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Staying Connected with Critical Care in a Socially Distant Time with AACN · The SHEA Podcast

• 0:11
  SPEAKER_00: Hello, everybody, and welcome to We're All in This Together, COVID-19 Allies in Infection Prevention Podcast Series as part of the Society for Healthcare Epidemiology of America SHA Rapid Response Program.
• 0:24
  SPEAKER_00: My name is Steve Schuian.
• 0:26
  SPEAKER_00: I am an infection preventionist out of Pennsylvania, and I will serve as your SHA moderator and speaker.
• 0:32
  SPEAKER_00: I'm also happy to welcome Melissa Morris.
• 0:35
  SPEAKER_00: Melissa is a staff nurse from Memory University who works on the cardiovascular surgical ICU and will serve as the American Association of Critical Care Nurses as speaker for today's podcast.
• 0:48
  SPEAKER_00: The discussion on the podcast does not reflect Shay's or AHCN's perspective.
• 0:53
  SPEAKER_00: It facilitates communication and multiple perspectives and experiences as we go through this challenging time together.
• 1:00
  SPEAKER_00: Today's episode will focus on collaborations between healthcare epidemiology and critical care nursing and how we as a team can work together to address the most important questions surrounding the COVID-19 outbreak.
• 1:12
  SPEAKER_00: Let's get started with our first question.
• 1:15
  SPEAKER_00: I do need to disclose that I was a critical care ICU nurse for nine years before I became an infection preventionist and clearly never encountered what we're focusing and dealing with today.
• 1:26
  SPEAKER_00: My first question for Melissa.
• 1:28
  SPEAKER_00: How are you, Melissa?
• 1:30
  SPEAKER_01: Hi there.
• 1:30
  SPEAKER_01: I'm doing well.
• 1:32
  SPEAKER_01: How are you?
• 1:33
  SPEAKER_00: Good.
• 1:34
  SPEAKER_00: My first question for you, Melissa, is please describe what Emory University is doing to address COVID-19.
• 1:40
  SPEAKER_01: So what we've been doing to address COVID-19 is all of our teams came together actually pretty quickly to create specialized COVID ICUs and to disseminate information on the proper techniques for donning and DOSing and kind of how to handle everything as a whole.
• 1:56
  SPEAKER_01: We were very fortunate in that it took a very cohesive group to come together very fast to make sure that all of the frontline staff were very well educated and prepared on how to take care of these patients in the best way possible and to do it safely.
• 2:10
  SPEAKER_01: We were very fortunate that they were able to update all of our policy and procedures in our internet.
• 2:16
  SPEAKER_01: So we have a very localized, very easily accessible information to get everything that we need.
• 2:22
  SPEAKER_01: We've also recently had them rolling out ways to decrease some of the workload for us when it comes to excess charting, which has been really helpful from a workflow perspective.
• 2:33
  SPEAKER_01: And with everything that's been going on, we have a lot of staff here throughout Emory Healthcare that work in clinics or in outpatient settings that we've been able to relocate to different ICUs or different units that needed more help.
• 2:47
  SPEAKER_01: And we're very fortunate in that.
• 2:49
  SPEAKER_01: And we've had a big collaboration basically among everyone throughout the system.
• 2:54
  SPEAKER_00: Do you have dedicated staff nurses, dedicated COVID nurses, or does the staff rotate on your COVID units?
• 3:02
  SPEAKER_01: We have designated units for COVID, whether it's COVID units on the floor or COVID at specific ICUs.
• 3:10
  SPEAKER_01: And the staffing for those specific units, they are the majority of the people taking care of those patients.
• 3:17
  SPEAKER_01: But I will say that all of us, especially throughout the ICUs here at our campus, we all have floated to each and every ICU.
• 3:26
  SPEAKER_01: I'm doing whatever we need to do basically to make sure that there's enough nurses staffing to take care of these patients.
• 3:32
  SPEAKER_01: Even though my current unit is not actively at this moment in a COVID ICU, we still float to other units when it's necessary and we're all offered the opportunity to pick up extra shifts.
• 3:45
  SPEAKER_00: It sounds like your surge is over for now, your COVID surge?
• 3:49
  SPEAKER_01: I wouldn't say it's over.
• 3:51
  SPEAKER_01: Our numbers are definitely up from the highest that they had been back in April.
• 3:56
  SPEAKER_01: They're definitely up.
• 3:57
  SPEAKER_01: And it's something that changes every day.
• 3:59
  SPEAKER_00: Clearly, your team meets every morning and you undergo a safety huddle.
• 4:03
  SPEAKER_00: You watch each other's patients during mealtimes, during breaks.
• 4:07
  SPEAKER_00: Can you talk a little bit about what goes on in your safety huddle and your unit rounding?
• 4:12
  SPEAKER_01: During this COVID time, we've had kind of two different sets of huddles.
• 4:16
  SPEAKER_01: We have our nursing huddle that happens at the beginning of every shift, where we talk about kind of what's going on with the unit, any big pertinent things.
• 4:24
  SPEAKER_01: The newest thing that we've been doing huddle-wise is on our COVID ICUs and our COVID units, we have huddles in the morning where it's an interdisciplinary team huddle, basically, which has been very helpful because not only is that a moment that we all get to have to come together collaboratively and talk about what's going on, that's also a time where we learn the big wins for our units, what's been going on, how other people are progressing, some of the people maybe that have been sicker who are now going in the right direction and are getting better.
• 4:55
  SPEAKER_01: I feel like that's helped a little with the resiliency aspect of things is seeing those wins or having that time together where we get to discuss those things.
• 5:04
  SPEAKER_01: Because normally in an ICU, you see patients and you see them at their most critical moments, and then you get them better.
• 5:11
  SPEAKER_01: You get them better enough to go to the floor, and then you don't necessarily always know what's going to happen to them.
• 5:16
  SPEAKER_01: Nice to have these huddle moments with all of our staff and getting to hear our achievements.
• 5:21
  SPEAKER_01: I feel like that's really helped with the morale and everything for all of us here on our units.
• 5:26
  SPEAKER_00: Now, within your state, there's quite a lot of discussion between the governor and the mayor of Atlanta, and it pretty much mimics other states with the masking, mandatory masking.
• 5:38
  SPEAKER_00: What are your thoughts around that as you go to your COVID unit every day and you're hearing about these debates in the public domain?
• 5:46
  SPEAKER_01: Here at Emory throughout all of our campuses, we all do require mandatory masks.
• 5:52
  SPEAKER_01: That's something we've been doing for a while, and that's something that I wholeheartedly support.
• 5:56
  SPEAKER_01: And I feel like most staff members here would agree with that.
• 6:00
  SPEAKER_01: We adopted that several weeks ago, and something that we'll continue to do for the very long future.
• 6:06
  SPEAKER_01: We also recently, in the last couple of weeks, have started to where anytime we're in patient care settings or interacting with patients, we also have started all of us utilizing either goggles or face shields just for added protection.
• 6:20
  SPEAKER_01: So that's something new that we've been doing over the last few weeks.
• 6:24
  SPEAKER_01: And I just think it's really important.
• 6:25
  SPEAKER_01: It keeps at least helping to keep our patients safe and to keep all of us safe.
• 6:30
  SPEAKER_00: I'm also curious from a personal perspective, you're off duty, and can you talk a little bit about how COVID has impacted your life?
• 6:38
  SPEAKER_00: For example, when you're going grocery shopping, obviously you're wearing your mask, are you wearing goggles?
• 6:43
  SPEAKER_00: Can you talk a little bit about the personal impact with COVID?
• 6:47
  SPEAKER_01: Well, kind of just like you just said, when I go out, I do try to social distance as much as I can.
• 6:52
  SPEAKER_01: Obviously, there are times where I have to go places, and I do try to keep myself and others as safe as I can by wearing a mask and taking those proper precautions.
• 7:01
  SPEAKER_01: I feel like if anything, it's just made me cluster together the things that I need to do, and I'm definitely more conscious about going out or doing anything of that nature.
• 7:12
  SPEAKER_01: It's just it's caused me to really kind of reevaluate what's important and what can wait.
• 7:18
  SPEAKER_00: You mentioned being uh trained and educated as a cardiovascular surgical critical care nurse.
• 7:23
  SPEAKER_00: And I'm curious what has been your biggest challenge around COVID-19, which is a little bit different, and how have you handled it to date?
• 7:31
  SPEAKER_00: What has worked for you?
• 7:33
  SPEAKER_01: I guess the thing that's been the most challenging is this is obviously a patient population we've not really had to deal with before that we're not familiar with.
• 7:43
  SPEAKER_01: With cardiac surgery, I'm very used to my patient population.
• 7:48
  SPEAKER_01: I know what to expect, technically, what to expect with certain surgeries and how we manage these patients.
• 7:55
  SPEAKER_01: I guess that's been one of the biggest challenges, especially in the very beginning, is we were all seeing these things for the first time and trying to figure out how to provide the best management for them, especially this patient population.
• 8:07
  SPEAKER_01: They've all have a common thing of like plotting issues, for example.
• 8:10
  SPEAKER_01: And so working through different protocols, it's been a lot of constant education, not only from our infectious disease team, but from all of the disciplines working together to come up with the best way to manage them.
• 8:21
  SPEAKER_01: So I guess it's more of the unknown a little bit in the beginning, and every day seemed like we were learning something new.
• 8:28
  SPEAKER_01: That in itself was very different than my normal patient population that I was used to with cardiac surgery.
• 8:35
  SPEAKER_00: It sounds like Emory has been extremely proactive with facing the pandemic, and you've been rolling with the punches, so to speak, since February, March.
• 8:46
  SPEAKER_00: Can you talk a little bit about PPE fatigue?
• 8:49
  SPEAKER_00: Clearly, and I noticed from personal experience, it gets very hot, very burdensome to be wearing the PPE, and then your bathroom breaks and your food breaks are limited, and you have to maintain social distancing at mealtime with your colleagues.
• 9:04
  SPEAKER_00: Can you talk a little bit how that has impacted you at work?
• 9:07
  SPEAKER_01: In the beginning, it was definitely something to get used to.
• 9:10
  SPEAKER_01: Working in a cardiovascular surgery ICU, we're already accustomed to wearing masks with our transplant patients, but this is obviously something very new and very different at first, wearing everything from head to toe.
• 9:22
  SPEAKER_01: But one thing that Emory did that helped to alleviate some of that stress was they created warm zones in all of our units.
• 9:30
  SPEAKER_01: So you do not have to necessarily don and doff in between each patient interaction, which helps with that fatigue.
• 9:37
  SPEAKER_01: You can wear things gown and you can wear less things are visibly soiled, obviously.
• 9:41
  SPEAKER_01: But the big thing is that we're changing gloves, sanitizing hands, and then re-gloving to go in between rooms in these warm zones.
• 9:49
  SPEAKER_01: So that's definitely helped a lot with the fatigue of the time-consuming efforts that it takes to put things on and off.
• 9:57
  SPEAKER_00: It's great that they're very supportive of you and your colleagues.
• 10:02
  SPEAKER_00: Melissa, I'm wondering if you could talk about the loneliness that your patients encounter and how do you begin to address their psychosocial and their emotional needs?
• 10:11
  SPEAKER_00: They are critically ill, no loved ones at the bedside.
• 10:15
  SPEAKER_00: Uh, can you talk a little bit about that for me, please?
• 10:19
  SPEAKER_01: I will say that that's definitely been one of the bigger struggles throughout all of this.
• 10:24
  SPEAKER_01: Our patient family members are not allowed to be here at this time.
• 10:28
  SPEAKER_01: Unfortunately, that's the safest thing for them and for all of the staff.
• 10:32
  SPEAKER_01: One of the good things that we have, or one of the things that we're fortunate to have, is the ability of technology, which has come in handy a lot over the last several weeks.
• 10:42
  SPEAKER_01: We have iPads designated in all of our ICUs we utilize with our patients so we can zoom with their family members and they can see each other face to face.
• 10:53
  SPEAKER_01: I know that as these patients start to progress and get better, that that's something that they come to look forward to.
• 10:59
  SPEAKER_01: That's something we definitely take the time to do every day that we're here.
• 11:03
  SPEAKER_01: Another thing is taking the extra time to get to know our patients, the thing is that they like, spending those few extra minutes and time in the room with them instead of just quick transactions.
• 11:13
  SPEAKER_01: I think that that's been really important.
• 11:14
  SPEAKER_01: I think that that's been really helpful too, not only for the patients, but for us.
• 11:18
  SPEAKER_01: That's how we've been trying to combat the sense of loneliness that our patients are unfortunately feeling during this time with everything.
• 11:25
  SPEAKER_01: I will say that here we do have patients that we put on VV ECMO, our COVID-positive patients, if their respiratory system is compromised enough and it warrants it, we have them on VV ECMO.
• 11:37
  SPEAKER_01: And so I think seeing them come off that life-sustaining device and seeing them progress and get better.
• 11:43
  SPEAKER_01: We've had several patients that we've been fortunate to see that with.
• 11:47
  SPEAKER_01: Those are the success stories that we always hope for.
• 11:50
  SPEAKER_00: Now I'm curious as an infection preventionist, what opportunities are there for individuals such as yourself working in critical care nursing and myself working in infection prevention and healthcare epidemiology to collaborate together to handle the pandemic today and down the road after this pandemic hopefully comes to an end soon.
• 12:11
  SPEAKER_01: I think that one thing we've learned, especially after the first wave of patients came around back in March, was the importance of frequent debriefing.
• 12:19
  SPEAKER_01: That's something we definitely learned from the first time around as numbers have started to go up again.
• 12:25
  SPEAKER_01: Those of us on the front lines are the ones managing and taking care of these patients.
• 12:28
  SPEAKER_01: And so getting feedback and collaborating on ideas from your frontline staff, I think, is very important.
• 12:35
  SPEAKER_01: We're very lucky here at Emory that they have listened to all the things that we've had to say based on our experiences back in March, and they've taken that feedback and have rolled it out into the things that we're doing now.
• 12:48
  SPEAKER_01: Definitely the debriefing is something that we can all continue to do collaboratively, and I think it's been very effective.
• 12:54
  SPEAKER_00: So you are debriefing with your hospital's infection preventionists then?
• 12:58
  SPEAKER_01: Correct, yes.
• 12:59
  SPEAKER_01: They're very active.
• 13:01
  SPEAKER_01: Even when things first started, and now we still see our infectious disease teams very frequently coming onto the unit, checking on us, seeing how things are going, updating us with changes, and there's definitely been a bigger sense of camaraderie, I feel like, between all of us working together.
• 13:19
  SPEAKER_01: Something that's been enhanced even more so since everything started with COVID back in March.
• 13:24
  SPEAKER_00: Do you have any suggestions for the infection preventionists to keep this camaraderie going after the pandemic is over?
• 13:32
  SPEAKER_00: In other words, how do we maintain this very favorable, sustainable relationship?
• 13:38
  SPEAKER_01: I feel like part of that is just doing the things that they've already done that they have been doing, which is coming around and checking in on us, seeing how we're doing.
• 13:47
  SPEAKER_01: I think that helps kind of keep their face just shown on the unit and they have that visibility, but I also think that it helps overall with the resiliency that we have with everything, just knowing that we are truly working together collaboratively as a team to them continuing to do what they're already doing, which is just being a visible presence on our units.
• 14:06
  SPEAKER_00: Any sense where we're going with COVID and the schools and Atlanta is a very prestigious area with colleges and universities, and any sense where we're going with COVID and the pandemic when you're looking into your crystal ball?
• 14:20
  SPEAKER_01: I know.
• 14:21
  SPEAKER_01: I know.
• 14:22
  SPEAKER_01: I wish that I knew that answer.
• 14:24
  SPEAKER_01: It's uh something that we were talking actually a couple of days ago with one of our infectious disease doctors, and we all kind of came to the same conclusion that we're just trying to maintain optimism and hoping for the best that we'll kind of start on the downtrend of this peak again, but it's hard to say.
• 14:41
  SPEAKER_01: All we can do is hope that other people are taking the same precautions as we are here in a hospital setting.
• 14:47
  SPEAKER_01: And hopefully before too terribly long, we will start to see things on a downtrend again.
• 14:54
  SPEAKER_00: Well, I want to thank you for all that you do and all that your team does for providing the best of care to our patients.
• 15:00
  SPEAKER_00: So thank you very much for your time today, Melissa.
• 15:03
  SPEAKER_00: This has been very interesting and informative to me as well as I'm sure to our listeners.
• 15:08
  SPEAKER_01: Well, thank you.
• 15:09
  SPEAKER_01: Thank you for having me.
• 15:11
  SPEAKER_00: Thank you very much to Melissa Morris for joining us today and sharing her perspectives and experiences.
• 15:17
  SPEAKER_00: And a sincere thank you from Shay and to all healthcare personnel for all that you are doing to respond to COVID-19.
• 15:24
  SPEAKER_00: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 15:32
  SPEAKER_00: You will also find additional resources such as recorded webinars, the healthcare facility outbreak preparedness, and the SHA COVID-19 town halls, and the additional podcast series, COVID-19 update, what we now know, which is released every Thursday.
• 15:49
  SPEAKER_00: That concludes this episode of the Allies in Infection Prevention Podcast Series.
• 15:53
  SPEAKER_00: Thank you for tuning in.