Authors (including presenting author) :
Law KC(2), Yeung AWT(1)(2), Lee OK(1)(2), Lei PO(2), Chau WL(1)
Affiliation :
(1) Department of Medical & Geriatrics, Ruttonjee & Tan Shiu Kin Hospital, (2) Intensive Care Unit, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
The COVID 19 crisis has affected more than 188 countries and regions worldwide, causing large scale loss of life and severe human suffering. In early 2020, as COVID 19 spread across the globe, the mortality rate was as high as 7.134% and majority of patients required intensive care, which are precious resource to the healthcare system.
Ruttonjee Hospital is a small regional hospital that only have 6 ICU beds and 2 HDU beds with total not more than 30 either trained or more than 5-years-experience ICU nurses. AIIR rooms were located in another floor and split ICU team was required to cope with the foreseeable overwhelming need of ICU isolation beds. The idea of “ICU without walls” were needed to allocate lifesaving resources in a flexible manner, hence making ICU beds convertible and expanding the critical care service outside ICU and throughout the hospital.
Objectives :
In order to tackle with the sudden demand of ICU beds as well as related ICU skill to manage the COVID ICU patients outside ICU. Four essential ICU skills were identified and a crash training program was designed to trained up the experience medical nurses. The four skill included: 1) Continuous Renal Replacement Therapy; 2) Assist Intubation for COVID case; 3) Prone positioning for ICU patient 4) Arterial line care and monitoring.
This program applied an individual coaching and buddy system to transfer the four essential ICU skill from ICU trained nurse to experience acute medical ward nurse. Through demonstration, re-demonstration and clinical exposure or simulated scenarios to familiar with the four essential ICU skills. Participants were expected to understand theories and rationales through individual coaching and buddy system to support during a shift. Ultimate goal was to put caring process of critically ill patients into practice.
Methodology :
The training structure consists of three phases. Initial training was done via pre course reading material and videos related to the four elementary skills. Next phase consists of a simulation scenario during spare time. Scenarios mainly involving two parts in relation to the patient journey. Part I: Admission scenario including intubation, A-line and CVC setup; Part II: CRRT setup and monitoring and prone ventilation. Last phase was completed with clinical observation where participants was exposed to the four elementary skills via real practice. If the chance for real practice expose is limited, skills will be strengthening with simulated scenarios.
Result & Outcome :
Each participant was allocated a mentor and a log book were used to record demonstration, re-demonstration and number of real time practice under supervision. Clinical skill assessment of medical ward nurse was done by ICU qualified Advanced Practice Nurses to ensure the standard were achieved.
The outbreak of COVID-19 tremendously increased the demand of ICU bed as well as ICU nursing skill. Generally, the number of ICU nurses was accounted for less than 10% of the total nurses in the hospital. The SARS outbreak experience had enlightened the importance of transferring the ventilator care skill to ward nurses during pandemic war. However, the new pandemic outbreak told us, surge of patient deterioration was always unexpected. With the new familiar design of ICU equipment and higher education in nursing, transfer of more sophisticated care skill were essential to cope with the rapid growth of health hazard in the near future.
