Simulation for LTC shows how to handle Covid issues

VICTORIA, BC – Currently, there are no cases of COVID-19 in any Island Health owned and operated or affiliated long-term care (LTC) homes – and staff are determined to keep it that way. One of the strategies for helping care providers to anticipate and respond to a COVID-19 scenario is through the use of simulations.

“The request for simulations at our long-term care sites came from Dr. Kathleen McFadden, medical director at Yucalta Lodge in Campbell River. She and her colleague, Dr. Margaret Manville (pictured), medical director for the Island Health Long-term Care Program, became aware of a sense of anxiety among staff about what to do if a resident exhibited signs of COVID-19,” says Dacia Reid, LTC manager program practice and education. “An initial simulation was created to help the care team and give the team confidence to know what to do.”

The simulation takes place in a classroom setting with a physically distanced group of interdisciplinary staff, including housekeeping and dietary staff. An important component of this 20-minute session is a tabletop game where staff are asked to look at photos of people putting on and removing personal protective equipment (PPE) such as gloves, masks and gowns, and then place each photo into the correct order.

“During this simulation, staff are walked through all the steps in response to a suspected COVID-19 case – what are the roles for nurses, the responsibilities of a healthcare assistant, when are families notified, how are swabs administered and by whom,” says Reid. “Simulations help to make staff feel more comfortable and aware of what the steps are, and who does what and when.”

Simulation practice sessions are being offered to staff at Island Health’s 18 owned and operated sites and 42 affiliated sites, supported primarily by COVID Resource Coaches. COVID coaches are registered nurses and licensed practical nurses, some from the sites, some working on a casual basis and others, like Danielle Girard, the COVID coach at Yucalta Lodge, who have come out of retirement in the fight against COVID-19.

“COVID coaches are cheerleaders – we pass on important information to staff as we receive it and celebrate their successes, provide encouragement, build their confidence and help to enhance their skills,” says Girard.

Girard’s colleague, Helene Wackerman, is a clinical nurse educator and COVID coach at Cumberland Lodge. She says that long-term care staff have been eager to participate in the simulations that are offered at all Island Health long-term care homes. Evening and overnight staff have access to the PPE tabletop game so that they can use it to continue to hone this important skill.

“The sims allow us to connect with people in a meaningful way because they focus on information that really matters to everyone. It’s wonderful to see staff so interested in the topic and happy to confirm their roles and responsibilities,” says Wackerman. “The simulations also highlight for staff the importance of the observer role which allows them to support one another in learning and practice.”

Other important simulation exercises focus more on supporting all of the long-term care sites and identifying gaps. Island Health long-term care manager Bhavan Manhas and a team of representatives from various departments including the local Medical Health Officer and LTC facility physician, infection control, communicable disease, quality and improvement, community care facilities licensing, as well as partners from affiliated sites, have met on several occasions for their own simulation practices. Scenarios were developed by Manhas and her colleague, Emily Pridham.

“Our simulations are about helping to determine how our leadership teams are going to support one of our sites both clinically and operationally in the event of a COVID outbreak,” says Manhas. “Hindsight is always 20/20 and most people learn by doing. What we are learning from our leadership sims is helping us to further inform our protocols and procedures.”

Questions raised during the leadership simulations include: if staff at a site are exposed to COVID, how does Island Health ensure adequate staffing levels? Where should we locate containment zones within facilities to inform staff of high, medium and low risk of transmission? How is a COVID positive patient transported to an acute care facility during an outbreak?

“Preparedness is key. When a skilled basketball player with two seconds on the clock sinks the ball, it’s not just instinct, it’s practice,” says Manhas. “The more prepared we are, the better it is going to be for our residents because we will how to navigate any situation.”