Strategic Handling of PPE Shortages Instills Confidence in FMOLHS Caregivers

Added on Jul 8, 2020

PPE-COVIDStrategic Handling of PPE Shortages Instills Confidence in Caregivers at Franciscan Missionaries of Our Lady Health System
By Lauren Keeley

As COVID-19 cases escalated in New Orleans in early March, Franciscan Missionaries of Our Lady Health System (FMOLHS), headquartered in Baton Rouge, knew its first wave was not far behind. The news of the imminent spread launched the nursing leadership team into a week of deliberate planning. In collaboration with Our Lady of the Lake’s new chief medical officer, Dr. Katie O’Neal, who also happens to be an infectious disease specialist, the organization established a designated COVID-19 care unit and hinged its surge strategy on preserving personal protective equipment (PPE).

By centralizing stores of PPE and distributing it as needed to COVID units and units with isolation patients, FMOLHS was able to maintain a steady flow of PPE to keep its staff and patients safe while also reducing the opportunity for waste. Nursing leadership employed clear communication tactics, implemented comprehensive education on PPE use, and exhibited overall agility under the duress of uncertain and changing pandemic protocol. Their efforts yielded increases in patients’ perceptions of cleanliness that positively impacted the organization’s Overall Rating score and generated an influx of positive patient comments on the patient experience survey. Clinicians and staff felt equally taken care of, having had their fears assuaged and concerns routinely addressed by a strong leadership team.

“Initially, many of our nurses were hesitant to face this challenge,” recalled Nicole Telhiard, chief nursing officer for the Baton Rouge region of FMOLHS. “Now, being able to work on one of our COVID units is a point of pride for them.” Telhiard and her colleagues at Our Lady of the Lake Regional Medical Center (OLOL), along with Dina Dent, vice president of nursing for OLOL, and Jason Rogers, vice president of nursing for the OLOL Heart and Vascular Institute, attribute this shift in attitude to the organization-wide dedication to going above and beyond to protect and serve their team members.

Developing an Innovative PPE Management Strategy

FMOLHS was unique in its PPE strategy compared to some of its neighboring health systems. Instead of adopting a traditional “dirty unit” concept, in which all front-line workers remain in the same gown, gloves, masks, and other PPE throughout their shift on a COVID unit, FMOLHS made sure it had enough PPE saved so that caregivers could remove all of their PPE upon leaving a patient’s room and be free to chart and manage other administrative tasks, explained Rogers. To do this, leadership pulled all the PPE from all the units in the 830-bed hospital campus and centralized it. Then they distributed it to the COVID units and units with isolation patients on an as-needed basis, rather than keeping it spread out in various locations throughout the hospital. This strategy ensured that staff needing PPE would have access to it at their nurses’ station. Otherwise, they would have to walk unmonitored down hallways to retrieve PPE from the stockpiles in the many different supply rooms and rooms that did not have isolation patients.

This notion of containment informed much of the PPE strategy and proved to be an effective antidote to growing caregiver fears about exposure to the virus. The staff on a COVID unit did not leave the unit during their shifts. The organization provided their meals and relied on “clean” runners who were not allowed inside patient rooms to move food, PPE, medications, or lab work into or out of the unit. They also assigned PPE observers to watch and guide front-line staff in donning and doffing PPE properly. All COVID unit members were required to change into clean scrubs upon entering the hospital and change out of their dirty scrubs before going home. FMOLHS took care of the laundering so that there was limited risk of exposing those at home to the virus, said Telhiard.

At the front line, nursing leaders in partnership with central supply used a reconciliation sheet to review and track PPE deployment and how much PPE was left on hand. Once the demand increased and more COVID-19 units opened, FMOLHS started recycling its N95 masks via the proper sterilization process, said Dent.

Educating and Communicating the ‘COVID Way’

All these procedures fall under what Telhiard, Dent, and Rogers referred to as FMOLHS’s “COVID Way.” But because information from the CDC and CMS was continually changing, sticking to a tried-and-true “COVID Way” proved to be a challenge.

“Information was coming at us left and right, then changing a few days later,” said Rogers. “At one point, we were about to put all our COVID patients into negative pressure rooms and had to quickly pivot when we learned that wasn’t necessary.”

To manage the information overload, the leadership team had 9 a.m. calls seven days a week to review updated guidelines and new protocols. In addition to the CDC and CMS updates, FMOLHS also relied on COVID resources provided by Press Ganey detailing what other client organizations were doing around screening processes, visitation, and communicating with families, said Dent. These on-demand resources allowed them to develop and adapt their “COVID Way” to best meet the needs of patients and caregivers.

Information from the morning calls would be shared with front-line directors and managers, who would then cascade it to their teams via rounding, said Rogers. Any further updates that occurred throughout the day would be communicated through senior nurse leader and nurse educator rounds, disseminated via email in daily updates, and shared in on-site shift huddles, allowing staff to course-correct as needed.

Any changes in processes and procedures were documented and placed in a binder that lived on the unit. As the COVID census grew, senior leadership expanded the 9 a.m. calls to include all nursing and support departments. They also placed copies of the binder on all COVID units.

In addition to nursing leadership, the OLOL clinical education staff supported the COVID unit seven days a week. Like other health systems grappling with a sudden increase in patient volume, FMOLHS redeployed many non-acute care nurses from its surgical sites and children’s hospitals to work alongside the ICU nurses. In addition to training these nurses in the new procedures for care delivery on the COVID units, the education team oriented and educated the physical therapists, respiratory therapists, and physicians who worked on the units, said Dent. To account for the spectrum of ability, they developed an interdisciplinary care approach to education that included daily classes on PPE donning and doffing, daily education team rounds, and a two-hour intensive introduction to the “COVID Way” before each new COVID unit opened.

“After the education sessions, there was no more ‘I’m a med-surge nurse’ or ‘I’m an ICU nurse,’” said Telhiard. “It became ‘I’m a COVID nurse.’ Watching those relationships form and the diverse teams working in stride with each other was remarkable.”

Reflecting on Staff and Patient Feedback

Like many organizations navigating the new territory of a global pandemic, nursing leadership at FMOLHS were unsure how patients and staff would respond to the seemingly drastic but necessary PPE initiatives.

“I had some angst waiting for [patient experience] surveys to come back, but I was pleasantly surprised that our patient comments were filled with gratitude toward staff,” Dent expressed. “It was clear that patients felt clean, safe, and cared for.”

FMOLHS compared its Overall Rating performance with its cleanliness scores and found that the higher the cleanliness score was, the higher the Overall Rating was. Telhiard noted that in the cleanliness section of surveys, patients mostly commented on staff’s fastidiousness about washing their hands and wearing masks and the availability of clean linen. The commitment to caregiver safety was also deeply felt throughout the organization, said Rogers. The transparency around PPE preservation and distribution, coupled with the various education and 24-7 support programs, left caregivers feeling listened to, confident in their leadership, and safe.

The leadership team also conducted a review of each nursing division to collect feedback regarding the PPE strategy and pandemic response overall. They reviewed changes in processes to determine what to bring forward into the second wave and what to leave behind. Even with these deliberate steps to aid future planning, though, the team realized their agile culture and mindset of continuous learning would be the most beneficial in tackling the uncertain challenges to come.

“Living in the South, we are used to switching to disaster mode for hurricanes,” said Telhiard. “But it’s clear this is not going to be a two-week rapid response and recovery. This is going to be a long-term journey.” By prioritizing caregiver and patient safety early on with a comprehensive PPE strategy, FMOLHS has proven it is well-equipped to continue that journey.