When COVID-19 hospitalizations started accelerating in Monroe County, New York, last November, space was at premium for treating intensive care unit (ICU) patients at the University of Rochester Medical Center. Units across the hospital were repurposed as the virus surged throughout the community.
The pediatric intensive care unit (PICU) teams at Golisano Children's Hospital (GCH) were ready to answer the call to help. A low census at GCH—due to decreased volumes of patients with seasonal respiratory illnesses like RSV—meant there was space available for adults.
In late December, pediatric caregivers from multiple units began a rapid transition to treat adult patients who had recovered from COVID-19, but still needed ICU care. "We went from having five or six patients to a full census, including six adults, in about six hours," says Laurie Athans, director of Pediatric Nursing.
Learning to work with adult patients
As part of their care regime, PICU nurses provided regular bed baths for adult COVID patients, which included washing a patient who is in bed, turning them, and inspecting their skin. Bed baths are an overlooked, but critical part of daily care. "Skin is the largest organ, and you have to make sure patients are turning from side to side and are clean," says Athans. "This prevents pressure ulcers, as well as respiratory complications, because if people aren't moving, fluid can settle in their lungs and increase the risk of pneumonia."
While many of the PICU nurses were used to giving bed baths to children, they were less accustomed to treating adult-sized patients, who typically require more time and physical effort to complete the process. "It was different than the norm for us," says Karen Gozzi, nurse manager. "You need more helping hands for adults."
Doing their part to help
With a now-full PICU census, nurse leaders brainstormed ideas on how to make bed baths more efficient to free up time and resources. Gozzi devised a solution: she created a Sign-Up Genius page for volunteers and distributed it via email to nurse managers throughout GCH. "We sent it to pediatric units everywhere: ambulatory, radiology, surgical. I was impressed and overwhelmed with how many people signed up quickly," she says.
Due to the general overall low census across units in GCH, nurses from several departments were willing and able to help, leading to the creation of mobile, volunteer hygiene units. Every day, from 9 a.m. to 1 p.m., a team of three to four nurses would move through the PICUs caring for adults and performing bed baths.
This helped free up extra time for PICU nurses to perform other essential work, such as medication administration, assessment and documentation, and general patient care across the units.
Participating on the hygiene teams also helped boost morale for GCH nurses during the winter COVID surge. "The process helped with team building for our nurses and allowed everyone to feel like they were doing their part to help the community," Gozzi says.
A model for the future
Adult patients also benefitted from this approach. First, being transferred to the PICU allowed the adult ICUs to avoid doubling patients in rooms on their units. They also received consistent bed bath treatments that might not have been available in a crisis in a packed ICU. Finally, since these patients were on a path to recovery, some of them were able to see family members under GCH's visitation rules. "It was very gratifying for our bedside nurses to see that happen," Athans says.
The creation of the hygiene teams has provided PICU nurses with a model for comprehensively serving adult patients that will be critical if another COVID surge happens in the future.
"If you go up to the PICU now, there's not a nurse who isn't comfortable with helping an adult ICU patient," says Athans. "Our collaborative approach has helped make that happen."