NHS Wales - End of Programme Learning Report: National Nosocomial COVID-19 Programme (15 August 2024)

Summary

Due to the scale of the pandemic, despite being in a healthcare setting, patients in hospital and other in-patient settings faced an increased risk of nosocomial (hospital-acquired) Covid-19 infections. This report presents the outcomes of a programme of investigation work into cases of hospital-acquired Covid-19 in Wales. Expanding on the themes identified in the Interim Learning Report, published in March 2023, this report highlights further national learning in relation to communication with families and carers, clinical record keeping, staffing and resource, discharge planning and the impact of hospital environments.

Content

Below are the key learning points highlighted in this report, grouped across three areas:

People’s experiences

• Bereavement support services should be proactively offered to all families who are experiencing grief following the loss of a loved one. This is also an extremely important consideration as part of patient safety incident investigation processes. Families should be proactively signposted to information about bereavement services at the earliest opportunity.
• Every service user, family and carer should have timely access to a dedicated and easy-to-access single point of contact to provide feedback, and raise questions, concerns or queries. This is particularly key for patients and families involved in the concerns process. Supporting information should be available and easily accessible to assist families in understanding the sometimes-complicated language linked to the concerns process.
• All services and wards should have named dedicated patient support teams and volunteers to support families and carers who may be finding it difficult to visit a loved one in hospital. Future visiting guidance should pay particular reference to the role carers have as an important part of a patient’s care team. Health boards and trusts are now further recognising this in scenarios where visiting restrictions need to be implemented.
• The strain placed on ward staff had a negative impact on capacity which had an adverse impact on communication with patients’ families and carers. Under periods of extreme pressure, Patient Advice and Liaison Service (PALS) teams and volunteers, where appropriate, can be effective to support communications whilst ward staff prioritise patient care needs.

Patient safety incidents and concerns

• All policies and procedures relating to the management of patient safety incidents which occur during NHS-funded care should set expectations of the standards required across all care settings to minimise confusion for service users, families and carers who may be receiving care across multiple complex care pathways.
• All health-acquired infections need to be assessed against the requirement to report as a patient safety incident, in line with national incident policy, and an appropriate patient safety investigation needs to be initiated.
• Service users, families and carers place great value on good communication around the DNACPR process and need to be involved as much as possible in the decision-making process. Continued development and roll-out of an electronic advanced care planning document, is also seen as key to improvements which would support clinicians during the process and alleviate some of the potential issues around DNACPR documentation and broader communication.
• For clinical records to be completed to a high standard, clinical staff need the time to focus their attention on record keeping. There may also be wider value in reaffirming to clinical staff the value in record keeping and how it supports the patient safety agenda and investigation processes. Digital solutions for clinical record keeping support good practice, enhancing legibility and timely access to notes. Work underway by Digital Health and Care Wales and NHS Wales organisations to embed systems such as the online Welsh Nursing Care Record will enhance the quality of record keeping and improve patient safety.
• There is extensive value in continuing work to enhance healthcare staffing provision. Recruitment and retention must continue to be a priority across NHS Wales for preparedness and resilience in a future pandemic scenario.

Infection prevention and control

• NHS Wales organisations are encouraged to continue exploring and implementing digital communication methods that support timely and engaging communication with colleagues on updates to guidance.
• Policies and processes should reflect mechanisms that result in limiting the number of patient moves, ensuring patients are in the right place at the right time. Where patients are moved, families should receive proactive and timely communication on the location and rationale for the move.
• Patients who experienced delayed discharge were at an increased risk of deterioration and infection. It should be acknowledged that delayed discharges were arguably a symptom of unprecedented wider system pressures (secondary, primary and community care) including different ways of working, high levels of seriously ill patients, staffing pressures and limited patient movement due to IP&C precautions and national guidance regarding discharge arrangements and community support.
• An aging healthcare estate in Wales presents a number of challenges, especially around IP&C in a pandemic scenario. Where possible, health boards and trusts should continue make improvements that enhance IP&C measures and use learning from the pandemic to inform future hospital design.