Description: Nurses provide the bedside care required to safely navigate the COVID-19 patients through the disease process. The purpose of a playbook and workflow changes in the medical-surgical COVID-19 areas was to deliver quality direct patient care with decreased risk of exposure to the front-line staff. Workflow changes needed to be put in place to limit front-line staff exposure as well as to conserve personal protective equipment while caring for patients. Goals were identified: 1) follow infection prevention and control recommendations, including conserving PPE; 2) ensure proper use of PPE and education; 3) provide in-person care in the safest way and reduce contact time to minimize disease transmission to care givers; 4) identify means for communication to patient and families; and 5) develop process to keep staff informed of most recent CDC and facilities recommendations.
Application: Review of pre-COVID-19 workflow and PPE use was examined. In relation to communication to patient and families a plan using technology (Facetime, iPhone, etc.) and daily phone calls was instituted. Location of equipment such as IV pumps outside of room to decrease staff exposure time, number of staff members in room during CODE blue. Placement of patients in rooms with windows for viewing. Bundling of staff care activities such as vitals, medications, dressing changes, etc. Communications through team huddles and facility intranet on recommendations, as well as available PPE supplies and equipment. Information related to changes to medical and nursing care of the COVID-19 patients were communicated as care evolved to the nursing team and other disciplines.
COVID-19 sheds light on how vital it is to use PPE properly. Receiving comprehensive training on when and what PPE is necessary; how to don (put on) and doff (take off) PPE; limitations of PPE; and proper care, maintenance, and disposal PPE were critical. Nursing accomplished this by utilizing a CDC video, one-on-one training, guidelines on when and what PPE to use, and demonstration of donning and doffing PPE. When team members enter a COVID-19 patient’s room, a second nurse observed the individual’s use of PPE to ensure proper procedure was followed.
Educators rounded to support and re-education on proper PPE use, donning, and duffing. The focus was on protecting staff as well as patients.
Discussion and conclusion: Nurses working on the front line providing direct care to individuals with COVID-19 are required to be competent and knowledgeable about PPE and a planned daily workflow to care for these patients. The immediate efforts to control and prevent COVID-19 is an evolving process as new information is discovered about this disease. As result of the workflow changes, PPE was conserved; staff exposure and room time were reduced; and effective communication strategies for staff, patient, and families resulted.