When cases of COVID-19 began to mount this winter, Boston Children’s Hospital was ready to spring into action — in fact, the hospital has been preparing for such a pandemic for six years. In collaboration with Boston Children’s Chief of Medical Critical Care, Michael Agus, MD, Hospital Epidemiologist and Medical Director of Infection Prevention and Control, Thomas Sandora, MD, MPH, and Jon Whiting, MSN, RN, CCRN, director of Nursing Patient Operations for the hospital’s Medical Intensive Care Unit (MICU), Biocontainment Unit (BCU), and Life Support Programs, a team of highly specialized nurses from throughout the hospital was activated. Their mission: to educate and support staff in suiting up and carefully removing personal protective equipment (PPE) while keeping themselves safe and reducing the potential to inadvertently spread the virus in the process.

The BCU is comprised of a small inpatient setting staffed by a virtual team drawn from nurses and other clinicians throughout Boston Children’s. The unit was originally established in response to a prior infectious disease outbreak. When the Ebola crisis took hold in West Africa in 2014, “We viewed this as an opportunity to expand our own preparedness,” says Whiting, who — with the support and advocacy of Patricia A. Hickey, PhD, RN, NEA-BC, FAAN, vice president and associate chief nurse of Cardiovascular and Critical Care Nursing Patient Operations — collaborated with other forward-thinking Boston Children’s clinicians to develop hospital guidelines and protocols for the care of patients with highly infectious diseases.

“The BCU team is available 24/7 to educate and support frontline staff in the use of PPE, assist with patient transfers, and prepare frontline clinical and support staff to care for these patients,” explains Pascale Audain, BSN, RN, CCRN, who works in the hospital’s MICU and BCU. The BCU team nurses possess a broad range of clinical experience, including inpatient acute care, intensive care, cardiology, and emergency medicine. Many, including Audain and her colleague, Nick Barry, BSN, RN, have been volunteering in the BCU since its inception. “We act as a common thread between different parts of the hospital, facilitating communication between nursing, intensive care, infection control, environmental services, respiratory therapy, and physician colleagues,” says Barry.

Boston Children’s nurse Sharon McAuliffe, RN, CPN, dons personal protective equipment.

Practice makes perfect: Advancing care through simulation

Both in the BCU and throughout the hospital, Boston Children’s nurses are harnessing the power of medical simulation to enhance care of children with COVID-19 and other conditions. Under the leadership of Executive Director Peter Weinstock, MD, PhD, the SimPeds Program allows clinicians the opportunity to hone their skills in a simulated environment before delivering similar care in an actual patient care setting.

The equipment is far advanced from Rescue Annie, the dummy used to teach CPR for generations. Instead, the SimPeds Program features a state-of-the-art experiential learning facility, right down to exact replicas of an inpatient room and ICU suite. Here, physicians, nurses, and other clinical staff learn and practice medical and surgical interventions in a safe environment before performing them on patients. Trainings for and by nurses encompass everything from the rote to the complex — teaching techniques such as intubation and defibrillator use and helping sharpen critical thinking and communication skills.

The goal is to deepen the capability of nurses and teams in every specialty within the hospital. “Simulation is essential in cultivating resilience for nurses through both skill acquisition and persistent mindfulness — improving outcomes, reducing risk, and increasing team effectiveness,” explains Laura Wood, DNP, RN, NEA-BC, a member of the SimPeds advisory board and Boston Children’s Chief Nursing Officer and Senior Vice President of Patient Care Operations.

Led by nurse educators and other clinical team members, this training aims to help nurses learn by doing — an approach that has been associated with improved patient outcomes. “Simulation gives our nurses the opportunity to put their knowledge into action,” explains Shannon Olbrot, BS, BSN, RN, CCRN, of Boston Children’s Cardiac Intensive Care Unit. “The skills and confidence nurses gain from this type of education directly impacts the quality of patient care we provide.”

As the medical community grapples with COVID-19, Boston Children’s nurses are drawing on simulation training to refine care for the littlest patients with this disease. “Simulation training is critically important for treating children with COVID-19,” says Matthew Taylor, RN, the program’s curriculum development manager. “Nurses throughout the hospital are formally appointed to serve as Associate Clinical Directors of Simulation, contributing to the design, implementation, and evaluation of trainings to help prepare us for such real-life scenarios.”

Simulation has proven particularly crucial in helping to highlight important safety precautions around COVID-19, providing nurses with the opportunity to practice such techniques without the risking direct exposure to the virus. “We’ve modified our intubation and code scenarios to reflect practice adjustments, team dynamics, and safer procedures for putting on and removing PPE,” says Olbrot. Simulated versions of these measures are now available virtually, allowing nurses to perfect them through repetition and coaching long before ever coming in contact with infected patients.

Jon Whiting, MSN, RN, CCRN, director of Boston Children’s Biocontainment Unit

On the forefront of innovation

Simulation has been tightly integrated into the work of the BCU since its inception. The clinical team has long practiced full-scale simulated drills to prepare staff for the arrival of a patient with a highly infectious disease. During these drills, “We’ve spent up to four hours in extensive PPE to learn how to optimize care delivery processes before we’re in a real high-stakes situation,” says Barry.
Today, as clinical team members and nurses find themselves in the midst of just such a circumstance, that preparation has paid off. “In a time characterized by so much uncertainty, this work has been very grounding,” says Audain. “There’s a real appreciation at Boston Children’s for the role of nurses as central to care delivery and the patient and family experience — we’re all working towards the same goal.” And it’s powerful proof that when it comes to innovation, nurses don’t just have a seat at the table. They’re leading the way.

For more information about how Boston Children’s Hospital is going beyond the bedside, visit their website.