Med J (Ft Sam Houst Tex). 2021 Jan-Mar(PB 8-21-01/02/03):79-82.
Keller Army Community Hospital, a 12-bed community hospital located in the Hudson Valley of New York State, within the pandemic epicenter anticipated the surge of critically ill patients, which would overwhelm local resources during the coronavirus pandemic sweeping across the globe. In this facility, there were no Intensive Care Unit (ICU) beds and resources were mobilized in order to create a negative pressure Corona Virus Unit (CVU) consisting of seven ICU beds and two step-down beds. Although the creation of the CVU decreased the non-COVID inpatient capacity to five beds, the hospital also formulated a plan to expand overall bed capacity from 12 inpatient beds to 45 beds within 24 hours.
To create a ICU embedded within a CVU and implement a three day curriculum to prepare four mixed teams of critical care and non-critical care staff nurses to manage critically ill patients with the novel coronavirus disease 2019 (COVID-19).
Nursing leaders and hospital education staff developed a critical care curriculum utilizing Elsevier didactic, the DoD COVID-19 Practice Guide, and hands-on training for 34 nurses.1,2 Nurses had varied scope of practice levels from licensed practical nurses to advance practice nurses, with diverse critical care expertise to non-critical care nursing staff from the primary care medical home (PCMH), all of which participated in the cross-leveling to the CVU unit during the pandemic response. Educational elements included PPE donning and doffing, mechanical ventilation, central venous catheter maintenance, arterial catheter management, hemodynamics, and critical care pharmacotherapy. A medical model skills station with common critical care equipment such as ventilators allowed for instantaneous feedback and 13 hands-on skills training.
A fully functional ICU and CVU was created with thirty-four nurses who completed training within seven days with a didactic completing rate of 94.65 % and 100% hands-on skills. The program endures with monthly tailored re-fresher training to improve efficiency and maintain critical competencies. The team maintained operational readiness through the surge and remain resolute for the next surge.
On-going program execution and evaluation continues to develop new staff members due to permanent change of station, recent on-boarding, or because of evidence based clinical guideline changes. Training has continued, but shifted to include normal inpatient operations over the summer of 2020. Re-fresher classes covering the treatment and care of COVID patients continue with the anticipation of a second wave surge of COVID-19 cases emerges this fall based on epidemiology predictions.
凯勒陆军社区医院是一家位于纽约州哈德逊河谷的 12 床位社区医院，处于全球大流行期间预计将出现大量重症患者的疫情中心。在该设施中，没有重症监护病房（ICU）床位，因此动员资源创建了一个负压冠状病毒病房（CVU），其中包括 7 张 ICU 床位和 2 张降级床位。尽管创建 CVU 减少了非 COVID 住院患者的容量至 5 张床位，但医院还制定了一项计划，在 24 小时内将总床位容量从 12 张住院床位扩展至 45 张床位。
在 CVU 内创建一个 ICU，并实施一个为期三天的课程，以培训四个由重症监护和非重症监护护士组成的混合团队，以便管理患有新型冠状病毒病 2019（COVID-19）的重症患者。
护理领导人和医院教育工作人员利用爱思唯尔（Elsevier）教学法、国防部 COVID-19 实践指南以及对 34 名护士进行的实操培训，开发了重症监护课程。1,2 护士的执业范围从执业护士到高级执业护士不等，重症护理专业知识也各不相同，来自初级保健医疗之家（PCMH）的非重症护理护士也各不相同，他们都参与了大流行期间对 CVU 单元的跨级培训。教育内容包括 PPE 的穿戴和脱除、机械通气、中心静脉导管维护、动脉导管管理、血液动力学和重症监护药理学。一个带有常见重症监护设备的医疗模型技能站，例如呼吸机，可以提供即时反馈和 13 项实操技能培训。
经过七天的培训，有 34 名护士完成了培训，理论完成率为 94.65%，实操技能完成率为 100%。该计划在每月进行定制的复习培训以提高效率和保持关键能力。该团队在疫情高峰期保持了运营准备状态，并为下一次高峰做好了准备。
由于驻地永久变更、最近入职或基于循证临床指南变更，该计划持续执行和评估，以培养新员工。培训仍在继续，但已转移到 2020 年夏季的常规住院患者运营中。随着流行病学预测显示 COVID-19 病例出现第二波高峰，涵盖 COVID 患者治疗和护理的复习课程仍在继续。
