What One RT department feels they learned from COVID-19– A Compilation of “Lessons Learned”

by Beth Summitt MA, RRT-NPS, Respiratory Care Director at Riley Hospital for Children

I wanted to share with ISRC membership and peers some “lessons learned” throughout the pandemic. Many or most of these insights were compiled and shared by our supervisory staff. Communication was the key and visibility of leadership, even if it was virtual visibility was so important. Here is the list we valued most:

  • With the rapid COVID 19 pandemic presentation, developing plans and being proactive throughout the process made things seem to run smoothly.
  • The Institution seemed like a whole team where everyone worked together to support each other’s needs.
  • The respiratory director’s daily WebEx calls to support staff through the many changes that occurred was very helpful. She provided a fun way to communicate by asking questions to win candy and create a light moment in a tough situation.
  • The therapists enjoyed the free parking provided and were appreciative of the support from the community and groups at Riley providing meals for staff as they cared for patients.
  • Some enjoyed that the daily huddle being virtual so they didn’t have to rush to get downstairs and back up for report.
  • They did not like that we used COVID PPE (precautions) with all intubations, codes, ENT procedures, surgeries with those who we had no concerns for COVID and were not in COVID isolation before.
  • NICU director was active in the planning on what we would do if a COVID patient arrived, the process flow worksheet and pre-made intubation bags.
  • NICU staff felt like it would have been beneficial to run COVID simulations similar to how PICU did with their daily simulations.
  • Staff quickly came up with ways to support wearing masks daily by providing each other with headbands to make things a little more comfortable.
  • Donning and Doffing education videos and superusers were important in all areas.
  • Lots of changes, but quick team work and camaraderie pulled everything together.
  • Leadership team did a great job keeping staff informed in real time as policies were constantly changing.
  • Working together to get 32 babies out of the Methodist NICU and transferred to a temporary Riley unit (Mash unit) in less than 3 days was challenging, but pushed ourselves beyond an ability we didn’t know we had.
  • MASH space was not ideal, but necessary at the time.  It was difficult to work in the small space when multiple babies were in there.
  • COVID PUI/positive Moms delivered and the baby was handed to the RN and RT outside the delivery room.  The baby was taken to a separate treatment room for care.  This prevented the NICU staff having to be in the delivery room with Mom.
  • Infection prevention and their team were fantastic!
  • Daily simulations in PICU and the work of that team to get information out to staff was incredible.
  • Riley and Methodist multi-disciplinary NICU process-development workflow and coming together for one goal.
  • Superusers for PPE was helpful, but prior to an actual group of superusers, PICU staff filled that role.
    Acute care challenges with staffing and supporting our team members who opted out required lots of thinking “outside the box” and many collaborative discussions.
  • Leaning on each other for support and encouragement.
    The ease of accessing the IU Health Virtual Hub.
  • Turning the vent off before extubation. Some have continued this practice with all extubations so the condensation in the ventilator tubing doesn’t spray in the room.
  • We had to quickly experiment with new ways of communicating inside and outside the room since we had to keep the doors closed on these patients at all times.
  • The disciplines (RT, RN, MD) learned to lean on each other for support during critical moments in the critical care unit since we were significantly limiting the number of people who could be in the room. It was an opportunity to strengthen our relationship and trust with other disciplines.
  • Adapted trach collars for a closed system, this is especially nice because the inline suction was able to remain.
  • Placed filters on Bipap circuits, which would help minimize any potentially contagious virus from all patients.
    Virtual patient education was established and sustainable.
  • We got to see the best in each of our team members in their level of support to each other during this time. They work with each other to make sure those who can’t care for these patients are never jeopardized and don’t complain about it. Putting others’ needs before your own for their safety.
  • Trust was built with Administration as they communicated so well and ensured we always had the proper supplies we needed to feel we could safely care for these patients.
  • Appreciation to work in a corporation that was so well prepared for an unforeseen situation from a financial situation that we never had to worry about not having the staff and supplies we needed. Cutting staff or pay was never a concern for us like it was for so many other hospital systems.
  • Realization that “normal” is not really a thing we have the luxury of in the healthcare field as we should be constantly looking for new/better ways of doing everything. There was a constant need for change to keep up with the most current recommendations and we were able to successfully do it.
  • Appreciate normalcy. You will never know how much you appreciate normalcy until it is gone.
  • I realized how flexible I was to adapt to provide care to a different patient population. Flexibility was key.
  • I realized that I needed to adapt my clinical expertise to provide care to the Adult patient population.
  • Communication was more challenging with all staff wearing masks every day. It was difficult to determine another person’s demeanor since their smile was not visible.
  • With great communication from leadership, rapid change is possible.
  • A culture of change is promoted by experimenting and failing quickly, so the next experiment can be performed. Failure became something the staff didn’t fear, but a necessary part of change and growth.