should be in full PPE gear. All vitals are taken in those rooms as well to limit exposure.

• We just recently started using Sofia for SARS. We are billing 87426 for the test. However, we have not had enough time to see what reimbursement is

• Our school district gave parents an option to choose which method of returning to school was best for them. So we have not had any requests to provide letters of exemption.

• We are not providing any letters. We tell patients/parents it is up to them as a family to decide based on their individual circumstances. Otherwise we would be doing letters all day. Example: we had a request for information on how long should my child wear a mask and when should they get a ‘mask break.’

• We are telling folks to go back to school if their school is open. If they are concerned that their child’s medical condition puts them at higher risk of covid19, then we are having them discuss that with whatever subspecialist helps manage that condition. For the most common issues [such as asthma, eczema, adhd, h/o prematurity], we aren’t writing exemption letters.

• Currently, we are not allowing any vendors to come into the building. Any correspondence is done by phone or e-mail. We are limiting as much exposure as possible to our parents and patients. Drug Reps are also not allowed in the building. They are shipping formula, etc.
• We are currently not allowing Reps in our building.
• We do not have vendors coming in by appointment. We have continued to have some who regularly call on us continue to do so without any problems. The vendors would have access in order to restock if called for. Vendors can interact with healthcare givers if the situation merits for them to do so.
• Our parents do not need to see strangers just walking around. We will not allow the same level of access. But quite honestly, none have come since the world stopped.
• We are only having reps do “virtual lunches” for now. They provide a box lunch only (no buffet style), we go in shifts to social distance in our breakroom, setup a laptop where the rep can talk to us. If they want to send samples by mail is best, but they can drop off at the front desk too. We typically don’t have reps go to supply closets anyway, so this is not an issue. Pre COVID, we did not allow reps to just stop by, they had to schedule a lunch or breakfast to talk with providers. Too disruptive to the clinic.
• We are not currently accepting vendors. Once we resume visitors, they should be able to access the same area. However, we are still working on our plans for “sick season”.
• Vendors have to have masks. No hanging out at the office for now.
• We are still not allowing vendors into the clinics due to COVID. Frankly, however, they are all working remotely and I am not sure anyone wants to come in. Delivery people can deliver to main areas only. Even they get their temp checked!
• During COVID (and we haven’t determined yet how long that will be), reps will not have access to doctors, to clinical areas, to supply closets, etc. All reps have been great about calling to see if we need samples or formula and have been supplying us very well from their remote locations.
• We are not allowing reps in the office. Only patients with 1 caregiver for well appointments only. Sick appointments are via covered drive thru. We are requesting that they mail anything for the closet.
• Currently, we are not allowing any vendors/drug reps to come into the office. Any correspondence is done by e-mail or WebEx. We have done a couple virtual lunches.
• As of May 26, we will begin allowing product reps into our offices, however, they must let us know when they are coming. We have rearranged our office schedule to see only sick in the mornings and well appointments in the afternoons at one of our offices and reversed at another office (well in a.m. and sick in p.m.). Reps are asked to come during the designated “well” times, and they must wear a mask and sign in at the front desk. So far the reps have been very understanding.

• We upgraded from Tag2 thermometers to Tag 3 thermometers and activated the text message function thru Berlinger. It texts us any hour of the day if the frig or freezer goes out of range. So it was the additional cost of the Tag 3 plus texting service thru AT&T that I think is $120 per year per device.
  Prior to that, we used TempAlert who had wireless devices and those also texted us.
• We have data collectors on our refrigerators and freezers that alert me and the clinical supervisor by text and email if they become out of range.
• We have a device called Sensaphone. We have been using it for about 6 months. It has worked very well for us so far.
• We have sensors that were installed by our security company.
• Our IT person has something hooked up to notify us in the event of power failure. It goes to several people within the company. We would respond appropriately if notified.
• We use Refrigerator and Freezer 2 Tag data loggers and someone checks them each day. We have a backup on each unit. We are in the process of installing alarms that will notify a designated phone when the unit is out of range.