Monthly archives: August 2021

Drug safety notice: Prochlorperazine 12.5mg in 1ml Injection

We have recently been informed by suppliers that they are currently unable to supply Prochlorperazine 12.5mg in 1ml Injection. Prochlorperazine injections are used for the management and prevention of nausea and vomiting. Pharmacy currently has limited stock of Prochlorperazine injections and stock is not expected until mid September.

Alternative options for the management and prevention of nausea and vomiting in patients
unable to tolerate oral treatment are:

• Cyclizine IM/IV
• Ondansetron IM/IV

For further details please see Prochlorperazine injection information sheet.

For more information please contact the pharmacy department on ext. 5263/3783.

COVID-19 Bulletin: Friday 27 August

We continue to ask colleagues to remain mindful of the risks posed by COVID-19 and follow the existing rules and infection control and prevention guidance. We continue to see positive cases of COVID-19 across our organisation, and the only way we can safely facilitate patient care and protect our colleagues is by collectively following guidance to keep our Trust as COVID secure as we can. 

If you aren’t already, please sign up to take part in our saliva testing programme (LAMP). It is a fast, efficient and non-invasive way of protecting yourself and it assures you that you aren’t unknowingly spreading COVID-19 to your loved ones, colleagues and patients.

Numbers not statistics: This week (last week)

1. New: Self-isolation changes   

As you’ll be aware, on 16 August, national self-isolation rules changed. Public Health England guidance was altered to allow fully vaccinated NHS staff identified as a contact of a positive COVID-19 case to return to work without self-isolating in exceptional circumstances, provided they have had a negative PCR test and complete daily lateral flow testing for 10 days.

After careful consideration, the Trust has decided not to allow anyone that lives directly within the same household as a positive COVID-19 case to return to work apart from some agreed exemptions. This decision will ensure we can continue to support safe patient care and the safety of all our colleagues.

There will be an exemption to this for those working in critical care and where the prolonged absence of staff risks the safety of providing clinical or care services. On that basis, the team will mitigate that risk by allowing those who’ve had direct contact with a household member who is COVID positive to return to work with restrictions in place including being PCR test negative and having no contact with non-COVID-19 patients. Where the clinical need for delivery of services can be adequately covered in critical care, colleagues will stay in self-isolation.

The decision to allow staff to attend work in other areas will be made on a case by case basis. A COVID-19 self-isolation exemption decision assessment will need to be completed by a line manager. It will also require authorisation by the Director of IPC/Deputy Director IPC or the on-call manager out of hours.

This change is effective immediately. For the protocol and guidance, click here.

2. New: Wanted! Please return your respirator hoods     

Ahead of winter, the infection, prevention and control team (IPC team) are conducting an audit of all respirator hoods in use across the organisation.

The team would like to ensure that all hoods are available and  in good working order. Your cooperation will ensure we have the equipment in place ahead of winter and that it is fit for purpose.

If you have any respirator hoods that you no longer require, please contact the IPC team or Scott Shenton on ext. 5089 or 07866 007539.

3. New: COVID vaccination status for NHS staff entering care homes

From 11 November 2021, all care home workers, and anyone entering a care home, will need to be fully vaccinated, unless they are exempt.

These new government regulations state that all care home staff are required to provide proof of having had two doses of an approved COVID-19 vaccine or that they come within a specified exemption.  This is applied to all CQC regulated care homes providing nursing or personal care in England.

All Trust staff (including temporary, voluntary, bank and agency staff) working to fulfil a service in a care home funded by the NHS are in scope of these regulations. This will include, but is not limited to:

• Primary care (general practice, dentistry, optometry and pharmacy), community health, mental health, learning disability and autism (MHLDA), acute teams providing outreach into care homes, non-emergency patient transport services, end of life community teams and staff attending to maintain medical equipment
• Staff not in a front-line caring role who visit a care home. For example, in relation to continuing health care or a training provider.

Under current vaccination guidance, eight weeks are required between the first and second vaccine dose. Therefore, all staff entering a care home for work – who are not exempt – need to have had their first dose by 16 September 2021 at the latest.

Line managers are asked to liaise with their teams who may be affected by these regulations to:

• Understand and document vaccination and exemption status of staff members
• Actively support uptake of vaccination ahead of 16 September 2021 and conduct supportive one to one conversations to establish reasons for vaccine hesitancy
• Carry out a risk assessment for staff and services impacted and actively plan workforce deployment for services. This is to avoid disruption to our service provision in care homes
• Ensure that relevant staff will be able to demonstrate, via the NHS app or otherwise, that they have either been fully vaccinated or are exempt from the requirement.

Further information/guidance can be obtained via Group HR Business Partners. You can read the latest FAQs here.

4. Updated: Vaccines now available for expectant mums in antenatal at City every Tuesday and Friday

If you are pregnant you can receive your COVID-19 at clinics which are being held within our antenatal department at City Hospital every Tuesday and Friday, 1pm – 6pm.

The hub is still open to get your COVID-19 jab: The City Hospital vaccination hub in Sheldon Block is still open (under the leadership of SWB) for those aged 16 or older who would like their first or second jab. Colleagues are able to walk-in to the City Hub for their vaccination.

 The hub operates from 8am – 6pm daily for walk-ins, whilst it is open until 7.30pm for those who have booked an appointment. Bookings can be made via the national booking website.

The hub will be administering both Pfizer and AstraZeneca. Pfizer will be administered to the under 40s and AstraZeneca to the over 40s as per the current JCVI guidelines.

Alternatively, to find a venue closer to your home, click here.

5. Reminder: Do you know about long-COVID?

Long-COVID can lead to terrible fatigue and brain fog, whilst some people have reported hair loss as a symptom.

Be sure to check out this short video featuring Ruth Williams who is our community and primary care lead speaking about the devastating effects of long-COVID on those who have had the virus.

Referrals for long COVID assessment clinic:

 An online referral form is now available for patients who are registered for a GP in Sandwell who have been clinically diagnosed with COVID and who are still presenting with symptoms to a long COVID assessment clinic.

Once submitted the patient will be contacted with an appointment date and time. The assessment clinic is a virtual assessment clinic to identify the rehab needs of the patient.

After the patient has been assessed, they may  be given self-care advice, referred on to appropriate community services for treatment or referred to a consultant led MDT for more specialist care.

You can access the form by clicking here.

Note: Patients without a Sandwell GP should be referred to their own GP to access their own local COVID clinic.

6. Reminder: Warning – anti face mask posters

We have been alerted to anti face mask posters being put up in some Trusts nationally and at vaccination sites. Some of these contain hidden razor blades.

If you see any of these posters at our sites, please DO NOT TRY TO REMOVE THEM. Contact security on ext. 2222 who will do this safely.

When logging a call, please reference ‘the security alert for removal.’

7. Reminder: Wellbeing hubs at Sandwell, City and Rowley

Focusing on ensuring that colleagues have a good day every day, the new hubs aim to help improve mental health, relieve stress, build resilience and restore balance.

Recognising that colleagues need to be able to access services easily, the new hubs are set to provide much needed health and wellbeing for colleagues closer to their work base.

Services in the new wellbeing hubs include:

• Confidential chat – an opportunity for colleagues to offload and talk about anything which is troubling them
• Meditation
• Relaxation POD (massage chair)

The wellbeing hubs are completely confidential. All services and treatments are free of charge for Trust colleagues and delivered by trained wellbeing coaches.

The wellbeing hubs are a regular service available weekly across all the sites listed below between 8am – 4pm:

• Every Monday in the Jayne Wright Therapy Room, Trinity House, Sandwell
• Every Wednesday in the therapy room Archer, first floor, Rowley Regis Hospital
• Every Friday in the therapy room, City Gym

To book a session contact the wellbeing team on 0121 507 5886 or 0121 507 3854.

8. Reminder: Swabbing for safety – ensuring we protect our patients throughout their care pathway

We continue to see COVID-19 positive patients within our hospitals, therefore it is essential that colleagues ensure they are following the correct swabbing pathways. This is essential to maintain patient safety and uphold infection prevention and control principles.

It is important that colleagues take the time to understand their responsibility when it comes to swabbing. Please take the time to read the pathway guidance linked below as well as the ‘To swab or not to swab’ poster for further guidance on your responsibility to swab test patients in our care.

• Unplanned Admissions Swabbing Pathway
• To swab or not to swab poster

9. Reminder: Join the weekly saliva testing programme to protect your patients and loved ones

Did you know we currently offer a weekly testing programme for all colleagues that allows you to get reliable results on COVID testing through a completely pain free and non-invasive test?

You can register for LAMP testing and book in to a kit collection slot for the weekly test, which requires you to spit into a tube in the morning before you brush your teeth or an hour after you have eaten.

When you arrive at work, you can deposit your sample into a red collection box. Many of these are positioned around our acute and community sites. And within 24-48 hours you will get a text message confidentially sent to you alerting you to your results.

For a full list of drop off points and for details on how to register, click here.

Packaging samples

In order to help processing at the labs, please make sure that samples are correctly packaged:

	Peel label off the request form and attach it vertically to the outside of the pot, avoiding any overlap so that all details including the barcode can be seen clearly.
	Fold the request form in half top to bottom, then fold again but not quite in half so the patient details show. Put the request form inside the larger bag, in the sleeve for the request form, ensuring that your patient details are visible.  Then place the sealed smaller specimen bag into the outer larger bag sleeve marked LAMP SPECIMEN, sealing the sample sleeve closed, keeping the sample secure

For more information click here.

Uptake of the weekly saliva test is monitored to ensure we are doing everything we can to protect our patients, the public and each other.

The latest data by group is below:

Chief Executive’s Message – Friday 27 August

We are currently going through the process as a senior leadership team, of defining what our longer term objectives and goals are for the next few years.  Much is changing in healthcare in the NHS, some of it driven by the pandemic, some of it driven by legislation, some of it driven by workforce shortages and skills gaps.  Our new strategic objectives and subsequent plans, will have a particular focus on how the Trust needs to respond, longer term, to improving population health and our own staff experience and wellbeing.  However, one more immediate yet ongoing objective is to be better at delivering the fundamentals of care.  To be good or outstanding in everything we do.

One of the fundamentals of modern healthcare is the management of sepsis.  Sepsis is a global problem and accounts for about 20% of annual global deaths.  Many of those that survive sepsis can end up with long term health conditions. In our own Trust, 175 patients have a confirmed diagnosis of sepsis each week.  That is a huge number.  Sadly, it remains one of our commonest causes of death. The key to reducing deaths is prompt recognition as well as prompt treatment.  Our data show that  whilst we achieve a quite impressive 95% of eligible patients being screened for sepsis, we only achieve 65% receiving antibiotics within the first hour.  Research shows that delays in administration of antibiotics increase the chance of patients dying by nearly 8%. It is therefore important that all clinical areas review their processes, identify and improve on the barriers that are stopping us from achieving 100%.

The Trust is celebrating world sepsis day this year by a series of events in September to raise awareness. We encourage you to make sepsis a focus for your new safety huddles. All wards are encouraged to take part in the Sepsis board competition. I will be taking part with David Carruthers, Trust Medical Director and others in judging the best board on 20 September. If you wish to participate in the above competition, please contact essie.li@nhs.net. A sepsis board game tournament will take place in the MEC on the 17 September.  Group Directors will nominate staff to represent their groups to play against the Corporate Group.  I suspect the corporate team may be up against it here!  Sepsis is also going to be the focus of shared learning in the September QIHD.

Lets remind ourselves that delivering the fundamentals of care is our primary objective.  Improved sepsis management is a significant part of that.

Thank you to all colleagues working on the SurgiNet implementation that was successfully integrated within Unity on last week in readiness for the operational go live this autumn, replacing ORMIS. Training is required for all colleagues who will need to use the system so please make sure that you complete the necessary training. Your IT equipment will need to be up to date so if you are unsure contact the informatics team on ext. 4050 who will be able to advise you.

Do you want to quit smoking?

We are now offering free access to a 12 week smoking cessation programme for Trust colleagues.

Did you know an average smoker spends £242 per week, £2900 per year and £116,000 over a lifetime on smoking.

The stop smoking service provides expert advice, support and encouragement.  With help, you are up to four times more likely to successfully quit smoking.

Colleagues wanting to kick the habit can also access the free smoking cessation services during working hours.

A dedicated one-to-one personal advisor will be available for up to 12 weeks to support colleagues with nicotine replacement therapy (NRT) products offered as part of the service.

Clinics can be accessed via a telephone, though appointments during working hours must be agreed by line managers.  The initial booking session will take 30 minutes and thereafter appointments will take 15 minutes.

Please see contact details for the smoking cessation service below:

• Telephone: 0333 005 0095 or text the word “QUIT” to 60777
• Email: eh.sandwell@nhs.net
• Website: https://sandwell.everyonehealth.co.uk/

Note: Colleagues should contact jatinder.sekhon@nhs.net  or call ext. 5886/3854 for a voucher in order to register for the service.

Updated actions required for national supply issue with blood tube products

There are now additional actions required in order to balance the demand of blood tubes and ensure there is no disruption to urgent clinical care for patients.

It is important to note:

• Primary care have been asked to cancel all routine blood testing until September 17th. Please consider any impact on requests where follow-up testing is requested after discharge from hospital services – both timing and necessity for testing.
• To illustrate the scale of the request that is asked of us all, a 25% reduction in blood tube usage is asked for over the next 3 weeks. Please consider the approaches below again and how you can help minimise the risk of severe restrictions, the consequences of which will be great. Please discuss options daily with your teams.
• We are awaiting an update SOP for add-on testing to facilitate that process for additional tests where a sample already exists and will get that out as soon as it is available.
• The tubes affected are:
  1. 5mls Yellow top – SST 2 – clotted sample (e.g. U&E, LFTs etc)
  2. Purple top – EDTA (e.g. FBC, HbA1c)
• A summary of the new guidance is below:

Acute trusts, community hospitals and mental health trusts

Acute and mental health trusts must reduce their demand by a minimum of 25% for the three-week period up to 17 September 2021. We are asking laboratories to help you in documenting this change

These reductions should be made in line with the guidance on recommended actions and can include a combination of reducing non-essential (non-clinically urgent) testing, optimising inpatient and assessment unit sampling, encouraging add-on testing to reduce the need for blood tube usage, increasing use of point of care haemoglobin devices, reducing daily testing where possible and ensuring greater senior clinician input in requesting tests. All of these measures should be undertaken where safe to do so.

Primary Care and community care

All primary care and community testing must be halted until 17 September 2021, except for clinically urgent testing.

Examples of clinically urgent testing include:

• Bloods that are required to facilitate a two week wait referral
• Bloods that are extremely overdue and/or essential for safe prescribing of medication or monitoring of condition
• Bloods that if taken could avoid a hospital admission or prevent an onward referral
• Those with suspected sepsis or conditions with a risk of death or disability

There are a small number of QOF indicators which require a blood test to be undertaken. Unless clinically urgent, practices should move blood test activity scheduled prior to 17 September to a later point in the year when supply improves. We appreciate that this temporary position is frustrating for patients and services alike. It may mean practices rescheduling certain QOF indicator checks for later in the year, when supply has improved.

Given QOF is an annualised process, there are no current plans to change QOF payment arrangements for these indicators though we will keep this under review.

Please review the guidance and actions required in previous messages but also think about other ways your service can safely reduce test requesting.

Talk to your clinical lead if any concerns or queries.

National supply issue with blood tube products – actions required

You may be aware that that there is a global shortage of blood tube products and NHS England has been notified of supply disruption in relation to Becton Dickinson blood specimen collection products. This issue continues to cause concern at a national level. Although BD tubes are not used at SWBH/Black Country Pathology Service, we expect that there will be an impact due to availability issues elsewhere. We are required to follow the latest guidance in order to balance demand. This guidance is to optimise the use of blood tubes and ensure there is no disruption to urgent care and clinical services for patients.

Please review the guidance and actions below but also think about other ways your service can safely reduce test requesting.

Clinical directors and specialty leads have been asked to review the summary list of actions and confirm what steps they will be taking to reduce test requests and/or delay requests for 4-6 weeks following assessment of risk.

Point of care haemoglobin devices to be used where possible

• Ensure staff use point of care devices have been appropriately quality assured for haemoglobin measurement, e.g. in critical care and theatres, instead of using EDTA tubes.

Minimum retest intervals

• Follow the guidelines related to RCPath minimum retest intervals to avoid over-testing
  for items such as B12 and thyroid disease.

Encourage add-on testing to reduce the need for blood tube usage

• Encourage add-on testing by clinicians ordering tests.

Optimise inpatient and assessment unit sampling

• Only test for a clinical indication in patients and increase the testing interval for monitoring where it is clinically safe to do so.
• Keep testing levels under active review.
• Avoid routine group and screen testing unless patient likely to require transfusion.

Genomics testing

• Genomics is a high priority in the testing of unwell neonates, prenatal screening and cancer diagnosis. Stock should be used for these tests and should be prioritised accordingly to allow these tests to continue uninterrupted.

Reduce non-essential (non-clinically urgent) testing

For more information, read the guidance or talk to your clinical lead if any concerns or queries.

Trade Union event for colleagues to have their say on the NHS pay offer

An event organised by Unison is taking place on Thursday 2 September, 10am – 2pm at Sandwell courtyard gardens where colleagues are being encouraged to have their say on the new NHS pay offer. All colleagues are welcome to attend.

You can also have your say about the NHS pay offer here: https://www.nhspay.org/

BTC closure this Sunday

The BTC will be closed this Sunday (29 August) to allow essential maintenance works to be carried out.

All services will be shut down  and access will be limited to contractors working on site. No clinical or non-clinical activity will take place. The works are expected to take 10 hours to complete meaning the BTC will not be open until Monday morning.

Heartbeat: Don’t be a bystander – inspiring medic empowers colleagues to speak up

Dr Sarb Clare is one of our well-known clinicians who heads the acute medicine department and is also deputy medical director.

But she is also leading the way in empowering colleagues – by holding a series of events where she encourages people to speak and stand up for themselves.

She has established the Women Empowering Women Network and the latest session for medics, held on 30 June, called ‘Stand with me, not by me, be an ally, don’t bystand, but upstand’ addressed unconscious bias.

She explained: “We have delivered previous events before lockdown, but feedback showed that delegates still felt apprehensive about speaking up informally and formally due to upset, career damage and mistrust in the system.

“In response the network felt we needed to look at solutions and strategies that bystanders could apply to support the individual being harmed.

“We addressed our unconscious bias and looked at how to change from being a bystander to an upstander. We discussed banter and argued whether we should we ban this from the NHS.

“We also analysed real life scenarios and what interventions we can make. It was also important that people were informed of the formal pathways of grievance and escalation. This was delivered by our responsible officer Dr Mark Anderson.”

Dr Clare has spoken about this subject in a TEDx Talk. To watch this please click here.

Have you completed your basic prevent awareness training?

A number of colleagues have basic prevent awareness training which is due to expire at the end of August.  Previously this was covered by a leaflet attached to payslips, however, it will now need to be completed via e-learning to comply with national standards.  Please could colleagues and managers check records and ensure that this training is completed as soon as possible to avoid people going ‘out of date’ and to enable records to be updated.

This training can be completed via e-learning in ESR. The name of the course is 381 E-Learning – Preventing Radicalisation (Basic Prevent Awareness). 

Please click here for more information on how to access and complete the e-learning.