P0761 - Simulation as a tool for COVID -19 preparedness in Neonatal Intensive Care Unit

Background:

Recent emergence of COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, has
posed unprecedented challenges to various aspects of the healthcare system. The complexity and acuity
of NICU patients, along with extreme precautions needed to safeguard patients, families and healthcare
workers (HCWs) from COVID-19 has motivated creative thinking and multidisciplinary collaboration. We
present the use of simulation to design, test and implement safety guidelines for COVID-19
preparedness in the NICU.

Objective:

We hypothesize that a simulation-based intervention can be used to design, test and effectively
implement practice guidelines for personal and team safety while caring for suspected or positive
COVID-19 neonates.

Method:

To examine operational issues and practicality of local infection control COVID-19 recommendations in the NICU workflow, we developed high fidelity in situ simulations with goal of assessing HCWs use of personal protective equipment (PPE) and to conduct cardiopulmonary resuscitation while observing strict droplet and airborne precautions. A three-part simulation was designed to assess from identification of COVID-19 exposure through transportation to negative pressure room and culminating in performance of emergent procedures in a level IV NICU at St Christopher’s Hospital for Children. Donning and doffing of PPE was evaluated amongst other safety procedures. Debriefing included identification of failure modes, causes and actions to reduce the failure occurrence based on modified failure mode effect analysis (FMEA). Pre and post simulation surveys were administered to participants to elicit comfort level in managing a COVID-19 exposed neonate. A COVID-19 exposure process-checklist was generated from this feedback. We re-evaluated the comfort level of the providers after real-life code events in COVID-19 exposed neonates with post-experience surveys.

Results:

Fifty-four survey responses were collected. Participants included physicians (36%), nurses (18%), respiratory therapists (13%) and advanced practitioners (6%). Comfort level of providers in terms of general care of COVID-19 exposed neonates, donning and doffing PPE along with team dynamics in high acuity code was significantly higher after simulation. This comfort level was maintained after a real-life code event (Table 1). In actual patient event , those who participated in simulation reported improvement in team dynamics during code events. During debrief, participants suggested possible failures and actions to reduce failure occurrence (Table 2).

Conclusion:

Simulation based education was a useful tool to effectively test, identify potential failures and modify COVID-19 guidelines to enhance safety in the NICU. High fidelity simulation improved comfort level and safety practices among HCWs which were maintained in real life emergent events.