A Care Step Pathway for the Diagnosis and Treatment of COVID-19-Associated Invasive Fungal Infections in the Intensive Care Unit.

BACKGROUND: In March 2020, the World Health Organization declared COVID-19, caused by the SARS-CoV-2 virus, a pandemic. Patients with severe cases resulting in hospitalization and mechanical ventilation are at risk for COVID-19-associated pulmonary aspergillosis, an invasive fungal infection, and should be screened for aspergillosis if they have persistent hemodynamic instability and fever. Early detection and treatment of this fungal infection can significantly reduce morbidity and mortality in this population. OBJECTIVE: To develop an evidence-based care step pathway tool to help intensive care unit clinicians assess, diagnose, and treat COVID-19-associated pulmonary aspergillosis. METHODS: A panel of 18 infectious disease experts, advanced practice registered nurses, pharmacists, and clinical researchers convened in a series of meetings to develop the Care Step Pathway tool, which was modeled on a tool developed by advanced practice nurses to evaluate and manage side effects of therapies for melanoma. The Care Step Pathway tool addresses various aspects of disease management, including assessment, screening, diagnosis, antifungal treatment, pharmacological considerations, and exclusion of other invasive fungal coinfections. RESULTS: The Care Step Pathway tool was applied in the care of a patient with COVID-19-associated aspergillosis. The patient was successfully treated. CONCLUSION: The Care Step Pathway is an effective educational tool to help intensive care unit clinicians consider fungal infection when caring for COVID-19 patients receiving mechanical ventilation in the intensive care unit, especially when the clinical course is deteriorating and antibiotics are ineffective.

A Competency-Based Curriculum for Critical Care Nurse Practitioners' Transition to Practice.

BACKGROUND: Nearly one-third of new-graduate nurse practitioners report undergoing no formal orientation process, and postcertification orientation processes vary. A validated curriculum would address the need for structured training to enhance new graduates' practice transition. METHODS: A competency-based practice transition curriculum for intensive care unit nurse practitioners was created using a literature review and expert panels. Competencies were established that were based on clinical categories essential to nurse practitioner practice in the intensive care unit and adapted from existing Accreditation Council for Graduate Medical Education training, aligned with the precertification nursing curriculum. Participants recruited from academic and clinical backgrounds were asked to rank curriculum items using a 4-point Likert scale. Competencies were refined on the basis of participants' survey feedback. RESULTS: A total of 31 participants from academic medical centers and schools of nursing throughout the United States responded to the request for competency validation; 29% of participants provided qualitative data. All 9 competency topics received a mean rating greater than 3.5 and were deemed valid. Using the combined quantitative and qualitative data, a final set of competencies for nurse practitioners in the intensive care unit was developed. CONCLUSIONS: The curriculum developed and validated in this study can become the basis for practice transition for novice nurse practitioners. The curriculum is adaptable and can be used for surgical and medical intensive care units. As refined, the competencies provide a validated foundation for training of new-graduate nurse practitioners in the intensive care unit.