Rapid Critical Care Training of Nurses in the Surge Response to the Coronavirus Pandemic

Diana Brickman, BSN, RN, CCRN-K; Andrew Greenway, MSN, RN, CCRN, AGCNS-BC; Kathryn Sobocinski, BSN, RN, CCRN, TCRN; Hanh Thai, MSN, RN, AGACNP-BC, CCRN; Ashley Turick, BSN, RN, CCRN; Kevin Xuereb, MSN, MSEd, RN, ACCNS-AG, CCRN; Danielle Zambardino, BSN, RN, CCRN, TCRN; Philip S. Barie, MD, MBA, Master CCM; Susan I. Liu, BSN, RN, CCRN, TCRN

Disclosures

Am J Crit Care. 2020;29(5):e104-e107. 

In This Article

Methods

Expedited instruction needed to be thorough and effective while adhering to social distancing guidelines; we selected learning environments accordingly. Nurses from various locations such as pediatric ICUs, adult step-down units, and procedural areas, and advanced practitioners such as certified registered nurse anesthetists, were grouped on the basis of learning needs and experience; we tailored course content accordingly. During scheduled work hours, each group of up to 30 nurses, in subgroups of 10, rotated through a 3-hour curriculum consisting of 3 modules (~1 hour each). Scheduling the course during mornings, afternoons, and at midnight facilitated the education of more than 60 nurses each day. Matriculants immediately applied the knowledge they acquired from the curriculum, as they entered ICU practice supervised by critical care nursing staff.

We chose curricular topics on the basis of preliminary observations of COVID-19 critical illness, its complications, and anticipated patient needs. Acute respiratory distress syndrome, shock, and acute kidney injury, being the most prevalent complications, were weighted more heavily. We reviewed topics with the hospital's command center and with ICU nursing and medical teams throughout New York-Presbyterian/Weill Cornell Medical Center who were already beginning to provide care for these patients.

Clinical nurse specialists from the burn and surgical/trauma ICUs provided instruction on respiratory failure and ventilator management in patients with acute respiratory distress syndrome. They demonstrated various modes on a Puritan Bennett 840 ventilator with bilevel and tracking software (Medtronic, Inc). At a second station, ICU nurses described pathophysiologic states common in patients in the ICU, including shock and hemodynamics; reviewed pharmacotherapy used in patients with critical illness, including vasoactive agents, neuromuscular blockade, sedatives, and analgesics; and discussed how to diagnose and manage delirium. A skills station allowed hands-on practice with common critical care equipment including cardioverters/defibrillators, peripheral nerve stimulators, endotracheal and thoracostomy tubes, arterial and central venous monitoring catheters, pumps for feeding and medication, and hemodynamic monitoring devices. Intensive care unit documentation in the Sunrise electronic health record (Allscripts) was reviewed with nurses who were unfamiliar with the software interface. Last, continuous renal replacement therapy was discussed in detail, given the high incidence of acute renal failure and shock among critically ill patients with COVID-19. A NxStage System One hemodialysis machine (NxStage Medical, Inc) was available so that participants could review the setup and initiation of the machine, common alarms on the machine, and troubleshooting of potential issues.

With the assistance of the clinical manager of the surgical ICU pharmacy, we created laminated quick-reference "drip cards" based on formulary guidance for titratable continuous infusions. They specified available concentrations, peripheral versus central administration, bolus dosing (when applicable), and titration parameters. We designed these cards to attach to hospital identification cards. The education team also prepared educational resource binders for reference and distributed them to all authentic and temporary ICU areas. These binders included all class topics covered and all new protocols that had been created to inform the care of critically ill patients with COVID-19.

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