Title

Corazon Locsin Montelibano Memorial Regional Hospital Anesthesia Care Nurse Program

Organization

Corazon Locsin Montelibano Memorial Regional Hospital

Best Practice Focus Area/s

Human Resource

Year Implemented

September 2, 2013

Summary

The Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH) Anesthesia Care Nursing Program (ACNP) was developed in 2013 to address workforce shortages and enhance service delivery by training nurses to become competent at perioperative anesthesia care. CLMMRH developed this program by integrating into its curriculum the training of nurses who can assist physician-anesthesiologists, especially in rural government hospitals. With anesthesiologists operating as frontliners during the COVID-19 pandemic, those trained by the ACNP program have also proven to be important contributors, as their specialized skills allow them to perform delicate procedures such as the intubation of patients who need ventilators.

Background and Problem

As the only government tertiary hospital on Negros Island, CLMMRH is the end-referral hospital for Bacolod City, Negros Occidental, and neighboring towns in both Regions VI and VII.[2] However, despite the increase in the number of beds in 1981 by virtue of Batasang Pambansa Bilang 118, there was no corresponding increase in personnel positions up to 2013.

The lack of corresponding increase in the hospital’s workforce for those 32 years resulted in a shortage of healthcare workers for the growing population. Bacolod City alone grew from a population of 364,180 to 511,820 from 1990 to 2010, and there was still no increase in bed capacity or personnel services. In 2008, Region VI only had 234 doctors and 401 nurses in government and 0.78 beds per 1,000 population.

The services of the Department of Anesthesiology suffered during 2013, as the doctor-to-patient ratio was one doctor to every 21,632 population in Bacolod City, and was 1 for every 47,527 in Negros Occidental. From 2011 to 2012, only five full-time consultants and six resident anesthesiologists manned six operating rooms and attended to 5,816 cases annually. This was when there were very few medical graduates due to the exit of nurses from the country. There were no applicants for residency training in the department for 2012 and 2013. The two-year gap resulted in only two residents remaining in the middle of 2013.

This workforce shortage burdened anesthesiologists-controlled processes in the operating room and resulted in long turnaround times, the cancellation of scheduled surgeries, and overall decreased capacity. Dr. Julius Drilon, the Medical Center Chief, challenged the department in 2013 to innovate and empower the nurses to address this problem, with the main goal of fulfilling the organization’s mandate to deliver accessible, safe, equitable, efficient, and affordable anesthesia care. The initiative also sought to train nurses in the necessary competencies to complement the physician anesthesiologists so that service can be delivered to every patient consistently.

Solution and Impact

The solution to the workforce shortage was to design and implement a program that will empower nurses and enable them to be effective and efficient members of the anesthesia care team.

The training program introduced medical knowledge essential to understanding concepts in anesthesiology through a series of didactic lectures and case methods. These were aimed at developing anesthesia-related clinical competence among the nurses, subject matter beyond the scope of the usual medical, surgical and intensive care nursing. Trainees were made to demonstrate skills in performing safety checks, drug preparations, and assisting in performing anesthetic techniques. Emphasis was also given to non-technical skills such as communication skills, use of technology, and practice of evidence-based medicine. Most importantly, the trainers integrated values of professionalism, integrity, and teamwork to cultivate a culture of safe, humane, and compassionate care among the trainees.

On September 2, 2013, the CLMMRH Nurse Anesthesia Assistant Training Program (NAATP) started with four nurses, but the program was soon renamed to ACNP following the issuance of Department of Health (DOH) Administrative Order No. 2014-0014.The CLMMRH ACNP retained several features of the NAATP, including earlier exposure to clinical cases for skills-learning and a hands-on approach during tutorial sessions with consultant and senior resident anesthesiologists, which has proven essential to developing clinical competence. The program immediately contributed to easing surgical backlogs in the first year of implementation, as it was found that while only 85.02% of cases scheduled in October 2013 were performed, the figure had reached 99% by November 2014.

On March 14, 2020, the department deployed its team to respond to the COVID-19 pandemic, which led to a paradigm shift in the role of anesthesiologists in emergency care. The CLMMRH COVID-19 Airway Team is composed of a consultant or senior resident anesthesiologist and an anesthesia care nurse who are capable of performing intubations for suspected, probable, and confirmed COVID-19 cases. This is unique to CLMMRH as there have been no reports of any other institution in the Philippines where anesthesia care nurses have successfully performed this role–the CLMMRH COVID-19 team has had no record of failed intubation or any breach in infection control procedures.

Milestones/Next Steps

Since September 2013, the program has had five batches–one as NAATP and four as ACNP–with a total of 17 nurses trained. In October 2014, DOH conducted a site visit to inspect the program’s learning activities, instructional design, and implementation of said learning activities, as well as to interview four of the program’s trainees. Overall, the DOH found ACNP to be satisfactory and advised modifications to adopt specific topics in didactic lectures. Subsequently, the training program duration for the second batch was extended by six months.

References

Drilon, J., Tagbilaran, J., & Marisol, R., Quality Management System manual QMS.QM.001 Issue No. 006 (2020). Bacolod City.

Local Water Utilities Administration. (n.d.). Philippine Population Census. Provincial Population Data. chart. Retrieved June 18, 2020, from http://122.54.214.222/population/index.htm.

Manyazewal, T. (2017). Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities. Archives of Public Health, 75(1), 1-8.

Office of the Secretary, A.O. No. 2014-0014: Guidelines on the Department of Health Anesthesia Care Nursing Program (2014). Metro Manila; Department of Health.

Philippine Statistics Authority, The 2015 Census of Population (POPCEN 2015) (2015). Quezon City.

Department of Health. (n.d.). The Philippine Health System at a Glance. Department of Health. Retrieved March 30, 2022, from https://doh.gov.ph/sites/default/files/basic-page/chapter-one.pdf

Center for Health Development Western Visayas, 2013 Field Health Service Information SystemAnnex 3B.1 (2014). Iloilo City; Department of Health Center for Health Development Western Visayas.