Audit Findings on COVID-19 Preparedness in Auburn Hospital Operating Theatres

Got it COVered Auburn Hospital Operating Theatres COVID-19 Preparedness Audit Auburn Anaesthetic Meeting 28 January 2021 Tanya Manolios & Kenneth Cheung

Background COVID-19 first wave in Australia March-April 2020

Background Prevention of disease transmission Disease management Rapid change in hospital protocols Auburn hospital education and training: 1. Weekly emails and updates on latest COVID-19 updates 2. COVID-19 intubation drill 3. Personal Protective Equipment (PPE) + new equipment 4. Protocol for COVID-19 patient undergoing surgery

Aims, Objectives, Standards Aims: To assess the efficacy of COVID-19 training for operating theatre (OT) staff To ascertain gaps in knowledge To identify differences in knowledge between subspecialties Objectives: Conduct department-wide MCQ test targeting all OT staff after education and training programs

Methodology A prospective audit assessing all* OT staff (MOs from anaesthesia, surgery, O&G, RNs, OAs) within a two week period (28/04/2020 12/05/2020) Assessment via 16 question MCQ paper covering 3 domains: 1. COVID-19 general knowledge 2. PPE 3. Workflow changes MCQ papers distributed and collected by two anaesthetic registrars

Methodology Tests were voluntary, completed in own time, suggested closed book and encouraged to be done independently Marked according to agreed answers as per anaesthetic HoD, OT NUM, current* WSLHD guidelines Data was input into and analysed using Microsoft Excel Results were analysed using SPSS Statistics

Results 62 participants (total potential ~120) 18 - Anaesthetic and/or Recovery nurses 16 - Surgical nurses 18 - Anaesthetic doctors (consultants and registrars) 10 - Surgical and O&G doctors (consultants and registrars) Overall score = 66% Anaesthetic/Recovery nurses - 64% Scrub nurses - 62% Anaesthetic doctors - 75% Surgical doctors - 59%

Results General knowledge was highest scoring Surgical doctors scored lowest in this domain Included COVID-19 screening questions In general, changes to workflow scored the lowest amongst all subspecialties In these domains, there were no statistically significant differences between groups

Results PPE knowledge - Anaesthetic doctors performed better (score 82%) in this area than: - Anaesthetic/Recovery nurses (score 65%, p = 0.017, MD 0.18, CI 0.02-0.33) - Surgical nurses (score 59%, p = 0.001, MD 0.25, CI 0.09-0.4) - Questions regarding N95/P2 masks were often answered poorly across all subspecialties

Limitations Access to all staff Standardised testing MCQ writing Standardised guidelines/information, evolving nature of pandemic Time

Conclusions & Recommendations PPE simulations are effective; distributed information and practice can improve training The number of simulations conducted for workflow changes are insufficient for knowledge retention and more would be required for more rigorous training Inconsistencies within and between hospitals remain a barrier to effective practice

Acknowledgements Many thanks to: Alpha Tung Everyone at Auburn thank you!

References 1. Gold M, Helms D, Guterman S. Identifying, Monitoring, and Assessing Promising Innovations: Using Evaluation to Support Rapid-Cycle Change. Issue Brief: The Commonwealth Fund [Internet]. 2011 [cited 26 June 2020];(12):1-12. Available from: https://www.commonwealthfund.org/publications/issue- briefs/2011/jun/identifying-monitoring-and-assessing-promising-innovations-using 2. Lau R, Stevenson F, Ong B, Dziedzic K, Treweek S, Eldridge S et al. Effectiveness of strategies to facilitate uptake or implementation of complex interventions: A systematic review of reviews. Implementation Science. 2015;10(S1). 3. Qaseem A. Guidelines International Network: Toward International Standards for Clinical Practice Guidelines. Annals of Internal Medicine. 2012;156(7):525. 4. Shiffman R, Dixon J, Brandt C, Essaihi A, Hsiao A, Michel G et al. The GuideLine Implementability Appraisal (GLIA): development of an instrument to identify obstacles to guideline implementation. BMC Medical Informatics and Decision Making. 2005;5(1). 5. Gagliardi A, Brouwers M, Bhattacharyya O. The development of guideline implementation tools: a qualitative study. CMAJ Open. 2015;3(1):E127-E133. 6. Gagliardi A, Marshall C, Huckson S, James R, Moore V. Developing a checklist for guideline implementation planning: review and synthesis of guideline development and implementation advice. Implementation Science. 2015;10(1). 7. Liang L, Abi Safi J, Gagliardi A. Number and type of guideline implementation tools varies by guideline, clinical condition, country of origin, and type of developer organization: content analysis of guidelines. Implementation Science. 2017;12(1). 8. Wieringa S, Dreesens D, Forland F, Hulshof C, Lukersmith S, Macbeth F et al. Different knowledge, different styles of reasoning:a challenge for guideline development. BMJ Evidence-Based Medicine. 2018;23(3):87-91.

References 9. Taylor N, Clay-Williams R, Hogden E, Braithwaite J, Groene O. High performing hospitals: a qualitative systematic review of associated factors and practical strategies for improvement. BMC Health Services Research. 2015;15(1). 10. McCormack L, Sheridan S, Lewis M, et al. Communication and dissemination strategies to facilitate the use of health-related evidence. Evid Rep Technol Assess. 2013;(213):1-520. 11. Coronavirus Disease (COVID-19) - events as they happen [Internet]. Who.int. 2021 [cited 12 June 2020]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen 12. Australia Coronavirus: 28,777 Cases and 909 Deaths - Worldometer [Internet]. Worldometers.info. 2021 [cited 12 June 2020]. Available from: https://www.worldometers.info/coronavirus/country/australia/ 13. Ebben R, Siqeca F, Madsen U, Vloet L, van Achterberg T. Effectiveness of implementation strategies for the improvement of guideline and protocol adherence in emergency care: a systematic review. BMJ Open. 2018;8(11):e017572. 14. Continuing education meetings and workshops: Effects on professional practice and health care outcomes (Cochrane review). Journal of Continuing Education in the Health Professions. 2001;21(3):187-188. 15. Freemantle N, Harvey E, Wolf F, Grimshaw J, Grilli R, Bero L. Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews. 1997;.