This 10-page, color-coded chart provides detailed recommendations and guidelines for healthcare facilities during an influenza pandemic. The initial chart delineates activities in various areas (i.e., administration and planning, communications, operations, and training) by five stages of a pandemic. The remaining charts provide detailed strategies for managing oxygen, medication support, hemodynamic support and IV fluids, mechanical ventilation, nutrition, and staffing during periods of scarce resources. Vital sign targets and dosage guidelines are also integrated into the recommendations.
The charts may have significant relevance for healthcare institutions preparing for an increased case load during a pandemic, especially because they relate practical guidelines in a concise and simple manner. The color codes for pandemic stage are easy to follow.
One reviewer noted that the charts were one of the most specific guides to altered standards of care that person has seen. . Another reviewer described it as a model guideline, noting in particular that it is concise, practical and easy to follow.
Reviewers offered suggestions for agencies wishing to adapt these charts, including considering the following:
•Adding oral benzodiazepines to injectibles in the sedation cache recommendations;
•Adding manufacturer's information on how to disinfect or sterilize a number of medical products for reuse, such as oxygen cannulae;
•Weighing factors such as age in addition to the Sequential Organ Failure Assessment (SOFA);
•Forming a patient care team aimed at limiting the number of staff providing care to an infected patient to limit exposure and reduce the amount of PPE needed (such as having the nurse perform duties usually done by a Certified Nursing Assistant); and
•Clarifying that licensed or certified staff must act within their scope of practice.
