Quality improvement and rapid PDSA cycles to maintain routine surveillance of pulmonary pathogens during the COVID-19 pandemic in a pediatric cystic fibrosis clinic

BACKGROUND: The COVID-19 pandemic necessitated immediate transition from in person to telehealth encounters; novel nursing practices were needed to ensure that children with cystic fibrosis (CF) receive care that approximates evidence-based guidelines. LOCAL PROBLEM: The aim was to ensure that as many children as possible received routine surveillance of pulmonary pathogens by a CF culture sputum culture during a pandemic. METHODS: Multiple Plan-Do-Study-Act (PDSA) cycles were utilized to implement practice change over four months. INTERVENTIONS: Cultures were obtained via curbside appointment with a registered nurse (RN) or at the patients' home with mailed equipment. RESULTS: 133 cultures obtained: 50.37% (67) by RN collection curbside and 49.62% (66) by self/caregiver at home. 120 culture swabs or sterile cups were mailed; 55% (66) were returned. Cost of mailing equipment was $760.16. CONCLUSION: Nursing utilization of PDSA cycles developed novel processes that ensured guideline-based care during the initial months of the pandemic.