ABSTRACT
BACKGROUND: The current coronavirus disease 2019 (COVID-19) pandemic is creating unprecedented and unchartered demands on critical care units to meet patient needs and adapt the delivery of health services. Critical care nurses play a pivotal role in developing models of care that are effective, flexible, and safe. OBJECTIVES: We report on the accelerated development of a critical care nursing surge model responsive to escalating needs for intensive care capacity. METHODS: We conducted an exploratory prospective observational cohort study that included (i) a self-assessment and survey of learning needs of noncritical care nurses identified as candidate groups for redeployment in the intensive care unit and (ii) a pilot implementation of a team nursing model evaluated by individual questionnaires and the conduct of focus groups. We used descriptive statistics and qualitative content analysis to analyse the exploratory findings. RESULTS: We surveyed 147 noncritical care nurses; 99 (67.3%) self-assessed at the lowest level of critical care competency, whereas 33 (24.3%) reported feeling able to help care for a critically ill patient under the direction of a critical care nurse. Identified learning needs included appropriate use of personal protective equipment in the intensive care unit (n = 123, 83.7%), use of specialised equipment (n = 103, 85.1%), basic mechanical ventilation, and vasoactive medication. We completed 11 team nursing pilot assignments with dyads of critical care and noncritical care nurses categorised in tiers of competencies. Nurses reported high levels of perceived support and provision of safe care; multiple recommendations were identified to improve the model of care delivery and communication. CONCLUSIONS: The complexity, acuity, and unpredictability of the COVID-19 pandemic is placing new demands on critical care nurses to modify existing processes for care delivery while ensuring excellent outcomes and professional satisfaction. The study findings provide a road map to support nursing engagement in meeting patient needs.
Subject(s)
COVID-19 , Critical Care Nursing , Humans , Pandemics , Prospective Studies , SARS-CoV-2ABSTRACT
INTRODUCTION: The Covid-19 pandemic has required new protocols for endotracheal intubation mandating cumbersome personal protective equipment and modifications to prior intubation procedures. We assessed the success and complications of endotracheal intubation under such protocols. METHODS: We conducted a prospective study of endotracheal intubation in the emergency department, intensive care unit, or ward between September 11, 2018 and June 11, 2020 at two urban hospitals. Using a standardized form, we included basic demographics, intubation techniques, and success, and pre-specified complications, defined as critical (cardiac arrest or failure to intubate) or non-critical. At both sites, Covid-19 intubation protocols took effect on March 11, 2020, and we compared pre-post patients. The primary outcome was first-pass success without complications. Secondary outcomes included first-pass success and complications. We analysed by descriptive techniques. RESULTS: Overall, we collected 1534 patients before March 11, 2020 and 227 after; groups were similar in age and sex distribution. Staff endotracheal intubation increased from 37 to 63%. First pass success was 1262/1534 (82.3%) pre versus 195/227 (85.9%) post, for a difference of 3.6% (95% CI - 1.8-8.0%). First pass success without complications was 1116/1534 (72.8%) pre versus 168/227 (74.0%) post, for a difference of 1.3%, (95% CI - 5.2-7.0%). There were 226 complications pre (14.7%) versus 47 (20.7%) post, for a difference of 6.0%. (95% CI 0.6-12.1%). CONCLUSIONS: New pandemic endotracheal intubation protocols did not result in a decrease in first-pass success, or first-pass success without complications.
RéSUMé: INTRODUCTION: La Pandémie de Covid-19 a nécessité de nouveaux protocoles d'intubation endotrachéale exigeant un équipement de protection individuelle encombrant et des modifications aux procédures d'intubation antérieures. Nous avons évalué le succès et les complications de l'intubation endotrachéale dans le cadre de tels protocoles. MéTHODES: Nous avons mené une étude prospective de l'intubation endotrachéale dans le service des urgences, l'unité de soins intensifs ou dans un service de soins intensifs entre le 11 septembre 2018 et le 11 juin 2020 dans deux hôpitaux urbains. À l'aide d'un formulaire standardisé, nous avons inclus les données démographiques de base, les techniques et le succès d'intubation, ainsi que les complications pré-spécifiées, définies comme critiques (arrêt cardiaque ou échec d'intubation) ou non critiques. Sur les deux sites, les protocoles d'intubation Covid-19 sont entrés en vigueur le 11 mars 2020 et nous avons comparé les patients avant et après. Le principal résultat a été un premier passage réussi sans complications. Les résultats secondaires comprenaient le succès au premier passage et les complications. Nous avons analysé par des techniques descriptives. RéSULTATS: Dans l'ensemble, nous avons recueilli 1534 patients avant le 11 mars 2020 et 227 après; les groupes étaient similaires en termes de répartition par âge et par sexe. L'intubation endotrachéale par le personnel est passée de 37 % à 63 %. Le succès du premier passage était de 1262/1534 (82,3 %) avant contre 195/227 (85,9 %) après, soit une différence de 3,6 % (IC à 95 % 1,8 à 8,0 %). Le succès du premier passage sans complications était de 1116/1534 (72,8 %) avant contre 168/227 (74,0 %) après, soit une différence de 1,3 %, (IC à 95 % -5,2 à 7,0 %). Il y avait 226 complications avant (14,7 %) contre 47 (20,7 %) après, pour une différence de 6,0 %. (IC à 95 % de 0,6 à 12,1 %). CONCLUSIONS: Les nouveaux protocoles d'intubation endotrachéale pandémique n'ont pas entraîné de diminution du succès du premier passage ou du succès du premier passage sans complications.
