In April, Time magazine covered Frieda Fairman, a respiratory therapist of 14 years, currently at Harborview Medical Center in Seattle. A job that typically involved working with patient breathing issues ranging from sleep apnea to asthma to heart attacks has morphed to something much more intense. By the time COVID-19 swept the Pacific Northwest in March and April, she found herself in full swing anticipating the surge of cases that would eventually come her way. As she wrote to a friend or family member via text “as a respiratory therapist we are essential during an infectious respiratory disease pandemic,” and again, “respiratory disease patient care is literally my job by definition.”1
What is eerie now is how the rise of cases in the last weeks must feel like déjà vu to respiratory therapists and other healthcare providers throughout the United States. How can they be ready both emotionally and materially? If you are like most healthcare systems, procuring PPE to protect your staff continues to be a top priority. But have you given thought to preparing your facility or system for respiratory supplies? PPE has become an acronym that the global population has become all too acquainted with given the infectious part of this virus, but we also know that COVID-19 is a respiratory disease, and many suppliers of respiratory products continue to have challenges sourcing supplies. Complicating this challenge are new protocols many healthcare systems have put in place to treat COVID-19. As practices change, the types of products being used are changing as well, often too rapidly to keep up with, and systems find themselves competing to procure the essential supplies. Some of our own customers have increased purchases to deal with patient surge capacity, allowing us insight into some of the trends related to respiratory product demand. If possible, your plans should take these into account over the next several months.
One: patient preparation
As patients flood to urgent care sites and emergency rooms, the effort to identify risk and the need for hospitalization becomes key. Certain products and processes have been identified to help with this initial step:
- Pulse oximeters: Many acute customers are purchasing fingertip pulse oximeters and providing them to patients who have COVID-19 symptoms. This might be an instrumental way to determine when patients can monitor their breathing at home and when they need to come in. For example, patients might be asked to monitor their O2 saturation at home and given instruction on when to come in (i.e., if O2 saturation drops below 90%, for example, it’s time to come back in for treatment).
- Suction regulators and flowmeters, used to safely deliver oxygen to a patient—often critical during COVID-19—must be reliable, on hand and ready to use in emergencies such as clearing the airway of a patient that has aspirated foreign materials. Throughout the pandemic, the demand on these have continued to rise as hospitals increase capacity.
Two: oxygen therapy
With healthcare professionals stretched in multiple directions, optimizing caregiver efficiencies becomes critical. We know that oxygen therapy in patients with severe COVID-19 can save lives. And often it comes down to the availability of the right tools. Especially in resource-poor settings, there must be the assurance of supplemental oxygen therapy for the management of severe COVID-19. Here are some oxygen product trends providing safer care for those patients with higher acuity O2 needs:
- O2 masks designed to deliver a high concentration of O2, such as non-rebreather masks and “3 in 1” masks.
- OxyMask, an open style O2 mask, used to deliver a very wide range of O2 levels up to 90% FiO2; one of the distinct benefits during COVID-19 is that it cuts down on the need to continually change out O2 masks as a patient’s acuity level changes
While aerosol therapy is a critical and integral part of the clinical management of patients with pulmonary diseases, it increases the droplet generation and risk of disease transmission. Therefore, it is crucial to avoid unnecessary aerosol drug delivery to patients with COVID-19.2
Three: rethinking aerosol medication delivery
Aerosol therapy is a typical procedure used to treat pulmonary diseases at home and healthcare settings, but given the generation of droplets from aerosol delivery, it has a potential for “fugitive” emissions, resulting in respiratory pathogens and viral impact. In a nutshell, giving aerosolized medications to patients with COVID-19 can aggravate the spread of coronavirus. This is a real and present concern for caregivers and healthcare professionals who are susceptible to unintended inhalation of fugitive emissions during therapy. 3
Given the risks that delivering aerosolized medication pose, our partners are seeking products and solutions that reduce the amount of aerosol dispersed in the ambient air. Here are a few to consider when supply planning:
- Filtered nebulizers have seen a surge in demand, but supplies have been very short because historically they have not been used in large amounts.
- Instead of using traditional (unfiltered) nebulizers to deliver aerosolized medication, many customers are pairing metered dose inhalers with a spacer to reduce the amount of aerosol generated; instead of aerosol being continually dispersed in the atmosphere, the aerosol stay in the chamber while the patient breathes it in.
- Valved tee adaptors and MDI adaptors are being used at an increased rate as the number of patients on ventilators increases; these products are put inline and used to deliver aerosolized medication to patients on ventilators.
The knowledge that COVID-19 subjects can be asymptomatic and still shed virus, producing infectious droplets during breathing, suggests that health care workers (HCWs) should assume every patient is potentially infectious during this pandemic. Taking actions to reduce risk of transmission to HCWs is, therefore, a vital consideration for safe delivery of all medical aerosols.3
Four: ventilation consumables
Everyone understands that PPE and ventilator shortages have been acute during this pandemic. What many don’t realize is that as the number of patients on ventilators increases, demand for ventilation accessories focusing on patient and caregiver safety has increased as well. These items are critical to supply planning as the surge continues:
- Cuff pressure monitoring devices – Due to the practice of proning COVID patients, demand for products that ensure proper ET tube cuff pressure is high. Maintaining proper cuff pressure is important so secondary issues such as trach damage can be avoided. Products such as the AG Cuffill are single patient use and reduce the risk of cross contamination.
- Closed suction catheters – Maintaining a closed circuit is key for reducing aerosol in the ambient air for patient safety. This is especially true for intubated COVID patients who are typically on ventilators longer than traditional patients.
- BV filters are used on many products from vent circuits to resuscitation bags as a way of reducing aerosol in the ambient air.
- HME filters must be changed often to keep from clogging.
- Many customers are stocking up on resuscitation bags due to the increase in patient volume.
In order to bridge clinical efficiencies and a healthy supply chain, we’ve worked hard over the summer to understand the needs of respiratory professionals and prepare for the resurgence of higher COVID cases throughout the United States. Here are just a few examples:
- We’ve brought in additional inventory on all codes that experienced demand during the COVID surge in during Spring 2020
- We’ve worked to move 99% of our respiratory portfolio off allocation as of 11/23, enabling us to help many systems and facilities who may be continuing to have challenges with current supply shortages
- We’ve created a COVID list to help customers quickly identify which codes may be needed and check for backorders on current products
- We’ve developed a Respiratory Products Optimization Program to help customers improve efficiencies and reduce SKUs
Our goal is always to help healthcare providers get the products and solutions they need to provide the best patient care and ultimately save lives. Respiratory techniques, like oxygen therapy and proning patients to help with their overall respiratory health, along with having the right supplies to mitigate any further contagion, are clearly making an impact on the positive recovery of many COVID-19 patients.
Learn more about how Medline is empowering healthcare providers with critical respiratory products to help in the fight against COVID deaths by speaking to your Medline Representative today, contacting ProductSupportRespiratory@medline.com or calling 1 800 MEDLINE for more information.