PRP162: Supporting the Effective Implementation of COVID-19 Infection Prevention and Control: Tabletop simulations for primary care

Myles Leslie, PhD; Mahzabin Ferdous, MBBS; Jan Davies, MD, FRCPC, MSc, FRAeS; Raad Fadaak, PhD, MA; Michelle Cheng, BSc; Lee Green, MD, MPH; Marlot Johanna Blaak, BSc, MSc; Jia Hu, MD, CCFP, MSc; Judy Seidel, PhD; Nicholas Myers, BSc MB BS; Nelson Lee; Nicole Pinto, MPH


CONTEXT: The COVID-19 pandemic has introduced uncertainty about when and how to implement Personal Protective Equipment (PPE) and Infection Prevention and Control (IPC) measures. Primary care clinics responding to the ongoing pandemic are facing challenges as evolving PPE and IPC policies are received and interpreted, or created de novo. As part of conducting ‘engaged scholarship’ the Quality Improvement research described here identified the need for policy interpretation support in primary care clinics in Alberta, Canada. OBJECTIVE: Optimize in-clinic safety and staff confidence, reduce admissions to acute care, and limit unnecessary visits to hospital emergency departments by supporting primary care teams as they identify and address PPE/IPC challenges. STUDY DESIGN: Participatory action research to co-design, prototype, and pilot ‘Tabletop Simulations’ in support of local PPE/IPC policy creation and implementation. The simulations feature Human Factors (HF), IPC, and sociological expertise, with participating primary care teams 'walking through’ COVID-19 clinical scenarios alongside these experts. Underlying processes, system elements, and cultural factors shaping implementation are identified and addressed. SETTING OR DATASET: In-person and virtual simulations with rural and urban primary care Access Clinics (designated for COVID-19+ patients requiring care), as well as regular service clinics in Alberta (n=12). With 13 participants attending in-person sessions and 59 participants in virtual sessions. Population studied: Primary care teams (physicians, administrative staff, nurses, clinic managers). INTERVENTION/INSTRUMENT: ‘Tabletop simulations’ focus on process, system, and culture (re)development to improve COVID-19 patient care and clinic safety. OUTCOME MEASURES: Clinic-specific recommendations are reported on completion of simulations. Follow-up interviews are conducted with a sample of participants from all participating clinics. RESULTS: Recommendations focus on managing risk of COVID-19 transmission in small clinical spaces; the implementation of standardized protocols to manage contamination; and effectively using available physical and electronic resources to improve processes, systems and culture. OUTCOMES TO BE REPORTED: Primary care clinics gain significant value from rehearsing care routines through simulations; and also require additional resources that focus on the effective translation and adaptation of evolving PPE/IPC policies.

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