ABSTRACT
Best practices for clinical care delivery among Covid-19 positive and negative patients within the same inpatient oncology unit were unknown in March of 2020. Oncology leadership collaborated with the hospital epidemiology and infection control department at this NCI designated Comprehensive Cancer at the start of the pandemic and determined that Covid-19 positive oncology patients requiring inpatient care be admitted to the biocontainment unit (BCU) in the main hospital. This meant non-oncology nurses cared for cancer patients. Covid-19 cases surged at this academic medical center starting in December 2021 due to the Omicron variant strain. This very contagious strain affected oncology patients much more than previous strains. Patient care challenges emerged, and the need for trained oncology nurses became evident. Since there was a lack of evidence regarding the safety of caring for Covid-19 positive and non-Covid inpatient oncology patients within the same unit, a five-bed inpatient oncology BCU was opened within the cancer center. Conversion of five beds to a negative pressure BCU was facilitated by infection control and clinical engineering. Inpatient oncologic care was anticipated for hematologic and solid tumor malignancies. Nurses with expertise from each of these areas was needed. The oncology nurse manager team met daily to plan staffing the beds based on the patients admitted. Resource coverage was provided by the clinical nurse specialist and oncology educator group. Workflows and education were developed and implemented related to the BCU especially donning/doffing personal protective equipment. Quality initiatives such as central line and safety rounds were maintained. This unit was operational for five weeks and treated 18 COVID-19 positive oncology patients. Oncology staff were cross-trained to this unit from five inpatient areas and included 35 oncology registered nurses and 44 support staff. Opening an oncology inpatient BCU in our cancer center allowed oncology nurses to provide safe, quality cancer care to COVID-19 positive oncology patients. This dedicated BCU closed when the number of Covid-19 oncology patients decreased. Covid-19 positive oncology patients are now safely cared for in the individual negative pressure rooms located on each oncology inpatient unit because of the best practices developed during this time. Staff expressed appreciation at coming together from different units to care for Covid-19 oncology patients during this crisis. This successful cross- coverage concept is now helping address staffing issues faced in this post-Covid era.