Chief Survey Results Archive

June 12, 2020

 

GREEN - Sufficient to meet all needs	88%
YELLOW - Rationing - limited use	12%
RED - Unable to complete required procedures because of PPE shortages 0%

Comment Highlights:

• Triple negative negates PPE for vast majority of cases
• Supply currently adequate but being rationed supply likely
  not adequate for return to full capacity mask and scrub
  handout at hospital entry. Guidelines for use MOH has
  inherent rationing messaging in documents circulated.
• Some sizes of N95 at critically low stock levels. Repeat fit
  testing required for staff affected. Health authority does not
  have a good process in place for notifying physicians about re-testing. Procedure gowns in short supply. We were using plastic gowns with an open back for droplet precautions.

RED - Unable to complete required procedures due to medication shortages?	0%
YELLOW - Rationing - limited use	8%
GREEN - Sufficient to meet all needs	92%

Comment Highlights:

• Propofol is being supplied as a 2% solution now.
• Propofol - using 2% outside of OR.
• Supply is likely not adequate should all facilities return to full capacity.
• Many alternate suppliers, anesthetic medication
  substitutions due to supply chain interruptions, but stocks
  holding so far. Increased risk of medication errors. Requires
  provider vigilance.
• We have been fortunate not to have introduced 2% propofol as some Ontario hospitals have. Such a change is relatively safe in ICU where pump settings need to be changed. In the OR, where the drug is usually hand bolused, doubling concentration can be quite dangerous.

June 5, 2020

 

GREEN - Sufficient to meet all needs	75%
YELLOW - Rationing - limited use	25%
RED - Unable to complete required procedures because of PPE shortages 0%

Comment Highlights:

• We have concerns with the limited number of Glidescope covers required to assist with intubation.
• 2 masks per shift

RED - Unable to complete required procedures due to medication shortages?	0%
YELLOW - Rationing - limited use	15%
GREEN - Sufficient to meet all needs	85%

Comment Highlights:

• Propofol will be coming in 200mg bottles rather than the 100 mg bottles and that may cause some confusion with the TIVA sets.
• Tant que la baisse des cas et surtout les soins intensifs se
  maintien.
• Propofol 100 ml in short supply, rationed for use for ER
  transfer.
• We are hoping to have COVID PCR testing of patients prior to elective aerosol generating procedures.

May 29, 2020

 

GREEN - Sufficient to meet all needs	70%
YELLOW - Rationing - limited use	30%
RED - Unable to complete required procedures because of PPE shortages 0%

Comment Highlights:

• Moved to triple negative assessment (asymptomatic, screen negative, swab negative 24-72hrs preop) = means
  decreased PPE use.
• We continue to use PPE in the most appropriate way in
  order to conserve the supply.
• N95 masks being saved in case need to reprocess.
• Rationnement des blouses et des N95.

RED - Unable to complete required procedures due to medication shortages?	0%
YELLOW - Rationing - limited use	12%
GREEN - Sufficient to meet all needs	88%

Comment Highlights:

• Propofol shortage - moving to 2% propofol in some areas;
  Rocuronium shortage - moving to vecuronium and maybe
  pancuronium in some areas.
• Cisatracurium has been highlighted.
• Only doing urgent surgeries and procedures currently.
• Meds and PPE may be issue as we prepare to restart elective procedures on a limited degree.

May 22, 2020

 

GREEN - Sufficient to meet all needs	57%
YELLOW - Rationing - limited use	39%
RED - Unable to complete required procedures because of PPE shortages 0%

Comment Highlights:

• Masks distributed on arrival to hospital, replaced as needed. Some types limited supply. not affecting current level of care gowns limited. reusables being made/sourced.
• We have sufficient PPE for current procedures, but cannot make 30 rolling stock that Ontario has recommended prior to ramping up elective procedures. I don't believe anyone in Ontario has a 30 day rolling stock.
• Reusing visors, same mask for multiple patients.
• Surgical blouses and N95 masks are fragile. Currently we are at 70% operating room capacity.
• Surgical and procedural masks extended and reuse of masks. Reprocessing of N95 should they be needed.
• Good supply for all we NEED to do but we don't have 30 days supply, as the gov't requests, before starting to ramp up elective surgery.
• N95 and face shields are under the lock and key. Have to be signed out. N95 used until "grossly" soiled. N95 collected at the end of the shift to be resterilized.
• Worst part of this crisis for us was having to provide leadership and organizational forces for the OR. The hospital, local leadership and govt totally neglected to prepare the OR for this pandemic.
• Lacking sufficient glidescope blades for protected intubations.

RED - Unable to complete required procedures due to medication shortages?	5%
YELLOW - Rationing - limited use	30%
GREEN - Sufficient to meet all needs	65%

Comment Highlights:

• Still concern re propofol and rocuronium. Using 2% propofol in ICU now.
• We have a drug shortage taskforce that monitors the drug requirement and inventory.
• We are not rationing at present but are monitoring the known shortages.
• Running out of Propofol, midazolam. Sedation drugs in icu dictated by what is in greatest supply.
• Midazolam and fentanyl are limited for use in endoscopy. Propofol is ok for the ORs. Currently activities at 70% normal.
• Little short on fentanyl, but not rationing yet. Using more Sufenta than previous to help conserve the fentanyl for other departments.
• Suffisant pour le niveau d'activité permis de 50% de la normale.
• Large vials of propofol kept for the ICU areas. Most drugs in limited stock.

May 15, 2020

 

GREEN - Sufficient to meet all needs	60%
YELLOW - Rationing - limited use	40%
RED - Unable to complete required procedures because of PPE shortages 0%

Comment Highlights:

• Attention, le niveau de nos activités chirurgicales est à au plus, 40% de la normale. Dans ce contexte, nous avons assez d'EPI pour fonctionner.
• Downgrading level of protection required for gown usage.
• Gowns are in short supply and we are limiting the number of FIT positive colonoscopies due to this short supply. These are yellow gowns used for contact-droplet. It is not clear to be if these are level 2 gowns. I am finding it difficult to
  confirm gown rating.
• Le sujet des épi n'est plus discuté sur les différentes tables même si le nombre diminue quotidiennement sans évidence de remplacement. touche particulièrement les masques N-95.
• Les blouses se trouvent encore en quantité limitée. Les blouses sont des blouses lavables uniquement, le problème vient de leur entretien le stock de N95 est également relativement bas.
• PPE is rationed and of inferior quality.
• Masks and scrubs distributed on entering hospital. Replacements only if required gowns less than 14 day supply.
• Still uncertain about overall supply. We seem okay but are rationing use.
• The Hospital is fit testing all the staff to a cheaper ( more comfortable though) N95 mask as the more expensive ones are going to be running short if a second wave happened. We have changed the system so that if a patient is classified as green (low risk) no one has to wear an N95 mask and that will make to supply of masks last a lot longer.
• Our anesthesia group requested COVID testing in addition to COVID screening of patients prior to general anesthesia during periods of community spread. This request was denied. One of our anesthetists was badly bullied when he insisted on a COVID swab prior to distantly urgent general anesthesia in a patient who was symptomatic.

RED - Unable to complete required procedures due to medication shortages?	0.00%
YELLOW - Rationing - limited use	24%
GREEN - Sufficient to meet all needs	76%

Comment Highlights:

• Attention, le niveau de nos activités chirurgicales est à au plus, 40% de la normale. Dans ce contexte, nous avons assez d'EPI pour fonctionner.
• Rocuronium, decreased quantity in anesthesia carts.
• Problems with Propofol and Rocuronium could arise if we try to ramp up our surgical load.
• We have more than one month supply of all meds. Propofol however did not get delivered this week. Usually it gets delivered weekly.
• Toujours en quantité limitée mais sans impact sur la clientèle. Touche particulièrement le rocuronium. Plan de contingence en place pour une utilisation restreinte.
• No limitation on access at this time but pharmacy advising as to stocks likely inadequate supply to increase surgical services significantly.
• We are currently at 50% of surgical activities and attempting to not use Midazolam nor Fentanyl in the operating rooms.
• Still short of large bottles of propofol.

May 8, 2020

 

GREEN - Sufficient to meet all needs	77.27%
YELLOW - Rationing - limited use	22.73%
RED - Unable to complete required procedures because of PPE shortages 0%

Comment Highlights:

• We are unaware of the current stock and supply chain issues related to PPE. We have been provided with supplies with no restrictions.
• Real possibility that PPE will no longer be used for every intubation in our ORs. Plan is for COVID testing pre-op and routine precautions if negative. Pt is expected to isolate
  between testing and surgery.
• Still uncertain about the overall supply chain. No indication that anything has improved.
• We need more data about safety of OR personel. Have any OR personel been infected? What PPE were they wearing? what is the real evidence that intubation is an AGMP? How long are other sites waiting? What is the utility of patient education, self isolation, and testing for elective surgery? Can we effectively treat as non-Covid?
• No neck covers but we are inventing substitute ways of covering neck. Reusing visors after wiping them down.

RED - Unable to complete required procedures due to medication shortages?	0.00%
YELLOW - Rationing - limited use	31.82%
GREEN - Sufficient to meet all needs	68.18%

Comment Highlights:

• Very precarious situation with Propofol. Major issue is with 50-100ml vials for intensive care. 2 weeks stocks of 20ml vials at current 40% OR capacity. Without lacking propofol we would be at 60%+
• Many anesthetic agents; specifically rocuronium.
• Propofol supply limited as far as I know.
• It depends on the modelling but so far things seem improved.
• In danger of running out of both Propofol and midazolam due to increased volume of ventilated patients in ICU.
• No large bottles of Propofol.

May 1, 2020

 

GREEN - Sufficient to meet all needs	53.85%
YELLOW - Rationing - limited use	46.15%
RED - Unable to complete required procedures because of PPE shortages 0%

Comment Highlights:

• Limited in N95 and surgical/protective gown supplies.
• Certain N95s particularly short.
• I think we have run out of the better fitting 3M 1870+ N95
  masks, using 8210 as replacement. I'm told we have "green" level of supply.
• We are deeply concerned about supply, but for now we have appropriate PPE available as needed. We are following Public Health guidance to reuse N95 masks between patients. The hospital is keeping our single mask at the end of the day (they are not discarded) in case a method of sterilization and reuse is agreed upon in future.
• Short of hoods.
• N95 stocks are improving. Blouses have been short.
• Fluctuating guidelines and directives mean parts of the medical/operative team often get differing messaging on PPE use etc.
• Sustainabililty of single use disposable supplies being discussed and reusables being considered.
• There is enormus concern about asymptomatic patients, both prior to having symptoms (1-6 days!) and after symptoms OR those (woman in Italy still PCR positive 60 days post symptoms) who never develop symptoms. How do we protect ourselves from these ''Green'' patients as our guidelines state only surgical mask for these patients.

RED - Unable to complete required procedures due to medication shortages?	0.00%
YELLOW - Rationing - limited use	34.62%
GREEN - Sufficient to meet all needs	65.38%

Comment Highlights:

• Cautious use of sedatives/induction agents/muscle
  relaxants. Almost no supply of MDI.
• Hospital does not have an inventory system to measure burn rate.
• At our site sufficient. Also currently sufficient in our
  corporation.
• Medications are available for now. Rocuronium is being
  sourced from different suppliers to meet need. It therefore
  comes in different looking vials, which could increase risk of drug error.
• Asked to limit Propofol.
• Remaining very limited stocks of Propofol Midazolam Fentanyl. Forcing us to stay at 40% of surgical capacity.
• We are not getting the large bottles of propofol in the OR
  anymore.

April 22, 2020

 

GREEN - Sufficient to meet all needs	46.88%
YELLOW - Rationing - limited use	53.13%
RED - Unable to complete required procedures because of PPE shortages 0%

Comment Highlights:

• Shortage of N95 and gowns most pronounced. Gloves,
  goggles, procedural masks seem "ok for now."
• Gowns particularly in short supply Neck protection in short
  supply. Used N95 masks are being collected for possible
  reprocessing Visors (used for droplet) are being wiped down and reused.
• Masques N95 très limités. De nombreux membres ont dû
  passer aux masques réutilisables en silicone (série 3M
  6000/6500/7500) mais les procédures de nettoyage et de
  désinfection sont mal déterminées / organisées.
• Our supply is apparently better than many peer and local
  hospitals, but they are still being treated as a scarce
  resource and limiting their use. The definition of AGMP is
  also narrow in an attempt again to ration the resource. This
  is very unsettling to all hospital staff.
• Réutilisation ou stérilisation des N-95 Confection locale des masques de procédure et jaquettes Transfert du matériel en centres pour personnes agées Actuellement, les N-95 sont en quantité restreinte mais nous pouvons encore travailler.
• Triage grids are in place to allocate appropriate PPE
  according to AGMP risk stratification.
• I've been told we are "green" for PPE, but I'm worried that this may include poor quality incoming PPE from China, given what I've heard about Alberta, and the Baltic countries experience.

RED - Unable to complete required procedures due to medication shortages?	0.00%
YELLOW - Rationing - limited use	38.71%
GREEN - Sufficient to meet all needs	61.29%

Comment Highlights:

• Taking precautions to limit use of sedatives/analgesics or muscle relaxants.
• Serious concern re drug supply with stock for 1 week or less only.
• Small site at larger corporation. Our supplies can easily be sequestered if needed elsewhere.
• Le propofol, le midazolam et le fentanyl sont très précaires.
  Nous avons changé pour utiliser le sufentanyl et le
  lorazapam par voie orale afin de prioriser le midazolam et le fentanyl pour les équipes d'endoscopie.
• Je suis TRÈS préoccupé par le fait que nous continuons d'intuber les patients asymptomatiques avec uniquement des masques chirurgicaux réguliers. Je crois qu'avec la propagation dans la communauté et les porteurs asymptomatiques CONNUS, nous aurons des équipes salle d'op infectées.
• Limited supply of propofol but this is likely due to central
  rationing from our pharmacy to prepare for the worst case
  scenario, which does not seem to be playing out in Toronto. Rocuronium is also in short supply but because elective surgery has been so curtailed, there have been limitations at present. Fentanyl is slightly better as they have been able to secure alternate unconventional supply.
• L'inventaire est rès difficile à obtenir en temps réel. Au-delà
  du message de pénurie, il est difficile de planifier tant
  l'usage que les différentes interventions à prioriser.
• Propofol: In the OR we have only the 20 ml bottles

April 15, 2020

 

GREEN - Sufficient to meet all needs	33.33%
YELLOW - Rationing - limited use	66.67%
RED - Unable to complete required procedures because of PPE shortages 0%

Comment Highlights:

• Low on N95 and especially low on gowns. Good supply of
  regular procedure masks and gloves.
• Our hospital says we have adequate PPE but they do not
  share the inventory. Nurses have masks rationed. We have
  run out of one size of N95 briefly.
• Have access to some N95 masks, getting FIT testing for
  respirator soon hopefully, have my own boots and shield
• All PPE is a concern, especially face shields, N95 masks.
• Some discussion from physicians to exceed Public Health
  Recommendations of April 6th, to add N95 for NON- AGMP
  care as well.
• Rationing means to use it wisely - limit people in contact ,
  use appropriately, save for possible reuse
• Tous limité limite les activité clinique 1 masque par personne par jours rationalisation de l'utulisation des n95
• Staff given PPE on entering hospital. Scrubs and masks
  appropriate for area of work
• At present, because of COVID situation we only do Surgical Emergencies + OB + Fractures. For a known COVID patient, all personnel (surgeon+ anesthetist + all nurses involved in O.R. were PPE. For other non proven surgical cases, we use PPE for anaesthetist and the anesthetic nurse. After intubation, 25 minutes wait time in O.R. and then the surgeon and nurses come in. After surgery all go out of O.R. except the anesthetist and the same assisting nurse and extubation is done and we wait for another 25 minutes settle time and then the O.R. is opened and pt is either kept to recover for some more minutes and then transferred to the Floor.
• Limited N95 masks. Vulnerable quantities of visors.
  Currently operating at less than 50% capacity and only
  performing semi-urgent and urgent cases.
• Pour la salle d'opération l'ensemble des équipements d'EPI
  est disponible mais les blouses sont en quantité limitée. Pas de limitation franche à l'usage mais les réserves sont basses (1 semaine)
• We've requested daily/weekly PPE supply updates from our hospital admin for the past 5 weeks. There has been very little response from hospital admin. The anesthetists really don't know how much PPE we have to perform important procedures.
• We are reusing N95 during the day on asymptomatic screen negative patients by putting another mask over top. In Covid positive patients we discared the N95 and use a new one. There is also a shortage of reusable and disposable gowns. Face shields provided by the hospital are adequate.

RED - Unable to complete required procedures due to medication shortages?	0.00%
YELLOW - Rationing - limited use	33.33%
GREEN - Sufficient to meet all needs	66.67%

Comment Highlights:

• Cautious use of rocuronium, propofol, sedatives and
  narcotics. Very low availability of salbutamol MDI.
• We have been asked to be aware of our use and are starting to take steps to protect our supply. No change to practice as yet.
• Limited use means - avoid wastage, use alternatives when
  possible, careful dosing.
• Pharmacy has pre notified that some meds may be in short
  supply in future
• I have already written today to our pharmacy in charge to
  make sure we have enough muscle relaxants in near future for use.
• Reportedly we are receiving 20% of our usual needs of
  Propofol, muscle relaxants and narcotics.
• Primary concern is the lack of guidance on managing intubation for asymptomatic patients. We do not have the PPE nor can we afford the time delays that would be involved in treating all asymptomatic patients as infected. Really as faster testing becomes available we need to statute that all patients coming for surgery should be tested for COVID19 until they can prove that they are immunized.
• With all the rules the Health Authority has turn overs are very slow and we are lucky to do half the work in a shift that we would have done before.
• Étant donné que les interventions chirurgicales sont
  diminuées à 20-30% nous pouvons maintenir nos activités
  d'urgence et une salle d'oncologie/obstétrique sans
  difficultés. Cependant, si nous avions à fonctionner à 100%,
  nous aurions de la médications pour un peu plus de 10 jours.
• Limited Roc, Propofol, Fentanyl, Midaz. Being rationed from
  Kingston.
• Very low on paralytics including critical shortage of
  cisatracurium and very low on rocuronium. Next worst
  situation is propofol so we are trying different strategies in
  the ICU to reduce consumption. Fentanyl is low but not
  critical.

April 8, 2020

 

GREEN - Sufficient to meet all needs	29.41%
YELLOW - Rationing - limited use	70.59%
RED - Unable to complete required procedures because of PPE shortages

Comment Highlights:

• N95 masks enough for now with conservative utilization approach. Unsure if regular surgical mask supply is enough for expected demand.
• Inventaire pour une semaine d’utilisation Livraisons limitées
• N95 mask recycling program - but have enough at the moment. Some equipment not available such as ankle high boot covers.
• N95 and face shields available but in very small number
• Ensuring that PPE is being used appropriately Collection of PPE for possible reuse
• My staff are being denied n95 for point of care assessment concluding pt could be asymptomatic carrier
• hospital protocol based on Ontario Health guidelines
• We currently have what we need but are still rationing to manage our supplies.
• Hospital has only told me that we have 2 weeks supply, for the whole hospital. OR is only doing life & limb board cases only. All cancer surgery and other "essential elective" cases are on hold. We are in planning to process and re-use N95 and surgical masks.
• Sufficient but we are being very careful to only use when absolutely indicated (ie. not for every intubation). Fears we may have shortages in the next 3-4 weeks if shipments don't arrive
• Assuming no community spread so far so OR PPE use on case by case approach now
• N95 masks being rationed - available but kept under lock and key.
• We are storing PPE already (specifically N95s) and rationing surgical masks (2 masks max per day). One N95 per day regardless of whether you come and go from hospital (worrisome for self contamination). For intubators, no established neck protection (being made ad hoc by anesthetists).

RED - Unable to complete required procedures due to medication shortages?	0.00%
YELLOW - Rationing - limited use	23.53%
GREEN - Sufficient to meet all needs	76.47%

Comment Highlights:

• Our site currently has sufficient supply as surgery has been effectively on Hold. However this could easily be diverted to our larger sites and our stores would be depleted.
• no elective procedures being done
• Inventaire pour un mois d’utilisation Allocations limitées
• There was an attempt to sequestrate Rocuronium from the OR.
• Not aware of any shortages being reported
• pharmacist has notified me of potential shortage of some commonly used medications ie midazolam
• Again, we have all we need, there is no rationing but many medications are on allocation and supplies are fixed.
• Warning of potential shortages of multiple meds
• Shortages of rocuronium, propofol - doing everything under regional that can practically be done that way, limiting intubation/GA. But warnings re limited supplies rocuronium, ketamine
• Paramount to have Canadian sourced supply of PPE and testing reagents.
• Insufficient operating rooms if all cases are considered possible covid positive. Rooms are out of service until patient is recovered and the room has been cleaned. There may be other urgent cases to do.
• The impact of delaying surgery to increase acces tu ICU bed is not without consenquences. I think that the real impact is not seriously taken in account. 
• Clearly, the forced rationing/vigilant limitation and stewardship of N95 heightens the stress of staff and physicians. ESPECIALLY anesthesia where we are NOT using N95 for intubation in asymptomatic patients w/o travel/Covid contact despite guidelines from GTA hospitals recommending N95 for all intubations during this pandemic.