Monthly archives: March 2020

Covid-19 Bulletin: Friday 13 March 2020

The Trust is now publishing a daily bulletin. This will take all guidance and information and tell you which changes we are implementing when and how. Please use this bulletin and daily cascade arrangements within clinical groups to guide local action.  Remember KINDNESS is our watchword in implementing these changes.

1. Tonight and tomorrow we are separating some wards and our A&E flows.

In order to safely treat all our patients, we have temporarily cancelled non-urgent routine surgical procedures that require inpatient beds.  From Tuesday most outpatient clinics will be telephone only.  Plans are in place to scale up our acute medical units and critical care. We are also separating patients with suspected COVID-19 in our AMUs and EDs.

At City, AMU 1 will be used for patients with suspected COVID-19 and AMU 2 for all other patients with expansion into D25. AMAA moves to the Medical Infusion Suite which will be relocated to Rowley Regis Hospital. ITU has expansion capacity at D16.

At Sandwell, AMU A bays F and G will be kept for patients with no COVID-19 symptoms with expansion into Lyndon 2 for patients who don’t need monitors.  ITU can expand into the now vacated OPAU.

Surgical patients on L3 are today moving to L2, and L3 will next week become the general surgical ward allowing SDU to endeavour to continue its current function.

2. Changes to COVID-19 testing

In line with national guidelines there will be no further testing in the community. Testing is now only for inpatients regardless of travel history if they present with

• Either clinical or radiological evidence of pneumonia
• Acute respiratory distress syndrome
• Influenza like illness (fever ≥37.8°C and at least one of the following respiratory symptoms, which must be of acute onset: persistent cough (with or without sputum), hoarseness, nasal discharge or congestion, shortness of breath, sore throat, wheezing, sneezing)

Clinicians should be alert to the possibility of atypical presentations in patients who are immunocompromised.

3. Isolation protocol and PPE requirements

A clear protocol is in place for isolation of patients and the PPE requirements for attending to our patients. The attached document gives the full detail. You must read this to ensure you know what to do.  It may differ from prior guidance you have seen.  It covers:

• Isolation in a HBNO4 side room or side room with en-suite facilities for COVID-19 confirmed cases
• Cohort isolation in a bay for suspected COVID-19 patients (who fit the case definition and have been swabbed)
• Cohort isolation or side room for patients in contact (adjacent beds) to COVID-19 positive patient

If capacity prevents such patients being managed as outlined, this must be highlighted to the site team.

COVID 19 Isolation and PPE

4. Changes to services including visiting hours

Tomorrow at midday our visiting arrangements (on all sites) change to protect patients, relatives and staff. There is no visiting apart from immediate next of kin who can remain with children, end of life patients and people who can’t make decisions for themselves (only for people covered in their notes as needing support because of mental capacity act regulations).

We have put digital phones and tablets in place in our ward areas so that patients can telephone or video call their family and friends. We hope this will help them stay in touch and reduce social isolation. PLEASE NOTE THAT THE EQUIPMENT SHOULD BE THOROUGHLY WIPED WITH CLINELL WIPES BETWEEN EACH USE.

5. Updated guidelines for staff

As you are aware, the guidelines for self-isolation have changed and this applies to staff as well as the public. People are advised to stay at home (self-isolate) without any testing for COVID-19, regardless of travel history or contact with confirmed cases, if they have:

• A new continuous cough, OR
• High temperature (of 37.8 degrees centigrade or higher)

The geographic element of the case definition has now been removed. Travel and contact history are no longer important for diagnosis, which is on the basis of symptoms alone. If people who have travelled do not have symptoms they do not need to stay at home, regardless of their travel history.

Individuals should stay at home (self-isolate) for 7 days from the onset of symptoms following the current advice. If someone has serious symptoms they cannot manage at home they should use NHS 111 online (people should only call NHS111 if they cannot get online).

After 7 days of self-isolation, people who feel better and no longer have a high temperature can return to their normal routine. This includes back to work in a healthcare setting. If they have not had any signs of improvement after 7 days and have not already sought medical advice, they should use NHS111 online (people should only call NHS111 if they cannot get online) before they leave their home or let visitors in.  The cough may persist for several weeks in some people, despite the coronavirus infection having cleared. A persistent cough alone does not mean someone must continue to stay at home for more than 7 days.

Staff who have been in contact with a confirmed COVID-19 case are able to carry on working if they are asymptomatic. They should self-isolate for 7 days if they have symptoms. The questions and answers for staff are attached.

COVID FAQ’s 12.03.20

Covid-19 Bulletin: Thursday 12 March 2020

The Trust is now publishing a daily bulletin. This will take all guidance and information and tell you which changes we are implementing when and how. Please use this bulletin …

Heartbeat: Acknowledging and endorsing is essential to maintain safe care

Imaging and pathology have for a long time been an indispensable part of diagnosing and treating patients. When there is something you want to visualise and understand, whether it’s a broken bone, a blood culture or biopsy, they are the teams we turn to, and systems like Unity have now streamlined and simplified the requesting process to the delight of clinicians across the Trust.

However, once requests for imaging and pathology have been received, processed and reported, colleagues are now also presented with the findings and are tasked with one final undertaking, acknowledging that results. Acknowledging (or endorsing) results is essential, it takes seconds and is the only way to show that the results from imaging or pathology have been seen and acted upon.

To find out more about the process of endorsing results, Heartbeat spoke to Medical Director David Carruthers. He said: “I don’t need to tell you all about the importance of looking at and acting on results from your patients. Endorsement is an important part of that quality system.

“There are several ways to endorse results in Unity and it only takes seconds to do so, so please take the time to familiarise yourself and make it part of your routine. We will be releasing a range of short videos to demonstrate these processes but they are documented in quick reference guides.”

He added: “We are looking at the broader issues around results system and I think one of the most important aspects is the encouragement, support and time given on ward rounds and after clinic to discuss and endorse the results of your patients, documenting where needed actions that are taken or noting abnormalities. There is a lot to cover on ward rounds but if all parts of the system are working efficiently then quality and safety will improve.”

More information about the process of endorsing and acknowledging results can be found on Connect on the following link.

Suicide awareness – safeTALK

Whether directly or indirectly, most people with thoughts of suicide invite help to stay safe. This three hour accredited session prepares participants to recognise these invitations and connect a person with thoughts of suicide to intervention resources. Powerful videos illustrate the importance of suicide alertness, while discussion and practice stimulate learning.

Participants will be better able to move beyond common tendencies to miss, dismiss or avoid suicide, recognise people who have thoughts of suicide, and apply the TALK steps (Tell, Ask, Listen and Keep Safe) to connect a person with thoughts of suicide to a suicide first aid intervention caregiver.

Date: Wednesday 8 April
Venue: The Berridge Room, Courtyard Gardens, Sandwell Hospital
Time: 10am–1pm

Note: Future dates and alternative venues are available for all sessions.

For bookings and information please contact Jatinder Sekhon or Emma Williams on ext. 3306.

Clarification around isolation and PPE

We have agreed to follow national guidance:

Note: Taking throat and nose swabs are not classed as aerosol generating procedures.

This will also be applicable to community swabbing – for symptomatic, unconfirmed cases – surgical mask with routine contact precaution plastic aprons, gloves and strict hand hygiene.

The agreed list of aerosol generating procedure (AGP) is:

• Intubation, extubation and related procedures such as manual ventilation and open suctioning
• Tracheotomy/tracheostomy procedures (insertion/open suctioning/removal)
• Bronchoscopy
• Surgery and post-mortem procedures involving high-speed devices
• Some dental procedures (such as high-speed drilling)
• Non-invasive ventilation (NIV) such as Bi-level Positive Airway Pressure (BiPAP) and Continuous Positive Airway Pressure ventilation (CPAP)
• High-Frequency Oscillating Ventilation (HFOV)
• High Flow Nasal Oxygen (HFNO), also called High Flow Nasal Cannula
• Induction of sputum

Coronavirus drive-thru facility at Sandwell

A Coronavirus drive-thru facility will be set up  on the Sandwell Hospital site over the coming days.

It will be situated on Little Lane car park and will be by appointment-only as directed by NHS 111.

The drive-thru will be operated by Sandwell and West Birmingham Clinical Commissioning Group.

Covid-19: Guidance for colleagues returning from affected areas

Public Health England have now also issued guidance for healthcare workers who have retuned from affected areas/countries. Please follow the link below for more information:

https://www.gov.uk/government/publications/novel-coronavirus-2019-ncov-guidance-for-healthcare-providers-with-staff-who-have-travelled-to-china/guidance-for-healthcare-providers-healthcare-workers-who-have-travelled-to-china

Colleagues should not attend a healthcare setting if there is a risk they could spread the coronavirus. If you feel you are symptomatic and you have been to one of the affected countries, you should self-isolate immediately and contact Occupational Health for advice on 0121 507 3306.

Coronavirus Occupational Health – Advice for staff

*If you have returned from Italy to the UK in the past 14 days please contact Occupational Health for further advice if you are at work or before returning to work.

We have lots of school students who have returned from skiing  trip from Italy. Please see the map of Italy below for reference in regard to testing for COVID 19 at present.

Yellow area – no special measures

Orange area – specified towns (see inset and listed below) are Category 1. Otherwise orange areas are category 2.

The specified areas (see inset map) are in the region of Daegu and Cheongdo.

The specified towns (see inset map) are in the regions of Lombardy and Veneto.

In the Lombardy Region:

• Bertonico
• Casalpusterlengo
• Castelgerundo
• Castiglione D’Adda
• Codogno
• Fombio
• Maleo
• San Fiorano
• Somaglia
• Terranova dei Passerini

In the Veneto Region:

• Vo

The H10 Costa Adeje Hotel, Tenerife has been included as a high risk (category 1) area and accordingly,  symptomatic individuals who have returned from this hotel since the 17/2/2020 will need to be tested if they develop symptoms according to the clinical case definition.

Clifton Scott sadly passed away

We are sorry to report the sudden passing of Clifton (Cliff) Scott, pathology delivery/transport driver on Saturday 29 February.

The Scott family invites colleagues to join them in marking the 9th night of his passing on Friday 13 March, 8:00pm at the Reminice Social Club, 178 Soho Hill, B19 1AG.

There will also be a homegoing ceremony on Wednesday 25 March at 12pm at the Church of God of Prophecy, 20 Farm Street, B19 2TZ with his resting place at Handsworth Cemetery, B21 8JT. Refreshments will also be provided at Jewels Conference Suite, 171 Rolf Street, B66 2AS.

Heartbeat: Rapid response team targets frail older patients

Against a national background of an ageing population and increasing frailty, our therapy colleagues have identified opportunities to provide a service targeted at this patient group. The initiative is designed to prevent unnecessary hospital admissions through our front door and keep frail older people safe in their own homes.

Emma Hibbs, Advanced Physiotherapist explains: “We know that nationally around 50 per cent of the population aged 65+ live with some degree of frailty. Our population is diverse, and experiences high levels of deprivation, with a reduced life expectancy. And, the number of people living with dementia is expected to rise vastly by 2030.

“To meet the demand of older patients, we created our Rapid Response Therapy Service (RRTS) to provide urgent assessment of frail older patients coming into our emergency departments to ensure they receive the most appropriate care for them, including avoiding admission where possible and providing ‘wrap-around’ community support.

“The integrated team is made up of physiotherapists, occupational therapists and assistant practitioners covering the emergency departments, acute medical units and older person assessment units for 12 hours a day from 8am to 8pm, seven days per week with a 10 minute response time to ED bleep referrals.”

The team uses proactive screening and identification of patients for therapy intervention and aims to divert demand from acute services where appropriate. Early access to comprehensive therapy intervention and proactive use of community and voluntary services to support discharge delivers a reduced readmission rate, as patients are safely cared for out of hospital. Patients who require admission are assessed and an individual plan for their care is drawn up to allow discharge as soon as medically appropriate.

Nuhu Usman, Acute Medicine Consultant and Clinical Director of Emergency Care added: “On forming the rapid response team we had several ambitions, including reducing the numbers of frail older people who are admitted from 24-hour care, reducing length of stay for those patients, delivering a reduced readmission rate and a reduction in four-hour breaches.

“The team has received positive feedback from colleagues across our emergency department at Sandwell, and an admission prevention rate of 92 per cent for frail older people coming into Sandwell ED, with an overall increase in therapy activity of 41 per cent.

“With early access to comprehensive therapy assessment and discharge planning for patients through a ‘home first’ mind set and a substantial increase in onward referrals made to other community services in the voluntary sector and social services, we can see the difference the team has made.”

Farewell to Dr Roger Stedman: 20 March

This month we are saying goodbye to Dr Roger Stedman who is leaving the Trust to take up a post in Wiltshire. Many of you will know Roger from his role as Medical Director when he joined the Trust in 2012 and then in recent years in his role as consultant in anaesthetics and critical care medicine.

If you would like to catch up with Roger and wish him well over a coffee and cake before he leaves please come along to the Postgraduate Centre at City Hospital on Friday 20 March between 12pm – 3pm.