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Paediatric Pandemic Preparedness And Workflows: The KTP_NU6MI Experience

Overview: Principles of Pandemic Measures, Applied to Pediatric Care, Children’s Emergency, Inpatient Services, Specialty Outpatient Clinics, Leveraging on
Technology ■ Goelusion
Rationale & Principles of Our Pandemic Measures (Part of overall National Pandemic Preparedness & Response)
1. Protection of Healthcare Workers (HCW) and Teams : Integral to the continued provision of healthcare service
2. Compliance with Infection Control Policies: Training and use of PPE (Personal Protective Equipment) and PAPR (Powered Air Purifying Respirator),
Prevent infection to HCW and nosocomial transmission
3. Staff Segregation a) Location: Children^ Emergency; Inpatient; Outpatient clinics, b) Function: Junior Doctors (Active tearr (Intensive care unit,
Isolation wards) and Inactive team (Nephrology, Oncology, Day therapy)), Attending Doctors rostered weekly for inpatient subspecialty service
4. Social Distancing Measures at Work: Teams from different specialties are instructed to see a common patient separately and Handoffs and Handovers are
conducted by phone calls, secure communicatio 门 platforms
5. Principles Specific to Paediatric Care: Family-centred care and Infection control measures to include parents and caregivers

Children emergency
Located in the same area as adult Emergency Department, shared resources. Main areas include:Fever facility isolation rooms,Fever facility isolation
resuscitation rooms,Main Children’s Emergency. Strict screening protocols. All children/ accompanying caregivers with any fever, acute respiratory illness,
recent travel abroad in the last 14 days would be isolated in the fever facility
Protection of healthcare workers: Personal protection equipment in isolation facility, Powered Air Purifying Respirator (PAPR) for aerosolizing procedures,
Surgical mask in all other clinical areas
• Transfer of patients from CE to inpatient ward: Via a designated route, Involving security escort to clear the route, and environmental services team to disinfect
exposed surfaces thereafter
Challenges faced: Division of manpower due to patients diverted to different physical locations,Strict nursing protocols and escalation tools
Inpatient Services
• Overall containment policy in Singapore: admit and isolate all confirmed cases. Paediatric service: Nested within an academic hospital providing a full range of
adult services. Bed policy: Isolate all children with fever or any acute respiratory illness
• Unique considerations: Difficulty in enforcing strict hygiene measures in children. Increased risk of aerosolization
• Stratification policy: High risk: negative pressure rooms, Low risk: neutral pressure single rooms Resource Preservation
• Postponement of all elective non urgent admissions. Ring fencing shared hospital resources
• Visitation Policy: One dedicated caregiver, Caregivers under quarantine: Screened twice daily
• Reducing footprint of patients and staff: Deferment of non urgent appointments, Home delivery of medications, Teleconsultation
Reducing exposure risk: Telephone triage, Increase isolation room capacity, Physical distancing,Closure of playground
Swab and go: Special patient populations: Immunocompromised patients, Multidisciplinary clinics, Foreign non-resident patients Staff segregation •
Dedicated floors for service staff• Assignment of room assistants
Leveraging on Technology for Continued Care During COVID-19 Pandemic
Travel History and Contact History of Singapore citizens and permanent residents are integrated into our
NEHR (National Electronic Health Record)
Taking your physical event virtual? Tele-Consultation, Clinical Needs Patient suitability (IT literacy and
understanding) Informed consent
Foreign Patients: Language: English may not be their primary language, IT literacy: Email a set of tooltip
slides and screenshots to set up Zoom account and to join scheduled appointment meeting, Time zone difference between foreign country and Singapore

Conclusion & Future Challenges

COVID-19 pandemic may be prolonged as successful therapy, or the potential availability of an effective vaccine remains in the distant horizon.
Together with public health measures to reduce community spread, effective clinical and operational workflows W\W be required to ensure patient and
staff safety, whilst continuing to deliver best clinical care. Continually work in progress, we hope to enable and incorporate new solutions and innovative
technology in our ongoing battle with COVID-19.