ABSTRACT
Preparedness for emergencies: strategies to increase the supply of beds and advanced intensive skills. Introduc-tion. The recent pandemic has highlighted the importance of emergency preparedness plans. In addition to techno-logical and structural resources, it is essential to have pro-fessionals with skills that allow them to safely work in in-tensive care areas. Aim. The aim of the contribution is to propose an intervention model to develop the skills of nurs-es of operatory theatres or intensive care to enable them to work safely in critical care settings. Methods. A plan was devised, involving a multiprofessional group to increase the number of beds in the intensive and semi-intensive care areas, as well as to train staff, hypothesising the activities to be reduced by moving staff to different areas. Results. The proposed organisational model could be implement-ed in other hospitals;it guarantees emergency prepared-ness and the expansion of the skills of the staff involved. Conclusions. Nursing staff with advanced skills should be readily available to safely guarantee the expansion of in-tensive care beds. The current division between intensive and semi-intensive settings could be revised in favour of a single critical care area.
ABSTRACT
Introduction: On December 21st, 2020, the European Medicine Agency authorized the first SARS-CoV-2/COVID-19 vaccine. As far as the organizational, procedural and monitoring aspects of the vaccination campaign are concerned, it was necessary to follow the regional guidelines and activate the health authority paths. Target: Defining the training plan for preparation and administration based on bookings, availability of vaccine doses and proper storage. Planning the vaccination process. Materials and Methods: Applying a Work Breakdown Structure we have decomposed the project in sub-projects into sub-projects and their macro-activities, chosen the health care workers involved, scheduled the meetings, drafted the internal path coordinating with logistics and resources. We met daily to standardize information and establish the steps achieved and tackle the next ones. We organized the training sessions and recruited the dedicated staff. Results: The vaccination organization structurally required 5 nursing clinics and 6 medical clinics and a booking agenda. Sending an e-mail communication containing all the information and the forms for informed consent and medical history facilitated and speeded up the medical examination. The training involved 16 nurses and 6 doctors. The nurses followed a theoretical-practical course with simulation for dosage and drawing the right amount in order to guarantee the presence of the 6th dose. We identified a vaccine-like bottle filled with the expected total liquid amount. To guarantee everyone the test, we set up more testing stations, the people concerned repeated the sequences also verbally. The health care professionals prepared, using the standard aseptic technique, all the steps from dressing to handling, dilution and withdrawal, in order to obtain the 6th dose. The outcome of the training process was verified on the very day of the vaccinations when we counted the final results with the possibility of obtaining the 7th dose from the single bottle and/or the recovery of one dose for every two bottles used. Conclusions: This process requires special care in order to ensure a correct and safe practice with the goal of optimizing vaccine doses and vaccinate more people. The staff responded with excellent participation and enthusiasm, without taking anything for granted. Training, as it always happens, is at the basis of all consolidated and new processes.
ABSTRACT
Background: Enrolment of patients in phase 1 trials is a difficult task everywhere and at every time. It is reported that on average less than one patient per month is enrolled worldwide in phase 1 trials. COVID-19 pandemic has been a further problem during 2020, with many trials closed by the sponsors for logistic reasons and for the fear of causing a fatal infection in cancer patients. Materials and methods: We reviewed the activity of our phase 1 unit in terms of enrolment of new patients during six months, three before and three during COVID-19 pandemia, and of treatment of patients enrolled before the pandemic. Results: Out of 8 trials active at our unit, only one did not close the possibility of enrolling new patients during the pandemic. No treatment was stopped because of the pandemic. During the pandemic we enrolled three new patients in the only one open trial. The same number of new patients had been enrolled during the previous three months. In addition, three further patients were pre-screened during the pandemic resulting not eligible. Operatively, an intensive strategy of testing healthcare workers (nurses, doctors, study coordinators, biologists) with blood testing for anti-COVID19 IgM and IgG, and pharyngeal and nasal swabs was applied. In addition, patients were managed with a triage protocol that similarly included blood testing at each access and swab testing in case of IgM/IgG presence. Overall, no one of the health coworkers resulted positive to blood or swap testing and only one patients was positive to IgM testing, with negative swap and subsequently negative blood testing, possibly representing a false positive case. Sanitization of phase 1 rooms was also performed regularly, once per week or more frequently at need in case of patients or health workers resulting positive to blood testing. Conclusions: Our phase 1 unit was able to maintain the same level of activity during the pandemic, thanks to one trial that was not suspended by the sponsor and this goal was reached thanks to organization and preventive measures set up by the Institutional dedicated professionals. Overall, a good result was achieved in terms of safety of both patients and healthcare workers.