Purpose
The Resident COVID19 Core Care Plan (CCCP) provides a standardized, evidencebased framework for nursing staff to assess, monitor, and manage residents who are suspected or confirmed to have COVID19 while they remain in a longterm care setting. The plan emphasises early detection, infection control, symptom relief, and coordination with medical providers.
Key Principles
- ResidentCentred Care: Tailor interventions to each residents baseline function, comorbidities, and personal preferences.
- Infection Prevention: Strict adherence to PPE, hand hygiene, and environmental cleaning protocols.
- Rapid Assessment: Use of a concise screening tool to identify changes in temperature, oxygen saturation, respiratory status, and mental status.
- Communication: Clear reporting lines between nursing, medical, and family/nextofkin contacts.
- Documentation: Realtime electronic record updates for continuity of care and regulatory compliance.
Screening & Initial Assessment
When a resident is identified as a Person Under Investigation (PUI) or COVID19 positive, the following steps are initiated:
| Step | Action | Frequency |
|---|---|---|
| 1. Vital Signs | Temperature, heart rate, blood pressure, respiratory rate, SpO | Every 4hours (or as ordered) |
| 2. Symptom Check | Cough, dyspnea, fatigue, loss of taste/smell, GI symptoms, confusion | Every 4hours |
| 3. Functional Status | Mobility, ADL assistance needed, falls risk | Daily |
| 4. FallBack Labs | CBC, CRP, BMP (if indicated) | Within 24hours of positive test |
| 5. Advance Care Planning | Confirm DNR/DNI status, discuss goals of care | At admission of COVID19 diagnosis |
Core Interventions
1. Infection Control
- Place resident in a designated cohort area or isolate room.
- Assign dedicated staff for the cohort when possible.
- Use N95 respirator (or equivalent) for aerosolgenerating procedures.
- Follow CDC clinical care guidelines for PPE donning/doffing.
2. Respiratory Support
- Monitor SpO; maintain 92% for most residents, higher target if COPD.
- Provide supplemental oxygen via nasal cannula or face mask as ordered.
- Consider highflow nasal therapy only if facility has appropriate monitoring.
- Escalate to medical team for worsening hypoxia (SpO<90% or rapid decline).
3. Symptom Management
- Fever: Acetaminophen 650mg PO q6h PRN, not exceeding 3g/24h.
- Cough: Dextromethorphan 1020mg q46h PRN, assess for constipation.
- Dyspnea: Lowdose morphine (e.g., 2.5mg PO q4h PRN) after physician approval.
- Delirium: Reorient resident, maintain sleepwake cycle, lowdose haloperidol if agitation threatens safety.
4. Hydration & Nutrition
- Encourage oral fluids; aim for 1500mL/day unless contraindicated.
- Offer highprotein, highcalorie supplements.
- If oral intake falls below 75% of needs for >48h, discuss enteral feeding options.
5. Mobility & Skin Integrity
- Assist with gentle rangeofmotion exercises twice daily.
- Reposition at least every 2hours; use pressurerelieving mattresses.
- Inspect skin daily for breakdown.
6. Psychosocial Support
- Maintain regular virtual or window visits with family.
- Provide mental health resources, such as a calming music playlist.
- Document residents mood and coping strategies each shift.
Escalation Triggers
Any of the following should prompt immediate communication with the attending physician or oncall provider:
- SpO<90% on maximum supplemental oxygen.
- Rapid respiratory rate increase (>30 breaths/min).
- New onset chest pain or pressure.
- Altered mental status not explained by baseline dementia.
- Hemodynamic instability (SBP<90mmHg or MAP<65mmHg).
Documentation Checklist
- Initial assessment findings and COVID19 test result.
- Vital signs trend chart.
- Medication administration record (including PRN usage).
- Daily skin, mobility, and nutrition notes.
- Communication log with provider and family.
- Advance directives review and any changes.
Training & Competency
All nursing staff assigned to the CCCP must complete the following:
- Onehour online module on COVID19 transmission and PPE.
- Handson simulation of oxygen delivery and escalation protocol.
- Quarterly competency validation with a checklist signed by the Nurse Manager.
Quality Improvement
Data collected from the CCCP will be reviewed monthly by the Interdisciplinary Quality Committee. Key performance indicators include:
- Time from positive test to isolation (goal<2hours).
- Percentage of residents with SpO92% throughout stay.
- Rate of pressureinjury development among COVID19 residents.
- Resident/family satisfaction scores regarding communication.
Findings will inform policy updates and staff education.
Conclusion
The Resident COVID19 Core Care Plan equips nurses at Nursing Matters & Associates with a clear, actionable roadmap that balances rigorous infection control with compassionate, residentfocused care. By following the structured assessment, intervention, and documentation steps outlined above, staff can safeguard health, reduce complications, and support the dignity of each resident during the pandemic.
