PG21 In-situ simulation to ‘live’ process testing: developing and training a safe donning and doffing process for the staff of a large UK critical care unit in preparation for the COVID-19 pandemic

Abstract

<h3>Introduction</h3> When it became increasingly clear that COVID-19 would likely come to the United Kingdom (UK), in early February 2020 the Critical Care interprofessional education team at the University Hospital of Wales started work to develop the ideal local Standard Operating Procedure (SOP) for donning and doffing personal protective equipment (PPE) while concurrently training the unit’s staff to safe PPE use in the event of needing to care for COVID-19 patients. <h3>Methods</h3> The unit’s Ebola PPE SOP was used as the starting point. From this, initial changes were made to adjust for COVID-19. The SOP was tested during planned simulation training sessions. As the risk of COVID became ever closer, more and more on-unit training sessions were implemented to meet the needs of the large workforce. Staff were empowered to voice their suggestions on how to improve the donning/doffing process while undergoing their training. Suggestions were then subsequently trialled and incorporated accordingly. <h3>Results</h3> The SOP involved numerous rapid PDSA cycles while training staff to use PPE safely. Thus, evolving the SOP through many iterations. The aim was that all staff had at least one ‘successful’ rehearsal at donning/doffing before doing in real life, to ensure safety, reassurance and address the understandable concerns at performing this important procedure. <h3>Discussion</h3> The process of developing the donning/doffing SOP started by using in-situ simulation to identify the safest way of removing each piece of PPE and in which best order, incorporating government/public health recommendations as they were published [1,2]. This allowed us to quickly establish a safe and robust version of the SOP to train staff for our particular critical care unit. Evolving the SOP soon became a ‘live’ process incorporating suggested changes identified from staff’s increasing real experiences going in and out of the ‘hot zone’ moving us to the ideal SOP, taking into consideration the particular PPE available to the unit at any given time point and the setup of the donning and doffing areas. Version nine of the donning/doffing SOP is currently in use and continues to be updated when needed. <h3>Conclusion</h3> In–situ simulation is an invaluable tool for developing, evolving and testing clinical based procedures, pathways and systems The use of in–situ simulation allows for staff to rehearse at donning/doffing PPE in a controlled, safe environment before undertaking this crucial process in real circumstances <h3>References</h3> Public Health England ( 2020). COVID-19. Putting on (donning) personal protective equipment (PPE) for aerosol generating procedures (AGPs). Airborne Precautions – Gown version. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/911333/PHE_COVID-19_Donning_Airborne_Precautions_gown_version__003_.pdf (Accessed 31st August 2020). Public Health England ( 2020). COVID-19. Removal of (doffing) personal protective equipment (PPE). Airborne Precautions for AGPs – Gown version. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/911334/PHE_COVID-19_Doffing_PPE_Airborne_Precautions_gown_version.pdf (Accessed 31st August 2020).