4.2 nurse staff allocation and support
According to the requirements of Nosocomial Infection Prevention and
Control[3], the ICU should be equipped with a
sufficient number of professional medical staff. At that time, there
were 138 nursing staff, including 135 nurses and 3 head nurses, in
charge of 36 beds. The ratio of the number of nurses to the actual
number of beds was 3.8:1. We adopted a 4-hour shift model. That is, they
worked 4 hours a day for 6 consecutive days and took a day off after six
working days. The psychological counseling hotline in the mental
hospital was open 24 hours a day. Staff could call it for free whenever
they need to.
There are 18 primary nurses on duty during each shift. On average, one
nurse is in charge of two critically ill patients. Two additional nurses
are specialized in dealing with medical orders, informing corresponding
primary nurses, admitting patients, documenting critical values from the
clinical laboratory, replenishing supplies and rescue drugs, checking
accounts and discharging patients. One nurse is responsible for the
preparation of medicines for all patients in the ward and the
replenishment of commonly used medicine. The persons from the infection
control department hold the supervising position, whose job
responsibility includes checking and ensuring that all personnel wear
protective equipment appropriately when entering the ward, supplying
consumable items and clearing the semi-polluted area. One addtional
position was for staff catering, transportation and accommodation.
We set a lead nurse on each shift, who had the responsibilities of
managing, inspecting, supervising, guiding, and assigning patients to
each primary nurse. Each team consisted of nurses with ICU backgrounds
and non-ICU backgrounds. The combination of different working years was
another consideration.
Running Effect
From 4/2/2020 to3/4/2020, the wards have been running for 59 days. A
total of 172 critically ill patients with COVID-19 were admitted to the
temporary ICUs. Oxygen therapy is a key component of treatment for
patients with COVID-19 and mechanical ventilation was commonly used in
the critical ill. We had 126 patients who received invasive mechanical
ventilation and 68 patients who received noninvasive ventilation during
hospitalization. Fiberoptic bronchoscopy examination, as a high-risk
procedure, was also performed 43 times for diagnosis and treatment. To
protect the involved staff in this procedure, we developed a revised
standards for this procedure, including detailed preparation prior to
exam, precaution strategies and decontamination of bronchoscope and
environment. ECMO therapy is the last resort for maintaining critical
patients’ respiratory and cardiac function. Six patients had undergone
this treatment in our unit. Additionally, 281 CRRTs and 15 tracheotomies
were successfully carried out at the patients’ bedsides. In spite of the
heavy workload and high-risk working environment, none of the staff were
infected or had any mental health problems, fortunately.
Acknowledgment: The work is supported by the Nature Science
Foundation of Hubei Province [No.2019CFB645] for language editing.
Conflicts of interest : None.
References
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