Going viral: lessons from an accelerated PPE teaching programme during the COVID-19 pandemic.

This article was migrated. The article was marked as recommended. Introduction: at the beginning of the COVID-19 pandemic in the United Kingdom, there was an urgent need to establish a teaching programme to rapidly upskill hospital staff in the use of Personal Protective Equipment (PPE). Aims: to train all members of clinical and non-clinical staff operating within the respiratory department of the Royal Brompton Hospital over a period of one week, using a series of multi-professional simulation-based sessions and to then share the learning points gained in order to assist others facing the same issue. Results: using an iterative style and a mastery learning model, the designated teaching faculty rapidly implemented a situated teaching programme, managing to train all staff members within the given timeframe. Given the time-critical nature of the programme, sessions required considerable flexibility to change to fit a learner-driven agenda, drawing benefits from an andragogical approach and an emphasis on interprofessional learning.

Working accuracy of pulse oximetry in COVID-19 patients stepping down from intensive care: a clinical evaluation.

INTRODUCTION: UK guidelines suggest that pulse oximetry, rather than blood gas sampling, is adequate for monitoring of patients with COVID-19 if CO2 retention is not suspected. However, pulse oximetry has impaired accuracy in certain patient groups, and data are lacking on its accuracy in patients with COVID-19 stepping down from intensive care unit (ICU) to non-ICU settings or being transferred to another ICU. METHODS: We assessed the bias, precision and limits of agreement using 90 paired SpO2 and SaO2 from 30 patients (3 paired samples per patient). To assess the agreement between pulse oximetry (SpO2) and arterial blood gas analysis (SaO2) in patients with COVID-19, deemed clinically stable to step down from an ICU to a non-ICU ward, or be transferred to another ICU. This was done to evaluate whether the guidelines were appropriate for our setting. RESULTS: Mean difference between SaO2 and SpO2 (bias) was 0.4%, with an SD of 2.4 (precision). The limits of agreement between SpO2 and SaO2 were as follows: upper limit of 5.2% (95% CI 6.5% to 4.2%) and lower limit of -4.3% (95% CI -3.4% to -5.7%). CONCLUSIONS: In our setting, pulse oximetry showed a level of agreement with SaO2 measurement that was slightly suboptimal, although within acceptable levels for Food and Drug Authority approval, in people with COVID-19 judged clinically ready to step down from ICU to a non-ICU ward, or who were being transferred to another hospital's ICU. In such patients, SpO2 should be interpreted with caution. Arterial blood gas assessment of SaO2 may still be clinically indicated.