I would like to encourage everyone to read this e-blast, as new information is included. From now on our COVID e-blasts will have a date behind new information, to make it easier for centers to read what is new and breaking.
Today, the Governor issued Executive Order 109, directing the suspension of all elective surgeries and invasive procedures scheduled to take place after 5:00 PM on Friday, March 27.
While there has been a frenzy of speculation, this does not close ASCs. Indeed the Governor’s order closely resembles the recommendations that NJAASC sent to everyone last week.
It states that medical and dental operations that can be delayed without undue risk to the current or future health of the patient, as determined by the patient’s physician or dentist should be cancelled.
That allows procedures that fit within guidelines- as NJAASC recommended, to be performed.
Below, please find a synopsis from NJAASC and the Executive Order itself. I would urge all of you to read the Executive Order in its entirety.
While procedures can still be performed, there must be close scrutiny of cases, and each center must establish written guidelines to ensure adherence to the provisions of the Order.
This includes as stated in the Order: ‘
a process for consultation with the treating provider about a designation that the surgery or invasive procedure is elective under the terms of the Order.’
NJAASC is preparing a template that we will then submit to the Department of Health for comment. If they respond all centers can then utilize it with their blessing. If not, we will recommend it to all ASCs anyway- so stay tuned for further e-mails regarding this issue.
Remember, this is an internal guideline- a center policy and procedure so to speak, it would not have to be submitted for every case you perform
The Order also mandates that ASCs in possession of PPE, ventilators, respirators or anesthesia machines not required for the provision of critical health care services, should undertake an inventory and sent the information to the State.
OEM is to establish a process for submittal- to be determined.
Now I know NJAASC at the behest of the Department of Health asked all ASCs for this information last week- and thank you to all who responded, it was overwhelming.
However not everyone did so and that was a week ago, so while we are asking for clarification, my educated guess will be that we are all going to have to do this again.
The situation remains somewhat unclear and fluid, so stay tuned to e-blasts from NJAASC to further clarify the provisions of the Governor’s Order.
Governor Murphy’s Executive Order 109 and ASCs
TRENTON -- As part of the state's effort to preserve the capacity of the health care system to respond to COVID-19, Governor Phil Murphy today signed Executive Order No. 109, directing the suspension of all elective surgeries and invasive procedures performed on adults that are scheduled to take place after 5:00 p.m. on Friday, March 27. The Governor's Executive Order applies to all medical and dental operations that can be delayed without undue risk to the current or future health of the patient, as determined by the patient's physician or dentist.
"Our new reality calls for aggressive action to reduce the burden on our health care system and protect our frontline medical responders," said Governor Murphy. "Given the dramatic shortfall in personal protective equipment we face, it's imperative that we work with our partners in health care to strategically preserve supplies and equipment for emergency purposes only."
In addition to the suspension outlined above, Governor Murphy's Executive Order also requires the following:
* Protecting the capacity of hospitals: Physicians and dentists, who are planning to perform surgery or invasive procedures in their offices, must consider the potential burden of post-surgery complications on local hospitals prior to performing any operation.
* Explicit exemption for family planning and termination of pregnancies: The order provides that it shall not be interpreted in any way to limit access to family planning services, including termination of pregnancies.
* Inventory of personal protective equipment to be taken: Any business, non-hospital health care facility, or institution of higher learning in possession of PPE, ventilators, respirators, or anesthesia machines not required for the provision of critical health care services shall undertake an inventory of these supplies and send that information to the State by 5:00 pm on Friday, March 27. The Office of Emergency Management shall establish a process for affected entities to submit this information.
The Order requires facilities to immediately notify patients whose operations have to be suspended.
EXECUTIVE ORDER NO. 109
WHEREAS, through Executive Order No. 102 (2020), which I signed on February 3, 2020, I created the State's Coronavirus Task Force, chaired by the Commissioner of the New Jersey Department of Health ("DOH"), in order to coordinate the State's efforts to appropriately prepare for and respond to the public health hazard posed by Coronavirus disease 2019 ("COVID-19"); and
WHEREAS, in light of the dangers posed by COVID-19, I issued Executive Order No. 103 (2020) on March 9, 2020, the facts and circumstances of which are adopted by reference herein, which declared both a Public Health Emergency and State of Emergency; and
WHEREAS, in accordance with N.J.S.A. App. A:9-34 and -51, I reserved the right to utilize and employ all available resources of State government to protect against the emergency created by COVID-19; and
WHEREAS, as of March 21, 2020, according to the Centers for Disease Control and Prevention ("CDC"), there were more than 292,000 confirmed cases of COVID-19 worldwide, with over 12,000 of those cases having resulted in death; and
WHEREAS, as of March 20, 2020, there were more than 15,000 confirmed cases of COVID-19 in the United States, with at least 201 of those cases having resulted in death; and
WHEREAS, as of March 23, 2020, there were at least 1,914 positive cases of COVID-19 in New Jersey, with at least 20 of those cases having resulted in death; and
WHEREAS, in recognition that the CDC has advised that social mitigation strategies for combatting COVID-19 require every effort to reduce the rate of community spread of the disease and that COVID-19 spreads most frequently through person-to-person contact when individuals are within six feet or less of one another, I issued Executive Order No. 107 (2020) on March 21, 2020, the facts and circumstances of which are adopted by reference herein, which ordered steps to mitigate community spread of COVID-19 limiting the unnecessary movement of individuals in and around their communities and person-to-person interactions in accordance with CDC and DOH guidance and requiring all businesses or non-profits, wherever practicable, to accommodate their workforce for telework or work-from-home arrangements and reduce staff on site to the minimal number necessary to ensure that essential operations can continue; and
WHEREAS, Executive Order No. 107 (2020) required the closure of facilities where personal care services are performed that, by their very nature, result in noncompliance with social distancing guidelines, including but not limited to cosmetology shops; barber shops; beauty salons; hair braiding shops; nail salons; electrology facilities; spas, including day spas and medical spas, at which solely elective and cosmetic medical procedures are performed; massage parlors, tanning salons, tattoo parlors, and public and private social clubs, whether or not they serve alcohol; and
WHEREAS, Executive Order No. 107 (2020) did not limit, prohibit, or restrict in any way the provision of health care or medical services to members of the public, and allowed to remain open health facilities that provide medically necessary or therapeutic services; and
WHEREAS, even as we institute social distancing measures, the number of COVID-19 cases in New Jersey is likely to increase for the immediate future, and, consequently, requires the State to take additional steps to preserve our health care system's capacity to treat those who require emergency or intensive care; and WHEREAS, limiting exposure of healthcare providers, patients, and staff to COVID-19 and conserving critical resources such as ventilators, respirators, anesthesia machines, and Personal Protective Equipment ("PPE") are essential to combatting the spread of the virus; and
WHEREAS, the Centers for Medicare and Medicaid Services have issued guidance to limit non-essential adult elective surgery and medical and surgical procedures, including all dental procedures, to assist in the management of vital healthcare resources (including PPE) during this public health emergency and to limit potential exposure of healthcare providers, patients, and staff to the virus; and
WHEREAS, the United States Surgeon General has encouraged hospitals and healthcare systems to consider stopping elective procedures; and
WHEREAS, limiting non-essential adult elective surgery and invasive procedures, whether medical or dental, will assist in the management of vital healthcare resources during this public health emergency; and
WHEREAS, while certain surgeries and invasive procedures are medically appropriate, they are not time-sensitive and a postponement will not endanger the health of the patient, and at the same time, these procedures, whether undertaken in a hospital, ambulatory surgery center or provider office, necessarily draw upon the skill and time of critical health care professionals and involve the use of equipment and supplies that may be needed to treat those who are critically ill; and
WHEREAS, the Constitution and statutes of the State of New Jersey, particularly the provisions of N.J.S.A. 26:13-1 et seq., N.J.S.A. App. A: 9-33 et seq., N.J.S.A. 38A:3-6.1, and N.J.S.A. 38A:2-4 and all amendments and supplements thereto, confer upon the Governor of the State of New Jersey certain emergency powers, which I have invoked;
NOW, THEREFORE, I, PHILIP D. MURPHY, Governor of the State of New Jersey, by virtue of the authority vested in me by the Constitution and by the Statutes of this State, do hereby ORDER and DIRECT:
1. Beginning at 5:00 p.m. on Friday, March 27, 2020, all "elective" surgeries performed on adults, whether medical or dental, and all "elective" invasive procedures performed on adults, whether medical or dental, are suspended in the State. An "elective" surgery or invasive procedure, for purposes of this Order, is defined as any surgery or invasive procedure that can be delayed without undue risk to the current or future health of the patient as determined by the patient's treating physician or dentist. An "elective" surgery or invasive procedure does not include the administration of vaccines.
2. Providers planning or determining whether to perform surgery and invasive procedures in their offices must also consider any possible post-operation complications that may place additional stress on local hospitals that do not have the capacity to accept transfers and need to coordinate any possible postoperation admissions with local hospitals prior to performing surgeries or invasive procedures. Ambulatory surgery centers are to coordinate any possible post-surgery admissions with local hospitals prior to performing any surgery or invasive procedure.
3. Each hospital or ambulatory surgery center shall establish written guidelines to ensure adherence to the provisions of this Order, a copy of which shall be provided to DOH. In establishing such guidelines, the hospital or ambulatory surgery center shall include a process for consultation with the treating provider about a designation that the surgery or invasive procedure is elective under the terms of this Order.
4. Nothing in this Order shall be construed to limit access to the full range of family planning services and procedures, including terminations of pregnancies, whether in a hospital, ambulatory surgery center, physician office, or other location.
5. The Commissioner of DOH shall have the authority to issue binding guidance, in consultation with the Director of the Division of Consumer Affairs, on any of the provisions contained in Paragraphs 1 through 4.
6. All elective surgeries or invasive procedures, whether medical or dental, already scheduled for after 5:00 p.m. on Friday, March 27, 2020, are to be cancelled or postponed indefinitely. Facilities are to immediately notify all patients and providers that have scheduled elective surgeries or invasive procedures that these operations cannot proceed as scheduled under the terms of this Order.
7. Any business or non-hospital health care facility, including but not limited to dental facilities, construction facilities, research facilities, office-based healthcare or veterinary practices, and institutions of higher learning, in possession of PPE, ventilators, respirators, or anesthesia machines that are not required for the provision of critical health care services should undertake an inventory of such supplies and send that information to the State by no later than 5:00 p.m. on Friday, March 27, 2020. The Office of Emergency Management shall establish a process by which entities subject to this provision can submit this information.
8. The Director of the Division of Consumer Affairs, which houses over fifty professional licensure bodies, is authorized and empowered in his or her sole discretion, but in consultation with the Commissioner of DOH, to issue orders restricting or expanding the scope of practice for any category of healthcare professional or veterinarian licensed by a board in the Division of Consumer Affairs, including but not limited to, orders restricting elective surgeries, procedures, and examinations, or for further limiting the scope of practice, or the location for the delivery of service of other licensees subject to regulation by any licensing board or committee within the Division of Consumer Affairs. The Director of the Division of Consumer Affairs is also authorized and empowered in his or her sole discretion, but in consultation with the Commissioner of DOH, to waive any restriction on the entry or reentry into practice (or any restriction on the prescription of controlled dangerous substances or on access to the prescription monitoring program) of any person who has received training for employment in a healthcare profession or who has retired from practice.
9. Any actions taken by the Commissioner of DOH or the Director of the Division of Consumer Affairs pursuant to this Order shall not be subject to the requirements of the Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq.
10. Paragraph 17 of Executive Order No. 107 (2020) is hereby superseded to the extent it is inconsistent with this Order.
11. It shall be the duty of every person or entity in this State or doing business in this State and of the members of the governing body and every official, employee, or agent of every political subdivision in this State and of each member of all other governmental bodies, agencies, and authorities in this State of any nature whatsoever, to cooperate fully in all matters concerning this Executive Order.
12. Penalties for violations of this Executive Order may be imposed under, among other statutes, N.J.S.A. App. A:9-49 and -50.
13. This Order shall take effect immediately.
GIVEN, under my hand and seal this 23rd day of March, Two Thousand and Twenty, and of the Independence of the United States, the Two Hundred and Forty-Fourth.
/ s / Philip D. Murphy
/ s / Matthew J. Platkin
Chief Counsel to the Governor
NJAASC has curated authoritative information and a list of resources for our Membership’s reference. We will continue to update this as more information becomes available.
ASC STAFFING & HOSPITALS -3/23/20
Q: If any ASCs have staff that want to assist and work in the hospital, how should they go about it?
A: The ASCs need to work with their local hospital. The ASCs should know which is their local hospital.
Stefanie Mozgai, BA, RN, CPM
Department of Health
Health Facility Survey & Field Operations
CMS ANNOUNCES QUALITY REPORTING RELIEF-3/23/20
FAQ FROM DEPARTMENT OF HEALTH- 3/23/20
NJAASC RECOMMENDATIONS FOR PERFORMING CASES IN ASCs
REPORTING GUIDANCE FOR ASCs REGARDING CHANGE OF SERVICE OR CLOSURE
FROM ICAR TEAM LEAD
Given the congregate nature of long-term care facilities (LTCF) and residents served (e.g., older adults often with underlying chronic medical conditions), this population is at an increased risk of serious illness when infected with COVID-19. LTCF have experience managing respiratory infections and outbreaks among residents and healthcare personnel and should apply those outbreak management principles to COVID-19.
All LTCFs should remain vigilant with prompt detection, triage, and isolation of potentially infectious persons to prevent unnecessary exposures among residents, healthcare personnel, and visitors at the facility. Infection prevention measures include:
- Implement active screening of residents and staff for fever and respiratory symptoms. Remember that older adults may manifest symptoms of infection differently and that other symptomology should also be. Vital signs should include heart rate, blood pressure, temperature, pain and pulse oximetry. These assessments should happen, at a minimum, daily. The facility staff should have a heightened awareness for any change in baseline in their residents.
- Stop current communal dining and all group activities such as internal and external group activities.
- Follow all current CMS guidance regarding the restriction of visitors and non-essential healthcare personnel, except in certain compassionate-care situations
- Review the CMS Quality, Safety & Oversight (QSO) Group memo Ref: QSO-20-14-NH at https://www.cms.gov/files/document/qso-20-14-nh-revised.pdf for expanded recommendations.
- Connect with your association and monitor NJDOH, CDC, and CMS announcements, at least daily.
- Conserve personal protective equipment (PPE) in accordance with CDC’s Strategies for Optimizing the Supply of PPE - https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html.
- Contact your local health department with any questions or concerns. Contact information is available via the local public health directory at http://www.localhealth.nj.gov/.
- Report any new cases or persons suspected of COVID-19 occurring in or associated with your facility to your local health department.
In addition to actions described above and attached
, facilities should consider the following immediate actions when there is a confirmed case of COVID-19 to prevent further spread to their residents and staff:
- Close the unit to new admissions except as needed to cohort ill individuals or staff.
- Consider closure of the facility to new admissions.
- Consider implementing universal use of facemask for HCP while in the facility
- Encourage residents to remain in their room. If multiple cases are present restrict residents (to the extent possible) to their rooms except for medically necessary purposes.
- Mask all residents (who can tolerate masks) who are symptomatic when providing direct care; if masks are limited or not tolerated use of a tissue to cover the nose and mouth is appropriate.
- Adhere to internal environmental cleaning protocols to ensure appropriate measures are being taken to clean and disinfect where appropriate including high-touch surfaces and all shared medical equipment (e.g., lifts, blood pressure cuffs, medication carts). Consider increasing the frequency of cleaning in the facility.
- Quarantine and monitor exposed contacts including healthcare workers and roommates
For more information and ongoing updates please visit:
Jessica Arias, BSN, RN, CIC
Infection Control Assessment Response (ICAR) Team Lead | Infection Preventionist
Infectious and Zoonotic Disease Program | Communicable Disease Service
Division of Epidemiology, Environmental, and Occupational Health | New Jersey Department of Health
P.O. Box 369 Trenton, NJ 08625| Phone 609.826.5964 | Fax 609.292.5811