Title Description Tags
Infection Prevention Highlights to Prevent Team Member Exposure

The Infection Prevention Highlights to Prevent Team Member Exposure document outlines many of the measures we have implemented at Duke Health to keep our team members safe while continuing to provide high-quality care to our patients. This is intended to provide to team members with a key overview of many of the changes made to operations, guidance and recommendations to protect our patients, visitors and each other. Uploaded 06.02.20

Clinical Guidance and Forms (General), Employee Health
Duke Raleigh Hospital COVID-19 EVS Room Cleaning Checklist

This document provides a checklist for Duke Raleigh Hospital EVS team members on the cleaning procedures for inpatient rooms during the COVID-19 response. Uploaded 7.22.20

PPE, Clinical Guidance and Forms (General), Duke Raleigh Hospital
Maestro Care Update for Exposure to COVID-19 Status

This document outlines more information about the Maestro Care Update for Exposure to COVID-19 status. Beginning Thursday, May 28th, a new infection status, “Exposure to COVID-19” will be visible within Maestro Care for patients who have a known exposure to a person infected with COVID-19 (e.g. newborn of a mother with COVID-19) or patients requiring admission with a recent stay in a congregate setting (such as nursing or group home). When admitting a patient with this history, you must notify Infection Prevention at your facility during business hours to update the infection status and assure isolation order for Contact and Droplet entered in Maestro Care. Some patients may have a negative SARS-CoV-2 test; however, due to their exposures (to another person or congregate living facilities), special contact and droplet precautions are indicated for a defined period while in acute care clinical settings. Please contact your facility's Infection Preventionist with questions. Uploaded 05.28.20

Clinical Guidance and Forms (General), Maestro Care
Tips for Communicating with Patients while Wearing a Mask

In these times where face masks and physical distancing are necessary to reduce the spread of infection, patients with hearing loss (and even some with normal hearing) are experiencing increased difficulties understanding spoken language. Check out these tips that may help improve communication when the patient or caregiver is experiencing communication difficulty. Uploaded 08.04.20

Clinical Guidance and Forms (General), Patient Communication and Signage
Position Statement – Patients Scheduled for Elective Procedures Who Refuse COVID-19 Testing

This document is a position statement for patients scheduled for elective procedures who refuse COVID-19 testing. For the care and safety of our patients, visitors, and staff, Duke Health providers will not schedule, or will cancel, elective procedures for patients who refuse pre-procedural COVID-19 testing. This document provides guidance for the Duke Health provider faced with this scenario. Uploaded 05.29.20

Clinical Guidance and Forms (General), Testing Guidance
Temporary Workflow for Discontinuing Special Airborne Contact Isolation

During the “wash in” period of implementing the new CDC guidance for a symptom-based strategy to discontinue Special Airborne Contact Isolation, Infection Prevention will work very closely with teams to ensure treatment teams are comfortable with the new process. Below is the proposed temporary workflow for discontinuing Special Airborne Contact Isolation. After Maestro updates are complete and team members are familiar with the guidance, we will move towards automation. This document outlines the inpatient and outpatient processes. Uploaded 08.04.20

Clinical Guidance and Forms (General)
Patient Letter – COVID-19 Test Refusal Prior to Procedure

This document is a letter to provide patients scheduled for elective procedures who refuse COVID-19 testing. For the care and safety of our patients, visitors, and staff, Duke Health providers will not schedule, or will cancel, elective procedures for patients who refuse pre-procedural COVID-19 testing. Uploaded 05.29.20

Clinical Guidance and Forms (General), Testing Guidance, Patient Communication and Signage, Elective Procedure, Periop Testing
Duke Health Pre-operative and Pre-Procedural Guidelines for COVID-19 Testing

The purpose of this document is to outline the Duke Health recommendations for the use of testing for surgical and non-surgical procedures. The following recommendations apply to all Duke Health patients > 3 days old undergoing the following procedures: bronchoscopy, transesophageal echocardiography, electrical cardioversion, electrophysiology procedures requiring general anesthesia, electroconvulsive therapy, upper and lower endoscopy, fluoroscopically guided enteric tube placements, and interventional radiology procedures requiring anesthesia. Uploaded 08.04.20

Testing Guidance, Clinical Guidance and Forms (General)
Special Droplet and Special Droplet & Contact Sign Ordering Reference

Special Droplet and Special Droplet & Contact signs are now available for order in Eprint. This document is a reference that provides guidance to order these signs. Uploaded 06.05.20

PPE Signage-Clinical, PPE, Clinical Guidance and Forms (General), High-risk Populations
Federal Medical Complex Butner Federal Forensic Patient Care

This document can be accessed through the Secure Policy Center. This document outlines care policies and FAQs for the care of forensic patients from Butner Federal Medical Complex (FMC). These policies address the care of an inmate patient who is under the legal custody of law enforcement or a correctional facility. Uploaded 06.05.20

Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, Clinical Guidance and Forms (General), High-risk Populations
Duke Health Policy for Providers Managing Cardiopulmonary Arrest and RRT in COVID-19 Patients

The document provides guidance to providers on appropriate PPE for CPR and/or RRT on COVID positive patients or PUIs. Uploaded 04.03.20

PPE, Clinical Guidance and Forms (General)
Decedent Care: Visitation Procedure at DRAH During End-of-Life

This flowchart applies to DRAH and shows the procedure for supporting family presence and participation/visitation during end-of-life of patients with suspected or confirmed COVID-19 infection. Uploaded 06.24.20

Clinical Guidance and Forms (General), Operations and Visitation, Duke Raleigh Hospital
Respiratory Therapy Guidance During COVID 19 Response

This document provides guidance for the safe delivery of respiratory therapeutics during the COVID-19 pandemic. Updated 05.07.20

Clinical Guidance and Forms (General), PPE, PPE Signage-Clinical
Inpatient Management of Multisystem Inflammatory Syndrome in Children (MIS-C)

This document is titled "Inpatient Management of Multisystem Inflammatory Syndrome in Children (MIS-C)." This document provides early guidance to clinicians managing children with symptoms associated with the recently described Multisystem inflammatory syndrome in children (MIS-C) in the Inpatient setting. Uploaded 06.29.20

Clinical Guidance and Forms (General), Testing Guidance, Pediatric Specific Guidance, Pediatrics
Position Statement and FAQs for Antibody Testing

This document provides guidance to physicians to facilitate conversations with patients regarding requests for antibody testing for COVID-19 (SARS-2-CoV). Uploaded 05.08.20

Clinical Guidance and Forms (General), FAQs and Talking Points, Testing Guidance
Emergency Department Evaluation for Suspected Multisystem Inflammatory Syndrome in Children (MIS-C)

This document is titled "Emergency Department Evaluation for Suspected Multisystem Inflammatory Syndrome in Children (MIS-C)." This document provides early guidance to clinicians managing children with symptoms associated with the recently described Multisystem inflammatory syndrome in children (MIS-C) in the Emergency Department. Uploaded 06.29.20

Clinical Guidance and Forms (General), Testing Guidance, Pediatric Specific Guidance, Pediatrics
Management of Patients with Suspected or Confirmed COVID-19 in the Outpatient Setting

This document provides recommendations for outpatient management of patients with suspected or confirmed after receiving a COVID-19 diagnosis. Uploaded 05.08.20

Clinical Guidance and Forms (General), Ambulatory DPC, Ambulatory PDC
DRH ED – Inpatient Testing Protocol

This document contains information about the Duke Regional Hospital testing protocol for patients who need to be admitted from the emergency department. Updated 06.19.20

Clinical Guidance and Forms (General), Duke Regional Hospital
Disinfection Guidance for Inpatient Tablet & Accessories

This document provides disinfection guidance for electronic equipment used across DUHS for patients on isolation. The equipment includes tablets mounted on an IV pole, Bluetooth speakers, charging cords, etc. Updated 05.19.20

Telehealth, Clinical Guidance and Forms (General)
Outside Hospital Transfer / Direct DRH Admit Testing Protocol

This document contains information about the Duke Regional Hospital testing protocol for patients directly admitted to DRH or who have been transferred to DRH from another facility. Updated 06.19.20

Clinical Guidance and Forms (General), Duke Regional Hospital
Guidance for Appropriate Repeat COVID-19 Testing

This document provides guidance for providers on appropriate test utilization for COVID-19 PCR (appropriate COVID-19 repeat testing). Please note that all test orders available at DUHS (POC test, rapid test, pre-procedural test, inpatient test, outpatient test, and IP test) have gone through a rigorous validation process and that all results may be used as part of these repeat testing strategies. Updated 08.05.20

Testing Guidance, Clinical Guidance and Forms (General)
Guidance on Transfers of Care During Pandemic

This document provides general guidance to Duke Health physicians evaluating requests to accept new patients during the declared state of pandemic emergency in North Carolina. Scope includes Requests to Assume the Care of an Outpatient; Requests for Inpatient Direct Admission; Requests for Inpatient-to-Inpatient Transfers. Uploaded 07.05.20

Clinical Guidance and Forms (General)
Duke University Hospital Guidance for Interpreter Services on Duke-Issued Tablets for Patients with Suspected COVID-19

If scheduled before entering patient’s rooms, Duke Interpreter services can connect to a patient or provider tablet via Jabber to facilitate communication. This document provides guidance and outlines the workflow for using this service at Duke University Hospital. Updated 05.20.20

Telehealth, Clinical Guidance and Forms (General), Duke University Hospital
Decedent Care: Visitation Procedure at DRH During End-of-Life

This flowchart applies to DRH and shows the procedure for supporting family presence and participation/visitation during end-of-life of patients with suspected or confirmed COVID-19 infection. Uploaded 07.06.20

Clinical Guidance and Forms (General), Operations and Visitation, Duke Regional Hospital
Tracheostomy Protocol During COVID-19

This document provides multidisciplinary guidance for safely performing tracheostomies and for post-tracheostomy care in patients who were diagnosed with COVID-19 (tracheostomy protocol). Please note, there is a new recommendation that special airborne contact isolation may be discontinued once the patient meets appropriate criteria using the symptom-based strategy. Updated 08.04.20

Clinical Guidance and Forms (General)
Managing Infants born to Mothers with Suspected or Confirmed COVID-19

This document summarizes the PPE recommendations for healthcare workers providing care to maternal-infant pairs in the inpatient and outpatient settings. It outlines guidelines for managing infants born to mothers with suspected or confirmed COVID-19. Uploaded 07.07.20

Pediatric Specific Guidance, Clinical Guidance and Forms (General)
Duke Guidelines for Antithrombotic Therapy in Hospitalized Patients with COVID 19

The attached document contains information about the guidelines for antithrombotic therapy in hospitalized patients with COVID-19. Uploaded 05.22.20

Clinical Guidance and Forms (General)
DRH Protocol for Inpatients with New Symptoms Concerning for COVID-19

This document shares protocols for inpatients who develop new symptoms that are concerning for COVID-19, what type of precautions and testing should be used, and what unit the inpatient should be assigned to based on their test results. Uploaded 07.15.20

Duke Regional Hospital, Clinical Guidance and Forms (General)
COVID-19 Inpatient Anticoagulation Protocol – for ICU and non-ICU patients

The attached document contains information about managing COVID-19 inpatient anticoagulation protocol (antithrombotic therapy) for ICU and non-ICU patients. Uploaded 05.12.20

Clinical Guidance and Forms (General)
Duke Raleigh Hospital COVID-19 EVS Room Cleaning Procedure

This document includes guidelines for Duke Raleigh Hospital EVS team members on cleaning procedures for inpatient rooms during the COVID-19 response. Uploaded 7.22.20

PPE, Clinical Guidance and Forms (General), Duke Raleigh Hospital
Contact/Reference List for COVID-19 Topics

This one-pager lists contact information and document references to help quickly answer common questions related to COVID-19. Topics include testing, PPE, interpreter services and employee health. This resource is intended for DUHS team members at Duke University Hospital, Duke Regional Hospital and Duke Raleigh Hospital. Uploaded 04.23.20

Clinical Guidance and Forms (General), Testing Guidance
DUH ICU Guidance

This document is meant to serve as internal guidance for the identification and management of patients admitted to Duke University Hospital with COVID-19 who progress to shock or respiratory failure. Uploaded 04.15.20

Clinical Guidance and Forms (General), Duke University Hospital, ICU Care
DRH ICU Protocol

This document is meant to serve as internal ICU guidance for the identification and management of patients admitted to Duke Regional Hospital with COVID-19 who progress to shock or respiratory failure. Uploaded 04.15.20

Clinical Guidance and Forms (General), Duke Regional Hospital, ICU Care
ICU Educational Resources for the Non-ICU Clinician - Duke University Health System

This document includes ICU educational resources for the non-ICU clinician. The information includes links to websites with free modules provided by the Society of Critical Care Medicine (SCCM). Uploaded 04.01.20

Clinical Guidance and Forms (General), ICU Care
DUH Visitor Exception Approval Process During COVID Visitor Restriction Period

This flow chart provides guidance for family presence and participation during end of life for COVID positive patients, PUI's, and non-COVID patients at Duke University Hospital. Uploaded 04.16.20

Clinical Guidance and Forms (General), Operations and Visitation, Duke University Hospital, Decedent Care
Duke University Hospital Conservation of Thermometers and Stethoscopes

This document lists the instructions to help conserve thermometers and stethoscopes used for all isolation patients at Duke University Hospital. Uploaded 04.06.20

Clinical Guidance and Forms (General), Operations and Visitation, Duke University Hospital, PPE Conservation
Guidance for De-escalating Isolation after a Negative Test for COVID-19

The flow diagram outlines a recommended decision algorithm for symptomatic patients with a negative COVID-19 nasopharyngeal swab whose clinical presentation remains highly suspicious for active COVID-19 infection. It shows the process for updating isolation status, isolation precautions and transferring patients off a COVID-19 unit with negative COVID-19 test results. This flow diagram DOES NOT apply to asymptomatic patients. This document reflects a change in the management of patients from skilled nursing and other congregate living facilities after COVID-19 has been ruled out. Updated 05.01.20

Clinical Guidance and Forms (General), Special Airborne Contact
Criteria for Discontinuation of Special Airborne Contact Isolation

This document provides updated guidance to healthcare workers on when to discontinue special airborne contact (SAC) isolation for patients with COVID-19 (Discontinuing isolation). This guidance applies to all areas of Duke Health including adult and children’s inpatient, outpatient, surgical, procedural and other care areas. CDC now recommends using a symptom-based strategy alone for discontinuation of special airborne contact isolation for patients infected with COVID. Enough evidence has accumulated to show that patients are not shedding live, infectious virus after a specified amount of time passes from symptom onset. As such, Duke Health will no longer use the test-based strategy (i.e. 2 negative tests) to discontinue Special Airborne Contact isolation for patients with COVID and begin using the symptom-based strategy outlined below. Updated 08.04.20

Clinical Guidance and Forms (General), Special Airborne Contact
Interim Recommendations for Care of Inpatients from Congregate Living Facilities

This document provides additional clarification for the management of inpatients being admitted to the hospital from congregate living settings. Uploaded 04.22.20

Clinical Guidance and Forms (General), High-risk Populations
Recommendations for Negative Pressure Rooms and/or HEPA Filtration

This one-pager highlights the importance of wearing appropriate PPE during aerosol-generating procedures. It also explains the role of negative room pressurization, and recommendations for what to do if a HEPA filter is not available. Uploaded 04.10.20

Clinical Guidance and Forms (General), PPE
Recommendations for Discharging COVID-19 Positive Inpatient Who Continues to Require Isolation Precautions

This document includes recommendations for healthcare workers to safely discharge a COVID-19 positive inpatient who continues to require isolation precautions. Uploaded 04.03.20

PPE, Clinical Guidance and Forms (General), Discharge Instructions
Guidance for Procedural Areas Caring for Suspected or Confirmed COVID-19 Patients

This guidance is for healthcare workers in procedural areas and explains when to use HEPA filters in procedural rooms for patients with suspected or confirmed COVID-19 infection. Uploaded 04.09.20

Clinical Guidance and Forms (General)
Dialysis Process in Suspected or Confirmed COVID-19 Room

This document provides guidance to dialysis nurses in the following settings: DUH (ICU with anteroom), DUH (no anteroom), and DRH (with and without anteroom). Uploaded 04.10.20

Clinical Guidance and Forms (General)
Peritoneal Dialysis Process for DUH in Suspected or Confirmed COVID-19 Room

This document provides guidance for peritoneal dialysis nurses and describes the process for DUH in suspected or confirmed COVID-19 room. Uploaded 04.10.20

Clinical Guidance and Forms (General)
FAQs for Telehealth Appointments

This clinical guidance document is for clinical staff and answers frequently asked questions about Duke Health's updated telehealth services for patients. Payers have updated their policies to allow telehealth services to aid patients (for COVID-19 or any other condition) during this time. Temporarily removed on 05.06.20

FAQs and Talking Points, Clinical Guidance and Forms (General), Telehealth
Isolation Procedures and COVID-19 Testing for Asymptomatic Immunocompromised Patients in the Inpatient Setting

This document provides guidance on testing and isolation procedures for the hematopoietic stem cell transplants (HSCT), solid organ transplants (SOT) and acute leukemic patients who are admitted to the hospital. Uploaded 07.02.20

Clinical Guidance and Forms (General), Pediatrics, High-risk Populations
Provider Rounding Tips for Patients on Isolation

This document is for healthcare providers and lists tips for provider rounding teams to limit in-room exposure times and number of in-room visits and to assist in bundling care for patients in isolation. Uploaded 03.22.20

Clinical Guidance and Forms (General), PPE Conservation
Tip Sheet for Signatures Upon Discharge for Inpatient

This document contains tips for and the smart phrase for documenting discharge instructions in Maestro in place of a signature. Uploaded 03.25.20

Operations and Visitation, Discharge Instructions, Smart Phrase, Signature, Clinical Guidance and Forms (General)
Maestro Care screening tip sheet

This document outlines Maestro Care travel and communicable disease screening tips for healthcare workers to assist with the rapid identification and isolation/protection of known or suspected COVID-19 patients. Uploaded 03.30.20

Clinical Guidance and Forms (General), Maestro Care
Navigating COVID-19 in Maestro Care

To reduce the confusion associated with caring for patients with suspected or confirmed communicable diseases, this document explains action steps for positive travel screenings and Maestro Care flags linked to COVID-19. Uploaded 03.30.20

Clinical Guidance and Forms (General), Maestro Care
Quick Tips on Documentation and Coding During the COVID-19 Pandemic

This document offers providers tips on MaestroCare documentation and coding to accurately capture patient conditions for public health reporting, resource allocation and quality of care. Uploaded 04.06.20

Clinical Guidance and Forms (General)
Decedent Care: Death Notification Process at DUH

This flowchart applies to DUH and shows the death notification process for patients with suspected or confirmed COVID-19 infection. Uploaded 04.08.20

Clinical Guidance and Forms (General), Duke University Hospital, Decedent Care
Decedent Care: Visitation Procedure at DUH During End-of-Life

This flowchart applies to DUH and shows the procedure for supporting family presence and participation/visitation during end-of-life of patients with suspected or confirmed COVID-19 infection. Uploaded 04.08.20

Clinical Guidance and Forms (General), Decedent Care
Decedent Care: COVID-19 FAQ at DUH

This FAQ provides guidance designed to ensure that DUH healthcare workers are following current recommendations while providing care to patients and their families if a patient passes away who is suspected or confirmed of having COVID-19 infection. Uploaded 04.08.20

Clinical Guidance and Forms (General), FAQs and Talking Points, Duke University Hospital, Decedent Care