Adaptations and Evolution during COVID-19 in a Pediatric Satellite Setting

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Background Information

The global Covid-19 pandemic has required the rapid development and implementation of processes that support safety and quality of care. Prior to this unprecedented challenge, our satellite pediatric ambulatory surgical center consisted of four units: a preoperative unit (Preop), six operating rooms, a Post Anesthesia Care Unit (PACU), and an Inpatient Short Stay unit. Although the Preop and PACU nurses were cross-trained to cover both areas, Inpatient nurses maintained a distinct skill set and were a standalone unit. In effort to support virus containment, including social distancing, a flexible staffing model required the integration of Preop, PACU, and Inpatient nurses into one cohesive team.

Objectives of Project

Development and implementation of changes to perioperative processes that support quality care and safety during Covid-19.

Process of Implementation

Inpatient areas were converted to support the preop care of patients/families and facilitate the adoption of COVID safety regulations. Inpatient nurses were oriented to the Preop nurse role, Preop Covid test screening, and Visitor/Employee lobby screening. This cross-training educational program included in-services on Preop documentation and procedures and one to one orientation with a Preop nurse. Presently, nurses may care for the same patient/families preoperatively and during their inpatient stay which promotes quality care and an improved surgical experience. Changes to staffing models were evaluated through staff survey, analysis of Press Ganey patient satisfaction feedback and surgical throughput data.

Statement of Successful Practice

A majority (83.3%) of nurses agreed or strongly agreed that the new flexible staffing model promoted team cohesion and ensured safety and quality throughout the surgical experience. Between May and September 2020, our integrated perianesthesia team cared for 1206 perioperative patients. Press Ganey scores were overwhelmingly positive. One family stated “Before surgery the nurse kept us calm, engaged, & informed. After surgery that nurse did the same thing & was also a great teacher regarding home care”.

Implications for Advancing the Practice of Perianesthesia Nursing

As ambulatory surgical centers, continue to adapt during the pandemic, it is imperative that perianesthesia nurses design and implement flexible staffing models that promote team cohesion and ensure safety and quality during surgery.

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