Checklists help facilities prepare for safer surgery rescheduling

Address employee concerns & promote effective communication with all parties

• Continue following recommendations from the Centers for Disease Control and Prevention and remind all employees of the processes in place to help reduce the risks of acquiring COVID-19, such as using masks and maintaining social distancing outside the workplace.
• Evaluate and confirm that all education and staff competencies are up to date prior to restarting the surgical program. This may include mandatory training (e.g., Basic Life Support, Advanced Cardiovascular Life Support and Pediatric Advanced Life Support), fire- and disaster-based scenarios, and the relaying of other emergency preparedness plans.
• Thoroughly communicate with staff members any/all plans for reopening the elective surgery schedule.
• Remind employees of the needs of the community as they relate to surgical care. Make it clear what the surgical backlog looks like, what is realistic in regards to meeting those needs and the level of staff support that will be needed. Note: Training and refamiliarization about specific specialties may be needed to ensure employees’ ability to meet the needs during procedures.
• Reestablish communication with physician offices. Employees in these offices may be new and unfamiliar with surgical preparation protocols or scheduling processes.
• Evaluate the list of surgical procedures that were canceled. Reprioritize those patients with physicians and begin rescheduling.
• Ensure adequate staffing levels to cover the variety of specialties being scheduled, and also communicate with anesthesiology to ensure they can handle the case volume.
• Communicate with rescheduled surgical patients and share what the healthcare organization is doing to ensure patient safety (e.g., extensive cleaning, proper use of personal protective equipment (PPE), specific training and safety measures that have been put into place to allow a safe/safer reopening).
• Verify that scheduled patients are safe to travel to/from appointments.

Tackle key sterile processing-related tasks

• Inventory all instrumentation, equipment, implantable items (screws, plates, mesh, etc.). Also, inventory supplies (blue wrapper, filters, integrators, tape, etc.) to ensure adequate quantities are available to effectively reprocess instrumentation and equipment.
• Contact vendors specific to the specialties being performed in the facility and ensure they have the resources available to cover the scheduled cases.
• For washer-decontaminators and sterilizers that were taken offline during the COVID-19 shutdown (or for any other reason), contact the manufacturer(s) for guidance to ensure safe operation and proper performance. For guidance on steam quality issues, review ANSI/AAMI ST79:2017, Section 3.3.3, and AORN 2020 Guidelines for Sterilization (recommendation XI).
• Verify that Sterile Processing (SP) staffing will be adequate to cover longer workdays that will likely be needed to meet the higher surgical case volume. Note: If SP staff are managing PPE for the facility, there could be conflicts when prioritizing instrumentation or PPE. Prior to scheduling surgeries, ensure they have enough staff to fulfill both roles.
• Check all sterile packages and instrument trays for integrity and expiration dates.

Take a closer look at logistics

• Reestablish any paused/canceled contracts (e.g., linen service, biohazard/waste management, etc.).
• Ensure there is an adequate supply of hand sanitizer, tissue and no-touch trash receptacles throughout the facility and in all patient care areas.
• Consider stationing an employee at all entrances to instruct everyone arriving to sanitize hands, wear a face mask and maintain social distancing.
• Post appropriate signage in all relevant areas communicating instructions for social distancing, appropriate wearing of masks, hand sanitation, etc.
• Inventory all supplies and medications, and check for outdated expiration dates. Communicate appropriate updates about all new protocols/processes with employees and patients/their family members.

Implement pre-admission testing protocols

• Establish procedures to pre-screen patients through an approved portal/app, such as Zoom or Teams. Screening should include pre-established criteria, with added screening for fever, respiratory infections or possible COVID-19 exposure.
• Consider having patients sign appropriate documents electronically.
• Update arrival communication with patients and consider staggering arrival times to help enforce social distancing requirements while in the facility.
• Devise and confirm a thorough cleaning schedule of patient waiting areas.
• Complete a full inventory/evaluation of supplies, implants, medications and equipment.
• Communicate appropriate updates about all new protocols/processes with staff and patients.