As the CNE at Sutter Santa Rosa Regional Hospital (SSRRH), please accept my support of the ICU Team for the DAISY Award for Extraordinary Nurses in Patient Safety nomination. As one of the first hospitals in California to receive a COVID-19 patient, the ICU Team at SSRRH has been at the heart of the COVID-19 pandemic essentially since the beginning. Given the timing of our first COVID-19 cases, this team was required to become experts in COVID-19 care in a very short period. This team rose to the challenge, and their outcomes have been stellar.

Right from the beginning, this team relentlessly questioned and challenged our processes to ensure that they, their colleagues, and patients and families remained safe and connected during such isolating times. The ICU nurses collaborated with BioEthics, Infection Prevention, Supply Chain, Pharmacy, and Respiratory Therapy to develop what would become the standard of care for COVID-19 patients right from the beginning. As an example, this team quickly saw the need to connect patients and families despite visiting restrictions. They were the first in the Sutter System to adopt the use of iPads to connect patients and families using video, a practice that spread across the organization. From a safety standpoint, they implemented the “buddy system” for appropriate donning and doffing of PPE. They identified that our current PAPRs were causing skin issues on nurses' foreheads, and they partnered with Infection Control and Supply Chain to find alternative PAPR hoods. They also were instrumental in the ongoing selection of PPE and patient care equipment that ensured staff safety and comfort.

Most notably, this ICU Team quickly recognized the need for additional safety measures related to code blue and rapid response events in a COVID-19 isolation room. ICU nurses collaborated with the Code Blue Team to make numerous updates to our code blue and rapid response processes, including the creation of a “Respiratory Code Blue” and a “Respiratory Rapid Response.” This team voiced concerns that the emergent nature of these overhead pages could create conditions in which responders could potentially bypass isolation signage to quickly respond to the call. Adding “Respiratory” to the overhead page alerts responders that they need to don PPE prior to entering the room and that extra precautions must be taken to ensure that crash cart contents do not become contaminated. This was yet another process adopted as a best practice across our Sutter System ensuring the safety of our code blue teams.

Finally, this team’s results speak volumes. Throughout 2020, zero ICU staff developed COVID-19 or experienced high-risk exposure. Additionally, SSRRH’s hospitalized COVID-19 survival rate of 89%, aligns with top tier national performance. The team has seen the extubation and survival of numerous COVID-19 patients over the last two years. These results were not by chance. This team’s fixation on patient and staff safety and the implementation of novel and revolutionary ideas led to these excellent outcomes for our patients, staff, and community.

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The words I use to describe the past year and a half are not written in any dictionary. The staff of the Intensive Care Unit at Sutter Santa Rosa Regional Hospital collaborated on multiple occasions every day to support safe, evidence-based care to our most vulnerable patients. The care of patients with COVID were our primary focus, yet we continued with the customary care we provide all patients with critical needs.

In the initial stage of the pandemic, the staff were scared and nervous but enthusiastic to learn and engage in keeping patients and staff safe. They researched safe care of a respiratory isolation patient outside of their work hours and emailed suggestions to contribute to policy and practice development. Staff were eager to participate in review and refinement of our new work. The charge nurses collaborated with the Code Blue team and Intensivist staff to develop a safe way of responding to Code Blue and Rapid Response events. Alerting the responding team to patients that were Covid positive, and this practice spread throughout the organization as a best practice. The staff also created a “buddy system” to ensure our personal protective equipment was donned and doffed correctly.

Christmas of 2020 was a particularly difficult time. Holidays and deaths in critical care are generally hard on the employees, but the number of deaths that we witnessed in the month of December was devastating. During this time, we gathered in small groups to discuss the current information of the virus, shared our personal feelings of grief and supported one another in returning to our daily work. A portion of our discussions were focused on managing our own emotions so that we could safely provide the care that our patients needed. One particular case was a husband and wife of a large family, and we coordinated efforts for each family member to say their goodbyes, assuring that they were protected with donning and doffing with the same equipment but allowing that hard felt closure to say their final goodbyes. Not only through technology.

For the majority of 2021, we continued to improve upon our protocols as new information was discovered. We collaborated on our sickest patients and used our knowledge to teach each other, the patients, and their families. As we end the year, our protocols are revised with new information, we don and doff with expertise and our patients are finally surviving the virus and going home. As the manager of the Intensive Care Unit, I am proud to say that none of our staff contracted COVID-19 while at work, and we had no spread of COVID-19 within the unit. The staff participated in the development of our safe practices and influenced the outcome of safe patient care and a healthy work environment.

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We’d like to nominate the ICU staff for their exceptional care, their outstanding bedside manner, and their unwavering empathy for my grandmother and our family. Your physicians and nurses took such incredible care of my grandmother and treated us with so much respect and kindness. They ensured we could see her face and even hold her hand during the last moments of her life despite the circumstances that COVID-19 brought.

During a routine exam we learned that my grandma needed immediate care and potentially an amputation. We never imagined she would spend her last few months of life in the hospital and that this would be one of the last times we would see her in person. Initially, she was happy and joyful, describing the hospital as a “5-star hotel.” She couldn’t believe how well she was treated and how kind your nurses were. She worsened over the next few weeks. We tried to ease the news that she wouldn’t return home, but that was difficult over the phone. Your staff helped tremendously, ensuring that each member of her care team thoughtfully explained this news to her, so it finally became reality.

Over those weeks, your staff set my grandmother up daily to FaceTime and see our faces. Most importantly, we could see hers – This was so incredibly special. I sent photos and videos of my son, who she loved and adored beyond words. This kept her spirits up and gave her the strength to push forward. She was finally released to a rehab facility but later returned to the hospital. That’s when we learned she had signed a waiver stating she wanted only comfort care. That night will live as a most profound memory in my life, one that I’ll always be incredibly grateful for. I was given the greatest gift of seeing my beautiful Nana one last time. She was disoriented after those 8 weeks in the ICU; however, her face lit up when she saw us. We held hands, told stories, and laughed together. I’ll never forget that night. It was the most cherished gift I’ve been given. When she approached her final hours, my father came to see her one last time. Her room was the most soothing, comforting room he’d ever seen. The nurses were like heavenly angels here on earth. She was very disoriented, but she recognized my father immediately. He was given as much uninterrupted time with his mom as he would like. He told her it was ok for her to go and she peacefully passed a few hours later, holding the hand of one of your angel nurses. We are forever grateful that my grandmother felt comfortable, could laugh, and enjoyed the company of the nurses and staff who cared for her over those 8 weeks. Each time we drive by Sutter we smile, remembering my grandmother and being so appreciative to your amazing staff who took care of her. Thank you from the bottom of our hearts.