CUPS Health and Education CentreResponse to H1N1

Who we are• Health• Education• Housing• Outreach

• 140 staff total

Health Clinic

• Health Clinic:– 1800 visits per

month

– Primary, episodic, crisis based care

– Mental Health, Women’s Health, Prenatal Care, Chronic Disease Management, Specialist

Family Resource

Centre•1000 visits/month

•Crisis Counselling & Advocacy•Goal Setting & Ongoing Support•Parenting & Life Skills•Low-income Housing Assistance•Children’s Programming

One World Child Development

Centre

•Early intervention education centre

•Thriving, instead of surviving

•Preschool to Kindergarten

• 60 students

Outreach and Housing

Other agencies visited by CUPS RNs, NPs and MDs:

•Hospitals•Shelters•Detox and Treatment Centres•The street (DOAP & Outreach team)

•2000 visits/month – •the absolute homeless

Inner City Agencies: What did we do?

• Dec 2008 - Pandemic Planning Committee

• Jan 2009 - Influenza Pandemic Preparedness for Inner city Agencies

• Feb 2009 - City of Calgary Infectious Disease Management Plan

• April 2009 - Personal Emergency Preparedness

• May 2009 - Pandemic Influenza 101

CUPS: What did we do?

• Jun-Aug 2009• set up our emergency structure

• June 2009 • Instructions for staff, Microsan stations

• July 2009• Patient triage process implemented and inventory

organized• The ‘Black Book’

PATIENTRECEPTION

?? ASK ??-cough/cold/fever in last 48hrs?

ORPatient looks very unwell/ is coughing

MICROSAN HANDSMASK

Continue as usual

NO

2nd LPN to Triage need for immediate care ( treatment room) : ILI symptoms : temp/O2 sats/HR

Seat pt in reserve seats

Notify LPN

YES

Non urgent URGENT fever> 38 oral

Pt to wait in lab chairsRefer MD/NP onlyCall Agency PRN

Pt to wait in reserve seats. Refer to RN, MD, NP

MICROSAN

Getting ready continued…

• Sept 2009 • Train the Trainer program for managers.

• Presentation on influenza preparedness given to all staff, by department

• N 95 masks for medical staff

• Mandatory staff meeting to present CUPS plan and to address expectations and concerns.

How does influenza spread?

What was our experience?• More staff than patients sick

• Close to 30% absenteeism at the peak• One ICU admission

– Camp Bus Driver: resulted in one child treated with Tamiflu.

• 8-10 patients with ILI symptoms in any one day• NP swabs only on those with risk factors or very ill.

• Aug 2009- First positive H1N1 patient• Only 3-4 positive H1N1 patients thereafter

• H1N1 <10% of all NP swabs

• No known deaths

ImmunizationsSeasonal flu vaccine was received from AHS on Oct 16/09. • Oct 16/09 – Nov 4/09 320 given• Nov 5/09 – Feb 28/10 103 given

H1N1 vaccine was received from AHS on Dec 6/09.• December/09 109 given• January/10 64.5 given• February/10 12 given

Dec 6 - 12

Dec 13 - 19

Dec 20 - 31

Jan 3 - 9

Jan 10 -16

Jan 17 - 23

Jan 24 - 30

Jan 31 -

Feb 6

Feb 7 - 13

Feb 14 - 20

Feb 21 - 27

0102030405060

H1N1 Vaccine

Other clinic actions:• CUPS

• Fluids available for patient distribution.• Individual patient teaching on hand washing and use of masks• H1N1 Flu talks for clients - LPN • H1N1 inservices for staff throughout organization - RN

• Agencies• H1N1 inservices for agencies - RN • Patient assessment, and assistance with suspected outbreaks • Teaching and advocacy to other agencies on behalf of patients.• Community Medicine residents helped agencies develop their

pandemic plans

• Outreach staff transported patients to shelters, hospitals, urgent care centre , hospital pharmacy

Patient Reactions to H1N1Measures

• Mostly good• Receptive to teaching, well informed• Barriers: Fluids, Tamiflu• Felt hyped by media• Started asking for H1N1 shots in October

• Transportation• Addiction, Mental Health• Other barriers

Tamiflu• CUPS received Tamiflu from AHS on Nov 4/09

• 1 course dispense for an adult in early December

• Prescriptions written once universal coverage approved

• Tamiflu prescriptions issued for few staff who became ill

Concerns• Earlier access to vaccine• Immunization for all staff at partner agencies• Earlier and easier access Tamiflu • Central distribution centre for required supplies • Better communication, clear guidelines for who to

contact

What if things had gotten worse?

• Phase 1: described• Phase 2: 2 clinic sites

• Ill patients • Well patients for routine care

• Phase 3: Shut down majority of programs, organize 3 teams

• Team 1: Routine care for prenatal patients at CUPS site women’s clinic.

• Team 2: Ill patients at CUPS site main clinic, home visits and

care by support staff• Team 3: Outreach RN/NP/MD/support staff going to shelters for triage and care.

If you are sick at home with influenza symptoms, please call CUPS.

If sick more than three days please call Health Link: 403-943-LINK