Care of the COVID-19 Positive patient
Topic of Interest
Role of CNS in COVID-19 Pandemic
Patient Populations
Interprofessional Collaboration
Abstract
COVID-19 Patient Populations Abstract
Title: Care of the COVID-19 Positive Patient
Authors: Allison Wier DNP, RN CMSRN AGCNS- BC APNP, Angela Burns BSN, RN, CMSRN
Significance & Background: Since winter of 2019, a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused disease (COVID-19) in over 22,773,308 people with over 795,196 deaths across 188 countries (1). As the COVID-19 pandemic continues to emerge, care has had to transform to meet the patient’s unique needs at a Midwestern academic center. Since research on this virus is emerging, staff had to follow the current limited evidence and Center for Disease Control recommendations as the basis of their care. Care recommendations and PPE requirements were changing several times per week. Standards of care were needed to decrease confusion and improve patient outcomes.
Evaluation Methods:
Through analyzing the available evidence, a group of Clinical Nurse Specialists and educators developed and implemented guidelines to standardize care of patients with COVID-19. These guidelines focused on staff protection, personal protective equipment (PPE), and nursing-centered clustered care.
A COVID-19 order-set was created. Care standards included: every 2-hour respiratory rates and continuous Pulse-ox, prone positioning, lab monitoring, and Aerobika. An early warning pathway for transfer to the ICU was developed and included a respiratory rate above 24 and oxygen needs greater than 5L.
While implementing the changes, the CNS provided real-time feedback to improve patient care outcomes and staff safety.
Outcomes:
There has been many positive patient outcomes since the care standards were operationalized. Since March 17, 2020, the hospital has had over 650 discharges with 23 deaths in the non-ICU setting. The average length of stay is 7.17 days. Once the early warning pathway was implemented, there was only one patient who required intubation on the floor.
CNSs were deployed to complete tracers with coaching on the proper use of PPE. Since this occurred that has been minimal staff who have contracted the virus and compliance rates with the use of proper PPE have consistently been greater than 90%.
Implications
Clinical Nurse Specialists were able to quickly come together to standardize care for patients with Covid-19 and patient outcomes improved. The standard care guidelines have been implemented for patients in the ICU and med/surge care settings across the enterprise.
Patient and family education at the time of discharge now includes precautions and interventions needed to prevent the spread of the virus across the community. The impact of these guidelines has increased the survival rate of COVID-19 patients at this facility and can have a positive impact across the country as well.
Reference
John Hopkins C. Coronavirus COVID-19 (2019-nCoV). 2020; https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6.