The William Beaumont Army Medical Center Simulation Center conducted a scenario-based training for Infusion Center staff early December at the hospital campus. The training event prepared the team to treat COVID-19 worst-case scenarios.
Mr. Thomas Soto, administrator for the Simulation Center at WBAMC, coordinated with Maj. (Dr.) Mark Query, an officer in charge of the Antibody Infusion Clinic, and Maj. Jarrett Edwards Clinical Nurse Specialist, to conduct a scenario-based learning event using a COVID airway mannequin that simulated contamination.
The airway mannequin is a simulation that is able to “exhale” a fine mist. In simulation, this mist contains a dye that is visible under UV light; which allows trainers to show participants how exhaled “virus” can contaminate an environment, personal protective equipment (PPE), and individuals in that environment. It allows participants to see how proper PPE helps to protect them and how improper PPE usage may put them at risk of contaminating themselves.
“We supported the effort to conduct an evaluation of the equipment to support COVID readiness training in the tri-service community. We executed the scenario in austere environments and now are looking to continue implementation in clinical settings as needed,” said Soto.
Edwards described the training in detail to explain the scenario. It began with the simulated patient calling the nurse and reporting itching at the IV infusion site.
The itching quickly spread from the site to be more generalized. The mannequin patient also began reporting tightness in their throat, difficulty breathing, and a dry cough; which are early signs that lead to an anaphylactic reaction.
The nurse-in-training would identify this change, call to other staff to initiate the allergic response process, and get the allergy kit. According to a standard operating procedure, the nurse would administer an epinephrine auto-injector card (Epi-Pen) at the first signs, and then monitor the patient for improvement. If the patient did not improve, the nurse would give a second Epi-Pen to the patient, and a cardiac or respiratory arrest alert (Code Blue) would be initiated.
The training concluded once the crash cart was retrieved from the seventh floor east wing of the hospital and the first member of the code team arrived and received the report from infusion center personnel.
“The event focused on training the staff on the process to respond to a COVID-19 patient with an allergic reaction caused by infusion as well as allowing for the team to review the process and make sure it was appropriate and efficient in meeting the needs of the patient and the staff responding. The area is not normally a patient care area, so it is important to ensure that staff have the capability and the resources they need to respond to emergent situations,” said Edwards.
Infection Control was also added to the scenario-based training to evaluate donning and doffing PPE procedures. Monica Flores, a registered nurse with Infection Prevention and Control, explained the event.
“During the training, our nurses verbalized and demonstrated excellent knowledge and proper technique for donning and doffing. The following are extremely important since adequate hand hygiene and personal protective equipment techniques are critical protective measures that can mitigate exposure risk, especially while providing care to patients with a highly infectious disease, such as COVID-19,” said Flores.
“Dr. Query took feedback received during the event to finalize the center’s allergic reaction response SOP (standard operating procedure), which included an easy to follow algorithm tailored to meet the center’s specific needs,” said Edwards.
Soto added that he hopes to continue the training in the future to help mitigate risks and reduce the spread of the virus in clinical settings. The simulation program can provide this training to anyone who wants to promote best clinical practice guidelines concerning donning and doffing PPE procedures.
The WBAMC Simulation Center serves Graduate Medical Education, Allied Health, and Fort Bliss by providing medical simulation training and support for educational programs to ensure patient safety, and quality training of the Individual Critical Task Lists to maintain a Ready Medical Force.