COVID 19 Toolkit
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Click here for COVID-19 Frequenty Asked Questions below the Toolkit


COVID-19 Toolkit for the Perianesthesia Nurse

updated March 2021

ASPAN recognizes that throughout this unprecedented pandemic, conditions in US hospitals and ambulatory surgery centers are rapidly shifting and escalating from standard operations to emergent/extreme/surge operations. The following recommendations are intended to provide guidance to perianesthesia nurses who may be working in these extreme situations. It is TREMENDOUSLY important to remember that the information regarding COVID-19 is constantly changing, new knowledge is constantly being generated – the best advice we can offer you is to stay informed with scientific sources which are provided in the resources.

Click here for the entire COVID-19 Toolkit for the Perianesthesia Nurse

Strategies for Caring for the Nurse
Self-Care
Donning and Doffing Review
Home Recipes

Strategies for Caring for the Patient
Strategies for Caring for the COVID Positive Patient
Care of the Critically Ill COVID Patient
Sample Critical Care Unit Skills Training Checklist
IV Drip Sheet
COVID Resources


COVID-19 FAQs

  1. What are the recommendations for returning patients to the OR who have recovered from COVID?
  2. If everyone is vaccinated, do we still need to wear masks and physically distance ourselves?
  3. Do ASPAN Standards still apply during a global pandemic or local crisis?
  4. What does ASPAN recommend for the standard of care during the Phase 1 in regards to PPE? 
  5. What barriers or social distancing guidelines for open bay PACU's should be in place?
  6. Is there evidence to support testing of all patients receiving surgery or only elective outpatients?
  7. Has COVID-19 changed how we are doing preoperative nursing assessments and testing? 
  8. How are ACUs/PACUs currently managing visitation?

  1. What are the recommendations for returning patients to the OR who have recovered from COVID?

Several studies have been published with various recommendations regarding the right time to return to surgery. The closer to a positive test that an individual has surgery, the higher the postoperative mortality rates.1 In addition, depending on the severity of illness during active COVID-19 infection, further delays may be recommended.2 The American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation joined to create a statement regarding elective surgeries.2 The table below represents the recommendations from this joint statement.

COVID-19 Infection Wait Times
Asymptomatic or mild, non-respiratory symptoms 4 weeks
Symptomatic patient (e.g., cough, shortness of breath) not hospitalized 6 weeks
Symptomatic patient with diabetes, immunocompromise, hospitalization secondary to COVID 8-10 weeks
Required intensive/critical care due to COVID-19 12 weeks

 

References:

  1. Phend, C. (2021, March 9). Wait at least this long after COVID for surgery – large international study defines period of high mortality risk. Medpage Today. Wait at Least This Long After COVID for Surgery | MedPage Today
  2. American Society of Anesthesiologists: ASA and APSF Joint Statement on Elective Surgery and Anesthesia for Patients after COVID-19 Infection (asahq.org)

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  1. If everyone is vaccinated, do we still need to wear masks and physically distance ourselves

While vaccines will support efforts to reduce both the spread and the intensity of COVID-19 infections, experts in the fight against the pandemic have been consistent in their advice to continue wearing facemasks, practice physical distancing, avoid major crowds, and maintain excellent hand hygiene practices.1 At this time, the extent to which the vaccines can accomplish the goal of reducing COVID-19 in our communities is still extremely difficult to predict.

Reference:

  1. World Health Organization. (2021). COVID-19 vaccines. COVID-19 vaccines (who.int)

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  1. Do ASPAN Standards still apply during a global pandemic or local crisis?

If you are a perianesthesia nurse working under customary work conditions and caring for typical perianesthesia patient populations, continue to follow the ASPAN 2021-2022 Perianesthesia Nursing Standards, Practice Recommendations and Interpretive Statements.1  However, if you are a perianesthesia nurse who has been deployed to another unit, caring for patients in a surge situation or critical care unit, or other types of patients, or working under a different type of care delivery system due to the emergency response of your institution, follow the institutional standards of care that have been put in place for this pandemic.

The American Nurses Association defines crisis standards of care as “a substantial change in usual healthcare operations and the level of care it is possible to deliver, which is made necessary by a pervasive (e.g. pandemic influenza) or catastrophic (e.g. earthquake, hurricane) disaster. This change in the level of care delivered is justified by specific circumstances and is formally declared by a state government, in recognition that crisis operations will be in effect for a sustained period.”2 ASPAN recognizes that current conditions in US hospitals and ambulatory surgery centers can rapidly shift or escalate and change from standard operations to emergent/extreme/surge activity(ies). 

References:

  1. American Society of PeriAnesthesia Nurses. (2020). 2021-2022 Perianesthesia Nursing Standards, Practice Recommendations, and Interpretive Statements. ASPAN. 
  2. American Nurses Association. (2020). Crisis standard of care: COVID-19 pandemic. crisis-standards-of-care.pdf (nursingworld.org)

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  1. What does ASPAN recommend for the standard of care during the Phase 1 in regards to PPE?

In general, n95 masks should be preserved for any aerosolizing-generating procedures (AGPs) (e.g., bronchs, intubation, extubation, CPAP, nebulizers). Many anesthesia departments are doing any airway manipulation (particularly extubations and nebs) while still in the OR, while they are still in full PPE (e.g., n95). Perianesthesia units should be following the CDC recommendations for modified droplet precautions. In most cases, all patients are required to wear a surgical mask, all staff nurses also wear a surgical mask as well as eye protection (face shield and/or goggles) whenever within 6 feet of a patient and each other. Even if the patient is actively coughing, keeping both the patient and the nurse in a standard mask is appropriate for droplet precautions.

The Joint Commission issued the following statement on June 3, 2020: Patients undergoing elective surgery (or other aerosol-generating procedures) whose preoperative test for COVID-19 is negative should still be treated with universal respiratory precautions because of the risk of false-negative COVID-19 tests. Because of sampling technique, sample site, the test performed and the timing of the test, there is a risk of false negative COVID-19 tests. Therefore, we support the recommendations of the American Society of Anesthesiologist and the Anesthesia Patient Safety Foundation and others who call for use of a surgical mask and eye covering by operating room (OR) staff for all operative cases and an N95 mask, eye protection, gloves and a gown to be worn by all in the OR during aerosol-generating procedures (AGP) such as intubation and extubation, surgical procedures that might pose higher risk for transmission such as laparoscopic surgery and gastrointestinal endoscopy that requires insufflation, or procedures in anatomic regions where viral loads might be higher, such as the nose and throat, oropharynx, respiratory tract. If it is not possible to have all staff who are in the room during and after an AGP wear an N95 mask, then staff not wearing an N95 mask may enter the room following an AGP after the CDC-recommended time for air clearance (99% efficiency) to occur within the room.2

The other thing that many anesthesia departments are doing now, is focusing on administering as many spinals, MACs, regionals, and blocks as possible to reduce the need to intubate patients.

Resources:

  1. Centers for Disease Control and Prevention. (2020). Using personal protective equipment (PPE). https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html. Accessed March 14, 2021.
  2. The Joint Commission. (2020, June 3). Position Statement: Preventing Nosocomial COVID-19 Infections as Organizations Resume Regular Care Delivery Accessed March 14, 2021.​

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  1. What barriers or social distancing guidelines for open bay PACU's should be in place?

The general principles of keeping patients 6 feet apart apply, however, many units are working on trying the 'one-stop-shop' model so that each nurse is exposed to the SAME patient, rather than multiple patients, and tries to preop, recover, and discharge the patient from the same basic care area. Other actions that can help with engineering appropriate workflow in the PACU include having all patients extubated in the OR to minimize aerosolizing procedures in PACU area; if a PACU patient uses a CPAP, use 'nurse-cuing' to breath while in PACU rather than turning on the CPAP which requires a negative pressure room or a private room where air clearance times can be observed; if a PACU patient needs a respiratory treatment, like nebulizers, they should also be moved to negative pressure rooms or a private room - in this case, suggest reverting to inhalers rather than nebs. All patients (and any visitors) should be masked on entry into the building - the mask is then placed in a plastic 'take-out' dish or paper bag to be reapplied to the patient after surgery. In cases where the patient is ill, and is a PUI (not confirmed COVID, but suspected) or COVID positive, the staff are advised to recover that patient in the OR or a negative pressure room using appropriate PPE whenever possible and avoid unnecessary AGPs.

Resource:
American College of Surgeons. (2020, April 17). Joint statement: Roadmap for resuming elective surgery after COVID-19 pandemic.  Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic (facs.org). Accessed March 14, 2021.

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  1. Is there evidence to support testing of all patients receiving surgery or only elective outpatients?

The American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation issued a Joint Statement on Perioperative Testing for COVID-19 on April 29, 2020 and an updated version on June 1, 2020. Refer to the following link for the full statement: https://www.asahq.org/about-asa/newsroom/news-releases/2020/04/asa-and-apsf-joint-statement-on-perioperative-testing-for-the-covid-19-virus.1

Most organizations conduct syndromic questioning for symptoms prior to procedures. In spite of test results, due to the potential for false-negatives, droplet precautions should be maintained although The Joint Commission recommends full respiratory protection during aerosol generating procedures regardless of the COVID status of the patient.2

In the event of a positive test, elective surgical procedures should be postponed due to the association of a higher incidence of poor outcomes in COVID-19 patients having surgery.

Resources:

  1. Anesthesia Patient Safety Foundation. (2020, June 1). ASA and APSF joint statement on perioperative testing for the COVID-19 virus. https://www.apsf.org/news-updates/asa-and-apsf-joint-statement-on-perioperative-testing-for-the-covid-19-virus/. Accessed March 14, 2021.
  2. The Joint Commission. (2020, June 3). Preventing nosocomial COVID-19 infections as organizations resume regular care delivery.  Position Statement: Preventing Nosocomial COVID-19 Infections as Organizations Resume Regular Care Delivery.  Accessed March 14, 2021.

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  1. Has COVID-19 changed how we are doing preoperative nursing assessments and testing? 

In some healthcare settings, the face-to-face visit has been replaced with the technology-assisted processes such as telemedicine for consults. Unless the patient has a need for physical presence to have diagnostic testing such as labs or ECGs done prior to surgery, the nursing assessment and preoperative teaching can be done by phone, by telemedicine (such as ZOOM or Skype). 

According to recommendations found in the Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic, the following bullets should be considered:1

  • Special attention and re-evaluation are needed if patient has had COVID 19-related illness.
  • A recent history and physical examination within 30 days per Centers for Medicare and Medicaid Services (CMS) requirement is necessary for all patients. This will verify that there has been no significant interim change in patient’s health status.
  • Consider use of telemedicine as well as nurse practitioners and physician assistants for components of the preoperative patient evaluation.
  • Some face-to-face components can be scheduled on day of procedure, particularly for healthier patients.
  • Surgery and anesthesia consents per facility policy and state requirements.
  • Laboratory testing and radiologic imaging procedures should be determined by patient indications and procedure needs. Testing and repeat testing without indication is discouraged.
  • Assess preoperative patient education classes vs. remote instructions

Reference:

  1. American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses, American Hospital Association. (2020, April 17). Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic. https://www.facs.org/covid-19/clinical-guidance/roadmap-elective-surgery  Accessed March 14, 2021.

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  1. How are ACUs/PACUs currently managing visitation?

Visitation is challenging during this time. In general, the majority of organizations have implemented strict NO VISITOR policies with certain exceptions. 

Examples of visitation guidelines include: 

  • End-of-life care: Two visitors are allowed at a time. Other family members need to remain outside of the facility to rotate in special circumstances
  • One visitor in labor and delivery and post-partum
  • One visitor for patients in inpatient hospice units
  • One visitor for accompanying patients for hospital discharge
  • One visitor for patients undergoing emergency surgery related to a traumatic event
  • One visitor to accompany a patient for outpatient surgery, but must leave after escorting the patient to the reception area, may return for postop instructions

Resource:
Centers for Disease Control and Prevention. (2021, February 23). Interim infection prevention and control recommendations for healthcare personnel during the coronavirus disease 2019 (COVID 19) pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. Accessed March 14, 2021.

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Current Articles:

COVID – IMPACT ON HEALTHCARE WORKERS

COVID – AFTER INFECTION

COVID – VACCINES

COVID – LESSONS

COVID – Vanderbilt University


Additional Information:

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Archived Articles: 

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