Nursing subject matter experts to care for emerging infectious diseases

Abstract

<p>Session I presented Saturday, September 29, 10:00-11:00 am</p> <p><strong>Purpose:</strong> As our world becomes ever-more interconnected, the transmission of infectious diseases is happening quicker and more widely than ever before. Highly infectious diseases, such as Ebola, Middle East Respiratory Syndrome and multi-drug resistant tuberculosis have changed the way we screen patients for communicable disease, and how we maintain the well-being of our healthcare workforce. Emergency department nurses are the frontline staff that receive and treat patients with suspected exposures to these deadly diseases. Personal Protective Equipment (PPE) is designed to prevent patient to healthcare worker transmission, yet requires proper donning and doffing to be effective. A potential solution for these low frequency, high risk activities is creating and maintaining a core group of subject matter experts (SMEs) who maintain competence through simulation. The objective of this project was to promote patient and staff safety, through the creation of a group of infectious disease experts to respond to and treat patients suspected of highly infectious communicable disease exposure.</p> <p><strong>Design:</strong> This was a staff development project with a strong quality assurance component. Setting: The project took place at a level one, urban, academic emergency department (ED) in one the 10 designated regional treatment centers for patients with Ebola or other highly infectious diseases.</p> <p><strong>Participants/Subjects:</strong> Of the over 150 ED staff nurses, all full-time nurses were eligible for participation upon completion of the assigned competencies. Enrollment as a designated SME was determined by self-nomination.</p> <p><strong>Methods:</strong> As part of hospital-wide preparedness efforts the Emergency Preparedness Committee, sent an e-mail soliciting nurse volunteers to be part of a subject matter expert group. Those who wished to participate were required to attend orientation meeting. The ED collaborated with members of the Department of Hospital Epidemiology and Infection Control to conduct training, observations, and feedback. Each team member received enhanced contact and droplet PPE training in the patient care rooms to include actual space constraints. A step-by-step checklist was created to assure donning and doffing was done correctly. Each member had to be signed off as competent before they could be an active caregiver. Quarterly donning and doffing observations were required to maintain competencies in a simulated setting or during actual patient care by a trained observer. The creation of a dedicated team also allowed for ordering of appropriate sizes of PPE for each team member, including paper scrubs, gowns, gloves and footwear.</p> <p><strong>Results/Outcomes:</strong> The initial roster of training SMEs consisted of 24 full-time nurses and 3 training that provided nearly 24-hour coverage over the course of 12 months. As the Ebola epidemic has subsided the number of trained experts has also diminished and we currently employ 12 experts. Training goal is quarterly.</p> <p><strong>Implications:</strong> As the Ebola epidemic demonstrated preparedness to respond to highly infectious diseases is essential to ensuring staff safety. Simulated patient care through training and exercises ensure staff are competent to not only during critical donning and doffing steps, but to also perform patient care in the PPE. While maintaining a subjective matter expert group has challenges it represents a tangible solution in providing high-risk emergency nursing care.</p>