Welcome to OPENPediatrics Nursing World Shared Practice Forum. My name is Cheryl Toole and
I'm here today with Dr. Jon Whiting. Jon is the Director of the Nursing Patient Services Medical
Intensive Care Unit, the Biocontainment Unit, and Life Support Program at Boston Children's
Hospital. Jon is a member of the American Academy of Critical Care Nurses and led his team to the
achievement of Gold Beacon status, the highest designation awarded, recognizing exceptional care,
outcomes, satisfaction, and healthy working environment standards for excellence.
Jon serves on numerous multidisciplinary councils and committees, including,
but not limited to nursing, pharmacy, and therapeutics, ICU Governance, Nursing
Administrator on Duty Leadership Council, and the Emergency Management Team. Jon is responsible for
the clinical and administrative operations for the medical ICU, policy and procedure development,
quality and cost effectiveness, and high reliability practice and safety standards.
In addition to this, Jon is the Nursing Director, and was instrumental in the development of the
first biocontainment unit at Boston Children's Hospital. Through this work, Jon has facilitated
the training and implementation of policies and procedures around emergency responses. The
biocontainment team at Boston Children's Hospital was first activated during the second largest
Ebola outbreak in history in 2014, and most recently, during the COVID-19 pandemic of 2020.
Jon, thank you for joining us today. To begin our discussion, as the nursing director of the
medical ICU at Boston Children's Hospital, when did your practice or focus expand into the area
of biocontainment? And why was the biocontainment team established at Boston Children's Hospital?
Thanks, Cheryl. It's great to be here today and talk about this team.
As you said, the biocontainment team at Boston Children's Hospital was established in 2014 in
response to one of the largest Ebola outbreaks the world had seen. The threat of Ebola was becoming
more apparent as several Ebola patients were being seen in hospitals throughout the United States.
Boston Children's Hospital recognized this early on as a potential threat and identified the
need for a specialized team of clinicians who were trained in treating patients with
highly infectious diseases. This dedicated team of nurses and physicians were recruited
from throughout the hospital in many different specialty areas. Since the team was developed,
we have trained quarterly in the high level personal protective equipment, or PPE,
to establish best practices and guidelines for the care of highly infectious, acute patients.
The quarterly trainings have consisted of high tech simulation to guide practice and create
guidelines and protocols for safe and optimal care for patients with highly infectious diseases. Our
simulation days also consisted of team building exercises, guest lecturers, and group discussions.
COVID-19 allowed the team to move out of the virtual realm and into the clinical areas,
sharing the expertise gained through their training.
Peers and procedures that may seem basic such as basic drawing of labs,
obtaining x-rays, and IV placement became much more high risk for the clinician
due to the increased risk of exposure with this disease. Through extensive simulation trainings,
we've been able to evolve our guidelines and protocols on caring for these patients with
extreme focus on safety for our patients, our clinicians, as well as the community at large.
Well, that's certainly no small task, for sure. You described the training and preparation
developed for the care of patients with Ebola. I don't think any of us could have possibly imagined
that the world would be facing a new threat in the form of a catastrophic pandemic in 2020. How did
this work by the biocontainment team model change to rapidly respond to the threat of COVID-19?
That's a great question. As the COVID-19 crisis began to become more evident and we witnessed the
severity of the crisis from around the world, leaders of Boston Children's Hospital saw an
opportunity to use the team to train, educate, and support staff throughout the organization
to safely care for patients with COVID-19. We knew that through our training the team
could safely care for these patients. But it was still unclear the amount of patients that
we'd be seeing at a pediatric institution, as this disease was primarily in the adult world.
We're able to learn from other areas, such as Seattle and New York,
as they experienced the widespread capacity issues that hospitals around the world were
facing as they attempted to manage the massive influx of the COVID-19 patients.
It was at this point that we realized that the biocontainment team would be unable to care for
all of the COVID-19 patients that we'd potentially be seeing here. And that their expertise may
be of better use in educating and supporting front line staff in the care of these patients.
Knowing that the proper use of personal protective equipment is essential in preventing
the transmission and spread of this disease, it was apparent that the use of this team,
who had been training for these types of infectious disease scenarios for so many years,
would be essential in supporting the needs of the organization. The team was activated and deployed
around the institution to educate and support front line staff in the use of personal protective
equipment, assist with patient admissions and transfers, and ensure that the front line clinical
and support staff were adequately prepared to safely and confidently care for these patients.
The nurses from the biocontainment team were deployed around the hospital as site managers.
These site managers were used to oversee the donning and doffing of staff and the
appropriate personal protective equipment, and to help to identify areas and to improve safety
within our processes. The biocontainment team, along with the infection prevention and control,
helped in guiding practice around personal protective equipment and educating front line
workers on the ever changing guidelines being established by the Centers for Disease Control.
There could be days when the guidelines would change every hour.
And that would be up to six or seven times a day. The biocontainment team was available
throughout the hospital on all shifts for any supportive needs in relation to COVID-19.
The team helped in guiding practice, while educating and supporting staff.
The hands-on educational approach taken by the containment team
gave other front line staff the opportunity to witness and to learn the proper techniques
in safety guidelines that were being put into place. This education helped in building
confidence and decreasing anxieties around the care for caring for COVID-19 patients.
Thank you so much, Jon. We're going to pause now to turn to the audience to ask a question.
In your response to your question, please leave your city and country location.
Our question is this, do you have a biocontainment team available 24/7 to support patient care and
clinical staff needs related to COVID-19 or other infectious diseases? And what training
or experience is required of the nurses or clinicians on your biocontainment team?
Jon, were the nurses on the biocontainment team only used for resources for nursing?
Or were other disciplines also involved?
So the biocontainment team has collaborated with all disciplines within the organization in the way
of contact with patients and families. Extensive training has been done with non-medical support
services, such as environmental services, food services, and security to name a few--
all essential to the ongoing operations of the facility. Emergency management and
infection prevention control have also been essential in the activation for COVID-19.
Their collaborative efforts have helped in guiding our education support
as the team has worked closely with them in identifying the needs of the organization.
The team has been adaptable to many changes recommended by the CDC. They've helped in the
establishment of an internal COVID-19 website that outlines all the aspects of COVID-19 response.
They've also collaborated with the safety department, infection prevention,
control, and emergency management in the creation of videos that demonstrate the specific techniques
for donning and doffing of personal protective equipment needed in the care of COVID-19 patients.
The team has been essential in the re-emergence planning of the organization.
We've worked with front line workers in areas such as the ambulatory clinics,
procedural units, and the satellites around the region. Many of these areas had limited new amount
of patients during the initial phases of the pandemic, which kept many staff members at home.
Staff that may not have been emerged in the COVID-19 planning and
preparations needed education and guidance on all of our new safety initiatives and guidelines.
Site managers were deployed to these areas to do extensive demonstration and teaching,
allowing front line workers to feel comfortable and protected
caring for the potential COVID-19 patients that they may see. This has allowed the organization
to safely welcome back patients and for staff in these areas to provide safe and optimal care.
The nurses on the team were able to identify areas of improvement within our systems and work towards
resolutions. Building on their strong clinical skills and nursing experiences, they were able
to identify the needs, worries, and oftentimes frustrations of the clinical teams, and work
with them in identifying systems and processes that work best for each individual service.
Having nurses on the team from many different areas of the hospital
allowed them to have better understanding of how each individual unit works
and possible barriers to the standardized approaches that we were trying to implement.
The biocontainment team has become an essential part of the care teams,
promoting safety and quality care, while easing fears through increased education and support.
Jon, you talk about, I think, just the importance of how each of your team members had to adapt
the approaches for the specific environments and departments. I can certainly speak to the NICU for
instance where I work in the neonatal ICU. And our geography and layout of our unit is very different
and I just can't tell you how valuable it was to take what were the necessary precautions,
but not necessarily a one size fits all, and adapt them to the particular environment. And
your team was truly exceptional in doing that. I know that my team members truly appreciated that.
In framing expectations and managing fear, stress, and anxiety when faced with a crisis or
the unknowns as COVID has evolved, it's critical to support patients, and families, and staff.
How has this novel and innovative team helped to promote
safe and effective care for patients, families, and staff?
So I think that we all know that nurses continue to lead in innovative ways of increasing patient
and staff safety. The COVID-19 pandemic allowed a group of nurses to highlight the
skills acquired through simulation training of patients with highly infectious diseases.
The expertise and experience of these nurses allowed them to participate and
guide care at the bedside in a way that was novel to the institution.
The biocontainment team nurses were able to educate and support their colleagues,
allowing for optimal care of our patients and families. The bedside nurses were then
able to build their confidence and decrease anxiety when caring for the COVID-19 patient.
The biocontainment nurses worked with infection prevention and control and allowing parents to
remain at the bedside with their sick child as well. Parents were able to receive food
to the bedside and continue to receive the same psychosocial support that was in place pre-COVID.
At Boston Children's Hospital, we were able to use FaceTime and Zoom technologies to update families
at the bedside while limiting entry into the patient's room, providing more safety measures.
The hospital worked extremely hard in maintaining their stance on patient, family-centered care,
knowing the importance of support for the patient, as well as their family.
I think this was so important, Jon. And I think we definitely saw
that our ability to really need to keep the focus on family-centered care,
while keeping our patients and our staff safe, was so integral during this time. I think being
a pediatric institution is different than an adult institution, obviously because our patients
need their parents and families to be present to partner in that care. So I
think that that was also crucial as we looked at ways to optimize practice and safety.
We continue to navigate through and build upon lessons learned, including what we can adopt as
best practices throughout, and hopefully well beyond, the COVID-19 pandemic. How has the
biocontainment team helped in transforming practice at Boston Children's Hospital?
Building on their strong clinical skills and nursing experience, the biocontainment nurses
were able to identify the needs, the worries, and the frustrations of the clinical teams,
and work with them in identifying systems and processes that work best for each
individual service. The biocontainment team has trained quarterly since 2014,
using the high-tech simulations to guide their practice and create guidelines and protocols
for safe and optimal care of patients with these highly infectious diseases.
COVID-19 allowed the team to move out of that virtual realm
into the clinical areas, sharing their expertise gained through their training.
The team has become an essential part of the care teams, promoting safety and quality care,
while easing fears through increased education and support.
This innovative team will continue to build upon their clinical skills and use the experiences from
COVID-19 to continue building guidelines of protocols that will be transferable
to other possible infectious outbreaks in the future-- and hopefully, not in the near future.
The biocontainment team has successfully trained all areas of the organization to safely care for
COVID-19 patients and continues in providing excellent care for our pediatric populations.
We are going to pause now to turn to the audience to ask a question. In your response
to your question, please leave your city and country location. Our question is this,
what were one or two practice or communication processes that were most instrumental in preparing
your teams during COVID-19? And did you use high tech simulation during your training?
Jon, in what other ways has the biocontainment team helped to assure that patients, families,
and staff are protected from COVID-19?
So the biocontainment team became active members of the hospital's rapid response teams
and was present at over 150 events between March 2020 and August of 2020.
These teams respond to all hospital emergencies that may require some type of medical
intervention. The role of the biocontainment nurse was to ensure that all members of the team
providing care for the patient are donned in the proper personal protective equipment and ensure
that all safety initiatives and guidelines are being followed during these situations.
The biocontainment team was staffed with four nurses for each 12 hour shift, ensuring 24 hour
coverage. Each nurse carried a hospital issued phone that was accessible to all disciplines
within the organization. During the period of activation between March and August 2020,
the biocontainment team answered over 4,900 calls in regard to COVID,
personal protective equipment, transfers, and education.
This number does not include the number of text messages that were received during that time.
We are still compiling the data. But expect that number to be at least
triple or quadruple the amount of phone calls that we received.
That is truly extraordinary. What's next for the biocontainment team at Boston Children's Hospital?
So that's a good question, Cheryl. I think right now
although the biocontainment team is not activated at the moment,
we're always ready to switch over from our virtual to a real-time schedule.
The team will continue with our simulation trainings that occur four times a year, along with
yearly regulatory drills that allow us to showcase the preparation that we have put into place.
Working with infection prevention and control, we will continue to navigate the COVID-19 pandemic
and continue to be aware of any other emerging infectious diseases around the world.
The COVID leadership team at Boston Children's Hospital
actively follows infection rates within the city, the state, and the country.
The work that was done during our activation has allowed for front line workers to continue
to practice and work safely during these stressful times caring for our fragile pediatric population.
Jon, the work you and your team have done and continue to do has truly been amazing.
Your leadership with biocontainment to ensure safety for our patients, families, and front line
clinicians has been second to none. As leaders managing stress and uncertainty during crisis,
while framing expectations and retaining flexibility
to rapidly shift priorities, is essential. You model this every day in your leadership, Jon,
doing the most important work there is, caring for the children, families, and staff who rely on us.
Thank you so much for sharing your story with us today on OPENPediatrics.
Thank you, Cheryl. This has been a great experience.