ABSTRACT
Professional Development Emergency situations are a part of medicine, but their unexpected nature adds to staff and patient anxiety. Cancer patients undergoing radiation alone or in combination with chemotherapy are at risk for complex adverse effects. Staff need to recognize that emergencies can present in different ways and intervene quickly and knowledgably to avoid mortality and morbidities. Evidence shows that a multidisciplinary approach is more effective in addressing these situations and critical thinking provided through simulation training is evidence-based. Although simulation shows an increase in confidence and ability to critically think during emergencies, very little information exists in the literature on the use of simulations training for oncological emergencies. When a declining patient is identified, it is essential for staff to act as a team to avert more complications and possible death. Because of this need for collaboration and to incorporate appropriate PPE due to COVID-19, simulation training and mock codes were critical components of the educational program. To improve emergency management of declining patients, a standardized educational program, including simulation training was provided to a multidisciplinary staff within the radiation oncology unit. Pre-assessment questionnaires were sent to all radiation oncology staff who cared for patients at risk for declining conditions. The training sessions were intentionally kept small to promote hands-on learning and open dialogue. Staff then had "hands on" education with simulation that included how to use, connect, and prepare emergency equipment;inventory supplies in each drawer of the "crash" carts, including medications;and understanding of roles and responsibilities. The exercise ended with all staff working together as a team to complete patient scenarios. Post-assessment questionnaires were sent to participants which confirmed an increase in confidence, critical thinking, and an increased feeling of teamwork during an emergency. Because of the small group sessions, staff reported that they felt comfortable asking specific questions and were not afraid to make mistakes. Implementation of the standardized simulation educational program proved to be effective at increasing staff confidence and teamwork during oncologic emergencies. Analysis of the data suggests that staff appreciated the opportunity to be part of the simulation experience and declining patient situations have become a team effort with delineated roles and responsibilities to ensure safe patient care.
ABSTRACT
Background and purpose: : To develop the safest possible environment for treating urgent COVID+ patients, we describe the unique construction of negative air pressure CT simulator and treatment vaults in addition to screening, delay and treatment protocols and their evolution over the course of the COVID pandemic. Materials and methods: Construction of large HEPA filter air flow systems into existing ductwork in CT simulator rooms and photon and proton treatment vaults was attempted to create negative pressure rooms. An asymptomatic COVID screening protocol was implemented for all patients prior to initiation of treatment. Patients could undergo simulation and/or treatment in the biocontainment environments according to a predefined priority scale and protocol. Patients treated under the COVID-19 protocol from 6/2020 to 1/2022 were retrospectively reviewed. Results: Negative airflow environments were created across a regional network, including a multi-gantry proton therapy unit. In total, 6525 patients were treated from 6/2020 through 1/2022 across 5 separate centers. The majority of COVID positive patients had treatment deferred when deemed safe. A total of 42 COVID positive patients who were at highest risk were treated under the COVID-19 biocontainment protocol, in contrast to those who were placed on treatment break. For 61.9% of patients, these safety measures mitigated an extended break during treatment. The majority (64.3%) of patients were treated with curative intent. The median number of biocontainment sessions required by each patient was 6 (range: 1-15), prior to COVID clearance and resumption of treatment in a normal air flow environment. Conclusion: Constructing negative pressure environments and developing a COVID-19 biocontainment treatment protocol allowed for the safe treatment of COVID positive radiation oncology patients within our department and strengthens future biopreparedness. These biocontainment units set a high standard of safety in radiation oncology during the current or for any future infectious outbreak.
ABSTRACT
Background and purpose : To develop the safest possible environment for treating urgent COVID+ patients, we describe the unique construction of negative air pressure CT simulator and treatment vaults in addition to screening, delay and treatment protocols and their evolution over the course of the COVID pandemic. Materials and methods Construction of large HEPA filter air flow systems into existing ductwork in CT simulator rooms and photon and proton treatment vaults was attempted to create negative pressure rooms. An asymptomatic COVID screening protocol was implemented for all patients prior to initiation of treatment. Patients could undergo simulation and/or treatment in the biocontainment environments according to a predefined priority scale and protocol. Patients treated under the COVID-19 protocol from 6/2020 to 1/2022 were retrospectively reviewed. Results Negative airflow environments were created across a regional network, including a multi-gantry proton therapy unit. In total, 6525 patients were treated from 6/2020 through 1/2022 across 5 separate centers. The majority of COVID positive patients had treatment deferred when deemed safe. A total of 42 COVID positive patients who were at highest risk were treated under the COVID-19 biocontainment protocol, in contrast to those who were placed on treatment break. For 61.9% of patients, these safety measures mitigated an extended break during treatment. The majority (64.3%) of patients were treated with curative intent. The median number of biocontainment sessions required by each patient was 6 (range: 1-15), prior to COVID clearance and resumption of treatment in a normal air flow environment. Conclusion Constructing negative pressure environments and developing a COVID-19 biocontainment treatment protocol allowed for the safe treatment of COVID positive radiation oncology patients within our department and strengthens future biopreparedness. These biocontainment units set a high standard of safety in radiation oncology during the current or for any future infectious outbreak.