• Work on repairing document links

• PPE Advice Matrix

• Anaesthetic setup and technician guide
• In theatre communication for COVID cases
• Extubation guide
• Extubation checklist
• Guidelines for managment of COVID-19 patients summary sheet
• Sequence of events flowchart
• Paperless anaesthetic record - iPad instructions

• Communication – useful phone numbers
• Covid box label
• Emergency out of theatre rescue airway box label
• Emergency aerosol PPE pack

• Pre-op instructions for anaesthetists (included elsewhere)
• Anaesthesia management in pictures

• Added duty anaesthetist daily update template

• Sequence of events
• Theatre setup checklist
• Anaesthetic setup and technician guide
• Anaesthetic guideline summary sheet
• Intubation guide
• Intubation checklist
• Extuabation guide
• Extubation checklist
• Disconnection checklist
• Donning 1A - standard PPE
• Donning 1B - aerosol PPE
• Donning 1C - sterile, aerosol PPE
• Doffing 2A - standard PPE
• Doffing 2B - aerosol PPE
• Doffing 2C - sterile, aerosol PPE
• Communication in covid theatre
• Guidance for wards bringing patients to theatre
• ICU transfer
• Donning and doffing buddy role
• Circulating and scrub nurse role 
• Courier role
• MRT role
• COVID nurse coordinator (replaces Theatre nurse coordinator role)

• Sequence of events flowchart
• Obstetric sequence of events flowchart
• Closed circuit suction help sheet
• Guideline for specimen handling
• Guideline for cleaning theatre
• PACU role

We have adjusted the COVID theatre sequence of events. The patient will now be extubated on their own bed which will be brought into theatre at the end of the operation. This to reflect that the operating table is often not suitable for a person emerging from anaesthesia. It also aligns with the pathway for Obstetric Patients in theatre.

For further detail see the sequence of events (step 12) and the extubation guide. During the case you will have access to the intranet as well.

Another development has been the introduction of the PACU nursing team. A PACU nurse will join us in the COVID 19 theatre for any obstetric cases and can be available if required for non obstetric cases too.

If you require any assistance with COVID queries or cases coming to theatre; the COVID coordinator is available (on amion)

Key Features:

1. Goal to de-couple Respiratory Infection from travel, although presence of case definition AND travel is significant.

2. Please note that although the symptoms now capture a large number of people, the emphasis is on clinical suspicion of RESPIRATORY INFECTION, rather than just the presence of symptom (eg nasal congestion or post nasal drip from known allergic rhinitis).

Key Features:

1. Distinguish between Aero PPE apparel (aeroPPE gear) vs FULL Aero PPE PROCESS

   Aero PPE gear refers to Donning/ Doffing with apparel which includes N95 mask

   This can be done under urgency for potentially life or limb threatening situations when low community prevalence of COVID19 and undifferentiated situation, yet delay will result in predictable patient harm. Eg unconscious trauma with active life threatening bleeding, with no other known risk factors for COVID19, but unable to clarify.

   FULL Aero PPE PROCESS

   Includes Aero PPE gear/ apparel but combined with comprehensive COVID PROCESS (additional staff members / process stop & checks) which inevitably delays care. This, and any potential harm that arose from process delay, can be justified in known COVID POSITIVE or high suspicion of risk to staff.

2. Any Respiratory Symptoms now suspicious in keeping with Case Definition 3 April

3. Consider Discussion with Respiratory Physician

   Extremely valuable in clarifying risk/ access to testing

4. Binary outcome for non immediate risk limb

   Maintains simplicity

   Delay for full PPE process should not lead to patient harm