Monthly archives: May 2021

COVID-19 Bulletin – Friday 28 May

Numbers not statistics: This week (last week)

No. of our patients confirmed with COVID-19	No. of positive COVID-19 patients who have been discharged	No. of COVID-19 positive patients who have died in our hospitals	No.of COVID-19 positive current inpatients	No. of COVID-19 research trial participants to date
6,422 (6,388)	6,424 (6,378)	1,211 (1,210)	21 (21)	1,135 (1,135)

New: Get in the loop with COVID-19 weekly saliva testing

The COVID-19 weekly saliva testing programme (LAMP – Loop Mediated Isothermal Amplification) is now well established across our organisation in lots of areas. Thank you to everyone who has taken the time to register and continue with the testing programme.

This reliable test is an easy way to help us all ensure we are remaining safe, and, most importantly, keeping our colleagues and Trust as COVID secure as we can. Detecting positive cases sooner reduces the risk of the virus being passed on to patients, colleagues, and family members and beyond in our communities.

Even if you are vaccinated it is vital that you register and carry out the weekly tests. This will identify asymptomatic cases and is of particular benefit in helping to pick up positive cases that would then be sequenced to identify any variants.

All line managers are asked to remind colleagues to:

• Call and book a kit collection slot by calling 0121 507 2664 and selecting option 6
• To undertake weekly testing and drop off their samples.

Samples can be dropped into the phlebotomy department  Mon – Friday  from 7:30am –  3:30 pm and in the following locations:

• OPD first floor Corridor D Sandwell Site
• Ground floor BTC
• Ground floor Rowley Regis Hospital
• First floor Neptune Health Park
• Second floor Lyng Health and Social Care Centre
• Victoria Health Centre
• Oldbury Health Centre.

Alternatively, you can drop off your samples in the LAMP collection bins at Sandwell outside the Bryan Knight Suite, outside Pathology or A&E.

At City, the LAMP collection bins can be found outside Pharmacy main spine, outside Pathology and A&E.

The latest data by group is below.

Further information including the directorate and professional group rates is published here.

New: Maintain vigilance as restrictions ease 

The sun is shining (finally), pubs are open, and long-awaited catch-ups with family and friends are now a thing. We love that we can all start to enjoy some of the things we’ve missed out on throughout the pandemic.

Over the past year, we have all stood strong and faced COVID-19 head on. As we start to move towards a life with fewer restrictions, we urge colleagues to do so safely. We have all gone above and beyond to ensure we can continue to offer essential patient care, and we need to continue to follow this sensible approach.

Please ensure that you:

• Continue to follow social distancing, regularly wash your hands and follow our infection prevention and control guidance at work including use of the correct PPE.
• Carry out your weekly COVID-19 saliva testing (LAMP).
• Get your COVID-19 vaccination.

New: ICU welcome back visitors in a new phased approach

From Monday, 31 May, ICU will be recommencing patient visits on a phased basis. This is the approach that will be taken for those wishing to visit patients in ICU:

• One nominated next of kin (NoK) is able to visit for the duration of a patient’s ICU stay
• The NoK must be free of illness and willing and able to wear a fluid-resistant surgical mask (FRSM)
• One hour visiting slots are available and this time includes donning, bedside & doffing time
• Visits are booked the day before with the ICU admin team
• A maximum of three visitors are allowed on ICU in any time slot.

For non-COVID-19 patients at the end of life:

• Two next of kin can visit for up to one hour (this includes donning, bedside & doffing time).

For COVID-19 positive patients:

• No routine visiting
• 15 minutes for two next of kin visiting at the end of life.

Please read this guidance for more detail on ICU visiting.

We’d like to remind colleagues that there are exceptional circumstances where visiting is allowed in all areas, for example for young patients, patients who lack mental capacity and patients who are at the end of their life. For these patients it is important that we are able to safely facilitate visiting, so please if in doubt ask your group for advice.

New: Had your COVID jab yet?  

One of the most effective ways you can protect yourself, your loved ones and patients is by getting your COVID-19 vaccination. If you are yet to get the first dose of the COVID-19 vaccination, please do so. Pictured is our Chief People Officer, Frieza Mahmood getting her first vaccination.

• You can still book in to get your jab at either Tipton Sports Academy vaccination centre or at the Saddlers Shopping Centre, Walsall.  Please note: If you are under 40 you’ll need to go to Saddlers at this time to receive a Pfizer jab. Pfizer will  also be available at Tipton from Tuesday, 1 June.
• The hub at Tipton Sports Academy, Wednesbury Road, is running Monday to Sunday, 8am to 7pm.

Book your slot via the national booking website. You can also use this link to book an appointment locally to your home. For the Saddlers Shopping Centre follow this link to book: Walsall Saddlers Centre.

We advise all colleagues to take the time to read the COVID-19 guide for healthcare workers.

Please ensure you take your Staff ID with you when you attend your appointment as it’s important you’re able to confirm you are eligible for the vaccination.

New: Travelling abroad guidance for colleagues

There are now specific rules in place regarding the requirement for COVID-19 tests and the need to quarantine on arrival to the UK, which differ depending on whether the country or territory in question is on the red, amber or green travel list.

Before booking to travel internationally, employees have a responsibility to check the government website to ensure they understand the rules in place for the country they intend to travel to. The rules can be accessed by clicking here.

All requests for annual leave need to be submitted to the manager for approval, in line with local leave policies. Managers will take a number of considerations into account such as:

• The impact of the request on maintaining service delivery
• The need to ensure all employees have time for rest and recuperation.

For full details, please read the travelling abroad guidance.

Note: These rules apply even if the employee has been vaccinated.

New: Wellbeing and recovery

The Trust has considered how best to ensure people are able to recover and reflect on their experiences over the past 15 months, recognising that people’s experiences have been different and yet everyone has been impacted both professionally and personally.

Support for wellbeing

There are a range of wellbeing support resources in place that were expanded throughout the pandemic. These will be continued and refined over coming months and colleagues are urged to make use of this support. All the details can be found here.

Personal Development Reviews: Focus on wellbeing conversations

All PDRs should be completed by the end of July 2021 and the focus on these reviews is for each employee and their line manager to have a conversation about wellbeing with the inclusion of a personal recovery plan.

Team development and integration

As well as individual recovery plans it is recognised that teams need time together to reflect, discuss experiences and identify ways to move forward together. In order to facilitate this, the Trust will make funding available to enable teams to have time together that could be away from their workplace.

In order to arrange this, teams should discuss their preferences with Group Ops Directors / Group Senior Finance Managers who will shortly be provided with additional information on how to resource such requests. Suggestions will be made available to teams including locations, content, speakers and facilitators.

The wellbeing hour

Each team is encouraged to nominate one hour per week as a dedicated time to focus on wellbeing. This can be at any time that best suits the service or department. Within the wellbeing hour colleagues could be encouraged to take time within the working day to focus on something that helps with wellbeing such as a learning & development activity, reading, walking or team discussion. This hour must be discussed and agreed with your line manager to ensure that we are still able to deliver clinical services with minimal disruption for patients and other colleagues.

As well as the above measures we are also aiming to expand our wellbeing resources, including access to the Sanctuary, cutting down on meetings to save time for colleagues and creating welcoming spaces on our sites for outdoor socialising in a safe way.

New: Changes to FIT Testing

We have recently made changes to how you arrange to get FIT tested. Previously colleagues have been asked to call ext.5050 to arrange an appointment. It has now changed and colleagues can now access FIT testing in the following ways:

• Log onto ESR and complete the FIT testing course
• For any urgent requests, contact the Infection, Prevention and Control team on ext. 5195.

Reminder: Chapel services and Friday prayers

In case you missed it, social distancing and infection control measures have been put into place which will ensure that colleagues who wish to use the chapel and prayer rooms can do so safely.

Jummah (Friday) Prayers have resumed in the chapel at Sandwell and Millers old restaurant in City. Prayer times are staggered so that there are only a maximum number of people using the spaces at any one time on both sites.

Christian services have also resumed in the chapels at both sites, which also remain open for individual worship. Both spaces are set out to reflect social distancing measures.

The chaplaincy has continued to provide a service throughout the pandemic and every Sunday they light candles for colleagues and patients. If you would like a candle lit for a loved one who has passed away or is sick, please email mary.causer@nhs.net or call ext. 3552.

• Friday prayer – Khutbah, 1.15pm (Jamat, 1.13pm)
• Sunday communion services – City Chapel, 11am and Sandwell Chapel 2.30pm
• City Hospital catholic mass – 12pm, first Wednesday of every month
• Sandwell Hospital catholic mass – 11.30am, first Friday of every month.

Chief Executive’s Message – Friday 28 May

Hello, colleagues

Take a look at the photographs above…. ask yourself – “what do I see here? Is this appropriate?”

These are appalling examples of inappropriate, unprofessional and thoughtless abuse of expensive infectious waste disposal bags and the disposal of used hospital linen – an expensive and finite resource. This practice, if one can call it that, happens in our own Trust.

Waste is generated by all of us, at work and at home. But it seems that, all too often, we give less thought to waste disposal at work than we do in our own home environments. In the majority of cases, what we see is colleagues using the nearest bin if we are lucky. Little thought is given as to whether the appropriate route for disposal is being used. I know our multiple waste streams can occasionally be confusing and COVID hasn’t helped the situation. But it would be hugely helpful if we could make things a little simpler. Let’s keep packaging, plastics and general waste out of our orange bags. Let’s reduce the new prominent litter in our hospital streets and our high streets, namely PPE (gloves and masks).

The following behaviour is not professional. It isn’t in line with our values and it is not what I expect from myself, or my colleagues. We can only change our own behaviour. It is us which will set the tone. So let’s please eradicate the following. Change your practice today:

• Waste bags discarded on top of empty waste bins
• Cross contamination risks with bags piled on top of each other on the floor
• Linen and waste on the same linen trolleys
• Linen/scrubs being thrown in to orange bags and destroyed
• Bins with the wrong coloured bags being placed in them.
• Dangerous sharps being disposed of into cardboard boxes
• Cardboard not being broken down. (Fire Risk)
• Patients property being put into orange bags and subsequently destroyed.
• Poor segregation.
• Inappropriate disposal, domestic waste in orange bags
• Pharmacy waste placed in orange bags

Thank you for your help. Have a good weekend

Richard

Midland Met Q&A sessions – we want to hear from you…

Midland Metropolitan University Hospital (MMUH) stands proudly between Sandwell and West Birmingham and, it will be our flagship hospital.

Our brand-new, state-of-the-art acute hospital will serve over half a million people living in our local communities. It will bring together all acute and emergency care services currently provided across two hospital sites and several clinical teams into one place, providing a hub for emergency care, with the build also boosting regeneration in the local area.

Over the coming months, we will be keeping you up to date with all things Midland Met. One of the ways we’ll do this is by facilitating regular Q&A sessions giving you the chance to have your say. Please use this opportunity to exchange views with senior leaders and have your burning questions answered.

In May, we hosted two Q&A sessions where Rachel Barlow, Director of Transformation Ruth Wilkin, Director of Communications and Jayne Dunn, Director of Commissioning & Equipping, talked openly about our move to MMUH.

Watch this clip to find out how the team described the model of care at MMUH.

Heartbeat: Frailty at the Front door – an insight in to Advanced Clinical Practice

Establishing a front door frailty service has been a focus at SWB in recent years, last year saw two notable events; the creation of the first frailty specific trainee Advanced Clinical Practitioner (tACP) role and the first phase of the ED ‘Frailty Intervention Team’ (FIT). An unlikely duo of opportunities in such a challenging year.

The Rapid Response team has long been an established integrated therapy service at the front door, but in 2019, we began a therapy led enhanced service project in ED. It aimed to provide a proactive comprehensive assessment to prevent admissions and early intervention therapy, for those whereby a decision to admit was made. The pilot was a great success and from this, the ACP role was created, which was soon out for advert later in the year. I was very fortunate to be successful in obtaining this exciting role and commenced it in it early 2020.

Frailty as we know, is multifaceted and a speciality that requires a high level of assessment and management skills alongside complex problem solving abilities. The comprehensive nature and breadth of application lends itself well to an ACP that can assess multiple components, if not most of a comprehensive geriatric assessment. The primary presentation of a fall in an older adult naturally lends itself to an advanced physiotherapy assessment and places our profession at the forefront of frail older adult care.

So, why advanced clinical practice? On a personal level, there were many reasons for this. I’m a physiotherapist at heart, and I have been fortunate enough to work across many areas from sport to acute NHS rotations and I chose to specialise in front door based work. My previous role was the rapid response team Lead and what I enjoyed most about this was the teaching, education and leadership responsibilities. However, with rotations, this bought lots of repetition and I’d reached a point where I wanted a new clinical challenge. Having worked in ED for many years amongst extended scope practitioners, the role appealed to me but MSK wasn’t my clinical interest.

Advanced practice was an area I hadn’t really come across until a few years ago. However, when we were providing an enhanced therapy service in ED, at times I became frustrated that I was limited within my physiotherapy remit. For example, with presentations after a fall, ruling out injury or acute illness and prescribing/de-prescribing, I could see that an advanced practice role would improve outcomes for patients with the benefit of it being one clinician. I have always been interested in understanding the medical model and could see the benefits of being an ACP; I could do so much more for the patient with the advantage of having Physiotherapy at the core. When I researched further into the world of ACP, the four pillars immediately resonated with me (clinical practice, leadership and management, education and research), as they combine all of my interests into one job, so when the frailty tACP post became a reality, I jumped at the opportunity.

We launched the ED frailty intervention team in July, and it continues to evolve into a multi-disciplinary team delivering comprehensive geriatric assessment. I’m fortunate to work with a team that is supportive, nurturing and have a network of people around me helping me on my ACP journey. Whilst the COVID-19 pandemic posed and continues to pose many challenges, it was opportune that such a team could be created to integrate and work alongside our ED colleagues. It’s already demonstrating measurable impact, not only with patient outcomes but helping to relieve the pressure of increasing presentations and admissions to hospital. As well as helping to identify and address all of the unfortunate consequences that shielding, isolation and multiple lockdowns has had on our local population with increasing frailty, falls and associated deconditioning. The future vision of this frailty team is that it will be led by a team of ACPs.

As I sit here writing this on the 1 year anniversary of starting my role, reflecting back and whilst it hasn’t been a ‘typical’ year, it’s been one full of challenges to learn from and grow. It’s an exciting time for advanced practice, both nationally and locally at SWB. Whilst we are still in the midst of the pandemic, we are continuing to build and embed the work of the frailty team. Alongside this, there is an evolving ACP response across the Trust creating opportunities across the MDT inclusive of Physiotherapy. This is a chance to really showcase the talents of our profession in advanced practice roles.

Heartbeat: Physio team capture special moments in a patient’s recovery

For the physiotherapists working within the Trust’s critical care unit, watching a COVID-19 patient speak or stand for the first time in weeks is a truly special moment.

In fact, each time a patient reaches a milestone in their care, the team records it in a positivity log – as Vanessa van de Bovenkamp, Senior Rotational Physiotherapist explains: “The past year has been like a rollercoaster. There have been highs and lows as we have seen some very poorly patients, especially during the second wave. But we also keep a positivity log where we record special moments where we have seen patient firsts.

“This maybe the first time a patient has spoken after having a tracheostomy fitted or when they have been able to stand up. They may have been unconscious for weeks or even months and we have been involved in delivering intensive physiotherapy with them to help their recovery. The team meets once a week and we go through the log to talk about these moments. It’s a really uplifting session which we all agree is really important during such challenging times.”

Vanessa has worked at the Trust for nearly five years, but has been based with the respiratory service since last September. It means much of her work has led her into the intensive care unit, where she sees many of her patients fighting for their lives. She adds: “COVID-19 is a respiratory disease and physios play an integral part in the recovery of a patient who has been ventilated, supporting doctors and nurses working within intensive care. Those who have had the virus will need physio for their chest but also for their limbs, having been unable to move for a long period of time. “We check the patient’s chest for any build up and will give them physio to loosen this. By focusing on all of their limbs we are able to help them avoid having issues in these areas in the future.

“Physios also assist with proning which helps with the pumping of the heart and improves oxygen delivery to the body.” She added: “The role of a physio within intensive care has certainly increased during the pandemic and although it has been challenging, it is an important one which will help patients in the long term who have battled this virus.”

Are you using the most cost effective Clinell universal wipes in your ward or area?

Clinell universal wipes in packets, buckets and tubs are being used in large volumes throughout the Trust both in clinical and non-clinical areas.

The most cost effective Clinell wipes are the ones which come in a green bucket as the bucket can be reused providing it is not broken or soiled.

The refill packs also significantly reduce the amount of plastic waste generated.

It has been agreed that all areas should move back to the bucket and refill instead of packets and tubs. From Tuesday 1 June all other versions of Clinell wipes will be masked to mandate use of the reusable bucket (NHSSC code – VJT190) and the refill (NHSSC code – VJT192).

Note: Please ensure you wear nitrile non-sterile gloves when using the wipes as the chemicals may cause skin irritation.

For more information please call ext. 4938.

 

Do you know how to barcode samples correctly?

Barcodes must be placed vertically down sample tubes to allow the barcode to be scanned. Samples labelled any other way are not suitable for analysis.

Please see barcode labels on sample containers sheet for further details.

Sample collection in Unity: All successfully collected samples must be marked as “Collected” on Unity. If you do not mark the sample as “Collected,” pathology will not receive the request message in their laboratory system. This means that the colleague who has requested the bloods will not receive the results back in message centre.

Please see sample collection sheet for more information.

Heartbeat: DNACPR – a need to know

COVID-19 and pandemic working has highlighted good ways of working together for delivery of high quality and evolving care. However, a new report from the Care Quality Commission (CQC) found worrying variation across the NHS in do not attempt cardiopulmonary resuscitation (DNACPR) decisions during this period.

There were examples of good practice but also patients not properly involved in decisions, or unaware that such an important decision about their care had been made.

This article describes what we need to know and within SWB how this should be achieved.

COVID-19 pressure had an impact, including the time that colleagues had to hold meaningful conversations. A lack of training and large amount of rapidly changing guidance also presented significant barriers. Decisions concerning DNACPR were incorrectly combined with other clinical assessments regarding ongoing care.

Wherever patients are cared for, it is not acceptable for DNACPR decisions to be made without proper conversations with the individual, or an appropriate representative, taking into account their wishes and needs.

However, the issues raised in the CQC report; including limited understanding of the importance of good conversations around what should happen if someone was to become very ill, and the need for proper and consistent processes around this – pre-date the pandemic.

As highlighted by the CQC: “Personalised and compassionate advance care planning, including DNACPR decisions, is a vital part of good quality care. Done properly, it can offer reassurance and comfort for people and their loved ones – before and during difficult times.”

If a patient is admitted to hospital acutely unwell, and they are at foreseeable risk of cardiac or respiratory arrest, a judgement about the likely benefits, burdens and risks of CPR should be made as early as possible.

At SWB, we expect that an initial consideration is made, discussed and documented within 12 hours of admission (i.e. the initial consultant review after admission).

Some patients, with capacity to make their own decisions, may wish to refuse CPR.

We recognise that a consultant discussion often does take place at the time. Some decisions are recorded by our trainee doctors and for some, never signed off by the consultant in charge of care, in patients admitted for many days. This can lead to discharge problems (e.g. to medically fit for discharge wards). It also leaves non-consultant colleagues unsupported in the decision making process.

Cardiac arrest is an expected part of the dying process and when CPR will not be successful, a decision not to attempt it will help to ensure that the patient dies in a dignified and peaceful manner.

When the healthcare team is as certain as it can be that someone is dying, CPR should not be attempted.

We must carefully consider whether it is necessary or appropriate to tell the patient that a DNACPR decision has been made but as made clear in high profile legal cases on this matter: “there should be a presumption in favour of patient involvement. There need to be convincing reasons not to involve the patient.”

Distress of the patient (or discomfort of the healthcare provider…) is not enough to justify withholding these discussions: the Court of Appeal acknowledged many patients may find this discussion distressing, but unless it would cause physical or psychological harm, this is not sufficient reason not to discuss it.

If a patient lacks capacity, we should inform others close to the patient about the DNACPR decision and the reasons for it. That explanation is expected to be at the earliest practicable and appropriate opportunity: this may well be in the middle of the night.

We must do this even when we think that CPR has no realistic prospect of success.

In cases when CPR might be successful (e.g. in restarting the heart) it might still not be seen as clinically appropriate because of the likely clinical outcomes (e.g. significant physical or cognitive problems afterwards).

Decisions about whether CPR should be attempted must be based on the circumstances and wishes of the patient.

This may involve discussions with the patient or with those close to them, or both, as well as members of the healthcare team.

If the patient has capacity, we should offer the patient opportunities to discuss (with support if they need it) whether CPR should be attempted in the circumstances that may surround a future cardiac or respiratory arrest. If they are prepared to talk about it, we must provide accurate information about burdens and risks, including the likely clinical and other outcomes if CPR is successful. This should include sensitive explanation of the extent to which other intensive treatments and procedures may not be seen as clinically appropriate after successful CPR. For example, support for multi-organ failure in an ICU may not be clinically appropriate even though the heart has restarted.

Some patients may wish to receive CPR when there is only a small chance of success, in spite of the risk of distressing clinical and other outcomes. If we consider that such an intervention is not clinically appropriate, we should ensure that they have accurate information and explore reasons for the request. Try to reach agreement: it may be that limited CPR interventions are acceptable to both patient and clinicians.

When the benefits, burdens and risks are finely balanced, the patient’s request will usually be the deciding factor.

If, after discussion, we still consider that CPR would not be clinically appropriate, we are not obliged to agree to attempt it in the circumstances envisaged and should explain our reasons and any other options that may be available to the patient, including seeking a second opinion.

Ensure that any discussions with a patient, or with those close to them, about whether to attempt CPR, and any decisions made, are well documented.

If a DNACPR decision is made and there has been no discussion with the patient because they indicated a wish to avoid it, or because it was your considered view that discussion with the patient was not appropriate, note this in the patient’s records.

These decisions require reassessment and ongoing documentation: Doctors Worklist, within Unity, is the agreed workflow. Medical teams are expected to use this to complete these reviews contemporaneously.

We must remember and be clear that a DNACPR decision applies only to CPR. It does not imply that other treatments will be withdrawn or withheld. For example, some patients come to ICU with a DNACPR order and go on to receive multiple organ support.

Star Awards 2021 – Employee of the Year

Do you know an employee who has an excellent attitude to work, colleagues and patients, someone who has repeatedly gone beyond the call of duty, made improvements to the delivery of services or the patient experience, or who consistently demonstrates the Trust’s promises to provide excellent care?

Nominate them as the Employee of the Year in this year’s upcoming Star Awards!

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Ways to nominate:

• You can complete a paper nomination form which you can download by clicking here.
• You can send in a video nomination for free to swbh.comms@nhs.net via www.wetransfer.com. Choose go to free. When doing the recording remember to state clearly who you are and the name of the person/team you are nominating.
• You can complete the online form by clicking here.

Be sure to check out last year’s award ceremony featuring last year’s winner for the award, Edward Fogden (timecode: 57 minutes, 24 seconds).

If you have any questions regarding the Star Awards, please contact the communications team on 0121 507 5303 or email swbh.comms@nhs.net.

For more information, please visit our dedicated Star Awards page on Connect.

Do you know how to order batteries for your department or area?

Our main reception at Sandwell are no longer be supplying batteries for any departments, wards or individuals. This means going forward batteries will need to be ordered by individual areas. Please see codes below for ordering of batteries:

• WPA214 – AA batteries
• WPA416 – AAA batteries
• WPA149 – LR14 ‘C’ batteries
• WPA150 – LR20 ‘D’ batteries

For more information in regards to ordering batteries, please email lisa.southall1@nhs.net.