Pandemic Influenza Plan - Local Guideline : Level 1.

Transcription

1 Pandemic Influenza Plan - Local Guideline : Level 1. Type of Document: Please tick the relevant box: Policy (must do) Guidance (should do) Protocol/procedure (must do) Directorate responsible for Guideline: Medicine Department responsible for Guideline: Rockbourne/M.A.U. Persons responsible for Guideline: F.Dawson. Fenella Hill. Date Written: 8 th May 2009 Date Guideline becomes live: Confirmation of Pandemic Influenza Target Audience: All staff

2 1. Indications 1.1 Background The trust has already produced the Pandemic Influenza Plan which provides information regarding the Intensive Care s responsibility to increase capacity and open up a second area in which to treat those patients affected by the influenza virus. It does not, however provide guidance on how this should be achieved regarding the redistribution of staff and equipment or availability of stocks/supplies. It also offers no guidance on the treatment of critically ill patients affected with the influenza virus prior to the opening of the Rockbourne influenza area. 1.2 Aim/purpose To provide local guidance to all staff who may be involved in both the treatment of those patients affected and those involved with the relocation and opening of a Pandemicunit. 2. Clinical Management 2.1 Prior to the opening of the Rockbourne Influenza ONE Patient requiring level 1 care with suspected Influenza Virus Is Sideroom available Yes No Admit patient to Sideroom. Ensure Infection Control, Consultant Microbiologist, Directorate Manager, Directorate Senior Nurse, Site team, Lead Clinician and Lead Nurse aware of admission. Ensure supplies of PPE and infection control procedures as per trust policy Allocate 2 members of nursing staff per shift Await further advice Yes Move patient out of sideroom Can patient be moved out of sideroom? No IF MULTIPLE ADMISSIONS LIKELY PREPARE FOR OPENING OF ROCKBOURNE INFLUENZA Unit AND CONSIDER CONTACTING EXTRA STAFF AS PER TRUST MAJOR INCIDENT POLICY

3 MULTIPLE Patients requiring ITU/HDU/level 1 care with suspected Influenza Virus Prepare for opening of Rockbourne Influenza Contact extra staff as per trust Major Incident Policy Provide support, help and advice as able to all areas with critically ill patients Create list of all ventilators, monitors and essential equipment currently available for use Create list of consumables available Identify staff to be relocated to Rockbourne Unit (See Section 2.3, 2.4) Await further advice 2.2 The opening of the Rockbourne Influenza level 1 unit The ITU/HDU department has identified the ability to double its capacity i.e. provide a 4 bedded level 2 bay and a 4 bedded level 3 bay on the Rockbourne unit for those patients requiring ITU/HDU care with either suspected or confirmed Influenza Virus. It will also continue to provide its 8 bedded unit on Radnor ward for those patients requiring ITU/HDU care without suspected Influenza Virus. THE ROCKBOURNE INFLUENZA ITU/HDU WILL ALSO TAKE ADMISSIONS OF CRITICALLY ILL CHILDREN WHO WILL BE ENCORPORATED INTO THESE BAYS Two separate bays have already been identified within the Rockbourne unit (Durrington B & C) to provide the Level 2 or Level 3 care. Access to Oxygen, Air, Suction and sufficient electrical supplies to support the required equipment has already been assessed and deemed adequate. Bays and Side Rooms have been identified within the Rockbourne Unit (Winterslow side) to provide Level 1 care. Current access to Oxygen, Air, Suction and electrical supplies should be sufficient. 2.3 Staffing (Nursing)of the Rockbourne Influenza level 1 Currently, staff will be requested to volunteer to work within the Rockbourne Influenza ITU/HDU/level 1 and a questionnaire has been issued within the department to ascertain the skill mix and numbers of those volunteers. Once allocated to work within the Rockbourne Influenzalevel 1, those members of staff will not return to work on their own ward, and separation of the 2 working groups will be encouraged during work breaks. Any staff returning to work having recovered from the influenza virus will be requested to work on the Rockbourne Influenza unit as the risk of contamination will be deemed significantly lessened. In the event of no staff volunteers, the Trust will need to provide support and direction as to how staff should be allocated to work within this unit. Staffing levels would be set at enhanced ward staffing levels. Nurse staffing would therefore be required as follows: 1 Trained nurse and 1 Healthcare Support worker per 5 patients. 1 Trained Nurse co-ordinator to cover a maximum of 20 patients. Should more than 20 level 1 beds be opened this would require a second Trained nurse to assist coordination, relaying messages and covering staff breaks.

4 2.4 Staffing (Medical/Anaesthetic) of the Rockbourne Influenza ITU/HDU/level 1 Unit 2.5 Training and Staff Support 2.6 Equipment required on the Rockbourne Influenza ITU/HDU/level 1 In order to be able to provide level 2 and level 3 care the following equipment has been deemed necessary and a source identified of where supply may be obtained. Between both bays: Blood gas analyser Whiteparish A& E / NICU ECG Machine?Rockbourne ward Resuscitation equipment, Theatres Resuscitation department including defibrillator Intravenous Fluids Pharmacy Theatres / wards Drugs Pharmacy theatres Controlled Drugs Pharmacy None Intubation equipment Theatres/Radnor Portable transfer 1 Set from Radnor A&E equipment X-ray equipment Radiology None Four Level 2 beds will require: 4 beds Rockbourne Medical equipment 4 tables for charts Rockbourne Medical equipment 4 monitors + ECG. SaO2, Theatres Day surgery NiBP, Temp, Invasive pressure lines X 2 12 infusion pumps Medical equipment Theatres 8 syringe infusion devices Medical equipment Theatres 4 Naso-gastric feed Medical equipment Wards pumps 4 NIV (CPAP/BiPAP) Respiratory team Spinal unit 4 Electrical extension Medical electronics Offices leads 4 O2 regulators Rockbourne Medical equipment Suction equipment Rockbourne Medical equipment Consumables for all above equipment Stores/procurement from existing ward stocks Four Level 3 beds will require all of the above equipment, and, in addition: Extra 8 syringe infusion Medical equipment Theatres devices 4 Ventilators Theatres Day surgery 4 End tidal CO2 Theatres? day surgery monitoring Closed circuit suction Radnor Stores Ventilator tubing Theatres/Radnor Stores Ten Level 1 beds will require the following equipment and access to the equipment listed in the 1 st table i.e. Blood gas analyser, ECG machine 10 beds Rockbourne Medical equipment

5 10 tables Rockbourne Medical equipment 10 infusion pumps Medical equipment Theatres 10 O2 regulators Rockbourne Medical equipment Suction equipment Rockbourne Medical equipment Consumables for all above equipment Stores/procurement from existing ward stocks Stocks of consumable equipment are recognised as limited due to necessary space required for storage and cost of ordering excess supply. In the event of a pandemic virus, supply will be further restricted. IT MAY BE NECESSARY AT THESE TIMES TO PRACTICE OUTSIDE OF TRUST POLICY AND/OR MANUFACTURERS RECOMMENDATIONS AND PROVIDE BEST POSSIBLE PRACTICE WITHIN LIMITED RESOURCES E.G. ROUTINE CHANGING OF VENTILATOR TUBING MAY BE DISREGARDED AND SINGLE USE EQUIPMENT MAY BE UTILISED AS SINGLE PATIENT USE. THIS WILL REQUIRE FURTHER DISCUSSION FOR TRUST ENDORSEMENT AND RISK ASSESSMENTS ARE INCLUDED AS APPENDICES TO AID THE DECISION MAKING PROCESS. 2.7 Drugs and Controlled Drugs on the Rockbourne Influenza ITU/HDU/level 1 unit In the event of pandemic influenza it is recognised that treatment drugs such as Tamiflu will be required as stock items on the Influenza unit and therefore supplies will be difficult to monitor. For the purposes of the ITU/HDU influenza unit such drugs will be treated as a schedule 2 Controlled Drug and must be logged within the controlled drugs register. The following is a list of drugs commonly required in the treatment of level 2 and Level 3 patients and, in the event of pandemic influenza, should be submitted to the pharmacy department in order to provide these drugs to the Rockbourne ITU/HDU. This list is not exhaustive, but other medications are not deemed priority and can be issued at a later time. Drug/Medication/Intravenous Fluid Approximate daily stock requirements N/Saline 0.9% 1000ml x 12 5% Dextrose 100ml x 10 50% Dextrose 50ml x 2 Hartmanns Solution 1000ml x 12 Gelofusine 500ml x 2 Volulyte 500ml x 8 Actrapid Insulin 1 vial Adrenaline 10ml x 6 Aminophylline Amiodarone 150mg x 18 Calcium Gluconate/Chloride Cisatracurium Dobutamine Frusemide 50mg x 6 GTN 50mg x 1 Heparin? Hydrocortisone 100mg x 12 Labetalol Magnesium Sulphate 5g x 4 Metaraminol Metoprolol Noradrenaline 4mg x 16 Omeprazole Potassium Chloride 40 mmol x 12 Propofol 10mg /ml x 12 Ranitidine 50mg x 24 Salbutamol Nebulised and Intravenous?

6 Vecuronium MICROBIOLOGY TO SUGGEST ANTIBIOTIC REGIMEN TO BE SUPPLIED AS STOCK Controlled Drugs Approximate daily stock requirements Fentanyl 100mcg x 4 Midazolam 50mg x 8 Morphine 50mg x 10 IT IS RECOGNISED THAT COMPLIANCE WITH TRUST POLICY REGARDING THE ADMINISTRATION OF CONTROLLED DRUGS MAY BE COUNTER PRODUCTIVE IN INFECTION CONTROL PROCEDURES. RISK ASSESSMENTS WILL HAVE TO PERFORMED AT THIS TIME DOCUMENTING RATIONALE FOR DEVIANCE FROM TRUST POLICY. 3. Environmental Management 3.1 Isolation Precautions See Section 2.3 Staffing (Nursing) of the Rockbourne Influenza ITU/HDU It is anticipated that each bay of the Rockbourne unit will function independently i.e. staff will be allocated to either bay but will not cross from one bay to the other on a shift basis. Each bay will be contained and the doors will remain closed whenever possible. Outside of each bay will be a trolley set up with the correct personal protective equipment for all staff use. The nurse co-ordinator(s) will remain supernumery outside of both bays and will only enter a bay if clinical need dictates. Full personal protective equipment will be worn in this instance. It is recognised that communication to the outside of the bay will be limited due to the application of face masks and therefore each bay will contain a whiteboard and marker pen so that messages can be written and displayed through the glass to the nurse in charge. Requests for equipment and stock can be performed in this manner to limit contamination to other areas. It is recognised that other personnel will require access to these bays (Radiology, Pharmacy). Full personal protective equipment will be worn in this instance and access will be restricted wherever possible. 3.2 Communication To ensure best possible infection control practice, no telephone calls will be taken by the nurse(s) within the designated bays. All communication will be dealt with by the nurse in charge outside of the bays, and, if required, clerical support will be requested. 3.3 Relatives and Visitors Relatives and visitors will be required to wear full protective equipment when visiting patients. They will be requested to keep visits to a minimum and limit the amount of visitors entering the hospital. Due to the confines of space, visitors will be restricted to 2 people per patient at any one time. Strict infection control procedures will be enforced, and visitors will be requested to remove all protective equipement and wash their hands prior to leaving the isolated bays.

7 Visiting times may be implemented and visitors and relatives will be requested to comply with these unless permission has been given after discussion with the nurse in charge and doctor in charge of the patients care. Risk Management 4.1 Acceptance of Elements of Risk It is recognised that in the event of a pandemic influenza virus, equipment, stocks and drugs may become limited in supply or diminish completely. In this event, decisions may be made to utilise other resources, equipment or drugs of a lesser quality or standard than those routinely utilised. One such example of this may be the application of invasive ventilation through ventilators supplied by the theatre department. These machines are not routinely used for prolonged ventilation, nor do they possess the same functions and modalities utilised in the Intensive Care Department. Their functional ability cannot, therefore, be guaranteed. However, risk assessments will need to be performed in the event of a pandemic influenza virus as the benefit of using this equipment may be greater than the consequences which could cause detriment to the patients well-being. 4.2 Compliance with Manufacturers Recommendations and Trust Policy It is also recognised that in the event of a pandemic influenza virus it may be necessary to practice outside of Trust Policy and/or Manufacturers recommendations and provide best possible practice within limited resources. Examples of this may include disregarding routine changing of consumables or utilising single use equipment as single patient use. It may also be necessary, at times, to practice outside of Trust Policy for the greater benefit of Infection Control Procedures and full risk assessment will be performed at that time. 5.1 NMC Professional Bodies Guidance All nurses and midwives are expected to practise within their competency level and acknowledge the limitations of their professional practice. If faced with any aspect of practice that is either outside their area of registration or beyond their competency level, they must seek supervision or advice from a competent practitioner. If working outside their normal area or scope of practice, nurses and midwives must consider their duty of care to the public. Their first consideration in all activities must be in the interests and safety of the patient/client. 5.2 GMC