How do you maintain competency on the 200 nurses that could potentially have to identify isolate and informed care for a patient in the emergency department?’ The answer is that it takes a collaborative approach among many stakeholders, including infection prevention, nursing leaders, environmental services, facilities management, employee / occupational health, emergency management, and security.” |
nurses that could potentially have to identify isolate and informed care for a patient in the emergency department?’ The answer is that it takes a collaborative approach among many stakeholders, including infection prevention, nursing leaders, environmental services, facilities management, employee / occupational health, emergency management, and security.”
She added,“ I know that sometimes the infection prevention department is tasked with being the lead on this, but I can’ t emphasize enough the importance of implementing a process that’ s collaborative across these disciplines. For example, for nursing leaders in the emergency department, you want to ensure that you are developing tools that are going to be useful to the ones that are going to have to implement them. You will need to look to environmental services and your facilities management department for proper air handling and identifying the best place to isolate a patient; your employee / occupational health department will need to provide that caregiver monitoring; and emergency management and maybe even security are going to be involved in the process; and then of course our public health partners are involved closely.”
Prather provided details around the Joint Commission elements of performance for each of the five big buckets.“ The Identify / Isolate / Inform process is based on Joint Commission standard element 1, which is that the hospital develops and implements protocols for high-consequence infectious diseases or special pathogens,” she said.“ So, how are you going to identify a highly infectious patient who walks through your doors? Do you have a screening process in place that will identify patients triggering a suspicion of having an HCID? Early recognition is key, and that starts with signs & symptoms first. Is your travel screen turned on in your EHRs and is it a hard stop? Are there epidemiological risk factors, including travel history, and did they have any exposure to sick individuals? Do they work in a healthcare facility or do they have contact with any sort of animals, such as bats or monkeys that can carry contagious zoonotic diseases? After you have that information, you’ re going to look at what kind of a patient they are; are they a suspect patient? Do they have signs & symptoms? Do they have a positive travel screen and an epidemiological risk factor based on a risk assessment that you’ ve done in your ED? Were they a person under monitoring from public health authorities because they had traveled to a country that was in an outbreak area? Those are very important key details to try to get the full picture of what’ s going on with them.”
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She explained that a suspect patient presents with both clinical and epidemiological risk factors for a specific infectious disease, while a person under monitoring( PUM) is an individual who is asymptomatic with history of exposure to known confirmed case or travel history to a known outbreak area( different based on outbreak).
Prather continued,“ We all know that the waiting room in the emergency department can get crazy, and sometimes you have lines out the door. So, it’ s critically important that there’ s a way to not only identify by your triage nurse or whoever’ s sitting at that front desk, but to self-identify and also self-isolate. That can be accomplished by having signs in the emergency department to don masks and use hand sanitizer.”
She added,“ Once you’ ve identified your patient, now it’ s time to isolate them, and that can be just as simple as having them don a mask. But this is where I want to emphasize the importance of having a plan that includes having already identified an ideal isolation room, which may be an existing airborne infection isolation room. Ninety-nine percent of the time it’ s going to have somebody else in it, so what is the backup plan? Where can you safely place that patient, especially if they’ re clinically stable, allow yourself a time to make sure and isolate them to maintain that culture of safety and then have a communication plan in place with your charge nurse to say,‘ How do we get that ideal room available as soon as possible?’ So, having those things done ahead of time from a preparedness perspective is going to be optimal, and then having a checklist or an algorithm for your caregivers to follow is going to be essential for getting the suspect patient isolated right away.”
Prather said that isolation technique is key when it comes to suspected HCID patients.“ Have your personal protective equipment( PPE) ensemble ready, have all of your resources – such as isolation signs, log sheets, supply sheets, etc. – in one place such as in a cart or a bin, and I think that’ s where it goes back to that collaboration with your nursing leaders in your emergency departments regarding what’ s going to make the most sense for them in terms of where these supplies will be kept and do the emergency department personnel know where it is? We’ re talking about, hopefully, a very low-frequency, but a potentially high consequence event that’ s going to take a lot of resources, so the more you can do ahead of time to create a process where they can go grab that bin or that cart, pull out those checklists, and they have a step-by-step plan of knowing what they need to do, identifying who’ s going to be that caregiver to go into the room,
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We all know that the waiting room in the emergency department can get crazy, and sometimes you have lines out the door. So, it’ s critically important that there’ s a way to not only identify by your triage nurse or whoever’ s sitting at that front desk, but to self-identify and also self-isolate. That can be accomplished by having signs in the emergency department to don masks and use hand sanitizer.” |