Monthly archives: April 2020

COVID-19 Bulletin: Sunday 5 April

This is our once a day bulletin. This will take all national and professional 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 our plans.

We will be looking to deploy our first dozen HCAs and nurses into the Birmingham NEC Nightingale Hospital. If you wish to volunteer interest in this general medical ward work, please drop your details to our Chief Executive via tobylewis@nhs.net by 4pm Monday 6^th. You must be available in April for work.

1. New swabs for patients and staff swabbing update

Capacity to test patients and staff is now expanding rapidly. Our Black Country Pathology laboratory at New Cross will be processing patient swabs alongside the current PHL Lab at Heartlands. Existing swabs can be used but new swabs will also be available. A briefing on that is attached.

Read the lab briefing document.

The local health and care system is still able to access staff testing for symptomatic staff and adult household members whose symptoms are preventing you being at work. So far we have tested and reported over 1,000 local staff which we understand is the 2^nd largest volume in the NHS. Please do come forward if you believe you meet the criteria, details of how to do that are below.

Monday – Friday 9am – 5pm, call 0121 507 2664 option 5
Weekends 9am – 4pm, call 07970428995 or 07816992873

2. If you are not getting the PPE you need, say so

Our guidance on PPE is displayed outside every department. Yesterday we altered our guidance to include visors or eye-wear with a surgical face mask for some situations in red areas. In order to help keep you safe and working with departments, we have moved to a ‘drop off’ system for most PPE. That system has been running this weekend. If you are a line manager / shift leader and are not getting what you need please email our CFO dinah.mclannahan@nhs.net and we will work out what’s gone awry.

Supply of both gowns and scrubs continues to be a challenge and external suppliers are being sourced to improve the position. That change, and Trust-led laundry, will be confirmed on Tuesday 7^th April.

3. This coming week is “the start of the surge”

It is really important that we have all of our new critical care capacity open this week. And that we bolster ward staffing numbers, whilst supporting the Nightingale ‘plan b’. If you are unsure where you are moving to please talk to your Group Director of Nursing or Group Director. If you listed for induction training, you must attend that if you are fit to be at work. The training will give you an insight into how you will work, what you need to know and how you will be supported.

It will not be possible for all staff who had booked leave over Easter to take that leave. Please be flexible with those creating “weekday” staffing models for the coming weekend. It will be much easier to work with individuals and support ‘a few days off’. If this has not proved possible by 08.00 Wednesday 8th then we will resort to a complete leave ban. That is not what we wish to do, because this is a marathon not a sprint.

4. Please put yourself forward for our Brigades

We launched on Friday our volunteerbrigade.swbh@nhs.net process to ask those working away from patient care now, or working from home, to opt into our brigades to bolster numbers in key areas like cleaning, portering, transport and clinical administration. Thank you to everyone who has come forward so far. Please do consider whether this is your role in the weeks ahead. We will support you with training and induction. Read more information here.

5. Changes to our staff pregnancy guidance

Last weekend we issued Trust guidance supported by the Royal College on working whilst pregnant. That initial guidance highlighted 28 weeks as the cut off period after which working in COVID-19 areas was not advised. Subsequently the guidance nationally was changed. We are now changing our guidance.

Staff who are pregnant and less than 28 weeks should talk to their manager and identify existing work which can be done with lower risk of exposure to COVID-19 patients. This might include clinical administration or audit work. We believe this will impact around forty employees. If you need further advice please contact extension 3116 who will help to identify opportunities outside your immediate work area.

Read the RCOG guidance document.

COVID-19 bulletin: Saturday 4 April

The Trust has some more capacity to undertake swab tests over the next 72 hours for symptomatic staff and index cases (i.e. adult family members) causing you to self-isolate. If you could be available please contact 07816992873 or 07970428995. We need your car registration too!

1. Changes in Trust service provision

We have been working hard to maintain services for those most in need whilst creating new capacity (over 140 beds and 4 times the scale of ITU) that our patients will need in the weeks ahead. If you are uncertain about which services are where, which have changed, or whether new referral pathways are in place, you can either search on Connect or contact your Group Director of Operations.

No services have closed to referrals. All requests for our care will be logged, triaged, and managed according to clinical prioritisation. Some services have moved site – ENT and urology are now largely based at Sandwell. Serenity has moved, with midwife led births taking place through our delivery suite. Leasowes has become wholly an end of life centre with community wards moving to expand Rowley Regis. Wards remain designated red or blue. The up to date register of that is maintained on the opening page of Connect.

On Sunday 5th arrangements for paediatric A&E attendances change on both acute sites. In the days before Easter we relocate Gynae-Cancer Centre, and make changes to Haematology. This is part of work to make sure that care ‘beyond’ Covid-19 continues.

2. Getting paid in the month ahead

Staff, both substantive, and bank workers, are working in new locations. Many are moving location even within a week. This is creating anxiety that payments may be delayed or made late. We are working to put in place additional checks to support you getting the right pay at the end of April. This is complex with many more staff working this Bank Holiday, others being paid new or critical rates in March, and revised bank rates (£2hr) and for some nurses (£4.50hr) who work a block of shifts. Please be assured any mistakes will be looked into and rectified.

Managers are asked to make sure that shifts are verified for March. Revised arrangements for verification in April, easing the burden of doing that, will be announced next week. We want to make sure people working hard are paid right and on time.

3. Updated PPE guidance

New posters will be issued over the next two days and posted Trust-wide reinforcing the PPE guidance published by the Trust over the last week. The video made by Dr Mark Anderson has been widely shared. Largely latest PHE guidance has caught up with us!

We have made one interim and immediate change to our policy. This will be further reviewed on Wednesday 8th. In Red Areas you only need to wear FFP3 masks when in close and active contact with patients (within 1m of those at risk of deterioration). In all other red circumstances we now recommend wearing a visor and surgical face mask, along with gloves and apron.

4. Confidentiality reminder

All of us know someone who is isolating for Covid-19 or may know someone being treated. That includes those being in our Trust and nearby. This is an incredibly distressing time for everyone.

Sadly it is also a time when media attention is on us all and NHS workers social media accounts are studied by journalists and others. It is timely to reiterate the need not to be source of breaching any families’ confidentiality at this or any time. Please consider the time needed to grieve of those we look after. This process of grief may be different to your experience in your career, because many are dying without all of their loved ones present. This can evoke different and complex reactions. That is why the Trust has put in place extensive grief and bereavement support for our workforce and those we look after as patients.

5. Join 140 colleagues and get into a hotel soon please

We have been asking you to think about relocating into one of our hotel rooms. These are great options to protect those you share a home with, and to help ensure you are able to work as we tackle Covid-19. You can access a hotel easily by emailing swbh.hotel-booking@nhs.net. And you can see more information about the hotels on offer here . If you receive a letter or email from us in the day ahead, please consider this option very seriously. If you do not get a letter – you can still self-nominate for a hotel.

Heartbeat: Eye can see clearly now

Clinicians at Birmingham and Midland Eye Centre (BMEC) are using state-of-the-art monitoring equipment as part of a trial which aims to improve the quality of life for children with a life-limiting disease.

We are working with Heartlands Hospital, in a trial which assesses whether the drug risdiplam eases visual problems in youngster suffering from Spinal Muscular Atrophy (SMA).

For each eye test, patients are seen by the research nurse, orthoptist, optometrist, photographer and ophthalmologist.

As part of the study, equipment worth up to £70,000 is being used by ophthalmologists which enables them to scan the back of the eyes.

They are monitoring five patients over a period of two years.

Abdul-Jabbar Ghauri, Consultant Paediatric Ophthalmologist and Paediatric Ophthalmology Service Lead, explained: “We are monitoring our patients who have SMA and are part of the trial for potential visual problems.

“The paediatric ophthalmology department has received some cutting edge devices in the form of an Aurora handheld camera and a Bioptigen handheld Optical Coherence Tomography.

“These allow us to take photographs and special scans of the back of the eye in patients who are not mobile enough to use our desk mounted equipment for example, those who are wheelchair users.

“The equipment is also being used in a similar manner for our other patients and has been particularly helpful in examining premature babies with retinopathy of prematurity.”

SMA is a rare genetic neuromuscular condition, affecting approximately one in 6,000 babies born worldwide each year.

It is typically diagnosed in children and causes muscles to weaken and waste away. Depending on its severity, people with the disease will have difficulties moving, eating, and in some cases breathing, making them increasingly dependent on parents and caregivers.

Mr Ghauri added: “The equipment is particularly useful in children as it is small and not intimidating. Taking photographs helps us to document any problems and is also useful when explaining the condition to parents.”

Clinical skills update for colleagues

If you are going to be supporting clinical areas in the coming weeks you may feel you need a refresher or full training.

You book on to the below update courses via ESR:

Essential Nursing Skills – fundamental nursing skills needed to practice
Intravenous therapies short course – IV fluid and Meds / Cannulation & Venepuncture
Catheterisation Study Day – Male / Female catheterisation

Note: Please pre book so we can try to maintain social distancing

For more information contact the swbh.nurse-education@nhs.net

COVID-19 bulletin: Friday 3 April

Yesterday’s Bulletin confirmed that we would be staffing most services on a weekday basis over Easter Bank Holiday (April 10th-14th). For clarity pay rates will be on a bank holiday basis as per terms and conditions of service. We appreciate you will still be away from loved ones. Thank you.

Dealing with grief and loss

We have support in place on our City and Sandwell Hospital sites to help people who are dealing with feelings of grief and loss, recognising the very tragic patient deaths that have occurred at our Trust and in other hospitals across our region. On Saturday our independent, confidential counsellor Linda Davies will be on site at City Hospital from 8am to check in with colleagues (day and night). You can contact her directly on 07973 664125 or pop in to see her at D20. Paulette Bassan from our chaplaincy team will be at Sandwell 10am – 3pm on Saturday walking the wards and can be contacted directly on 07967 893082. Eddie Briones and Eberneezer Asaju from our chaplaincy team will be available via bleep on Sunday to support colleagues. In addition, you can ask for an appointment directly with a confidential counsellor by calling 3306 or through Health Assured Counselling on 0800 783 2808 which is available 24/7.

We mourn the loss of our colleague, Areema Nasreen, in Walsall Manor earlier today. Colleagues from our Trust and from primary and social care are currently being treated in our services and elsewhere. Our thoughts are with them and those looking after them.

2. Getting into a hotel as soon as possible

For the last fortnight we have been asking you to think about relocating into one of our hotel rooms. These are great options to protect those you share a home with, and to help ensure you are able to work as we tackle Covid-19. You can access a hotel easily by emailing swbh.hotel-booking@nhs.net. And you can see more information about the hotels on offer here. If you receive a letter or email from us in the day ahead, please consider this option very seriously. If you do not get a letter – you can still self-nominate for a hotel…

3. Changing job to support the fight against COVID-19

The Trust is now asking for colleagues to consider whether you can help support our response to the pandemic in a new way, by being part of a brigade that works in a different role. We need to ensure that vital roles such as distribution teams, portering, ward service officers and catering are sustained in the weeks ahead. You have an opportunity to volunteer to temporarily change your role and work in one of these areas by contacting volunteerbrigade.swbh@nhs.net – Read more information here.

4. Now wash your hands – Dr Mark explains PPE

By popular demand we are publishing Mark Anderson’s short film again. Please watch it. Mark works in general medicine, on our GI wards and in endoscopy.

Dr Anderson explains that:

Washing your hands for 20 seconds and 2m social distancing are the most important things we can do as healthcare workers to protect ourselves
The order in which you put on and take off your PPE changes to the risk you face
Not everyone in a red area will be wearing the same PPE and that is ok

5. Making sure we are now only working for SWBH

The Trust has issued new guidance on rules about working for other organisations or for agencies. In line with many other NHS organisations, and just for the period of the Covid-19 outbreak, we are rescinding our contractual permission to work for us and for someone else. If you have queries about the latest guidance please contact our HR line on extension 3116. We need to maximise our ability to safely staff our services but also try to ensure that we do not have healthcare workers operating in lots of different places with the potential to transfer infection risk. Read our GUIDANCE NOTE

6. Staff swabbing – latest news

Thank you to everyone working so hard to create staff swabbing in our Trust. It has not always worked, and some samples a fortnight ago were not processed. But for the vast majority of people using the service you have had a result or have one coming. Hundreds of Trust staff have been tested. A tribute to some very dedicated colleagues across PCCT who have organised the testing and run the vans, and to teams in Occupational health who have helped with results. If you do get a result from the Boots service we started last Sunday, you must contact your line manager when you get your result.

To book an appointment for a staff swab this weekend please contact either 07816992873 or 07970428995 on Saturday and Sunday. You must be recently symptomatic, ideally at day 3.

Next week’s testing regime is not wholly certain region-wide. We will advertise more details on Sunday. A new service opens at Edgbaston Cricket Ground supporting specific groups of key workers. We will access to services into the Black Country Pathology laboratory. Other options are opening up all the time, so, to repeat at message from earlier in the week make sure your contact details are on ESR.

This week rates of return from isolation have jumped. Almost three quarters of people at the end of their period of isolation are returning now to work to join the fight. Thank you. Together we can keep staffing gaps down and support one another to care.

Chief Executive’s Message – Friday 3 April

I write this message on the day our local healthcare system lost Areema Nasreen. Areema died today on ITU at Walsall Manor. It is clear, from many colleagues here who knew her, what a contribution she made in her career moving from a housekeeper role to a registered nurse post in the last two years. National data on people dying in our country is announced daily but no amount of data can convey the individual tragedy this situation brings. Our COVID-19 bulletin today reconfirms the grief and bereavement offer being made available in the Trust, alongside the wider psychological support offer we explained on Wednesday. My thoughts today are not simply with Areema’s loved ones but with many colleagues across our Trust currently being treated with COVID-19 or worrying for someone who is being.

Lots of our colleagues are currently being trained or re-trained to work in different roles in the days and weeks ahead: Theatre colleagues from BMEC who will be working in intensive care, community nurses joining acute wards, doctors from radiology returning to general medicine. Our staffing models are based on 30 per cent absence. That figure combines sickness, isolation, and any leave that can still happen, consistent with our emphasis on wellbeing. Where we are, as nationally we are being urged to do by both professional clinical bodies and NHS England, lessening staffing ratios for registered roles, we are seeking to increase HCA ratios. One of the risks of that situation is that changed ratios expose staff and patients when short notice sickness arises, and Paula and Liam are working through how we best manage that at site level.

In today’s bulletin we launch our drive to make sure roles such as portering, ward service officers, distribution teams, and catering are sustained in the weeks ahead. Those roles too are seeing shortages from absence with isolation. And our need is growing as we work to try and keep frontline clinicians in patient-facing roles and try and reduce movement in and out of red areas where we can. As far as we can, we will be looking first for people to volunteer to temporarily move across into those roles. The process to volunteer is via volunteerbrigade.swbh@nhs.net – it remains possible that later next week we will need to move to a more insistent approach, formally redeploying staff from roles that will not be so needed in the next couple of months.

This message is heavily focused on how we manage our workforce and support everyone else’s wellbeing. In that context, I am delighted that Frieza Mahmood has been selected at this week’s Star of the Week. Frieza, our deputy director of people and organisation development, working along her HR colleagues, have been at the heart of organising our support for people at home and people re-deploying. Returns to work from isolation have risen from 25 per cent ten days ago to nearer 75 per cent. That is a huge tribute to those coming back to help and to care, and to the organisation that has gone into supporting individuals and line managers.

I know full well that despite incredible efforts neither Personal Protective Equipment (PPE) nor workforce antigen testing are yet working as I would want, or as you would want. PPE is boosted by the delivery this week of over 8,000 Alpha FFP3 masks, and by our improved supply and decision to expand surgical face mask use into blue areas. From Monday the main model of PPE supply will be department ‘drop off’. There will be no need to come to a central store other than where a ward’s use changes markedly. All of our efforts rely on you using the right equipment in the right way at the right time. Dr Mark Anderson has produced a genuinely helpful film that reminds us how to do that, not just what to wear but how to put it on and take it off to minimise risk.

I want to remind you here again that alongside handwashing, social distancing is crucial. I am pleased that I have seen examples this week of challenging of close association, people asking others “not to stand so close to me”, and things like our Trust’s Board on Thursday going WebEx for the first time. I want to also remind you that hand sanitiser bottles can be re-filled and re-used. Shout out to Dr Kanari who has been very active, alongside others in promoting the importance of getting this right. Social media is full of good examples of this, albeit it has got some examples of photographs of patient care and of harm that can only serve to scare the people that we serve. Please make sure your use of Facebook, Instagram or Twitter is consistent with our employee guidance on client confidentiality and the confidentiality of your colleagues. I hope you feel we are being direct and honest with you about the massive challenges we face. Please do continue to voice your concerns and examples with me. t does make a difference.

This time next week, on Good Friday, I will be in work knowing that we will be in the middle of the surge. Over the next seven days we are gearing up. Equipment is due with us tomorrow. Many of you are in this weekend getting trained. Hotels are available. Material to learn from and new colleagues to meet. This will not be the only surge. If we succeed, and we can, the curve will be flatter but will reoccur. The development of a step down general medicine hospital at the NEC will give some extra capacity in the middle of April and I want to thank colleagues who are going to volunteer to move across to support those services, on site or working from here and providing care remotely. More about that next week in our daily COVID-19 Bulletin.

The absolute focus of all my efforts and I hope of much of yours is on ensuring that our “plan A” is in place, staffed and ready. If we keep discharges moving from our sites, both community and hospital, then we will be best able to care for those arriving, needing your expertise. I do not underestimate how different providing care in full PPE at 1m distance is. Relatives involved, only by phone or video. This is a genuinely confusing situation, both in terms of information overload and psychologically. All of us are working to try and get this right, with resilience, compassion and precision. Things we would not have done before, like purple wristbands for patients with evidenced DNA CPR, or staffing models we will not keep after COVID-19, are now part of the months ahead. Everyone working in our Trust has the Board’s absolute admiration and support. It is clear that the country is with us. What we have to do is not what we trained for. But we are the best people now to do this. And we will prove that in the nights ahead, as we have the weeks gone by.

Heartbeat: Ward services officers on the frontline

The unsung heroes of our Trust who continue working on the frontline helping our workplace stay one step ahead of COVID-19 are our army of ward services officers. Compassionate and dedicated, our ward services officers continue to battle with COVID-19 by keeping our sites clean and tidy.

With their high standards of hygiene our ward services officers have taken on the challenge of ensuring that our wards and departments are spotlessly clean so that clinical colleagues can continue providing safe and effective care.

To find out more about the work of the ward services team, Heartbeat caught up with Ward Service Officers (WSOs) Christine Jukes and Julie Brazier. Giving an insight in to the work of WSOs Christine said, “We owe it to all of the patients at our Trust to make sure that we have a clean hospital for them to come in to and likewise for colleagues to work in. COVID-19 has simply reminded us how important our role is in making sure that the virus does not have an opportunity to settle, transfer or take hold in our hospital. Every one of my colleagues understands that the role they play in the current situation really does have an impact.”

Echoing the words of her colleague, Julie said, “I’ve worked here for 20 years and it’s fair to say COVID-19 has been a bit of a wake up call for everyone. We’re now more focused than ever on making sure every surface and touch point is spotlessly clean and kept clean throughout each day. COVID-19 is very easy to pass on through droplets and touch so our work is extremely important.

“However, it’s not all mops, buckets and dusters. As WSOs we’re an extra set of eyes on the wards. Whilst we clean, we have an opportunity to interact with patients. When we get them a drink we have an opportunity to have a chat and gain an insight in to their health and wellbeing and more often than not they’ll tell us when they’re feeling well and when they’re not. We’re able to work with the rest of the ward team and get involved.”

Latest edition of Heartbeat now online

The latest edition of Heartbeat is now available to view online.

This edition features the latest guidance around COVID-19 as well as the launch of the GEMS initiative.

Drug safety notice: Clenil Modulite 100mcg/dose MDI shortage

Chiesi, the suppliers of Clenil Modulite of which some of their manufacturing operation are located in Italy. They have reported a significant increase in demand for all Chiesi respiratory products, leading to shortages within the supply chain. Supplies are expected to run out quickly.

There are several alternative preparations available for our patients. Please see Clenil Modulite drug safety notice sheet for further information on managing this supply issue.

For more information please contact the pharmacy department (City ext. 5263, Sandwell ext. 3783).

COVID-19 bulletin: Thursday 2 April

We will be issuing revised Working From Home guidance on Tuesday 7^th, and some outline ideas for re-deployment of non-clinical staff to help in the fight tomorrow afternoon for feedback over the weekend. Everyone has a part to play in what our communities are facing: Everyone matters.

1. Easter will need to be a standard working night and day this year – needs must, with regret

In one week’s time there is four day bank holiday weekend. The expected COVID-19 Surge is likely to be here in the Black Country and West Birmingham that very weekend (10^th-14^th). On that basis, and like all NHS neighbours, we now have to confirm that all of those days will need to be staffed as standard days. Of course in truth, nothing is normal now, and the word standard is a poor substitute. But we mean that Friday and Monday will be the same as our routine acute, diagnostic and clinical support staffing, as per our COVID-19 Surge Plan. The exact weekend detail will be worked through in each clinical group and be circulated before Tuesday. Until you hear, assume that weekend is an emergency weekday.

We would all recognise that this is decided with regret, but we have to build on the amazing work being done to be ready with hundreds of trained and re-deployed staff gearing up.

2. Mark talks about how to wear your PPE

PPE guidance comes out a lot. Even though we now have pictures of what to wear outside every ward, it is confusing and can become confused.

Dr Mark Anderson, general internal medicine consultant, gastroenterologist and Deputy Medical Director has been walking the Trust listening to your views on PPE. With that feedback in mind Mark has made this short film of advice. Take a look. He’s right.

https://youtu.be/h0Bw8UO3uIs

3. Use, but please do not misuse (FIT, FIT, FIT..)

We briefed you yesterday on seven day a week fit testing. Phoning ext.5050 is the way to get yourself booked in. Now is the time to get tested on the PPE we need you to wear to stay safe. Our guidance on facial hair (clean shaven) reflects updated religious and faith leader guidance at this unique moment.

Whilst PPE and scrub supply is a real issue of collective concern, please can we appeal here to you not to wear unsterile surgical gowns and then cut holes in the cuffs to create a thumb loop. This creates risks if the gowns are used in sterile environments like theatres. Gowns should only be worn when carrying out Aerosol generating procedures. We have short supply and damaged stock risks harm to us all.

4. Death announcements from PHE / NHS England

All of us will recognise that the number of people dying with COVID-19 is rising in the country, and the Black Country remains a “hotspot”, with more deaths than in many other places. Each death is individual, a tragedy and never a statistic. Local rates may reflect the underlying nature of respiratory disease in our communities as one explanation. The impact of this on staff and families is huge and yesterday’s bulletin highlighted the psychological support services available.

Deaths in our care from COVID-19 are only announced nationally once COVID Positive status is confirmed. That can happen some days after death. In addition, we contact next of kin to talk to them about COVID-19, their own next steps and the national announcements. Only after that is complete do deaths get announced in daily national press releases, and sometimes there is a delay in such announcements. As you see rising numbers of deaths in our care it is understandable that you will feel greater concern, and we will try to discuss this openly. However, be aware that the exact timing of announcements may not reflect the timing of deaths.

5. Donations and support update

Over the last month we have benefitted from some fantastic donations to support the work that we do. We know there is gratitude for the help and it builds a sense that those around us are with us. That will continue and we will work to ensure that all staff who work here benefit when we are distributing donations – all disciplines and both in and out hospitals.

Over coming weeks, we will be working with partners to make sure donations that would benefit local communities, support groups and some of the most vulnerable in our society are diverted to those groups. Gurdwara Aid and some local schools are already helping us to make a reality. This reflects the fact that whilst we are exhausted and time-poor many in our communities have seen their income and social association dwindle since COVID-19. If you yourself are experiencing financial pressure, perhaps because someone in your family is no longer working, please remember the advice and debt support that the Trust offers as well as, in extremis, access to emergency financial support through our charity under a small number of very severe circumstances.

Emotional, physical and sexual abuse has risen UK-wide and locally since the start of social distancing and #stayathome. It is worth remembering this enhance risk among those we serve and worth highlighting the services we can provide if someone on our staff or among our student body is themselves at risk.

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Monthly archives: April 2020

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