Publish Date: July 8, 2020
Just as elective surgical volume began building in June, spikes in COVID-19 cases are halting elective surgeries this month in Texas and Florida. Other states, too, are seeing a resurgence and strategies for safety may need to be reconsidered.
This latest uncertainty after the all-hands-on-deck response to the initial coronavirus outbreak is leaving patients wary to schedule surgery and creating exhaustion and burnout among perioperative team members.
“It’s been almost five months since we entered a true battle to care for our patients with a deadly virus we’ve never seen before,” noted Lisa Spruce, DNP, RN, ACNP, CNOR, CNS-CP, ACNS, FAAN, AORN director of evidence-based perioperative practice, during a June 24 Town Hall webinar. “From the very beginning we were working without a roadmap to support their [patient] recovery, with inadequate resources to protect ourselves.”
Adapting to Change
To provide evidence-based direction for a coordinated coronavirus response, AORN has been presenting multiple Town Hall webinars and is providing online resources and tool kits to help perioperative teams respond to COVID-19 cases. The latest support tool is the Perioperative Care of the COVID-19 Patient, which recommends practices for varied patient and staffing scenarios and addresses intraoperative and postoperative actions such as environmental cleaning and sterilization, as well as suggestions for self-care to protect staff from burnout.
Spruce described the playbook as a needed “go-to” implementation tool to keep patients and team members safe for emergent, urgent and elective cases during the current wave of the virus and to be ready if additional waves follow.
“Plays” in the book give narrative guidance as well as checklists, flowcharts and algorithms that address specific decisions leaders are facing, such as selecting masks appropriately. For example, “if you are working under contingency capacity, you would want to review the types of procedures for which masks are worn and reduce non-essential use,” Spruce said.
The playbook also includes an ASC reopening readiness checklist for elective procedures after closure due to COVID-19.
Planning for COVID-19 Resurgence
With a COVID-19 resurgence in states across the country, surgical leaders have learned that they must plan for any contingency.
“Volatility, complexity, uncertainty and ambiguity remain our new normal,” but perioperative nurses have the resilience to face these unprecedented times head-on, according to AORN’s CEO/Executive Director, Linda Groah, RN, MSN, CNOR, CNAA, FAAN.
During the virtual town hall, Spruce and Groah shared these strategies and resources for an evidence-based response through the ups and downs of the pandemic:
Strategy #1: Secure PPE and Use it Wisely
Collaborate with medical device representatives to secure PPE supplies and information using the Re-Entry Guidance for Health Care Facilities and Medical Device Representatives statement to direct actions and traffic in your ORs.
Educate staff on the recommended uses of PPE to reduce the risk of airborne transmission of the coronavirus with guidance from the Perioperative Care of the COVID-19 Patient.
Strategy #2: Update your Surgical Safety Checklists for COVID-19
Be aware of Covid signs and symptoms and assess the need for revising nursing, anesthesia, and surgery checklists, including the Time Out. Find more guidance on these activities in the Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic and the Perioperative Care of the COVID-19 Patient.
Strategy #3: Consider Social Determinants in Perioperative Care
Re-evaluate preoperative assessment questions, postoperative education, and post-discharge planning with considerations for social determinants such as access to care beyond the hospital setting. Look for examples in the Perioperative Care of the COVID-19 Patient.
Strategy #4: Innovate to Connect with Patients Virtually
As telemedicine continues to gain momentum to connect patients and providers, consider how a patient’s loved ones can connect with care team members through virtual video communication, such as immediately after surgery in postoperative care.
Strategy #5: Reassure Patients that Surgery is Safe During the Pandemic
A recent AORN survey of perioperative leaders in hospitals resuming elective surgery confirms that patients are scared to reschedule surgeries. Nurses and surgeons can partner to explain cleaning and decontamination approaches in the OR between cases to comfort patients and ensure surgical volume can continue to grow where permitted.
The American College of Surgeons has posted an online resource with suggestions to reassure patients for safe surgery.
Strategy #6: Build Team Resilience
COVID-19 has increased stress for frontline providers. Perioperative leaders can work to change this with resilience-building activities, such as by exploring alternative staffing assignments to reduce fatigue and encouraging staff to view stressful situations as challenges rather than threats. Research suggests individual resilience can permeate to the entire team, according to www.supporttheworkers.org. Also think about cross-training to prepare team members for possibly being diverted to other care areas in the perioperative setting or within a health care facility to treat COVID-19 patients.
“Speed and agility are key through this pandemic,” Groah stressed. With a projected 12-18 months before this current situation resolves to the next normal, she says burnout will increase, budgets will tighten and the need for self-care will be essential.
Access these resources to help shape your own collaborative COVID-19 resurgence response:
- Re-Entry Guidance for Health Care Facilities and Medical Device Representatives
- Perioperative Leaders on Returning to Surgery Report
- Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic
- Perioperative Care of the COVID-19 Patient (free to eGuidelines Plus subscribers and with the purchase of the 2020 print edition of Guidelines for Perioperative Practice).
Free Resources for Members
Ensure you are providing safe patient care and implementing evidence-based practices with customizable tools, such as Guideline Quick Views, Policy & Procedure Templates, Competency Verification Tools, Key Takeaways, Audit Tools, and more for these Guidelines:
Environmental Cleaning Tool Kit
AORN Journal Articles