On the frontlines of the flu season: Q&A with Cleveland Clinic Executive CNO on best practices for nursing staff

The current influenza season is one of the most severe in recent memory, with 19,398 laboratory-confirmed flu-associated hospitalizations from Oct. 1, 2017, through Feb. 10, 2018, according to the CDC.

This year's flu outbreak is both widespread and harsh, with the pediatric death count hitting 84 for the 2017-18 season. Forty-eight U.S. states and Puerto Rico reported widespread flu activity for the week ending Feb. 10, the most recent data available.

The number of Americans hospitalized for the flu has increased to the highest levels in nearly 10 years, according to a Feb. 5 flu update. The most frequently identified virus type in positive specimens is influenza A, with 89 percent of cases attributable to the H3N2 strain.

Faced with an immensely taxing flu season, nursing teams across the country are holding down the fort at their respective organizations. K. Kelly Hancock, DNP, RN, executive chief nursing officer at Cleveland Clinic Health System and CNO of its main campus, discusses the biggest challenges of this flu season as well as best practices for nursing teams.

Editor's note: Responses have been lightly edited for length and clarity.

Question: What is the most challenging aspect of the current flu season for you and your team? Approximately how many patients has Cleveland Clinic admitted for the flu?

Dr. K. Kelly Hancock: Definitely here at the Clinic, we have seen a higher volume of flu admissions to the hospitals this year than we have in the past several years, to be honest with you. It's reflective of the rest of the country, I think, and we continue to monitor those admissions. As of Feb. 5, we have seen over 1,200 admissions for the flu for this year alone. We have definitely seen an increase compared to the past several years. Our hospitals were full then, and they continue to be full. So just managing through that [has been a challenge].

Also, the flu is contagious. So we have seen it cause some serious respiratory illnesses for patients. We require that all our caregivers receive a flu vaccination, because in caring for these patients, one of the challenges is that we need to make sure we protect ourselves and our families from the flu as well as other patients.

Some of our patients that have been the most vulnerable to the flu, leading [in some cases] to serious complications, have been our older patients and older adults. Then, we also see some of our more at-risk very young children and pregnant women, and anyone who is immunosuppressed or has any underlying health conditions. So for the nursing staff, it's really about making sure we manage those complex patients very carefully.

Editor's note: Responses have been lightly edited for length and clarity.

Q: What are you seeing this flu season that you haven't seen previously or haven't seen in a long time?

KH: What I've seen is definitely the severity of the illness [is greater], and so I think from our standpoint, improving public awareness [is important], such as making sure the symptoms of the flu are being recognized and that people are aware of them. Whether it's the fever — you know, having a moderate to a high fever — we've also seen a lot of patients with the dry cough, the headache, the sore throat, the chills, muscle ache and, particularly, fatigue. And I think we're seeing more often a more severe nature of those symptoms than we have in the past.

And what we try to educate our patients and our family about is that any type of fever, shaking, chills, any shortness of breath are signs that the influenza is getting worse, so you do need to seek treatment if you haven't.

As we have seen all across the country and all over the news, Tamiflu isn't for everyone, but what's concerning is that some areas of the nation are experiencing some shortages. But here at the Cleveland Clinic, we are in good supply of Tamiflu, which is good for those appropriate patients.

I think one of the ways in which our nurses can help deal with the flu season is really be educators and communicators about flu prevention with visitors who come in. So if people are visiting a patient, and we do see that they are experiencing some symptoms, we ask our nurses to advise them perhaps not to visit, because it's not in the best interest of the patient.

Q: What are some common missteps nurses make in dealing with the large influx of flu cases?

KH: I think oftentimes because there is such a large influx of patients, making sure that we follow the appropriate protocols for caring for these patients [is important], particularly around good hand hygiene and hygiene in general. We know the flu is spread through respiratory droplets, so making sure that we, as nursing caregivers, are covering our mouth and nose when we are sneezing or coughing — because that's how it would spread if we were sick. I also mentioned the visitor piece of that, which is making no assumptions that [a visitor who is showing signs of the flu does not have] the flu.

Q: What are practices you have employed to help your team perform at their best during this flu season?

KH: No. 1 is making sure people receive the influenza vaccine. Nurses need to be that educator and advocate for patients and their families.

The other thing we do really well as an organization, and it is applicable to a national front, is that, if [a caregiver is] sick, [they] need to stay home. You stay home when you are sick. If not, you put patients at risk; you put one another [at risk]. We have been very vocal about "If you are not feeling well, you need to stay home."

Particularly at this time of the year, it is very busy, so just encourage a healthy lifestyle [among your staff] and make sure they are eating well and getting enough rest at night and in some cases, taking an extra dose of vitamins and vitamin C.

Those are some best practices, but can also be some missteps along the way and things people take for granted in the busyness of our work.

Q: Have you incorporated technology to help nurses at the frontlines of the flu season?

KH: We have, actually. We have express care centers that see patients outside of our emergency room. We also have Express Care Online for virtual visits. It's for those patients who are experiencing nonemergent flu symptoms, so they don't have to come out in the winter months to seek diagnosis or treatment. It's really a telemedicine service that brings healthcare directly to the patient, wherever they are. They can use it through their phone, smartphone, tablet or a computer.

We've estimated so far, particularly during this flu season, that our Cleveland Clinic providers and nursing staff have seen 191 flu patients through this online app, Express Care Online. Plus, when you think about it, the expense for that is $49, which is covered by many medical plans and is less than going to your traditional urgent care or an ER visit. It allows our providers to care for more patients more efficiently.

Another benefit is avoiding spreading the flu to other people by using [the app]. Oftentimes, they are sitting in the waiting room, and as I mentioned, the flu is contagious and spread through respiratory droplets, so [the app] really gives us an advantage in keeping other patients safe. Since most people who are diagnosed with the flu are treated with fluids, bed rest and over-the-counter medications, an in-person visit is not necessary.

[The app has] really been an advantage in how we have leveraged our technology, particularly to help the frontlines of the flu season.



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