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One Healthsystem's Advancement of it's Mission in the Face of a Global PandemicTINA MCEACHIN, BSN, RN, CNOR, CNIV

DUKE UNIVERSITY HOSPITAL, CARDIOTHORACIC OPERATING ROOM

DURHAM, NORTH CAROLINA

SIGNIFICANCE• Since the dawn of time when faced with disease, medical science and pharmacological

therapies have allowed ailments to be treated.• The advancement of science and medicine have evolved and allowed for improvements in

the quality of life and increased the longevity of each successive generation.• However 2020 subjected all of society to a viral epidemic not seen in over one hundred years. • The rate of sickness, death, financial and psychological despair was incomparable to anything

seen in modern days.• Trying to combat the challenges of a Global COVID-19 Pandemic and the weight of a highly

publicized death of George Floyd ignited the flames of a already chaotic and tenuous global society.

SURGICAL TEAM• Healthsystem leadership• Doctors • Nurses• Respiratory Therapists • Clinical Scientists• Infection Prevention Specialists• All Frontline Healthcare Team Members• Ancillary Support team – Vendors & Supply Chain Network

PATIENT CHARACTERISTICS• Current hospitalized patient• Suspected or Rule Out for Covid-19 Patients• Newly diagnosed Covid-19 Positive Patients• The mystery of Covid-19 and it’s mode of airborne transmission placed anyone who took in

oxygen or interacted with other humans as a potential patient

INTERVENTIONS TO COMBAT A GLOBAL PANDEMIC

PREPARATION AND PLANNING• January 1, 2020 the World Health Organization (WHO) requested information on the cluster of

atypical pneumonia cases in Wuhan from the Chinese authorities.• January 21, 2020 The United States of America (USA) reported its first confirmed case of the

novel coronavirus. • January 24, 2020 The Director of the Pan American Health Organization (PAHO) urged countries

in the Americas to be prepared to detect early, isolate and care for patients infected with the new coronavirus, in case of receiving travelers from countries where there was ongoing transmission of novel coronavirus cases.

• February 11, 2020 WHO announced that the disease caused by the novel coronavirus would be named COVID-19.

• March 10, 2020 Governor Roy Cooper of NC took the next steps in the state’s Coronavirus COVID-19 preparedness plan and issued an executive order declaring a state of emergency.

• March 11, 2020 Deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction, WHO made the assessment that COVID-19 could be characterized as a pandemic.

• March 13, 2020 President Trump declares the COVID-19 Pandemic a national emergency.• March 24, 2020 DUHS initiated the Healthcare Worker Ability to Work Management Plan. This

new resource from EOHW provided new protocols, testing guidelines and returning to work criteria for all Duke Health team members. The COVID-19 Hotline was activated and hours expanded the next day.

• March 26, 2020 DUHS implemented team member COVID-19 screenings.• April 7, 2020 Performance Services developed a COVID dashboard to allow staff to stay

informed about the current status of testing and COVID-19 cases within the health system.• May 25, 2020 Death of George Floyd awakens social unrest in America and solidarity from

nations abroad.

IMPLEMENTATION

COVID-19 PANDEMIC ISSUES• Aug 2020 celebrated the successful discharge of more than 1000 hospitalized COVID Patients

throughout DUHS.• DUHS continued to thrive in spite of shifts and reorganizations of it’s daily workflow processes.• The excellent quality of care delivered to our patients, families and each other never faltered

during the pandemic. The crisis and Global Pandemic action plan allowed for the formation of new programs.

• These included:• Criteria for Discontinuation of Special Airborne Contact Isolation• Caring for Each Other Fund• Duke Led National Vaccination Research Study “HERO TOGETHER”• Duke Center for Healthcare Quality and Safety were featured in The Greater Good Science

Center articles at the University of California, Berkeley and The Joint Commission. • “Talking Points for Patients and Visitors” ongoing updates according to CDC Guidelines

SUMMARY & LESSONS LEARNEDCOVID-19 Pandemic • Dr. Martin Luther King, Jr stated, “Of all the forms of inequality, injustice in health is the most

shocking and inhuman.” • Our team has responded and continues to care for patients and their communities as infection

rates rise and fall. In perioperative services, team members have worked together to keep their patients and each other safe despite the fluctuating status of elective procedures and as urgent and emergent patients who are suspected or confirmed to have COVID-19 arrive for surgery.

• We have been resilient and become stronger as an entity despite the puzzles and chaos of the most stressful time in modern history.

• Recognizing and appreciating our multicultural talents and embracing all members of the team allows for unique and endless possibilities to what we can accomplish as a united front against any disease.

Implications for Practice• AORN Guidelines Advisory Board continues to devise and deliver evidenced based research to

assist clinicians on how to reduce the spread of COVID-19. They also shared where research gaps exist and questions that perioperative professionals are asking AORN to help them practice safely as the pandemic continues.

• Disparities in all sectors of life have a mental, physical, psychological impact on the patients and communities we serve. We must take every measure to confront these public health crisis if we are to continue to progress collectively as a holistic multicultural society.

REFERENCES1. Centers for Disease Control and Prevention. (2020). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/global-response.html2. COVID-19 (Coronavirus) AORN Tool Kit. AORN. https://www.aorn.org/about-aorn/aorn-newsroom/covid-19-coronavirus. Accessed December 18, 2020.3. Duke Today. (2020). Campus Survey. Retrieved from https://anti-racism.duke.edu/campus-survey/ 3. Guideline for transmission-based precautions. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2021:1097-1124.4. WHO Declares COVID-19 a Pandemic. https://pubmed.ncbi.nlm.nih.gov/32191675. Assessed Mar 2020

ACKNOWLEDGEMENTS Special thanks and gratitude to every essential worker and healthcare frontline hero who dedicated their time, talents and passion to fighting for our patients, families and communities now and always.

ASSESSMENT• The birth of Covid-19 began full of questions to the medical community as a novel coronavirus

described “as a cluster of cases of viral pneumonia of unknown cause”• Based on experience with SARS and MERS and known modes of transmission of respiratory viruses,

infection and prevention control guidance were published by the WHO and the CDC to protect healthcare workers recommending droplet and contact precautions when caring for patients, and airborne precautions for aerosol generating procedures conducted by health workers.

• At a news briefing in March 11 2020 , WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, declared the novel COVID-19 a Global Pandemic. He noted that over the past 2 weeks, the number of cases outside China increased 13-fold and the number of countries with cases increased threefold. Further increases are expected. He said that the WHO is "deeply concerned both by the alarming levels of spread and severity and by the alarming levels of inaction," and he called on countries to take action now to contain the virus. "We should double down," he said. "We should be more aggressive.“

• In line with this advice, DUHS began the implementation of it’s Medical Management Team to combat the current and impending medical emergency.

• To compound the stressor of a Global Pandemic, the summer of 2020 awakened the societal impact clothed in injustices and disparities and it’s societal impact due to the death of George Floyd.

• DUHS leadership at large reviewed it’s current policies to address the issue of societal racism and it’s impact on it’s patients, families, healthcare team and society at large.

COVID-19 PANDEMIC ISSUES• At the inception of the Global Covid-19 Pandemic the entire DUHS team developed and

participated in the comprehensive effort to keep the entire community healthy and safe. Steps to ensure this included:

• Duke Health Check App• Universal Masking & Physical Distancing • Hand Hygiene • Visitor Restrictions and Guidelines • PPE Compliance • Aerosol Generating Protocols• Virtual TeleHealth Visits• Covid-19 Vaccination Clinics• Emotional support and Coping with Stress during Covid-19 Workshop

SOCIETAL AND WORKPLACE ISSUES• DUHS Leadership Virtual Town Halls• Nursing Virtual Town Halls• Life Stress & Well Being Survey• Checking in with You 2020 Culture Pulse Survey• Anti-Racism.duke.edu Website & Dashboard• Racial Equity Advisory Council• DUHS convened over 100 programs and online events focused on racial justice many in

collaboration with outside experts and organizations• Moments to Movement Endeavor engagement of health system team, clinicians in the school

of Medicine and Nursing to address inequities and eliminate medical disparities

OUTCOMES

SOCIETAL AND WORKPLACE ISSUES• Nursing Culture Pulse Data showed:• 90.1% of nurses feel the care delivered in their units as Excellent or Good• 88% of nurses feel all aspects of their identity are welcome at DUHS• 79% of nurses feel that DUHS Communicates COVID-19 information in an open and transparent

way• A percentage of nurses did state feelings of burnout• Annual gala presented virtually to honor and celebrate hundreds of nurses, friends and

supporters of the nursing community for their dedication to our patients and profession• A new program “Mentoring Black Nurses Toward Success” was implemented• “DUHS Stands Against Racism Pledge” used as guide for decisions, a measure for progress and

a tool for accountability

OUTCOMES (cont.)