2021 Annual Conference

CNS Improving Outcomes
Role of CNS in COVID-19 Pandemic

The COVID 19 pandemic presented unique challenges including nursing staff caring for a novel patient population. Concern arose that caring for this novel patient population could result in an increase in adverse outcomes. In an inner city academic medical center, a 24 bed surgical intensive care unit (SICU) transitioned to a COVID intensive care unit for a 2-month period. Many of the COVID 19 population had primarily medical diagnoses including ARDS associated with COVID 19. Building a network of CNS colleagues provided an arena for the SICU CNS to obtain consults for the challenges experienced with this patient population. The CNS of the SICU collaborated with the CNSs from the medical intensive care units (MICU) along with other CNSs throughout the hospital to share best practices for caring for this novel patient population and adapt protocols to optimize the care of COVID 19 patients. Much of the collaboration occurred via formal work groups which focused on protocols such as proning, PPE, utilizing extension tubing to keep IV pumps outside the room, in room communication, and infection prevention measures. However, the informal collaboration between CNSs cannot be overlooked as an important factor in optimizing care. The CNS from the SICU frequently collaborated with the CNSs from the MICU to discuss challenges and successes related to the care of this novel patient population. Frequent collaboration with the CNSs from the MICU who were also caring for COVID patients provided a platform to perform informal case studies and learn from specific patient cases while sharing best practices. Informal sharing of these best practices provided a forum for the SICU CNS to better educate the SICU staff and strategize how to continue to promote best practices for a novel patient population.

Patient outcomes evaluated included rate of Central line associated bloodstream infection (CLABSI), catheter associated urinary tract infections (CAUTI), and overall mortality.

No CLABSI or CAUTI were reported during the 2-month period. Overall hospital mortality was 7.8% at the time the SICU transitioned back to a surgical ICU. 27% of patient mortalities occurred in the SICU.

Collaboration between intensive care unit CNSs provided an opportunity to share best practices and may have contributed to positive outcomes during the COVID 19 pandemic. Building relationships with CNS colleagues and having forums to share best practices whether formal or informal can contribute to improved patient outcomes among various patient populations. The Director of Nursing Practice oversees the CNS group in this institution and is instrumental in fostering these relationships. Successful collaboration during the COVID pandemic can provide a framework for how CNSs across ICUs and service lines can come together to idea share and improve outcomes for patients.