Monthly archives: July 2020

Message from infection control: Ensure you have blood culture packs ready for use

If you are in a clinical area where blood cultures are taken, please ensure that you have blood culture packs available for use.

These can now be ordered via NHS supply chain using code EHC3456. They come in a box containing 50 packs. Make sure that the packs are easy to locate and are readily available for use.

For more information please call ext. 5900.

Heartbeat: Spotlight on research midwives

A research midwife may not be something that you are entirely familiar with, but the part they play within our workplace is crucial. The role of a research midwife can be varied and includes procuring studies, recruiting and gaining consent, collecting and analysing data and publicising results. We spoke to research midwives, Sarah Potter and Lavinia Henry to find out more.

Sarah explained: “As part of our role we seek out and assist with the development and delivery of high-quality research studies within our maternity specialty. This includes disseminating information regarding the current research projects to the whole clinical team. It also includes teaching and training. In line with the Trust’s vision that all patient-facing colleagues can play a role in research activity, our goal is to ensure that as many women as possible have the opportunity to access research.”

It is, in fact, their experience as midwives that equips them with the knowledge and skills to excel in research. Lavinia told us: “Trusts that are research active have better patient outcomes. We work as part of clinical care teams in all departments so that research is integrated and a normal part of patient care.

“As midwives, we have expert knowledge of our client group, clinical environment and pathways, having worked in the maternity department before moving into research. This practical experience helps us to plan recruitment strategies, identify and overcome any potential barriers.”

She added: “An example of what we do includes explaining studies to potential recruits, whilst gaining and recruiting individuals for different studies, e.g. recruiting pregnant women, postnatal women and neonates into studies. We also conduct follow-ups, plus gather data and samples as required.”

Currently, there are several maternity studies ongoing all with the focus of developing and improving the effectiveness of care. Some of our current research trials include:

• Induction of labour, A RCT comparing two different treatments for induction and the effect of each on outcome.
• Prevention of preterm labour, a trial examining whether the choice of materials for a cervical stitch procedure has any influence on outcomes.
• Development of care pathways, analysing the timing of delivery for women whose babies are large for gestational age.
• The donation of umbilical cord samples at elective c/sections to be used in the development and improvement of treatment for rheumatoid arthritis and cardiovascular disease.
• Smoking cessation.

Since the outbreak of COVID-19, the team have been actively involved in research trials that are unique to the pandemic. Sarah commented: “Though challenging, this has been a unique opportunity for us to be actively involved with live, rapidly evolving studies examining the effectiveness of study treatments for a condition where there are no proven effective therapies. These research trials involve stepping out of our comfort zone to work in new areas, such as ITU and AMU, to meet the demands of the service.”

Sarah added: “Some of these studies are also open to maternity patients, and the experience gained on the wards means we are ready to support the maternity team with the delivery of these studies. Maternity also has a registry study open for women who have experienced COVID-19, or its symptoms, during pregnancy or the postnatal period. We are both looking forward to spending some time back ‘home’ in maternity identifying patients for this study.”

Unity maintenance: 28 July

As we prepare to go live with the upgrade of electronic patient record, Unity on 26 August, we are making changes to the servers on Tuesday 28 July between 7.30pm – 10.30pm.

Note: Aside from a delay in response for a few seconds we are not expecting any user impact.

Should you have any queries please contact the 24 hour IT helpdesk on ext. 4050 (0121 507 4050 for home workers).

Pharmacy electronic ad hoc stock ordering

As part of streamlining the processes for the pharmacy single site working the team are launching an electronic ad hoc stock ordering form.

The ordering form can be accessed by clicking on the Connect referrals link on the Connect homepage.

Upon completing the form an electronic requisition will be sent to the pharmacy stores, who will then process the order within the current timescales (3 hours). If your order is urgent please call ext. 5257.

This form can be used any day of the week. If you require assistance using the form please contact your ward pharmacist/technician. Pharmacy will still accept the current ad hoc stock ordering books during the launch of the electronic forms.

Please note as per current practice ad hoc orders will be processed:

Monday – Friday:

• Routine: 9am – 3.30pm
• Urgent: 9am – 5.30pm (call ext. 5257)

Saturday – Sunday:

• Routine: 10am – 1.30pm
• Urgent: 10am – 3pm (call ext. 5257)

For more information please contact Emma.Arhcer@nhs.net or Simon.Plant@nhs.net.

Reminder to colleagues: Single tender waivers

We are seeing increasing numbers of single tender waivers with poor justification or orders raised to pay invoices in recent weeks – here is a reminder of the principles that should be followed at all times, in accordance with the Trust’s Standing Financial Instructions (SFIs). The SFIs are designed to ensure that our financial transactions are carried out in accordance with the law and Government policy in order to achieve probity, accuracy, economy, efficiency and effectiveness. Put simply, if we don’t follow the SFIs, we can’t guarantee we are delivering value for money. The principles are as follows and apply to capital and revenue expenditure plans:

• Less than £10,000 – a minimum of two verbal quotations
• £10,000-£24,999 – a minimum of three written quotations
• £25,000-£122,976 – Competitive procurement exercise carried out by Trust procurement department – invite minimum three suppliers
• Above £122,976 – as above plus advertise in Official Journal of the EU (current requirement)

There are four key messages to note:

1. Plan your expenditure and your procurement route to ensure best value for public money
2. Do not enter in to last minute contractual arrangements that mean we cannot ensure value for money
3. Raise requisitions and purchase orders well in advance of incurring the cost
4. Involve the procurement team as early as possible

Mental health practitioner training course this Friday: Limited spaces still available

There are a few spaces available on the mental health practitioner training course on Friday 24 July, 8.30am-1pm. This is an online taught course and can be completed by laptop, tablet or PC from home or work. Spaces will be first come first served. Staff can only be allocated if they come from areas that currently don’t have any staff members trained and a request for a place must come from a manager recommending a staff member.

Please email richard.burnell@nhs.net if you wish to participate in the course or would like more information.

Heartbeat: Critical care at the forefront of COVID-19 research

Critical care has been at the centre of the Trust’s research portfolio and currently has four studies which the team are actively recruiting to. They are also delivering treatments for patients who transfer from the wards who have been recruited to the RECOVERY study.

Two of the studies are complex treatment trials at the forefront of COVID-19 research.

REMAP-CAP is a complex treatment trial which is testing multiple treatment options simultaneously. This is known as a platform study. In REMAP-CAP, the treatments being tested are corticosteroids, antivirals, immune modulation therapy, immunoglobulin therapy (in the form of convalescent plasma) and therapeutic anticoagulation.

Within these therapy types there are several randomisation arms. Most research is intervention/drug a versus intervention/drug b, so this study is much more complex than usual.

Heartbeat caught up with Dr Jon Hulme, Consultant Intensivist and Honorary Senior Clinical Lecturer, who is the principal investigator on the REMAP-CAP trial. He told us: “The impact that COVID-19 has had on some of our patients has been clear to see. Large scale, robust trials to test which drugs help, and importantly, which ones do not, are hugely important for our patients and those we will treat in the future. Whilst there is the temptation that will be felt by many to use treatments and drugs based on what they think might work, it is only through committing to trials like these that the real answers will be uncovered that will save lives.

“Clinical trials are important as we have shown by participating in the RECOVERY trial: this found that dexamethasone, a steroid that is cheap and widely available and is commonly used to reduce inflammation in conditions such as asthma, saves lives in those people most affected by COVID-19. It reduces deaths by one third in people on a ventilator and by one fifth in patients receiving oxygen only.”

Dr Farooq Wandroo, Consultant Haematologist and Honorary Senior Lecturer is a co-principal investigator. He added: “One of the characteristic findings we have observed in COVID-19 patients is low white cell count called lymphopenia (low number of immune cells). This is universally seen in all COVID-19 patients, often leads to infections and is associated with increased risk of death. We are trialling a new drug called interleukin-7 which will aim at improving the number of these white cells or immune cells and help fight COVID-19 infection better and may reduce the risk of dying. We would urge all clinicians to help promote this important study.”

The newest study is a commercial trial looking at whether Recombinant Human Interleukin-7 can improve clinical outcomes in patients in critical care with severe COVID-19 infections and, in particular, lymphopaenia. You can read further about this trial on page four of this edition of Heartbeat.

These studies are complex and challenging to explain to patients, particularly patients that are so ill.

“One of the problems that we often experience in intensive care or emergency medicine research is that patients are so ill that we cannot discuss the studies with them. This current research is considered so important that sites have been given permission to enrol patients even in these situations with a senior doctor who is separate from the study team taking the responsibility to assess the situation and decide on the patients’ behalf until they regain capacity,” added Dr Hulme. “We are also ensuring that patients who have limited English can participate in studies. Sometimes a lack of ability to speak English is written as an exclusion criterion for the study, in which case we cannot approach non-English speaking patients.

“The participant information sheet for REMAP-CAP has been translated into multiple languages (although a limited number and not the full spectrum of languages spoken by our patients) alongside which patients still need the research explaining to them. The whole team of doctors, nurses, research team and interpreters have worked together with patients and their families to ensure that all of our patients have the opportunity to participate.”

Complete your COVID-19 risk assessment now! New easy online form available

All staff must complete a risk assessment to understand your individual risks associated with COVID-19 and ensure the right protection is available for you.

The form is now readily available online so easy for anyone to complete and will only take a couple of minutes. The link works on our Trust network but you can also complete the Excel form that is here and return it to swbh.riskassessmentoh@nhs.net . You will be contacted individually if you haven’t completed your assessment so please do so as soon as possible. Contact occupational health on 0121 507 3306 if you have any queries or would prefer to have a risk assessment completed with an occupational health professional.

COVID-19 Bulletin: Wednesday 15 July

This is our weekly bulletin and will be issued every Wednesday. Please use this bulletin and cascade arrangements within care and corporate groups to guide your actions. We are determined to reduce avoidable harm and death in the people we are taking care of. Kindness remains the guiding principle of all the actions in our work to tackle the virus – kindness in how we look after patients, visitors, and one another.

Numbers not statistics: Today’s totals (last week’s data)

1. Complete your COVID-19 risk assessment now! New easy online form available

All staff must complete a risk assessment to understand your individual risks associated with COVID-19 and ensure the right protection is available for you.

The form is now readily available online so easy for anyone to complete and will only take a couple of minutes. The link works on our Trust network but you can also complete the Excel form that is here and return it to swbh.riskassessmentoh@nhs.net . You will be contacted individually if you haven’t completed your assessment so please do so as soon as possible. Contact occupational health on 0121 507 3306 if you have any queries or would prefer to have a risk assessment completed with an occupational health professional.

2. Summer childcare during the school holidays

A number of local organisations have confirmed that they will be operating holiday play clubs on a limited basis for children up to 11 years old. Colleagues wishing to access their facilities should make contact with them directly as soon as possible as places are limited.

Note: As part of their risk assessment arrangements parents may be required to provide details of schools/childcare facilities children have attended during the COVID-19 pandemic to enable them to comply with current public health guidance and maintain consistent child groups or bubbles.

You can access details of child care facilities in the local area here.

3. PPE Updates

PPE Hub on the move: The PPE hub at City which was on D18 has been relocated to the reception area outside the Foot Health and Diabetes Outpatients Clinic – on the first floor above Arches Café.This area is sufficient for PPE but unfortunately cannot facilitate space for scrubs. Scrubs should therefore only be collected from the wards where they are delivered daily.  Similarly, scrubs will no longer be available from the PPE area at Sandwell (outside the Bryan Knight Suite).  Again, scrubs should be collected from the wards.

The fit testing clinic at Sandwell has now moved to Hallam Building, Diabetes Building (by car parking barrier)

Do you know how to dispose of PPE correctly? Colleagues are reminded that surgical face masks must be worn only on the face covering the mouth and nose. They must not be pulled down to hang around the neck as this increases the risk of cross contamination to the user. Whilst a surgical face mask can be used in-between patients, gloves and aprons cannot, and colleagues must decontaminate hands between different patients. Masks must be changed immediately when they are: visibly soiled, damp, or damaged. Additionally please note the following:

• If you remove your mask for any reason then it must be immediately discarded into clinical waste and NOT reapplied, hands must be decontaminated.
• Do not touch the mask once it is secured on your face as frequent handling may reduce its protection. If you inadvertently touch the mask, immediately decontaminate your hands.
• Used masks must not be retained once removed (e.g. in a pocket or bag) this will increase the risk of cross contamination to the user.
• The mask must be removed before you go on to break and disposed of into the nearest bin. The same mask must NOT be reapplied as this will increase the risk of cross contamination to the user.
• Remember to remove masks from the back NOT by touching the front of the mask as this area will be contaminated.
• Always decontaminate your hands following mask removal.

Move to single use visors

The Trust has an ample supply of single use visors, so colleagues are now advised that in situations where they are required to wear one, they should be disposed of after single use. There is no requirement to wipe down and reuse visors.

4. COVID-19 patients and Dexamethasone

Use Dexamethasone power plan to prescribe Dexamethasone for patients with COVID-19 as per the recovery trial.This week’s tip of the week comes from Steven Shanu, Pharmacist and Jon Hulme Consultant Anaesthetist: “Use the Dexamethasone power plan to prescribe Dexamethasone for patients with COVID-19 as per the RECOVERY trial.” You can view the tip here.

5. Your health and wellbeing

Your health and wellbeing is paramount to us. The COVID-19 pandemic will take a toll on colleagues both mentally and physically. With this in mind we are encouraging all colleagues to download our mental wellbeing app, ‘Thrive.’ The Trust have partnered with Thrive to give you exclusive access to an award winning mental health and wellbeing app that can help with managing depression, anxiety and stress. The app tackles common stressors such as sleep, bereavements, work issues and more. It also signposts to external support services – with users able to seek immediate help directly from the app. To access the service:

1. 1. Go to https://swb.thrive.uk.com/ to create an account and claim your free access to Thrive.
2. Visit the Google Play or App Store and search and download the Thrive: Mental Wellbeing app.
3. Log in using the email and password you created your account with and enjoy using the app.

To find out more about how Thrive can help you, and how to access it, click here.

You can also access the full range of health and wellbeing support on Connect

The Recharge Booth continues this Thursday:

The Recharge Booth is a ‘virtual’ space that allows you to come together with others, reflect, recharge, decompress, and join a safe and confidential discussion. Hosted by Richard Burnell, it runs every Thursday at 2pm, sharing stories from different colleagues over a 20-30 minute session. This week the Recharge Booth will focus on the following story about feeling anger:

“I find speaking to colleagues about patients and relatives that I don’t like difficult. I’m fearful that if I say what I really feel I’ll be seen as unprofessional and uncaring. I know we have to remain professional outwardly at all times but I also want to be able to talk about the feelings I have inside without being judged. Recently I have dealt with one relative and one patient who were so aggressive and unreasonable that I wanted to cry. I totally understand I can’t respond unprofessionally in public, but I feel I am not even allowed to vent my true feelings in private. It’s hard to make sense of something when you have to keep so much of it inside.”

For more information please contact Richard Burnell on 07747 144874 or Angharad MacGregor on 07976 322893. Alternatively if you would like to be part of the Recharge Booth, drop an email to swbh.rechargebooth@nhs.net. A WebEx invite will be sent to your outlook diary, and you will simply need to click on the ‘join’ button to enter.

COVID-19 Bulletin: Wednesday 22 July

This is our weekly bulletin and will be issued every Wednesday. Please use this bulletin and cascade arrangements within care and corporate groups to guide your actions. We are determined to reduce avoidable harm and death in the people we are taking care of. Kindness remains the guiding principle of all the actions in our work to tackle the virus – kindness in how we look after patients, visitors, and one another.

Numbers not statistics: Today’s totals (last week’s data)

1. Wearing the right PPE for procedures

Colleagues are reminded that it is safe to carry out procedures on patients as long as the correct PPE is worn. Fluid resistant surgical masks (FRSMs) must be worn at all times in our clinical buildings and when treating patients. Strict hand hygiene, social distancing (where possible) and surface cleaning should occur as normal. If you are within one metre of a patient then a face visor should be also worn. When treating suspected COVID patients, the appropriate risk assessed masks should be worn. This includes within ED when assessing patients. Full PPE should be worn when aerosol generating procedures (AGP) are undertaken including an FFP3 face mask.

For more detail on the type of masks to use click here.

2. Complete your COVID-19 risk assessment now

Thank you to the 4,200 colleagues who have already completed their COVID-19 risk assessments. This needs to be completed by 31 July. It only takes a few seconds to complete by using the online form or the risk assessment calculator and sending it to swbh.riskassessmentoh@nhs.net. The occupational health team will then respond to you with actions required.

This is an important assessment which takes into account your individual risk of COVID-19, in light of underlying health conditions, age, gender and ethnicity. The occupational health team are continuing to carry out these risk assessments for people who request them which can be booked by calling 0121 507 3306 or emailing swbh.riskassessmentoh@nhs.net.

For more information click here.

3. Working from home guidance remains in place

Our current guidelines for working from home remain in place until the end of August. You are able to read the guide here.  We will continue to evaluate what is best for you and the services we provide.

With that in mind, our safe office space review is continuing with assessments of over 500 offices completed to date. There will also be engagement over long-term work from home arrangements during the summer. This longer-term strategy will reflect learnings from over the last three months and look to put arrangements on a firmer and more contractual footing that will carry the Trust through the period to 2023. This ensures fairness for existing and new employees and clarity about eligibility and decision making. We expect this longer-term guidance to see more home working than prior to COVID-19, mindful of social distancing and the open plan nature of office accommodation in particular in the Trust’s estate from 2022.

Pictured is Lesley McDonagh,Clinical Lead Nurse, Tissue Viability Team, who is currently working from home as she has to shield due to a medical condition.

4. Swabbing patients – Do you know when and how often you should be swabbing?

It is vital that inpatients are not only placed in the right care environment (Red, Lilac, Blue ward) but also that swabbing is carried out appropriately and effectively in each environment.

Remember:

1. Every patient MUST be swabbed on admission.
2. Patients on Lilac wards MUST be swabbed every 3 days.
3. Patients on Blue wards MUST be swabbed every 5 days.

Follow the Trust’s pathway here.

Guidance for those being treated at the Birmingham and Midland Eye Centre and surgical patients is as follows for patients undergoing the following procedures:

1. Emergency life/sight threatening then proceed as high risk – result unknown, screening in place
2. Elective  (Aerosol Generating Procedure – AGP) – swab required
3. Any AGP process – full PPE must be worn
4. Local (i.e. injections/eye/joint) – no swab required but screening should be undertaken and patients risk assessed and determined safe to proceed.

Alongside swabbing at the right time, it’s critical that swabbing is carried out using the right swabbing kit and collected in the right manner.

White\Green\Yellow swab kits should be used for all inpatient swabs and for retesting in blue and lilac areas. Black swabs are only for urgent testing in pre-agreed areas.

Guidance on how to collect samples is available in the linked document.

COVID-19 Patient Swabbing Guidance

Where swabs are taken, colleagues must ensure that they are hand delivered to the pathology departments as soon as possible so that they can be tested and reported without delay. Samples must not be left on wards for extended periods of time as this significantly delays the time taken to report results and ultimately puts patients and colleagues at risk.

 Triple bagging swab samples for safety

Remember when you are bagging your swab sample, you must ensure the red topped bottle is first put in a clear specimen bag, this should then be placed in a clear zip lock bag and finally packaged in a blue specimen bag alongside any paperwork.

5. NHS staff convalescent plasma donation

Colleagues who have recovered from COVID-19 are being prioritised for convalescent plasma donation.

Convalescent plasma is the antibody-rich plasma of people who have recovered from COVID-19, which can be transfused into people who are still ill.

Dr Zahid Sarfaz, one of our A&E doctors based at Sandwell Hospital became one of the first to donate his plasma to NHS Blood and Transplant (NHSBT) after he had recovered from COVID-19. He said: “Everybody has been playing their part. I am hoping that by donating plasma I can help too, plus it’s easy to donate. NHSBT primarily contact potential convalescent plasma donors directly. It is important that potential donors have recovered and that they have had time to develop a good antibody response. If people have a confirmed positive test result and they are willing to donate, they can also provide details via a form on the NHSBT website.”

NHS colleagues should call 0300 123 23 23, say they want to donate convalescent plasma and explain they work for the NHS. They will then be given priority. They can also provide their details by going to www.nhsbt.nhs.uk

Many early convalescent plasma donors have been GPs, hospital doctors, nurses, pharmacists, and allied health and clerical professionals.

6. The mental health impact of COVID-19 survey

 Stat-Stress have put together a survey aimed at NHS colleagues based in the West Midlands area  which evaluates the symptoms of post-traumatic stress disorder (PTSD), anxiety and depression, and post-traumatic psychological growth during the COVID-19 pandemic.

You can complete the survey by clicking the link: https://www.surveymonkey.co.uk/r/SSC-19

7. Communicating with hard of hearing patients

A number of colleagues have recognised that it can be difficult to communicate with patients who are hard of hearing whilst wearing a mask.

The Google Live Transcribe app is a great way to communicate with these patients as this video shows.

The app is free to download and is accurate when transcribing your words.

You can download the app here onto your mobile phone.