In 2017, Hurricane Irma wrought havoc on south Florida, including the Rehabilitation Center at Hollywood Hills, where 12 residents died in one day. The nursing home had lost power in the storm and had been without air conditioning for nearly three days before Memorial Regional Hospital, located next to the center in Hollywood, Fla., became aware of the situation. Working with the fire rescue team, the hospital evacuated the entire nursing home, and we saved more than 100 residents overcome by heat.
COVID-19 Arrives
Fast forward three years later, before the coronavirus overwhelmed south Florida, I watched as COVID-19—a threat larger than a single hurricane—spread throughout skilled nursing and rehabilitation facilities across the country with a high mortality rate among the vulnerable elderly patient populations.
We joined the Hollywood Fire Rescue team in outreach efforts to local skilled nursing facilities to assess their needs and help them get ahead of any outbreaks. Since March, that initial effort has evolved into the establishment of a task force, a systemwide long-term skilled nursing strategy and outreach to all facilities surrounding our system. The strategy includes infection prevention and control best practices and disseminating infection control education and support to nearly 60 long-term care partners in south Broward County.
Working with the Hollywood Fire Rescue Strike Force, Memorial Regional Hospital clinical teams have been conducting widespread testing of employees and isolating or transferring anyone who tests positive. For facilities outside the catchment area of Memorial Regional Hospital, the task force has put systems in place to quickly identify any individuals who present at any of the system’s EDs and report those cases to nursing home administrators.
We also notify the Department of Health and the Florida Agency for Health Care Administration to investigate facilities to ensure they are following good infection control practices, that employees have the personal protective equipment they need and that they are able to manage keeping the virus under control.
Often, there are wonderful people working in these facilities but they lack the training of medical professionals who work in acute care hospitals, and their resources are not as robust as ours. As a safety net hospital, Memorial Regional Hospital staff members are empowered by our leadership to go beyond the four walls of our hospital and out into the communities to teach at these facilities, assist them with obtaining the necessary PPE and, in some cases, help them build containment units within their facility to manage patients who test positive for COVID-19 but don’t need to go to the hospital.
We have truly developed a partnership with these facilities. We hold virtual meetings with our community partners once a month to check in. If we notice an increase in patients coming from a particular facility, we immediately call the administrator to find out what’s going on.
We’re extraordinarily proud of our work, and we believe we’ve been saving lives down here in south Florida. In fact, we recently published a study in the American Journal of Infection Control that found that over six weeks, we were able to contain the spread of the disease using a point prevalence testing containment strategy and applying infection control best practices. The findings are based on data from three serial point prevalence studies conducted on all residents and employees in 14-day intervals at a hospital-affiliated long-term care facility.
Leading With Structure and Empowerment
As a leader in this effort, I’ve learned two important aspects about myself. The first lesson I’ve learned is that people respond very well to structure. My goal with my staff is to be supportive and present—someone they can call day or night. I’m not going to be critical of what they’re doing. I’m going to be supportive, help make decisions and provide structure.
The second thing I’ve learned about myself is that I feel empowered by Memorial Healthcare System to make a difference. When it comes to doing the right thing for our patients and employees, I’m empowered to help make a positive change through this organization.
To be empowered as a leader, we have to get outside of our comfort zone sometimes. Truthfully, I walked into these two situations—Hurricane Irma and the COVID-19 pandemic—knowing nothing about what I was doing, but I had to get past the fear. Working as a nurse my whole life, I've been in hurricanes and emergency rooms with multiple issues where you have to keep a cool head. I have to show everybody that we are all empowered to make a positive difference, no matter what the situation is. We’re going to make mistakes—there’s no perfect world or answer to everything. But, don’t be afraid to try.
As Memorial Hospital experiences its second surge, which is worse than the first one, it’s all about keeping our employees safe and continuing to reach out to all of the facilities to ensure they’re safe and have the infrastructure to safely house patients who test positive for COVID-19.
There’s a lot going on right now and it’s a very trying time. Our goal as leaders is to take care of our staff so they can take good care of the patients. We have to come to work every day, leave whatever is going on in our lives behind us, and be there for our employees who are on the front lines.
Judith L. Frum, RN, RRT, is COO, Memorial Regional Hospital, Hollywood, Fla.(jfrum@mhs.net).