Tales from the Front

 In regards to California Assignment Despite Objection/InPatient:

 My colleague and I were called in to work for a call shift around 9pm on 3/15/2020. We work in the Post Anesthesia Care Unit at UC San Diego Health. We took care of one post-surgical patient, who we transferred safely to an inpatient unit after recovery. Upon return to our unit, we were notified by the Operating Room Charge Nurse that another patient was being prepped for surgery. The patient recently underwent surgery approximately 10 days ago, and the surgical site appeared to be infected. As a result, this patient checked in to the Emergency Department earlier in the day. S/he had a fever and active cough upon arrival. The ER Staff swabbed the patient for Influenza strains A & B, which came back negative. S/he was then admitted to an inpatient bed to receive antibiotics and await a further course of action. The surgical team decided to proceed with surgery to drain and wash out the wound. 

 Just prior to going to the Operating Room, the patient’s care team decided to order Covid-19 testing and designate it a rule-out Covid-19 patient due to the patient’s symptoms. S/he was then placed on contact and droplet precautions; the Covid-19 specimen was obtained and sent; and s/he was taken to the OR for the procedure BEFORE the result was obtained. With regards to the urgency of the case, we were told there were varying opinions. We overheard remarks that perhaps since the surgical team could not ensure that this patient would be placed in the first time slot for surgery in the morning, they would rather proceed in the middle of the night; they had already been flip-flopping on the decision for hours. (If the decision to proceed was truly best for the patient, as well as our staff during this pandemic, then I support it. But if it was simply a matter of convenience for the surgical team, I believe postponing the surgery until we at least had the Covid-19 result back would be best for hospital personnel and the community at large.)

 My colleague and I realized we did not have the appropriate Personal Protective Equipment (PPE) in our recovery unit. Nearly all of our supplies have been locked up or hidden by Administration. I texted our direct supervisors, who replied promptly via text and phone call to share how and where we could each obtain one N95 mask. We were told to keep the mask after usage for proof. I then walked down to a nearby Intensive Care Unit to obtain additional PPE, such as gowns, boot covers, splash shields, and hair nets. I explained the situation to those nurses, who were sympathetic and helpful. Thank you so much! I then contacted our Union. We were advised by a Union Rep to use the maximum amount of PPE we could find. 

 The Operating Room staff called to notify us they were coming out to our unit with the patient. We ensured the patient was placed in a negative-pressure isolation room per Cal/OSHA guidelines and donned our PPE to assume care. 

 Within three minutes of arrival, the patient began exhibiting symptoms of neurological compromise. I notified the Anesthesia Doctor to come evaluate the patient, and we activated a Stroke Code. When various personnel began arriving, no one would enter the room without an N-95 mask. Since none were readily available, this caused delays in patient care. The Operating Room Nurses, who nobly stuck around simply to be helpful, contacted the House Supervisor to obtain the necessary masks via the tube system. Only after the supplies were received did the team fully evaluate the patient. 

 Due to the lack of PPE, my colleague and I had to decide how we would obtain supplies outside of the room since we didn't have additional PPE to change into. This is not appropriate infection control protocol. We didn't want to possibly contaminate other spaces in our hospital. Throughout all of this, the patient's Covid-19 results were still pending. Based on the evaluation of the team members, the patient was transferred to a higher level of care. We obtained one additional N-95 mask to place on the patient as we transferred to the unit. To be abundantly clear, the patient had been exhibiting an active, hacking cough while under our care. When we arrived to the unit, the staff reported they did not have appropriate PPE in order to feel safe. My colleague and I offered to stay with the patient until these staff members obtained the PPE they requested. Once that was achieved, approximately 15 minutes later, we relinquished care.

 Thank you,