Preoperative COVID-19 Testing in a Pediatric Ambulatory Setting: Lessons Learned

Abstract

Background InformationPerianesthesia nurses have a unique set of knowledge and skills, which allows them to quickly adapt and continuously improve processes to meet the perioperative needs of their patients. The recent global SARS-CoV-2 pandemic required many perianesthesia nurses to support the screening of surgical patients by performing Polymerase Chain Reaction (PCR) tests preoperatively. Testing pediatric patients presents unique challenges that require constant assessment of processes that work well and the application of interventions to address barriers to success.ObjectiveThe development and implementation of a drive-thru COVID-19 preoperative testing site in a pediatric ambulatory setting.Process of ImplementationA core group of perianesthesia nurses developed a drive-thru testing site for pediatric patients scheduled for surgery. All pediatric patients require PCR testing within 24-48 hours preoperatively. Obtaining oropharyngeal (OP), nasopharyngeal (NP), or anterior nares (AN) swab can be challenging in the pediatric population. Numerous techniques were found to help support successful testing such as social stories, involving child life specialists, and distraction techniques (bubbles, music). Nurses use of pretend play, small incentives, and comfort holds provided additional reassurance. Verbal and written testing instructions have been continuously revised to include reminders to wear a mask, limit exposure, and how to provide care at home if a test result is positive.State of Successful PracticeThe preoperative COVID-19 testing site initially allowed for testing of a small number of patients requiring time-sensitive surgery during the height of the pandemic. We have since vastly increased our caseload and currently support testing of up to 70 patients daily. In a 6-month span, there have only been four patients who were unable to successfully complete their preoperative SARS-CoV-2 PCR test.Implications for Advancing the Practice of Perianesthesia NursingAs the global health pandemic continues it is imperative to utilize best practices for preoperative COVID-19 testing. Continuously reevaluating and implementing safe and effective testing techniques reduces the risk of transmission and supports quality care. Sharing ideas, lessons learned, and best practices of how nurses have implemented new perioperative processes is essential for advancing the practice of perianesthesia nursing during a global pandemic.