Sparrow Hospital Nurse Protects Pediatric Patient, Receives Award

speak up
Jennifer Brandt
Jennifer Brandt, RN at Sparrow Hospital, receives Speak-up! Award

The Michigan Health & Hospital Association (MHA) Keystone Center honored Jennifer Brandt, an emergency department registered nurse at Sparrow Hospital, Oct. 21 with the quarterly MHA Keystone Center Speak-up! Award.

Brandt was caring for a pediatric patient scheduled to be discharged from the emergency department based on lab results. However, Brandt noticed that the patient’s condition appeared to be declining and suggested that the patient be admitted to the hospital. The physician assistant agreed with Brandt’s recommendation, and the patient was admitted to the pediatric unit with subsequent transfer to the pediatric intensive care unit, where the patient was treated for multisystem inflammatory syndrome in children (MIS-C). MIS-C is a rare but serious condition that occurs after a COVID-19 exposure or infection that can lead to inflammation of vital organs.

“I’m extremely honored to receive this award, but even more so happy that we were able to correctly diagnose our patient and make sure the patient received the care that they needed,” said Brandt. “We have a culture at Sparrow Hospital that makes me comfortable to speak up, which helps ensure our patients receive the best care.”

Launched in March 2016, the MHA Keystone Center Speak-up! Award acknowledges individuals or teams within MHA Keystone Center Patient Safety Organization hospitals who speak up to prevent potential harm to patients or other staff members. The award fosters a culture within healthcare organizations that empowers staff to speak up about the quality or safety of patient care.

“What Jennifer did is what we want all members of our care teams to do if they feel like something may not be right,” said Karen Kent VanGorder, MD, chief medical and quality officer, Sparrow Health System. “The past few months have been extremely busy and taxing on the staff of Sparrow Hospital’s emergency department, but we are blessed to have healthcare heroes like Jennifer caring for patients every day.”

Additional award finalists for the third quarter of 2021 include:

  • Logan Bixman, C.S. Mott Children’s Hospital and Von Voigtlander Women’s Hospital
  • Shelah Perry, McLaren Health Care
  • Carrie Schmoekel, Covenant HealthCare

“Establishing a safety culture that empowers staff to speak up is one very important way that hospitals throughout Michigan are improving safety and quality for their patients,” said MHA CEO Brian Peters. “We are thrilled to recognize Jennifer and Sparrow Hospital for her actions that ensured a child received the care they needed for a very serious disease.”

Specifics on the MHA Keystone Center Speak-up! Award, including criteria and a nomination form, are available online. For more information, contact the MHA Keystone Center PSO.

Combating the Novel Coronavirus (COVID-19): Weeks of June 28 and July 5

MHA Covid-19 update

MHA COVID-19 UpdateAccording to a new report from The Commonwealth Fund, the country’s rapid rollout of COVID-19 vaccines and continuing vaccination efforts have saved about 279,000 lives and avoided 1.25 million hospitalizations in the United States. Approximately 67% of Americans had received at least one dose of vaccine as of July 7.

The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Children’s Health Leaders to Discuss Vaccines for Children in July 16 Webinar

The MHA will host a 45-minute webinar and discussion on COVID-19 vaccines for children, as well as the status of other scheduled vaccines for children, from 7:30 to 8:15 a.m. July 16 featuring remarks from several leaders in children’s healthcare in Michigan. The MHA has extended an invitation to this conversation to the Michigan Academy of Family Physicians and the Michigan chapter of the American Association of Pediatrics.

The agenda will include:

  • Brief overview of polling data related to individuals’ personal physicians as the trusted voice on vaccine choices.
  • COVID-19 vaccines for children, as well as comments on side effects and multi-inflammatory syndrome in children (MIS-C).
  • Status of other regularly scheduled vaccines in children, which have significantly declined during the pandemic.
  • Feedback and questions from participants.

The goal of the webinar is to increase awareness and preparedness with as many clinicians as possible before patients younger than 12 are eligible for COVID-19 vaccines and before school resumes and children are behind on other vaccines.

Members who have not yet registered may contact Ruthanne Sudderth at the MHA for registration instructions. Questions may be directed to Ruthanne or Laura Appel at the MHA.

Regulatory Flexibility for Sharps Containers Extended Through Oct. 31

The Department of Environment, Great Lakes, and Energy (EGLE) recently approved an MHA request to extend regulatory flexibility for hospitals facing an ongoing sharps container shortage. State regulation currently requires hospitals to replace sharps containers every 90 days or when full, whichever is sooner. Hospitals will continue to be exempted from the 90-day rule through Oct. 31, 2021; this will allow hospitals to replace sharps containers only when they are full.

The shortage was created by a production facility fire and increased demand for the containers due to vaccinations. The regulatory relief for MHA members was set to expire July 31 but was extended by EGLE for an additional three months.

The MHA will continue to monitor the situation and work with members to determine if additional exemptions should be requested. Questions on the extended exemption can be directed to Sean Sorenson-Abbott at the MHA.

State COVID-19 Data Dashboard Updates Will Occur Twice a Week

The state recently announced that its COVID-19 data dashboards will now be updated only on Tuesdays and Fridays instead of the former practice of updating them five days per week. However, providers are still required to enter their COVID-19 data into EMResource every day.

The state is reporting that, as of July 9, there are 211 confirmed adult COVID-19 hospitalizations and nine confirmed pediatric COVID-19 hospitalizations. More than 62% of adults 16 and older in Michigan had received at least one dose of vaccine as of July 9.

Michigan Announces Financial, Scholarship Prizes for Vaccinated Residents

Gov. Gretchen Whitmer June 28 announced the “MI Shot to Win Sweepstakes,” which may be entered by residents who get a COVID-19 vaccine. The sweepstakes includes $5 million in cash prizes for residents 18 and older and nine $55,000 college scholarships for vaccinated residents ages 12-17.

The goal of this public private partnership — also supported by the Protect Michigan Commission, Meijer, the Michigan Chamber of Commerce and the Michigan Association of United Ways, among others — is to help Michigan get at least 70% of residents vaccinated as soon as possible. Other states that have implemented similar prize programs have seen significant growth in vaccination rates. As the delta variant spreads in the U.S., reaching herd immunity levels is critical to preventing further outbreaks and deaths. In recent weeks, an average of 45,000 individuals in Michigan have initiated vaccination each week. As of July 7, 62 percent of state residents 16 and older have been given at least one dose.

The cash prizes for adults will be awarded via a $1 million drawing, a $2 million drawing, and 30 days of daily $50,000 drawings to anyone who has gotten at least one dose of the vaccine and registers for the contest.

The MHA will keep members apprised of the success of this incentive program. Members with questions may contact Ruthanne Sudderth at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the Michigan Department of Health and Human Services Community Health Emergency Coordination Center (CHECC).

Combating the Novel Coronavirus (COVID-19): Week of April 26

MHA Covid-19 update

Gov. Gretchen Whitmer announced during an April 29 news conference that future epidemic order actions will be based on four vaccination-based milestones that will enable the state of Michigan to return to normalcy. Dubbed the “MI Vacc to Normal” challenge, the program’s goal is to reach a point where 70% of adults in the state are vaccinated and broad mitigation measures are lifted unless unanticipated circumstances arise. Meanwhile, Michigan’s hospitalization rates, testing positivity rates and other important measures are improving, although relatively high levels of acuity and pediatric admissions continue to cause high levels of stress on hospital staff and resources.

The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Administration of Johnson & Johnson Vaccine Resumes

The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (CDC ACIP) voted April 23 to recommend that providers resume vaccinations using the Johnson & Johnson (J&J) single-dose COVID-19 vaccine for anyone 18 and older. The CDC issued an updated Morbidity and Mortality Weekly Report April 27 providing the most recent recommendations for use of the J&J vaccine. The Michigan Department of Health and Human Services (MDHHS) also issued an alert advising providers to resume use of the vaccine.

The J&J vaccine was placed on a pause April 13 while experts conducted a thorough safety review after reports of a rare blood clotting syndrome in some people. The CDC and the Food and Drug Administration (FDA) confirmed that 15 cases of the blood clots have been reported to the Vaccine Adverse Reporting System, including the six cases originally reported, and that all occurred in women between the ages of 18 and 59. Due to the unique treatment required for these adverse events, the agencies also ensured providers and clinicians were made aware of their potential and could properly recognize and manage them. Shipments of the J&J vaccine are scheduled to resume during the week of May 3.

Both the Janssen COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine and the Fact Sheet for Recipients and Caregivers have been revised to include information about the risk of the blood clotting syndrome and should be reviewed prior to administration of the J&J vaccine.

CDC and MDHHS Provide Updated Vaccine Information

The CDC has issued updated interim clinical considerations for COVID-19 vaccines authorized for use in the United States. Providers are encouraged to review these considerations, as they cover such topics as interchangeability of vaccines, people vaccinated outside the U.S., antiviral therapy and vaccination, vaccination of pregnant or lactating individuals, and much more.

In addition, the MDHHS issued an alert on several updates to Moderna vaccines, including vaccine vial fill volume, updated labeling, and storage and handling modifications.

A recent emergency use authorization (EUA) revision indicates the Moderna vaccine will be available in two different vials by early May. Shipments of the new vials could occur as early as May 3, including the current maximum 11-dose vial and a new maximum 15-dose vial. Details about these new vials and packaging are available in the updated Moderna EUA fact sheet for providers.

Updated guidance for storage and handling of the Moderna COVID-19 vaccine have also been issued that include changes to time frames. The MDHHS clarified vaccine temperatures and storage time frames with the manufacturer, and an updated storage and handling summary and preparation/administration Moderna documents are available online.

Share Children’s Hospital Clinical Collaborative Open Letter on MIS-C

Leaders from a group of children’s hospitals and hospitals with extensive pediatric care programs together penned an open letter to clinicians and families across Michigan to raise awareness of multisystem inflammatory syndrome in children (MIS-C) as the spring surge continues to recede. These clinicians warn that Michigan could see children across the state experiencing MIS-C symptoms two to five weeks following the surge’s peak as children are exposed to the virus.

The letter offers details of the symptoms to be aware of, when to seek medical care, and links to appropriate treatment guidelines for clinicians. The MHA is distributing this letter on behalf of this group of pediatric clinical leaders from across the state and thanks them for their leadership around this critical issue.

Member hospitals and health systems are encouraged to distribute this letter to their physicians and ambulatory or primary care practices. The association will also share it on its social media channels to promote greater awareness among Michigan residents, especially families with children.

Members with questions may contact Laura Appel at the MHA.

Recording Vaccines on Michigan Care Improvement Registry is Important Step

Because increasing numbers of patients are seeking second doses at providers other than the one that provided their first dose, members are encouraged to review the proper procedures for looking up and recording vaccinations in the Michigan Care Improvement Registry (MCIR). The MDHHS has shared that it is receiving growing numbers of incorrect or duplicate vaccination records and wants to ensure an accurate reporting of the populations that have been vaccinated. Several detailed training guides are available online that vaccination teams can review at their convenience.

When patients present without their COVID-19 vaccine card, vaccination providers are urged to check MCIR to confirm the date and brand of their first dose to avoid medication errors that impact the effectiveness of the vaccine and other issues. Patients should also be encouraged to keep their vaccine card in a safe place and take a photo of it in the event it is misplaced.

Vaccinating Those Who Have Recovered from COVID-19

Although previous guidance recommended waiting 90 days before administering a vaccine to someone who recently had COVID-19, providers are now advised to vaccinate patients as soon as their symptoms have subsided and they are well enough to receive a shot. The change is due to the vaccine no longer being in limited supply.

However, patients who received monoclonal antibody (mAb) treatments for COVID-19 should not be vaccinated until 90 days after treatment, per CDC and MDHHS recommendations. It is not yet known how effective vaccines are in those who have previously received an antibody treatment for a COVID-19 infection or whether the antibody treatment could interfere with the body's immune response to a vaccine.

The MHA recently cohosted a webinar with the MDHHS on mAb therapies and how to execute a successful mAb therapeutics clinic. A recording of the webinar is available online for those who were unable to participate.

Vaccination Rates Declining

As of May 1, more than 6.9 million doses of COVID-19 vaccine had been administered in Michigan, resulting in more than 4 million Michiganders having received at least one dose and more than 3 million getting all recommended doses of vaccine. Nearly 50% of adult residents have received at least one dose. However, the number of vaccinations administered in Michigan in the last week has dropped significantly, and supply has outpaced demand for the vaccines.

Because Black and Hispanic residents are being vaccinated at a slower pace than white Michiganders, the Protect Michigan Commission continues to make vaccine equity a high priority and has engaged partners to assist with doing door-to-door sign-ups, education and more. MHA members that are working with community partners are encouraged to ensure some of those partners are focused on reaching people of different races, ethnicities and cultures where they are in their communities.

Members with questions regarding vaccines should contact Ruthanne Sudderth at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

An Open Letter to Michigan Healthcare Professionals and Families from Michigan’s Children’s Hospitals Clinical Leadership Collaborative and the MHA

MIS-C most likely to Appear 2-5 Weeks after COVID-19 Surge

The 2021 COVID-19 spring surge in Michigan may be receding, which is welcome news for our state’s citizens. As children’s hospital leaders, we urge continued caution and use of public health measures: wear a mask appropriately (covering nose and mouth) per Centers for Disease Control and Prevention (CDC) guidelines, and practice good social distancing and hand hygiene always. Healthcare workers are stressed and exhausted. Every effort to avoid infection reduces the incidence of COVID-19 and helps keeps our families, friends and community members out of the hospital.

While we’re pleased to see the surge receding, an illness secondary to COVID-19 – multisystem inflammatory syndrome in children (MIS-C) – could become more prevalent as COVID-19 cases decline, and we want clinicians and families to be aware and prepared.

“It is important that parents and pediatricians are aware that the rare, but serious, MIS-C associated with COVID-19 could likely present in children between two and five weeks after the peak of Michigan’s recent surge of COVID-19,” said Dr. Matthew Hornik, president of the Michigan Chapter of the American Academy of Pediatrics. “This is based on analysis recently published in JAMA Pediatrics.”

Parents should be aware of MIS-C if their child was exposed to COVID-19 and later develops a fever without other explanation, and gastrointestinal symptoms (abdominal pain, vomiting, and/or diarrhea); rash or red eyes; and less commonly respiratory symptoms (cough, shortness of breath or chest pain/discomfort). Parents should seek emergency care right away if their child experiences any of the following warning signs:

  • Trouble breathing
  • Pain or pressure in the chest that does not go away
  • New confusion
  • Inability to wake or stay awake
  • Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
  • Severe abdominal pain

MIS-C results from a delayed immune response to COVID-19. According to Dr. Rudolph Valentini, chief medical officer at Children’s Hospital of Michigan, “A child infected with COVID-19 may not exhibit any symptoms of the virus, then later present with MIS-C. Symptoms include fever, general inflammation, and dysfunction of major organs including the heart, gastrointestinal system and kidneys.”

Pediatricians should refer to interim guidance from the American Academy of Pediatrics for recognizing symptoms and providing care for MIS-C. Because most children are ineligible to currently receive the COVID-19 vaccine, it is imperative that individuals who are 16 years and older make every effort to get the vaccine to allow us to achieve herd immunity and help protect our vulnerable children from getting COVID-19 and potentially MIS-C.

“Many pediatric patients who develop MIS-C will need treatment in the hospital including frequent admission to a pediatric intensive care unit,” said Dr. Matthew Denenberg, vice president of medical affairs at Helen DeVos Children’s Hospital. “With the number of COVID-19 cases Michigan experienced in the past six weeks, we must be prepared that some number of children will present with MIS-C. If your child isn’t doing well, don’t delay getting care. Hospitals are safe and ready to help.”

Please contact your healthcare provider if you have questions or concerns regarding MIS-C. For more information about MIS-C in children, please refer to the CDC website on MIS-C.