Skip main navigation

Military Health System

Clear Your Browser Cache

This website has recently undergone changes. Users finding unexpected concerns may care to clear their browser's cache to ensure a seamless experience.

Airman uses SBAR to improve COVID-19 swab technique

Image of Military personnel in full PPE at a car window demonstrating a swabbing technique. U.S. Air Force Tech. Sgt. Steve Zavala, 422nd Medical Squadron medical operations flight chief and trusted care champion, demonstrates COVID-19 testing procedures at RAF Croughton, England, August 3, 2020. Zavala discovered a COVID-19 testing technique that needed to be changed, so he elevated the concern and impacted testing procedures across the Department of Defense. (U.S. Air Force photo by Airman 1st Class Jennifer Zima).

Recently, an Air Force medical technician at RAF Croughton in England uncovered a COVID-19 testing technique that needed to be changed, so he elevated the concern and impacted testing procedures across the entire Department of Defense (DOD).

Air Force Tech. Sgt. Steve Zavala, 422nd Medical Squadron medical operations flight chief and trusted care champion, along with three fellow medical technicians, have been testing patients for COVID-19 at the 422nd MDS using the same testing procedure used for the seasonal flu.

“The particular method to collect the COVID-19 swabs is called the nasopharyngeal swab,” said Zavala. “The training that we received is dictated down from DHA [Defense Health Agency]. The DOD Global Respiratory Pathogen Surveillance questionnaire lays out step by step how to do a nasopharyngeal swab.”

One of the steps when collecting a sample, is to first have the patient blow their nose into a tissue. However, while watching COVID-19 testing on the news, Zavala noticed other medical professionals were not having their patients blow their noses before collecting samples.

“I was pretty confident we were doing something wrong here, something just didn’t seem right to me.” said Zavala. “I did some research and finally came across a step-by-step guideline according to the CDC [Centers for Disease Control and Prevention] on what you should do for nasopharyngeal swabs.”

Zavala noticed there were no recommendations stating that patients have to blow their noses. He then searched the Air Force Medical Service Knowledge Exchange COVID-19 page but didn’t find any recommendations for this there as well.

“There’s this big push for medical Trusted Care, not only in the Air Force but across DOD,” said Zavala. “We’re trying to mirror the reliability that the nuclear industry and commercial aircrafts have. Let’s take the naval aircraft carriers for instance. You have jets landing and taking off all the time on these little precise aircraft carriers, and how many times do we hear accidents happening with that? It’s few and far between that stuff happens in the airline and the nuclear industries. Medical has been trying to adopt the principles that those industries have, and we call it Trusted Care.”

Trusted Care is not a program, but a type of culture focused on improved communication.

“It took us three years to get to the point where we’re starting to see some of the positives from doing all of the Trusted Care work. Every department has their own daily huddle. That’s the time to bring up any safety concerns – it’s all safety driven. Every meeting that we have starts with safety moments and safety stories. It’s hard for people sometimes. They just fix things on the fly – they don’t think of things as a safety moment. The way that people learn the best is from stories. It’s to get people to look at things in a different way and maybe it will trigger that story in their mind when they see something else. In a hospital anyone can find something that can be a huge issue.

A Situation, Background, Assessment, Recommendation (SBAR) report is part of Trusted Care. It’s a technique used in healthcare to facilitate in communicating recommendations to improve patient care.

“You’re recommending an action be taken,” said Zavala. “You’re not just complaining about something wrong, but you’re recommending up to the highest levels.”

Zavala sent an SBAR report to his leadership, explained the situation and asked for clearer guidance on testing procedures in order to have more accurate results. They sent the SBAR, and the recommendations to discontinue nose-blowing, to the U.S. Air Forces in Europe Trusted Care Regional and head laboratories. From there, the report gained Air Force level attention.

“The form that is DOD-wide is going to be changed to match the CDC,” said Zavala.

“Speak up if you see something that doesn’t jive with what you’ve been taught,” said Zavala. “A big thing in Trusted Care is to exercise a questioning attitude. It’s always good to ask people for a cross check ‘hey, does this seem right to you?’ It ties into our core value of excellence in all we do. Why are we taking the time to do this, if you feel it’s not the best method?”

You also may be interested in...

Publication
Aug 1, 2022

Whole Health System Approach to Long COVID

The U.S. Department of Veterans Affairs Veterans Health Administration is leading an effort to equip health care providers with a Veteran-centered Whole Health System approach to caring for Veterans with Long COVID, also known as post-COVID-19 conditions.

Publication
Oct 21, 2020

Updated Guidance for Performing Temperature Checks at Military MTFs and DTFs

.PDF | 179.18 KB

This guidance is an update to Defense Health Agency Return to Full Operations Concept of Operations, V5.0 (June 12, 2020) as it pertains to temperature checks in MTFs and DTFs. Based on recommendations from the Centers for Disease Control (CDC), previous guidance directed MTFs to take the temperature of all individuals entering the facility. ...

Publication
Aug 6, 2020

Force Health Protection Guidance (Supplement 12) -Department of Defense Guidance for Personnel Traveling During the Coronavirus Disease 2019 Pandemic

.PDF | 4.56 MB

This memorandum supplements requirements in references (a), (b), and (c) with respect to coronavirus disease 2019 (COVID-19), and replaces reference (d). It provides pre- and postĀ­travel guidance for purposes of force health protection (FHP) of Service members, DoD family members, DoD civilian employees, and DoD contractor personnel.

Publication
Jun 3, 2020

Communication to ABA Providers Regarding Continued Temporary Authorization to Utilize Telehealth for CPT Code 97156 During the COVID-19 National Emergency

.PDF | 122.59 KB

TRICARE is announcing the continuation of the temporary exception to policy regarding the use of synchronous telehealth (TH) capabilities (both audio and video) for Applied Behavior Analysis (ABA) Family Adaptive Behavior Treatment Guidance services specifically during this COVID-19 pandemic.

Publication
May 26, 2020

Force Health Protection Guidance (Supplement 9) -Department of Defense Guidance for Deployment and Redeployment of Individuals and Units during the Novel Coronavirus Disease 2019 Pandemic

.PDF | 243.02 KB

This memorandum provides force health protection (FHP) deployment and redeployment guidance for Service members (including Reserve Component (RC) and National Guard members in a title 10 or title 32 duty status) and DoD civilian employees deploying within and outside the United States during the COVID-19 pandemic, consistent with references (a) and (b).

Publication
Apr 20, 2020

Modification and Reissuance of DoD Response to Coronavirus Disease 2019 -Travel Restrictions

.PDF | 960.08 KB

All DoD Service members will stop movement, both internationally and domestically, while this memorandum is in effect. All DoD civilian personnel, and dependents of DoD Service members and DoD civilian personnel, whose travel is Government-funded will stop movement, both internationally and domestically, while this memorandum is in effect.

Skip subpage navigation
Refine your search
Last Updated: July 11, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery