Patient Monitoring Alarms in an Intensive Care Unit: Observational Study With Do-It-Yourself Instructions.

BACKGROUND: As one of the most essential technical components of the intensive care unit (ICU), continuous monitoring of patients' vital parameters has significantly improved patient safety by alerting staff through an alarm when a parameter deviates from the normal range. However, the vast number of alarms regularly overwhelms staff and may induce alarm fatigue, a condition recently exacerbated by COVID-19 and potentially endangering patients. OBJECTIVE: This study focused on providing a complete and repeatable analysis of the alarm data of an ICU's patient monitoring system. We aimed to develop do-it-yourself (DIY) instructions for technically versed ICU staff to analyze their monitoring data themselves, which is an essential element for developing efficient and effective alarm optimization strategies. METHODS: This observational study was conducted using alarm log data extracted from the patient monitoring system of a 21-bed surgical ICU in 2019. DIY instructions were iteratively developed in informal interdisciplinary team meetings. The data analysis was grounded in a framework consisting of 5 dimensions, each with specific metrics: alarm load (eg, alarms per bed per day, alarm flood conditions, alarm per device and per criticality), avoidable alarms, (eg, the number of technical alarms), responsiveness and alarm handling (eg alarm duration), sensing (eg, usage of the alarm pause function), and exposure (eg, alarms per room type). Results were visualized using the R package ggplot2 to provide detailed insights into the ICU's alarm situation. RESULTS: We developed 6 DIY instructions that should be followed iteratively step by step. Alarm load metrics should be (re)defined before alarm log data are collected and analyzed. Intuitive visualizations of the alarm metrics should be created next and presented to staff in order to help identify patterns in the alarm data for designing and implementing effective alarm management interventions. We provide the script we used for the data preparation and an R-Markdown file to create comprehensive alarm reports. The alarm load in the respective ICU was quantified by 152.5 (SD 42.2) alarms per bed per day on average and alarm flood conditions with, on average, 69.55 (SD 31.12) per day that both occurred mostly in the morning shifts. Most alarms were issued by the ventilator, invasive blood pressure device, and electrocardiogram (ie, high and low blood pressure, high respiratory rate, low heart rate). The exposure to alarms per bed per day was higher in single rooms (26%, mean 172.9/137.2 alarms per day per bed). CONCLUSIONS: Analyzing ICU alarm log data provides valuable insights into the current alarm situation. Our results call for alarm management interventions that effectively reduce the number of alarms in order to ensure patient safety and ICU staff's work satisfaction. We hope our DIY instructions encourage others to follow suit in analyzing and publishing their ICU alarm data.

A National US Survey of Pediatric Emergency Department Coronavirus Pandemic Preparedness.

OBJECTIVE: We aim to describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a diverse set of pediatric emergency departments (PEDs) within the United States. METHODS: We conducted a prospective multicenter survey of PED medical director(s) from selected children's hospitals recruited through a long established national research network. The questionnaire was developed by physicians with expertise in pediatric emergency medicine, disaster readiness, human factors, and survey development. Thirty-five children's hospitals were identified for recruitment through an established national research network. RESULTS: We report on survey responses from 25 (71%) of 35 PEDs, of which 64% were located within academic children's hospitals. All PEDs witnessed decreases in non-COVID-19 patients, 60% had COVID-19-dedicated units, and 32% changed their unit pediatric patient age to include adult patients. All PEDs implemented changes to their staffing model, with the most common change impacting their physician staffing (80%) and triaging model (76%). All PEDs conducted training for appropriate donning and doffing of personal protective equipment (PPE), and 62% reported shortages in PPE. The majority implemented changes in the airway management protocols (84%) and cardiac arrest management in COVID patients (76%). The most common training modalities were video/teleconference (84%) and simulation-based training (72%). The most common learning objectives were team dynamics (60%), and PPE and individual procedural skills (56%). CONCLUSIONS: This national survey provides insight into PED preparedness efforts, training innovations, and practice changes implemented during the start of COVID-19 pandemic. Pediatric emergency departments implemented broad strategies including modifications to staffing, workflow, and clinical practice while using video/teleconference and simulation as preferred training modalities. Further research is needed to advance the level of preparedness and support deep learning about which preparedness actions were effective for future pandemics.

Implementation of Simulation Training During the COVID-19 Pandemic: A New York Hospital Experience.

SUMMARY STATEMENT: Simulation played a critical role in our institution's response to the COVID-19 pandemic in New York City. With the rapid influx of critically ill patients, resource limitations, and presented safety concerns, simulation became a vital tool that provided solutions to the many challenges we faced. In this article, we describe how simulation training was deployed at our institution throughout the course of the pandemic, which included the period of our medical surge. Simulation helped refine protocols, facilitate practice changes, uncover safety gaps, and train redeployed healthcare workers in unfamiliar roles. We also discuss the obstacles we encountered with implementing simulations during the pandemic, the measures we took to adapt to our limitations, and the simulation strategies and end products that were derived from these adaptations.

Feasibility and impact of inverted classroom methodology for coronavirus disease 2019 (COVID-19) pandemic preparedness at an urban community hospital.

Strategies for pandemic preparedness and response are urgently needed for all settings. We describe our experience using inverted classroom methodology (ICM) for COVID-19 pandemic preparedness in a small hospital with limited infection prevention staff. ICM for pandemic preparedness was feasible and contributed to an increase in COVID-19 knowledge and comfort.

Experience on how to implement a preanalytical and POCT unit in Madrid's IFEMA field hospital during this unprecedented COVID-19 emergency.

To fight the virus SARS-CoV-2 spread to Europe from China and to give support to the collapsed public health system, the Spanish Health Authorities developed a field hospital located in the facilities of Madrid exhibition centre (IFEMA) to admit and treat patients diagnosed with SARS-CoV-2 infectious disease (COVID-19). The Department of Laboratory Medicine of La Paz University Hospital in Madrid (LMD-HULP) was designated to provide laboratory services. Due to the emergency, the IFEMA field hospital had to be prepared for patient admission in less than 1 week and the laboratory professionals had to collaborate in a multidisciplinary group to assure that resources were available to start on time. The LMD-HULP participated together with the managers in the design of the tests portfolio and the integration of the healthcare information systems (IS) (hospital IS, laboratory IS and POCT management system). Laboratorians developed a strategy to quickly train clinicians and nurses on test requests, sample collection procedures and management/handling of the POCT blood gas analyser both by written materials and training videos. The IFEMA´s preanalytical unit managed 3782 requests, and more than 11,000 samples from March 27th to April 30th. Furthermore, 1151 samples were measured by blood gas analysers. In conclusion, laboratory professionals must be resilient and have to respond timely in emergencies as this pandemic. The lab's personnel selection, design and monitoring indicators to maintain and further improve the quality and value of laboratory services is crucial to support medical decision making and provide better patient care.

Impact of multi-professional simulation-based training on perceptions of safety and preparedness among health workers caring for coronavirus disease 2019 patients in Pakistan

This study aimed to evaluate perceptions of safety and preparedness among health workers caring for coronavirus disease 2019 (COVID-19) patients before and after a multi-professional simulation-based course in Pakistan. Health workers' perceptions of preparedness, safety, and their willingness to care for COVID-19 patients were measured before and after they attended a simulation-based training course to prepare them to care for COVID-19 patients at Combined Military Hospital Landi Kotal Cantt, from March 1 to April 30, 2020. The participants' perceived level of safety and preparedness to care for COVID-19 patients before the simulation-based course was low, but increased after completing it (P<0.05). They felt confident and were significantly more willing to care for patients with COVID-19 or other infections requiring strict isolation. Simulation-based training is an effective tool to improve perceptions of risk and readiness to deal with COVID-19 among medical and non-medical health workers in Pakistan.

Psychological support during COVID-19 death notifications: Clinical experiences from a hospital in Mexico.

It is estimated that more than 300,000 people have died because of COVID-19 globally. The vast majority of documented deaths have occurred within hospitals, leading to psychological impacts on both family members and health care workers. This paper describes the actions (online death notification education, remote crisis intervention, and support for health care professionals) taken at a hospital in Mexico to address the psychological impacts of the notification of a COVID-19-related death on both the deceased's relatives and the health care personnel involved. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Whole-Process Emergency Training of Personal Protective Equipment Helps Healthcare Workers Against COVID-19: Design and Effect.

OBJECTIVE: To develop an emergency training program of personal protective equipment (PPE) for general healthcare workers (HCWs) who may be under the threat of Corona Virus Disease 2019 (COVID-19) and evaluate the effect of the program. METHODS: A three-stage training program was designed. The complete clinical workflow together with infectious disease ward was simulated. To verify the effect of the program, an experimental training with pre- and post-test was conducted before large-scale training. RESULTS: Post-test scores were significantly improved when compared with the pre-test scores. Among all PPE, N95 respirator and protective coverall needed training most. Meanwhile, "proficiency level" and "mutual check & help" also needed to be strengthened as independent scoring points. CONCLUSION: This training program significantly improved the performances of participants. It may therefore be applied for general HCWs on a larger scale.

Effect of Implementing Simulation Education on Health Care Worker Comfort With Nasopharyngeal Swabbing for COVID-19.

OBJECTIVE: To determine if rapid implementation of simulation training for the nasopharyngeal swab procedure can increase provider confidence regarding procedure competency. METHODS: A simulation training exercise was designed as a departmental initiative to improve competency performing nasopharyngeal swabs during the COVID-19 pandemic. Sixty-one health care workers attended teaching sessions led by the Department of Otorhinolaryngology on proper nasopharyngeal swab technique. After a brief lecture, participants practiced their swab technique using a high-fidelity airway simulation model. Pre- and postintervention self-evaluations were measured via standardized clinical competency questionnaires on a 5-point Likert scale ranging from "No knowledge, unable to perform" up to "Highly knowledgeable and confident, independent." RESULTS: Forty-six participants in this study submitted pre- and postintervention self-assessments. Postintervention scores improved on average 1.41 points (95% CI, 1.10-1.73) out of 5 from a mean score of 3.13 to 4.54 (P < .0001). This reflects a large effect size with a Glass's delta value of 1.3. DISCUSSION: Lecture coupled with simulation-based teaching can significantly improve health care workers' confidence in performing nasopharyngeal swabs. Proper training for frontline workers performing swabs for COVID-19 is essential to improving testing accuracy and can be achieved in a simple and timely manner. IMPLICATIONS FOR PRACTICE: To meet the testing needs of the growing pandemic, many health care workers who are unfamiliar with nasopharyngeal swabs have been asked to perform this test. Simulation-based teaching sessions may improve health care workers' confidence and help prevent false-negative results. This intervention is easily reproducible in any setting where frequent nasopharyngeal swab testing occurs. LEVEL OF EVIDENCE/STUDY DESIGN: Prospective cohort study.

A Community Hospital's Response to the COVID-19 Pandemic.

The novel coronavirus 2019-nCoV (COVID-19) has disrupted and altered the way health care is delivered in the United States and across the world. Patient care guidelines and isolation recommendations continue to hastily change, demonstrating the key role of nursing professional development practitioners in educating and preparing frontline staff to provide safe patient care during the COVID-19 pandemic. This article describes a community hospital's strategic educational response to a highly contagious respiratory pandemic. Initiatives to increase staff education and conserve personal protective equipment are discussed.

Factors associated with preventive behaviours of COVID-19 among hospital staff in Iran in 2020: an application of the Protection Motivation Theory.

This study was conducted to predict the preventive behaviours of healthcare workers (HCWs) towards COVID-19 based on the Protection Motivation Theory (PMT). This cross-sectional and analytical study was conducted on 761 HCWs in Hamadan, Iran, using multi-stage random sampling. The preventive behaviours against COVID-19 among HCWs were assessed at a relatively desirable level. Based on the PMT, threat and coping appraisal were predictors of protection motivation to conduct COVID-19 preventive behaviours (P<0.001). The intention was also predictive of COVID-19 preventive behaviours (P<0.001). Consideration of personnel's self-efficacy and their knowledge regarding the effectiveness of protective behaviours in designing staff training programmes are recommended.