Impact of Covid-19 on ICU - Coursework Example

Impact of Covid-19 on ICU

Introduction

The surging Covid-19 pandemic has raised ethical and moral dilemmas regarding the method to be applied in allocating lifesaving resources as the demand outweighs supply in the ICU setting. Unfortunately, some of the changes in the ICU are disadvantageous to less-developed nations. The most notable fact about the pandemic is that it has adversely affected developed nations, thus raising a lot of concerns regarding the best modus operandi to be applied in allocating lifesaving resources. Most importantly, great changes have been advocated in resuscitation care. This paper is set to explore the changes that have emerged in ICU care, linked benefits, challenges and risks, and possible recommendations following the inversion of the Covid-19 pandemic.

Code Blue

Currently, the number of beds, mechanical ventilators, and other personal protective equipment in the ICU care has reduced following the increase in the number of admitted patients. Rationing of healthcare equipment has become the greatest challenge in ICU care (Chan, Berg, & Nadkarni, 2020). Before the pandemic, treatment was based on Deontological ethics, which states that every individual is valuable and entitled to lifesaving care. However, the applicability of such ethics has become a matter of debate following the inversion of covid-19 that has forced clinicians to apply utilitarian ethics to save most of the lives following the limited resource status quo.

Operations in ICU care have changed differently depending on the country of residence. For instance, it is recommended in Italy to set an age limit during this pandemic upon which a patient will be denied an ICU bed and a ventilator. On the other hand, the United States of America has recommended a rationing approach to be applied on ventilator and ICU bed resources. The primary agenda of these initiatives is to curb the rapidly increasing demand and limited resource challenge. The application of such initiatives has made physicians to shift from the normal deontological framework and adopt a utilitarian approach in making decisions in the hospital setting. In the normal time before the emergence of the Covid-19 pandemic, more than 1 out of 5 patients in the in-hospital cardiac arrest (IHCA) survived to the discharge stage. This statistic is an improvement from more than two decades ago when one out of eight patients survived. However, it is estimated that the survival rate will periodically decline with the current state of affairs. The decline will be caused by the delay in the delivery of code-blue resuscitation programs. Chest compressions are also delayed because CPR is an aerosol-generating procedure that may play the lives of the code blue team at great risk of contracting Covid-19 disease (Halpern, & Tan, 2020). Some hospitals have gone to a greater extent to ban the resuscitation performance and allowed for natural death for all patients irrespective of their prognosis and preferences. For hospitals that engage in the resuscitation process, how the program is contacted differs from prior Covid-19 practices. For instance, most hospitals monitor the temperature of the individual and ask for signs and symptoms specific to Covid-19 on the staff before they embark on the task. On the same note, CPR is started on all patients prone until the code team performs PPE and makes the patient lie on her/his back.

There exists a need to implement a more contextualized modus operandi to code blue responses to strike a balance between patents' welfare, the safety of healthcare practitioners, ethics, and scarcity of resources. Policies must be stipulated regarding the covid-19 status of the patients. All patients, regardless of their Covid-19 status, must be informed about the status of whether to allow natural death promote resuscitation prior the medication programs. Medical practitioner should then don PPE prior resuscitation for all patients with confirmed and suspected Covid-19 positive status. All practitioners must wear face masks to protect them from the disease.

Manual proning for intubated/non intubated patients

With the inversion of Covid-19, there exists a need for prone position CPR guidance. Prone positioning is an evidence based program for patients with severe acute respiratory distress syndrome. This condition is surging with the inversion of Covid-19. According to the United Kingdom Intensive Care Society, prone positioning must be used on patients with an oxygen requirement of 28% and above (Barker, Koeckerling, & West, 2020). Furthermore, guidelines are necessary on the frontline medical practitioners before the performance of prone position cardiopulmonary resuscitation including the best approach to be applied in turning the patient to curb the challenge of delays to CPR. Prone position resuscitation has proven to facilitate the generation of higher mean arterial and systolic pressures compared to the standard supine CPR which was employed prior Covid-19.

A great distinction has been created between non-intubated and intubated patients when it comes to prone CPR guidance. Intubated patients whose Covid-19 status has been confirmed as positive should only reside in regions whereby the seasonal use of FFP3 masks is mandatory. This initiative is fundamental in mitigating the challenge of delay which results from don PPE time consumption. the challenge of dislodging endotracheal lines and tubes is also high with the application of prone positioning because more than six practitioners will be required in turning the patient. Therefore, resuscitation institutions have the obligation to stipulate turning recommendations to be adopted by practitioners during the resuscitation process.

Delay to CPR is also a great challenge among non-intubated Covid-19 patients. Most of the non-intubated patients require turning in order to urgently secure a definitive airway. Therefore, even the most experiences practitioner will undergo challenges to initiate intubation in the prone position. Delay to CPR also puts the health of the practitioners at great risk of contracting the Covid-19 disease. The delayed CPR challenge can be minimized through the application of defibrillation before the commencement of compressions. This initiative has been advocated by the Resuscitation Council in the United Kingdom.

It is imperative to educate healthcare practitioners on the importance of maintaining their safety while dealing with patients in the ICU. Educational programs can play a significant role in ensuring the new approach is successful in accomplishing its predetermined objectives. Information on the spread of Covid-19 is still emerging. While it has been established that respiratory droplets are the primary means of transmission, airborne transmission through aerosol generating procedures is also possible (Tabah et al., 2020). Therefore, training and development is vital to maintain the welfare of the patients and practitioners through prevention of intra-hospital transmissions.

Low Staff Supply

Before the occurrence of the pandemic, the ICU care was fully filled with healthcare practitioners. The number of healthcare workers was enough to serve patients. However, with the invasion of the pandemic, most of the ICU care settings have run short of nursing practitioners. The current state of affairs regarding nursing shortage has played a significant role in shaping changes in the way the ICU operates in order to respond to the underlying challenge. Most importantly, the ICU has shifted its operations to maintain manpower capability.

The need for strict infection control measures has made ICU procedures to call upon additional power and time (Ziehr et al., 2020). The nurse to patient ratio has been increased in most of the isolation ICUs across the globe. There exists the critical nursing practitioner whose role is to provide care to the patients whereas non-critical practitioners play a significant role in the preparation of medications and equipment’s outside the AIIRs. There also exists the infection control specialty which deals with provision assistance services to the ICU staff regarding the appropriate doffing and donning of the PPE. Furthermore, a shift has been done in the in the ICU setting whereby nurses and doctors with experience have been transferred from other departments to increase staff supply so us to handle the increasing demand.

The surging community transmission of the Covid-19 pandemic has led to the overwhelming of the critical care manpower capabilities. As a result, most of the ICU departments have derived manpower from other divisions and departments within the hospital setting. Some institutions have initiated critical crash online educational programs on non-critical staffs through the provision of videos clips, leaning materials and hand-on practicums under the supervision of experienced critical nurses in non-isolation ICUs. Manpower is also being adopted from private hospital entities and retired nurses. Therefore, it is apparent that a new environment originating from disparity in the ICU is created following the nursing shortage in the healthcare setting.

The greatest challenge in the ICU with the current state of affairs regarding employee shortage is the high workload and anxiety over the spread of the disease thus resulting into much physical and mental fatigue. These consequences have a profound impact on the quality of healthcare delivery on the patients. When a nursing practitioner is worried in the job area, motivation towards healthcare delivery is adversely affected thus causing poor patient outcomes. The workload on the other hand also demoralizes the workers thus negatively impacting the quality of their services. On the same note, anxiety is a condition that leads to depression and the development of mental disorders. The risk of intra-hospital transmission has also been increased through the attendance to patients by ill practitioners. Therefore, hospitalization of healthcare practitioners for developing mental complications on the spread of the disease makes the problem more persistent.

Several approaches can be adopted to curb the underlying challenge. For instance, an appropriate communication channel must be established to promote rapid transmission of information to keep the healthcare practitioners informed of the new developments in the ICUs. It is also vital to formulate policies that prevent nursing from coming to the hospital in adverse conditions. On the same note, the nursing practitioners must be advised to seek early medication programs upon feeling ill. Most importantly, an education and re-training program must be implemented in the hospital setting (Goh et al., 2020). Nursing practitioners must be educated and trained on the strategies that must be applied in controlling infections, professional development and methods of identifying technical and logistical challenges in their working environment. Health care workers must also be trained on inspection, disinfection and safe disposal of PPE.