Claire Cox

Working in collaboration, The Faculty of Intensive Care Medicine, Intensive Care Society, Association of Anaesthetists and Royal College of Anaesthetists have developed this website to provide the UK intensive care and anaesthetic community with information, guidance and resources required to support their understanding of and management of COVID-19. Intensive care practitioners and anaesthetists are integral to the safe and effective care of patients diagnosed with COVID-19, and play a role in informing and reassuring the public about this viral outbreak. This website provides nformation, guidance and resources supporting the understanding and management of coronavirus (COVID-19), iincluding: airway management for adults and children obstetric management critical care management cross skilling podcasts and webinars PPE drug management.

This is a guide to end of life care symptom control when a person is dying from COVID19 for General Practice Teams, prepared by the Royal College of General Practitioners (RCGP) and the Association for Palliative Medicine. This guidance is produced during the COVID-19 outbreak in order to support the care in the community of patients and those important to them, at the end of their lives or who are unwell as the result of COVID-19 or other life-limiting illnesses. This document will be updated and adapted as further contributions are received and in line with changing national guidance. The most current version of the guidance document will be available on the public-facing pages of the RCGP COVID-19 Resource Hub and Association for Palliative Medicine website. Please check that you are referring to the most current version.

The British Thoracic Society have drawn together the following links to information for patients with lung disease and COVID-19. These include: asthma  cystic fibrosis  mesothelioma  pulmonary fibrosis  sarcoidosis UK  travel advice for patients  tuberculosis  lung cancer

This document from the British Thoracic Society links to updated guidance in the treatment of COPD patients and COVID-19.

The Resuscitation Council UK issued guidance on how to manage a cardiac arrest in the COVID positive patient. Imperial College Hospital in conjunction with the Imperial College School for Medicine have produced this video to accompany the guidance and shows practically what the process is.

This Standard Operating Procedure for ICU/HDU handover has been produced by the anaesthetic team at Brighton and Sussex Universoty Hospitals to aid a safe handover of care to the receiving team on the Intensive Care Unit/High Dependency Unit (ICU/HDU).  This double sided document is used to prepare the patient for transfer and collate all necessary information ready for the receiving team. It also includes the process and a handy check list. The form can then be placed in the patient notes as documentation of the handover. Also attached is the South East Coast Critical Care Network Critical Care Intrahospital Transfer form.

Handing over a patient to a team in critical care needs to be clear, concise and safe. Quite often there are distractions from staff moving the patient, attaching monitoring, starting the ventilator, asking questions and general background noise. This can lead to important information being missed, not understood or misinterpreted which could lead to patient harm. This short video shows how Brighton and Sussex University Hospitals NHS Trust has transformed the way that handover is received. By using a simple checklist along with a process, the critically unwell patient can be handed over quickly and safely. Further reading attached: Standard Operating Procedure for ICU/HDU Handover South East Coast Critical Care Network Critical Care Intrahospital Transfer form

I had been away from the hospital for a week and I was reluctant to go back in, fearful of what I would face, but I am amazed at how much has been achieved in 7 days. After working last week and caring for patients who were pending COVID-19 swab results, four days later I woke feeling unwell. A slight cough, tired, pale, feeling freezing cold but no temperature and generally feeling rubbish. This carried on for a few days, I then ended up with common cold-like symptoms and a residual cough. Normally, I probably wouldn’t call in sick, I would have just carried on. Following current guidance, I called in sick and was advised to take the next 7 days off. At this point testing was unavailable for NHS staff. I was sat at home not knowing if I had the virus or not while my colleagues were having to pick up the slack. If I am completely honest, I was glad I didn’t have to go back. I was anxious that we didn’t have the right personal protective equipment (PPE), systems for donning and doffing were not in place, we didn’t know what to expect over the coming days, training for redeployed nurses and doctors was not happening. I just didn’t want to go back anyway. I felt a coward. Over the coming days while I was at home, my husband then became ill, then my youngest son, then the eldest. All with mild symptoms, but still no idea if we had it or not. While I was off, I was contacted by the ‘staff welfare team’. It was just a quick phone call to see how I was, but it made all the difference. I felt like I wasn’t just a ‘worker’ off sick, I was someone that they cared about and were obviously keen to make sure I was coming back! This has never happened before. Reluctantly, I return to work, but it was like I had stepped into a different Trust. Wards with infected patients were labelled as RED wards; huge signs were outside the wards with designated places to don and doff PPE. There were clear guidance on which PPE to wear displayed in poster format. There were green footsteps and red footsteps on the floor enabling you to know which area you were in. PPE safety officers had been deployed to reassure and ensure all departments have enough stock. It felt safer. Leadership at all levels is being tested at this time. Where I work in Brighton, we are invested in ‘Patient First’. This is headed up by our Kaizen Team. All staff are trained in differing levels of quality improvement (QI). All wards and departments have improvement huddles, where they can raise a mini project and see it through. We all speak the same QI language. I dread to think what would happen if we didn’t have this in place during this awful time. By having this process, it has empowered ALL staff to speak up and give permission for frontline staff to improve processes where they work. Our executive leadership team have done an amazing job in such a small amount of time. They have increased ITU capacity, they have reshaped rotas, redeployed staff, re employed staff, transformed patient pathways (red and green pathways), pooled staff, set up systems for donations… There has been so much achieved in a short amount of time; the top-level organisation has been incredible. All this in seven days. They have been phenomenal at strategy, planning and overall management and leadership of what I call ‘the big stuff’. What they are not so good at is the ‘small stuff’. We, frontline workers are brilliant at this. The practicalities of work – where can I don and doff, where the bins should be, how do I know this bed has been cleaned? What do we do when someone dies? Can relatives visit? How do we know who is who in PPE? How can we make sure we don’t contaminate clean areas? How do we take blood now? We know what needs to be improved, we know what is missing. It’s the small details that worries staff, it’s the small details that can save lives. As I was walking seeing patients from different wards, I heard staff saying – this isn’t right – we could improve that. They can raise a ticket on the huddle board and they could initiate the change. If the change could be replicated else where in the Trust, the Matron or ward manager can then raise it at the Bronze meeting, the bronze would then raise it to Silver and then implemented. I often hear that we use a top down, bottom up approach but never really thought it works, as there is so much red tape involved in healthcare. Quite often frontline ideas never reach the top level and they fall flat. This time it’s very different. To test the system, you need to stress the system. This system of QI and communication is working. We are all learning together. None of us have dealt with a pandemic before. Frontline staff have been given the permission to improve the way real work is done, quickly and safely, while the top-level management are concentrating on strategy, planning, implementation and co-ordination of services. We are listening to each other, we are rapidly changing and adapting, the whole Trust is in a constant state of PDSA cycles. It feels dynamic, proactive and controlled. If this pandemic happened 10 years ago in our trust, I am convinced that we would not be in the position we are now. We have enough intensive care beds, we have the capacity to expand further, we are ready.

Since the severity of disease is closely related to the prognosis, the basic and essential strategies to improve outcomes that we should adhere to remain the early detection of high-risk and critically ill patients  This retrospective analysis of casein Jiangsu Province proved a good consistency between early screening of SpO2, RR, HR and early warning model. Therefore, a flowchart integrating early warning model and early screening procedure is recommended for high risk patients recognition and all patients’ screening to make it possible for early intervention. This article includes flow charts for: early recognition of high-risk and critically ill patients management of critically ill patients.

CARDMEDIC was inspired by a news article on a patient surviving COVID-19 after an admission to a UK Intensive Care Unit (ICU), where he described feeling terrified of not being able to understand what his healthcare providers were saying, due to the limitations of communicating through Personal Protective Equipment (face masks, visors, hoods etc). CARDMEDIC is a collection of communication flashcards designed to break through the Personal Protective Equipment (PPE) barrier, improving transfer of vital information from frontline healthcare professionals to unwell and critically ill patients. They are also used as an upskilling training tool, for example by healthcare professionals and volunteers working outside their usual realms of practice. They are simple and succinct, using basic language to share information and describe the plan of action. Set out in alphabetical order, it should be easy to find what you’re looking for.   You may wish to use the “HELLO MY NAME IS…” card at the start of every patient interaction to introduce yourself and set the scene for using the flashcards. The flashcards can be used in electronic format on either the patient’s or hospital’s phone / tablet / smart device, or printed, laminated, annotated and re-used – write on, wipe off.  CARDMEDIC are continually expanding their database, so please get in touch with suggestions or comments, as well as ideas for further flashcards.

Partners across the NHS and social care are mobilising at scale in response to the developing COVID-19 pandemic. The AHSN Network's role, along with England’s 15 Academic Health Science Networks (AHSNs), is to support them by helping them take full advantage of the most relevant innovations and technologies that can improve care for patients and support our services in this challenging context. Nationally, the AHSN Network is part of a coordinated NHS response to identify and enable the implementation of technologies that respond to areas of highest priority action, in particular solutions for remote consultation and patient monitoring, diagnostics and point-of-care testing. This web page sets out the AHSN's response to Coronavirus including their programmes; Industry and Innovation Medicines Optimisation Primary Care Innovations Patient Safety Collaborative Healthy Ageing National Programmes.

The Specialist Pharmacy Service (SPS) is supporting healthcare professionals with the COVID-19 Vaccination Programme in England. Read about how they are helping and the resources available.

These resources, set out by NHS England, give guidance for ambulance trusts on the following: assessment and diagnosis management - suspected coronavirus (COVID-19) cases infection Control discharge COVID-19 patient transport services: requirements and funding.

This guidance set out by Public Health England is for possible cases of COVID-19 where an emergency ambulance response is required.  Content includes: identification of possible cases on-scene clinician precautions personal protective equipment (PPE) patient assessment conveyance and patient handover post conveyance decontamination.

Older adults are vulnerable at the onset of natural disasters and crisis and this has been especially true during the coronavirus COVID-19) pandemic. Globally, more than 50 million people have dementia, and one new case occurs every 3 seconds. Dementia has emerged as a pandemic in an ageing society. The double hit of dementia and COVID-19 pandemic has raised great concerns for people living with dementia. This paper published in the Lancet discussed lessons learned from China in protecting this vulnerable group of society.

Following the emergence of coronavirus and its spread outside of China, Europe is now experiencing large epidemics. In response, many European countries have implemented unprecedented non-pharmaceutical interventions including case isolation, the closure of schools and universities, banning of mass gatherings and/or public events and most recently, widescale social distancing including local and national lockdowns. In this report, from Imperial College London, authors use a model (semi-mechanistic Bayesian hierarchical) to attempt to understand the impact of these interventions across 11 European countries.

A National Patient Safety Alert has been issued on the risk of harm from interruption of high flow nasal oxygen (HFNO) during transfer. This alert relates to the risk of harm caused by the interruption of HFNO to babies, children and adults in acute respiratory failure without hypercapnia during patient transfer. Some HFNO delivery devices have a transport mode, but most require mains power and will not deliver oxygen during transfer unless attached to a compatible uninterruptible power supply (UPS) device. The alert asks providers to add clear labels to HFNO delivery devices to make staff aware that even brief interruptions to mains power supply could lead to respiratory and cardiac arrest; and that HFNO in any emergency department or short stay unit must not be started without a plan for how to transfer the patient onwards. Where a UPS is used, action must be taken on the storage and maintenance of UPS devices to ensure they are ready for use and staff know where to locate them.

Published in Nursing Standard, these frequently asked questions are for nurses on coronavirus-related issues, including self-isolation, sick pay, redeployment and staff well-being.

A comprehensive understanding of infection prevention and control is essential for nurses when seeking to protect themselves, patients, colleagues and the general public from the transmission of infection. Personal protective equipment (PPE) – such as gloves, aprons and/or gowns, and eye protection – is an important aspect of infection prevention and control for all healthcare staff, including nurses. Its use requires effective assessment, an understanding of the suitability of various types of PPE in various clinical scenarios, and appropriate application. Understanding the role of PPE will enable nurses to use it appropriately and reduce unnecessary cost, while ensuring that the nurse-patient relationship remains central to care. This article, written by nurses from New Zealand and published in Nursing Standard, defines PPE and its components, outlines when it should be used and details its optimal application.

Respiratory infections can be transmitted through droplets of different sizes: when the droplet particles are >5-10 μm in diameter they are referred to as respiratory droplets and when they are <5μm in diameter they are referred to as droplet nuclei. According to current evidence, COVID-19 virus is primarily transmitted between people through respiratory droplets and contact routes. In an analysis of 75,465 COVID-19 cases in China, airborne transmission was not reported. This version updates the 27 March publication by providing definitions of droplets by particle size and adding three relevant publications.

No country has the resources to deal with this crisis in the way they would wish. The Chancellor of the Exchequer, Rishi Sunak, said, "we will be judged by our capacity for compassion and individual acts of kindness". All health systems have to find creative responses – to innovate, spread knowledge and collaborate. How should those who lead health and care services respond? Certainly with compassion at the heart of their leadership. This article, published by the Kings Fund, explains why compassionate leadership has never been so important with in the NHS.

The Oxford Simulation, Teaching and Research (OxSTaR) website hosts resources and educational material for different areas of healthcare with in the Oxford University Hospitals, including; Theatres Intensive Care Resuscitation Maternity General wards areas OxSTaR (Oxford Simulation, Teaching and Research) is based at the John Radcliffe Hospital. The centre provides a state of the art environment where medical students and multidisciplinary healthcare professionals can use adult and paediatric high fidelity patient simulators to rehearse a wide variety of medical scenarios.