Claire Cox

In this podcast from General Broadcast, Clinical Lead Daimon Wheddon and the Norfolk and Norwich University Hospital's Dr Caroline Barry, sit down to talk about ReSPECT. The ReSPECT process provides a written record of patients' treatment preference and focuses on treatments to be considered as well as those that are not wanted or would not work. People with a complete ReSPECT form do not require a separate DNACPR form although it is important to be aware that a patient can have a ReSPECT form and still be in favour of cardiopulmonary resuscitation. ReSPECT aims to inform decision making for ambulance clinicians when the patient may lose capacity to make decisions for themselves.

Dan Phillips, Clinical Lead from the East of England Ambulance Service, talks to General Broadcast about their aims to reduce time on scene for seriously unwell patients. He looks specifically at a project called 10-10 and how to improve outcomes for stroke patients.

On this General Broadcast episode, Patient safety Integration Lead Jordan talks with Andy Collen. Andy is a paramedic who has completed a huge range of roles, including being the medications and prescribing lead for the College of Paramedics, a national investigator for the Healthcare Safety Investigation Branch and has written a book about decision making in paramedic practice.

Leadership is all about people. During times of crisis, urgency, uncertainty and change the need for leadership is very real. Leadership that is exceptional and active. Colleagues can feel uninformed, anxious, not valued, not heard, confused and fearful. We know that these dimensions can hinder communication and performance but can be eased by regular contact with leadership, moments of clarity (even if short lived), transparency, openness, honesty and a sense that their concerns matter and are not simply dismissed.  The time required for away days, large gatherings, huge debriefs may be difficult to secure but the concepts remain valid and checking in with your people is time well spent. These 5 questions, developed by (East and North Herts NHS Trust, can be used quickly and on a regular basis. If each of us was asked these 5 questions each day or shift they allow us to share how we are experiencing things, reflect on our team mates and colleagues, take away actions for ourselves to help others and have the support from our leadership in helping and supporting us. Good leadership in tough times can be action focused and people centred. This video is the first on several that have been shared in a series of tools and techniques to help you and allow you to help others.

Researchers, patients, family members, health care staff and website developers have come together to create this website. It is based on over 120 interviews with former Intensive Care patients and family members at different stages of recovery. This website is aimed at: patients who have been on intensive care relatives and families who have been affected by their loved one being in intensive care.

This webpage written by the Royal College of Nursing, is designed for nurses and offers answers to frequently asked questions on coronavirus and the affect it has on their working life. Find out how to protect yourself, what you should expect from your employer and what to do if you have concerns.

Free online mental health and emotional wellbeing services have been set up to support frontline workers.  Frontline19 was set up by a small team of experienced pyschotherapists as a crisis response to the COVID-19 epidemic. They are working in partnership with Helpforce and are guided by a steering committee of industry professionals. If you are a frontline worker directly affected by COVID-19 and you need support to help you through this difficult time, please register for more info. Its quick, easy and absolutely free of charge. It's free, it's quick and it's easy. Connect on Zoom, Skype or FaceTime with a qualified psychologist, psychotherapist or counsellor at a time that suits you: confidential supportive non-judgemental accepting calming.

This is a step-by-step evidence based guide by University of Oxford is designed to support all healthcare professionals faced with the painful task of contacting relatives by telephone to inform them that a loved one has died.

The National COVID-19 Clinical Evidence Taskforce supports Australia’s healthcare professionals with continually updated, evidence-based clinical guidelines. This website includes: guidelines decision Flowcharts research under review.

In her latest blog, Claire, a critical care outreach nurse, reflects on how the 'ad hoc' team has to adapt to the new challenges the coronavirus pandemic brings. She offers insights into the challenges she and her team face and gives examples of potential solutions. What is an ad hoc team? An ‘ad hoc’ team is a team that is made up of various healthcare workers that have never met before. An example of this is the medical emergency team or the cardiac arrest team – doctors, anaesthetists, nurses and other allied health professionals scrambled from around the hospital expected to assess and treat a patient in crisis. Often, we don’t know each other’s names, roles or what skills we each have. What we did in Brighton is to get to know each other… We had a MET meeting every morning. We all got together and introduced ourselves, found out what skills we all had and made full use of any learning opportunities that arose. The ad hoc team worked well. We all knew what to expect, even when a complex situation arose – we all knew who to contact and how we could get the best for our patient. Then in comes a pandemic... Staff have been redeployed; rotas have been changed; the usual rhythm of the hospital has disappeared. Our regular meeting doesn’t happen. This causes problems: Who is who? What skills do people have? Has everyone been fit tested? Where do we get the PPE from during a MET call? How do we communicate to each other? What is the guidance to take blood, do an ECG, defibrillate, order an X-ray during the pandemic? All these questions and anxieties could be discussed at this meeting, but due to a change in working patterns, the change in doctors seeing different patients (Green and Red – COVID + or COVID –), its not possible to meet up. Our technical skills are not a problem – the team have great skills in advanced life support, using life saving equipment. What we are finding difficult is the non-technical skills: communicating, tone of voice, body language. It was hard enough to communicate in a high stress situation before all this pandemic… now its even harder and so much more important! Simulation Simulation has been a large part of how we train in low volume, high risk scenarios in hospital. Cardiac arrests, medical emergencies, emergency intubation, transfer, pacing… you name it we have probably simulated it here at Brighton. I have been on the medical emergency team for 9 years now. I like to think I have experience in most emergencies and know what to do and who to call. All of a sudden, I feel a novice. I don’t even know how to go into the room correctly, I don’t know what I should take in to the room, I don’t know what I should wear; every action, every protocol I would normally do can't happen due to current constraints. I am worrying so much that I feel paralysed to do anything for fear I’m doing it wrong. We have simulations every day at 3 pm at our hospital. These simulations are very low fidelity and include how a medical emergency or cardiac arrest in the COVID-19 patient should run. Simulation can never replace what a real-life scenario will feel like. What simulation can do is allow you to understand what needs to happen, in what order and lets you make mistakes in order for you to learn. Most adults learn from ‘doing’ and from experiences – I am so glad we had this simulation as I was about to attend my first MET call a few days later. My experience attending an airway medical emergency The call went out. "Medical emergency XXX ward – COVID positive". Shortly followed by "Anaesthetic emergency XXX ward- COVID positive". I ran faster knowing that as a team we all had to get there and put full PPE on before we could attend to the patient. If the patient has an airway problem, they will not be able to breathe properly and be at high risk of stopping breathing. I remembered at the simulation exercise that one person needs to be the ‘gate keeper’. I decided to take on this role as I wasn’t sure who had attended the simulation before and knew about this role. My role as gate keeper is to make a note of who is in the room, what role they have and to take messages in and out of the room from the doorway. The notes are not able to be taken into the room, so it would be the gate keeper's role to get the information across to the team inside. I was opening and closing the door and trying to hear muffled voices; I was equally trying to convey important medical information, but they couldn’t hear me well enough. It didn’t help that for many of the team English is not their first language; this made it even more difficult. Our anaesthetic team simulate situations on a regular basis as part of normal work. They turned up at the call already kitted up in PPE and wheeling a trolley with everything they needed on it; all their drugs and equipment were there. One of them – the lead anaesthetist – had a headset on which was connected to a walkie talkie. This made conversing with the team so much easier. We could ask questions from outside the room into the room and vice versa without having to open the door. Clearly, they had rehearsed this scenario before – they too couldn’t hear well so had solved the problem by obtaining walkie talkie devices. They asked for equipment, called for X-ray or asked for more information and I could either relay information, pass equipment or order tests for them – so much easier and safer. The patient had a complex airway and needed to be seen by a specialist. A consultant arrived; one I had not met before. He arrived anxious. He was worried about donning the PPE in the correct order and in swift time. I helped him donn and, while I did that, I reassured him on who was in the room, what had happened and what treatment the patient had had. He entered the room knowing he had the right gear on and what he was facing. This enabled him to think clearly and treat the patient. When it was time to transfer the patient to intensive care, we came across a problem. We had two differing protocols. One was from yesterday, the other was rewritten this morning… which was correct? This was quickly cleared up by calling the author of the protocol, but what would happen at 3 am if this was to happen again? Reflections It was my first time as gate keeper. To be honest, I didn’t know what I should be doing… some of the information from the simulation flew from my mind. Looking back, I should have asked for the name and role of who walked into the room and wrote it on their PPE or used stickers. People were in such a rush to get in and save the patient's life that it didn’t feel like a priority at the time. The walkie talkies were a genius idea from the anaesthetists – this is something that I will take back and see if we can implement the same for all MET calls (anaesthetists do not attend MET calls normally). It reduced the opening and closing of the door, which reduced the amount of aerosoled particles to come out from the room that may increase risk of infection to others. Flattened hierarchy – the moment I had with the consultant outside that room was something I hadn’t experienced before. I noticed his vulnerability, he looked for me – a nurse – for reassurance and guidance which was given with no judgement. At that moment we knew we were one team. Protocols keep changing. We are working where national guidance and local policy changes daily. Without robust ways of disseminating this information we run the risk of doing the wrong thing. As clinicians we are not at our desks monitoring for changes in guidance – we need ways of getting this information to us. We use the ‘workplace’ app – we have a ‘microguide’ for all our up to date policies. This is great to use in normal circumstances but when dressed in PPE we are not always able to access our mobile phones. I wasn’t inside the room. I could see the patient. I could see that he was scared. He couldn’t breathe, he was unable to talk anyway due to his altered airway. How were the team communicating with him? How was he being reassured? Our facial expressions say a thousand words – behind a mask the patient sees nothing. I have heard of the CARDMEDIC flash cards, but can we use them in an emergency? Perhaps we could add them on to the cardiac arrest trolley? The patient is doing well on intensive care now. It would have been ideal for us to debrief; however, half the team go with the patient the other half of the team need to get back to other sick patients, so this can't happen. So much learning comes from these calls; we haven’t got this bit right yet.

Read the latest episode in a series of podcasts from the Clinical Human Factors Group giving tips from frontline staff working with Covid patients. Podcast 1 – Interview with Chris Frerk Podcast 2 – Interview with Mark Stacey Podcast 3 – Interview with Stephen Hearns Podcast 4 – Interview with Claire Cox

Once registered, paramedics must continue to meet the standards of proficiency that are relevant to their scope of practice; the areas of their profession in which they have the knowledge and skills to practise safely and effectively. These standards set out by the Health and Care Professions Council were effective from 1 September 2014.

This document designed by the Patient Safety Movement is a dynamic document that gives a summary of therapies given to COVID patients in the US.

This resource has been developed by a group of multi-disciplinary health professionals at Lancashire Teaching Hospitals. The purpose of the website is to support patients with their initial recovery once discharged from hospital following treatment for COVID-19. It is hoped that the information and advice provided will assist patients and their families starting their rehabilitation journey. Although hospital admission is referred to throughout this resource, it can also be used for patients who remain in their own homes and we hope that the information and advice provided will assist all patients and their families starting their rehabilitation journey following COVID-19.

When it comes to communication, we rely on language at the expense of the rest of our communication toolbox. However, nonverbal communication is just as important as the words we use.1 In times of the COVID-19 pandemic, the use of face masks has become ubiquitous in many countries. Many facial expressions are the same across cultures, like happiness, sadness, anger and fear and our faces can express emotions without saying a word. Given widespread masking, this nonverbal communication has become increasingly difficult. This paper from Schlögl and Jones in the Journal of the American Geriatiric Society gives practical advice on how to communicate while having to wear a face mask to our most vulnerable patients during the pandemic.

Health Education England (HEE) has created this accelerated preceptorship guide, for use with newly qualified practitioners (NQPs) and Health Care Professionals (HCP's) on the NMC Covid-19 temporary register in response to the COVID-19 pandemic. The guidance is focused on how health and care organisations pan-London can support newly qualified practitioners (NQPs) and health care professionals (HCPs) on the Covid-19 temporary register. This is a fast-changing and emerging situation and guidance may be subject to further development. Therefore, these principles should be used in conjunction with advice and guidance from the regulatory councils (e.g. Nursing and Midwifery Council (NMC), the royal colleges, trade unions and national HEE guidance. For newly qualified practitioners and healthcare professionals on temporary register you will find: Accelerated Preceptorship Guide. Guide for staff supporting during Accelerated Preceptorship. Voice over - Guide for staff supporting NQPs. Support for staff during Accelerated Preceptorship. Voice over - Support for NQPs and other HCPs. Podcast One - general Information.

This is the YouTube Channel for the UCSF School of Medicine in the USA. Here you are able to listen and watch webinars on the latest 'grand rounds' on COVID-19. These webinars cover: paediatrics shape of the pandemic, digital innovation epidemiology, science & clinical manifestations of COVID-19 research general updates.

The global COVID-19 pandemic has the potential to severely affect those with rheumatic diseases or who are taking immunosuppressive therapies. Information is lacking as to how these groups will fare if they become infected. A global alliance has rapidly formed to try to address this information deficit. The rheumatology community has created a global, coordinated and timely response to the COVID-19 pandemic. The alliance aims to harness the breadth of expertise and knowledge in the rheumatology physician and patient communities to advance knowledge about COVID-19 for the benefit of all patients with rheumatic diseases.

Recordings with frontline staff at Bradford Royal Infirmary, taking you behind the scenes on the wards as they plan for the onset of COVID-19 and then cope as the patients arrive. Listen to various audio sessions by BBC Radio 4 as Bradford Royal Infirmary cares for patients with COVID 19 in their hospital.