Article Figures & Tables
Tables
- Table 1: Time-ordered matrix of activities for the needs assessment
Date, 2014 Activity/data collection Key stakeholders; no. involved in activity Physicians Nursing staff/care facilitator Respiratory therapists Housekeeping and waste management staff Infection control staff Administration staff Occupational health and safety staff Facility staff Other Oct. 21 Walk-through of ED and ICU areas 1 2 1 3 Walk-through of ICU areas 1 4 Interview with respiratory therapy lead 1 Interview with care facilitator 1 Interview with physician 1 Oct. 22 Interdisciplinary focus group 3 5 1 2 Walk-through of ICU 1 1 2 Interview with nurses 2 Walk-through of ED and ICU areas 1 2 3 Focus group with physicians 15 Oct. 23 Walk-through of ward and ICU 1 1 1 2 3 1 Interview with physician 1 Interviews with nurses 7 Interview with pharmacist 1 Oct. 24 Walk-through of simulation laboratory 2 Focus group with nurses 2 Walk-through of ICU (am) 1 1 2 3 Walk-through of ICU (pm) 1 1 2 1 Focus group with nurses 10 Interview with porter 1 Interview with dietician 1 Oct. 27 Walk-through of ED and ICU 1 2 1 2 2 3 1 Review of elements/results 2 2 Nov. 4 Focus group 2 2 Nov. 5 Interview 1 Interviews, after PPE training 2 2 1 Nov. 6 Focus group with respiratory therapists 9 Interviews 1 2 Nov. 7 Data validation — review in detail completed by numerous key stakeholders 4 3 1 1 1 2 Note: ED = emergency department, ICU = intensive care unit, PPE = personal protective equipment.
- Table 2: Summary of themes and desired results
Theme Desired results No. Results Gaps Solutions implemented for gaps* Screening before entry to ICU (or with any ICU team contact) with regard to transfer from ED, wards, OR, recovery room and other hospitals • A screening tool will be developed and kept up to date
• Hospital team members responsible for screening will always use the most current version of the tool to screen potential cases of Ebola
• All hospital team members performing screening will be appropriately trained to use the most secure screening process
• All potential cases of Ebola will be screened with the up-to-date tool and critical care hospital team members will be informed of the screening test result before any physical contact occurs
• All patients admitted to the ICU who are from a high-risk area or have had potential contact with Ebola will receive appropriate ongoing screening
• The screening result will be readily accessible to hospital team members• 6 • 5 • 1 yes
4 noResponse team activation • There should be an easy and rapid way to activate a response that would not overburden hospital team members who are also called on to provide care and manage the patient’s treatment
• The activation will ensure that only essential personnel are notified and expected to respond
• Dedicated response teams will be available to secure and manage any individual who has a positive screening test for Ebola. The team will be immediately available regardless of patient location or time of day• 3 • 3 • 3 in progress PPE • Hospital team members will perform a risk assessment before donning PPE
• There will be a clear process of donning and doffing appropriate PPE that will protect hospital team members while caring for patients with potential or confirmed Ebola
• All equipment used in the process of donning and doffing will be available and easily accessible
• Hospital team members will be proficient with the donning and doffing of PPE before any patient encounter or entering an Ebola precaution room
• Hospital team members will recognize when the clinical scenario changes and they must escalate their level of PPE• 5 • 5 • 1 no
4 in progressManaging postexposure to virus through body fluids • There will be clear definition of an unprotected exposure
• Hospital team members will recognize when exposure has occurred
• Hospital team members will be proficient in taking immediate actions if exposure to body fluids occurs
• There will be appropriate facilities available to decontaminate hospital team members if exposed
• Hospital team members exposed to bodily fluids will be informed of the procedure to follow over the ensuing days
• All hospital team members who help manage a patient with Ebola complete monitoring, even if there was no unprotected exposure• 6 • 5 • 3 no
2 in progressPatient placement, room setup, logging and signage • The most suitable rooms to manage the treatment of patients with suspected or proven Ebola will be selected and then redesigned and equipped if required
• Appropriate signage will be posted in the event of a suspected or confirmed case
• Entries and exits of all hospital team members and visitors will be logged• 3 • 2 • 1 yes
1 noIntrahospital patient movement • Hospital team members will be able to determine the most suitable room placement for any patient with suspected or confirmed Ebola
• Measures will be in place to optimize early recognition of deterioration of a patient’s condition to ensure safe transfer
• The transport process will be clearly defined and will only include essential staff
• There will be a clear and simple process to assemble the team required to transport the patient. Team members involved in the transport will be readily available at all times
• Team members will be proficient, given their respective roles and responsibilities during the transport• 5 • 5 • 2 no
3 in progressInterhospital patient movement • The critical care team will be informed of any patient(s) with suspected or proven Ebola who might require ICU admission
• There will be a clear process in place to ensure that the community hospitals receive all necessary information to initiate safe transport
• There will be a plan of transport from entry point at our hospital to the ICU, which will minimize the risk of contamination
• There will be a clear process in place to ensure that the transfer of care in the ICU occurs safely for both the patient and staff• 4 • 2 • 2 no Critical care management • Hospital team members will be supported in their decisions to withhold interventions to minimize the risk of spreading infection
• Hospital team members will modify their clinical assessment to provide the best possible patient care while minimizing the risk of contamination
• Hospital team members will modify noninvasive and invasive monitoring to provide the best possible patient care while minimizing the risk of contamination
• There will be a clear process in place to perform chest radiography and electrocardiography
• Hospital team members will take appropriate measures to decrease the risk of exposure to body fluids
• Hospital team members will avoid using aerosol-generating procedures whenever possible
• Hospital team members will take measures to safely obtain central access when required
• Hospital team members will safely draw blood
• Critical care staff will be aware of any laboratory testing that cannot be obtained for patients with suspected or proven Ebola
• Sharps will be safely handled and disposed of
• Hospital team members will consider cardiopulmonary resuscitation in the appropriate setting. Hospital team members will not perform cardiopulmonary resuscitation in end-stage Ebola virus disease
• Hospital team members will consider dialysis in the appropriate setting, and measures will be taken to minimize the contamination risk
• ECMO will not be offered in patients with proven Ebola
• Hospital team members will consider using nasogastric and feeding tube in the appropriate clinical setting, and the insertion procedures will minimize the risk of contamination
• The procedure used to handle food will minimize the risk of contamination
• Hospital team members will be proficient in the management of sudden terminal events
• There will be a plan detailing the management of obstetric patients and newborns
• Policies and procedures for transfusion of blood products will be clearly documented
• There will be a clear process to decide and plan discharge from hospital• 19 • 11 • 5 yes
5 no
1 in progressEbola-specific diagnosis and treatment • Hospital team members will order the most suitable test to diagnose Ebola
• Physicians will order and have access to the most appropriate therapy to target Ebola virus disease• 2 • 0 • Critical care staffing issues • There will be sufficient staff available at all times with the required expertise and PPE training to provide patient care and maintain the patient area
• The roles and responsibilities of hospital team members directly or indirectly involved in the care of patients with suspected or proven Ebola will be clearly defined
• Hospital team members who have cared for patients with Ebola will monitor themselves for signs of infection• 3 • 3 • 2 no
1 in progressVisitation and contacts • Visitation rights will be clearly defined
• Support will be provided to patients and their family members
• There will be a clear process on how to manage the treatment of anyone who has had unprotected contact with a patient with suspected or confirmed Ebola
• There will be a clear process on how to screen visitors to the ICU and manage the treatment of any visitor who tests positive for Ebola
• There will be a clear process on how to manage the treatment of any visitor who has a positive screening test for Ebola• 5 • 4 • 4 no Waste management, environmental cleaning, management of linens • Waste will be safely removed from the room
• Processes will be in place to handle spills
• Processes will be in place to clean and disinfect surface areas
• Measures will be taken to avoid contamination and facilitate cleaning
• There will be a clear process in place to handle and clean used linen
• Processes will be in place to clean and disinfect nondisposable equipment• 6 • 5 • 1 yes
3 no
1 in progressPostmortem • There will be a clear process in place to handle a deceased patient • 1 • 1 • 1 in progress Conflict resolution • There will be a clear process in place to respond to family members/visitors who refuse to cooperate with the established policies
• There will be a clear process in place to respond to patients who are uncooperative and/or aggressive• 2 • 2 • 2 no Communication • There will be a clear process of communication to ensure that hospital and departmental leaders collaborate
• There will be a clear process of communication, which will ensure that hospital team members are well informed and up to date
• Communication will be established with other institutions designated as Ebola centres• 3 • 2 • 2 in progress Totals 73 55 8 yes
29 no
18 in progressNote: ECMO = extracorporeal membrane oxygenation, ED = emergency department, ICU = intensive care unit, OR = operating room, PPE = personal protective equipment. *Gaps were only assigned a “yes” or “in progress” if a concrete plan or solution was identified and in place, and an individual/team was clearly tasked to complete. Gaps were assigned a “no solution implemented” if the research team had not identified a specific solution, which had been or was being implemented, during the study period. As the team works to implement solutions after the study period, completed solutions may be uncovered, which were implemented and/or have been completed by other groups.
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