Table 1.
COVID-19 Exposure: Checklist for Patients, Families, and/or Workers1
| Step | Checklist Questions | Additional Guidance* |
|---|---|---|
| 1. Identify disclosure team. | Which department(s) will you include in outreach to patients? | Verify that the people selected to be on the disclosure team have undergone prior training. |
| [ ] Quality/Safety/Risk [ ] Patient Relations or Experience [ ] Social Work [ ] Case Management [ ] Other_______ Disclosure training provided to staff? [ ] Yes [ ] No |
Consider using a “see one, do one” approach by pairing senior staff members to lead and junior staff members to observe and then practice. | |
| 2. Initiate disclosure. | Patient's preferred language confirmed in health record?[ ] Yes[ ] No[ ] UnknownInterpreter services activated?[ ] Yes[ ] No[ ] Not applicablePatient and/or family member successfully contacted?[ ] Yes[ ] No, unable to reach (______ attempt #) | Provide a transparent, open disclosure to the patient and/or visitor. The general location and date of the exposure may be shared, but specific identifying information regarding the affected provider should be kept confidential. Ensure that the disclosure is performed in the patient's primary language, with medical interpreters available, at the appropriate literacy level, as necessary. Offer reassurance that you are here to help them navigate through the best next steps, and to connect them with the resources they need. If unable to reach the patient, stop checklist and document the attempt in the medical record. We recommend at least three documented attempts spaced at least 24 hours apart before terminating outreach efforts.Suggested communication: “My name is ________ and I'm calling from ______. I want to make you aware that an employee who cared for you/your loved one on [Date/Time] has tested positive for COVID-19. Because you were in close contact with this person for more than 15 minutes, there is the potential that you were exposed. To assist you with the next steps, we have information, resources, and support tools available to ensure that you and your loved ones have the support you need.” |
| 3. Review symptomology. | COVID-19 symptoms reviewed? | Review known COVID-19 symptoms with the patient and/or visitor, keeping in mind that health literacy levels vary significantly. Ensure understanding by having the individual repeat back the symptoms they should be looking out for and encouraging them to raise any questions or concerns. Ask about others who joined the visit or who live at home who may be at risk.Symptoms include:• Fever (temperature greater than 100°F)• Cough• Shortness of breath• Sore throat• Running nose |
| [ ] Yes | ||
| [ ] No | ||
| Confirm if patient and/or visitor is experiencing symptoms, with level of severity identified? | ||
| [ ] Yes | ||
| [ ] No | ||
| Non-symptomatic patient and/or visitor recommendations reviewed? | ||
| [ ] Yes | • Sore muscles | |
| [ ] No | • Loss of taste or smell | |
| Depending on whether the patient and/or visitor reports having experienced any symptoms, and to which degree of severity, next steps may vary. | ||
| Suggested communication: “COVID-19 symptoms can vary. Have you been experiencing any symptoms of a viral respiratory infection, such as fever, coughing, sore throat, or sore muscles?” | ||
| [If yes] | ||
| “I'm sorry to hear you aren't feeling well. I'm here and I'm going to help you.” | ||
| [If no] | ||
| “That is good to hear. Even if you are not currently experiencing any symptoms, you should continue taking your temperature twice daily and pay attention to any changes to your health, such as a cough or shortness of breath.” | ||
| 4. Provide testing and isolation guidelines1if no symptoms or mild symptoms (skip if not applicable). |
Isolation guidelines reviewed? [ ] Yes [ ] No [ ] Not applicable Relevant testing information provided? [ ] Yes [ ] No [ ] Not applicable Available resources offered? [ ] Yes [ ] No |
If patients are not experiencing any symptoms or only mild symptoms (sore throat, cough, fever, etc.), emphasize the importance of isolating themselves for the next 14 days. This includes protecting family members from exposure: • Staying physically away (6 to 8 feet) from others as much as possible • Using a separate bedroom and bathroom if possible • Using separate household items (such as towels, utensils, and personal items) whenever possible • Limiting contact with pets • Avoiding personal household items • Cleaning “high-touch” surfaces daily • Checking temperature twice daily and self-monitoring for symptoms Assess the home situation for overcrowding and the presence of elderly, immunocompromised, and other individuals at high risk of harm if exposed. For some patients, it is not possible to practice physical distancing in their living space (for example, those living in crowded homes). Patients should consider relocating to a temporary residence, such as a rental or hotel, if they can afford it or if provided by their employer or other source. On the other hand, keep in mind that isolation may present a significant financial and social burden to some patients. Be sure to ask if there are any resources the patients need to ensure that they can safely and effectively quarantine themselves. If yes, direct them to resources outlined in Step 6. Explain that, should the patient become symptomatic, they may need to be tested for the virus. Depending on the health care system communicating the disclosure, instructions on testing may vary. If, during the disclosure, the patient or family member informs you that they have already tested positive for the virus, ensure that they understand the isolation guidelines prescribed earlier and that they are referred to a primary care physician for further management. Most importantly, make sure the instructions are clear, and the patient has the resources they need, such as transportation, for testing to take place, and access to primary care, if necessary. If the patient does not have the resources required, direct them to the resources listed in Step 6. |
| Suggested communication: “To be extra careful, there are several steps you can take to help limit the spread of this disease. The most important is isolating yourself as much as possible for the next 14 days. This means staying physically away from others, including your pets, using a separate bedroom and bathroom than others in your household, avoiding personal household items, and cleaning surfaces in your house that you touch routinely daily. | ||
| “If you develop any of the symptoms we discussed, we recommend that you get tested. Please write down this number, ________, to order and set up a time for you to get tested. The testing site is located at X.” | ||
| [If tested positive] | ||
| “I'm sorry to hear you have tested positive. In addition to the guidelines I described earlier on how best to prevent the spread of disease, I also recommend you connect with a primary care doctor, so they can assist you with management. Would you like me to reach out to your primary care doctor on your behalf?” | ||
| 5. If severe symptoms1(skip if not applicable) |
Emergency department contact information provided? [ ] Yes [ ] No Contact made to emergency department on incoming patient? [ ] Yes [ ] No [ ] Unable to reach Available resources offered? [ ] Yes [ ] No |
If the patient or family member is experiencing severe symptoms (shortness of breath, fever, etc.), ensure that the patient can be transported to the closest emergency department. Suggested communication: “We recommend that you be seen at the nearest emergency department. Do you have someone who can drive you there? If not, would you like us to call Emergency Medical Services for you?” |
| 6. Provide resources. |
All patient's concerns/questions addressed? [ ] Yes [ ] No [ ] No Available resources offered? [ ] Yes Social work referral made if needing more help? [ ] Yes [ ] No |
Have prepared a list of local resources that may be able to assist patients with a variety of needs. Should a patient/visitor voice a concern related to any of the items below, be sure to communicate how they are best able to access the resources they need. Consider having the contact information for your institution's Social Work and/or Care Coordination Department available for additional assistance. • Food security • Housing security • Transportation assistance • Caretaking/caretaker support • Psychological distress • Persons with disabilities • Intimate partner violence or domestic abuse • Primary care • Other Suggested communication: “Are there any resources you need (or are at risk of losing) that may affect your ability to follow our recommendations? We can help connect you with available resources. If you would like, I am happy to have a social worker reach out to you in the next 24 hours [M–F] to help.” |
| 7. Provide additional contact information. |
Additional contact information provided? [ ] Yes [ ] No Alerted primary care provider? [ ] Yes [ ] No |
Provide patient and/or visitor with direct contact information or hotline for the health care institution should any additional questions or concerns arise. Suggested communication: “If any other questions or concerns arise, you can always call X for more information and support. We'd also like to contact your primary care provider to update them.” |
References
1. Centers for Disease Control and Prevention. Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19. (Updated: May 19, 2020.) Accessed May 21, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html.
2. Liang BA. A system of medical error disclosure. Qual Saf Health Care. 2002;11:64–68.
*Guidance provided by the World Health Organization and Centers for Disease Control and Prevention may evolve over time and should be referenced for updates.