By David L. Taylor III, MSN, RN, CNOR
David L. Taylor III, MSN, RN, CNOR
The American Nurses Association (ANA) surveyed more than 32,000 nurses nationwide working on the front lines of the COVID-19 pandemic and found resounding echoes of concern regarding egregious shortage of personal protective equipment (PPE) for nurses, staffing and training. Nine out of ten nurses surveyed say that access to PPE is their top concern and fear going to work as a result. More than 25% reported being forced to create their masks and only half had the necessary training to conduct COVID-19 testing. Sixty-four percent of respondents said they do not have enough staff to do the job and are working short.[1]
Supply chains remain an issue and may linger for months and in some cases even years. Both the International Association of Healthcare Central Service Materiel Management (IAHCSMM) and the Association of periOperative Registered Nurses (AORN) released communications notifying their membership that sterilization wrap shortages may be looming and could impact their surgical and procedural programs significantly impacting their ability to reschedule a backlog of elective procedures.
Health care organizations of all types are spending a great deal of time searching for replacements for their depleted supplies and in some cases resorting to single-use items to fill voids in their supply chain. The U.S. Food and Drug Administration (FDA) has established a medical supply shortage list website, a first of its kind, to help organizations improve their access to information, saving them countless hours searching for supplies only to find they are back ordered or no longer available.[2]
As the uncertainty of the pandemic and the emergence of the COVID-19 Delta Variant looms, health care organizations continue planning to ward off problems.
It Starts with Leaders
As health care organizations navigate a new post-COVID-19 world, many providers have increasing concerns about safety, not just for themselves but for the patients and visitors as well. As hospitals and ambulatory surgery centers return to their regular activities it will be more important than ever to ensure that protocols are in place to keep patients and staff safe going forward.
Research has shown that leaders are essential for developing a safety culture when they are directly involved in improving safety measures. Leaders who are engaged and lead by example, help employees feel safe when reporting errors or mistakes. Transversely, leaders who fail to create an effective safety culture actually contribute to many of the adverse events that occur in health care organizations.[3]
As your organization resumes elective surgeries, physicians, staff members, patients and visitors alike will have questions about infection prevention practices and what safety measures are in place to assure them that their surgical encounter will not end badly as a result of contracting COVID-19 and the emerging variants. Your processes may look different and include a more proactive approach post-COVID-19 closure, but there are specific steps your organization can take to make everyone feel more at ease if and when a resurgence occurs. Frequent, reassuring communication with all parties will be crucial.
Checklists to Help Prepare Leaders Reopen Their Surgical Schedule
Plan Ahead
- Continue CDC recommendations and remind all staff of the processes in place to help everyone remain COVID-19 free, such as using masks and social distancing outside of work may be necessary.
- Evaluate and confirm all education and staff competencies are up to date prior to restarting your surgical program. This may include mandatory training, BLS, ACLS, PALS, online training, fire and disaster-based scenarios, and emergency preparedness plans.
- Meet with employees and communicate support and the need of the community as it relates to surgical care. Make it clear what the surgical backlog looks like, what is realistic in meeting those needs and what support will be needed by your staff.
- Training and refamiliarization of specific specialties may be required to ensure staff’s capacity to meet the needs during procedures.
Communication
- Re-establish communication with physician offices. Staff in these offices may be new and not familiar with surgical preparation protocols or scheduling processes.
- Evaluate the list of surgical procedures that were canceled. Reprioritized those patients with those physicians and begin rescheduling.
- Communicate with staff the plans for reopening the elective surgery schedule.
- Ensure you have adequate competent staffing levels in place to cover the variety of specialties scheduled
- Communicate with anesthesia to ensure they have the appropriate coverage
- Communicate with patients who have been rescheduled. Communications should include what your organization is doing to ensure their safety, such as extensive cleaning, use of PPE, specific training and safety measures you have put in place to reopen.
- Verify scheduled patients are safe to travel to/from appointments.
Logistics
- Re-establish any paused or canceled contracts such as linen service, biohazard, waste management, etc. If those contracted services are having staffing or supply chain issues, consider increasing par levels to ensure your organization has what it needs.
- Contact vendors specific to your specialties and ensure they have personnel to cover scheduled cases.
- Ensure you have an adequate supply of hand sanitizer, tissues and no-touch trash receptacles throughout your organization and in all patient care areas.
- If a resurgence impacts your organization, station an employee at all entrances who can instruct everyone arriving to sanitize hands, wear a mask and remind them of social distancing requirements.
- Post appropriate signage in all relevant areas communicating instructions for social distancing, appropriate wearing of masks, hand sanitation, etc. Signage should be in all appropriate languages for your particular area of the country.
- Complete a full inventory evaluating supplies, medications, instrumentation, equipment implantable items (screws, plates, mesh, etc.).
- Check all supplies for outdates, integrity of sterile packages and instrument trays.
- Communicate the appropriate updates about all new protocols and processes with staff and patients.
Pre-Admission Testing
- Establish procedures to pre-screen patients through an approved portal such as Zoom or Teams. Screening should include pre-established criteria with added screening for fever, respiratory infections or possible COVID-19 exposure.
- Consider having patients sign appropriate documents electronically using programs such as Docusign.
- Update arrival communications with patients such as staggering arrival times to help enforce social distancing, use of masks while in the hospital,
- Confirm your cleaning walkthrough schedule of the waiting area.
- Complete a full inventory evaluation of supplies, implants, medications and equipment.
- Check all sterile packages and instrument trays for integrity and expiration dates.
- Communicate the appropriate updates about all new protocols and processes with staff and patients.
The pandemic will probably not be over by the end of summer. The world may begin to experience ongoing spikes in cases and hospital admissions. It will be up to health care leaders to implement protocols and new processes to ensure they are keeping their patients safe and that we as a nation provide the necessary treatments and procedures to keep people healthy.
References:
1. https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/education/innovation/
2. https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medicaldevices/medical
3. https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-folders/topics-library/sea_57_safety_culture_leadership_0317pdf.pdf?db=web&hash=10CEAE0FD05B6C3A4A1F040F7B69EBE9
