Claire Cox

As the pandemic plays out, hospitals are reconfigured to increase critical care capacity, outpatient clinics become virtual, and elective procedures delayed. How are these affecting care for those who are in hospital but don't have COVID-19? In this podcast, Matt Morgan,honorary senior research fellow at Cardiff University, consultant in intensive care medicine and Partha Kar, consultant in diabetes and endocrinology in Portsmouth, join us to discuss how their working week is changing.

There has never been a wider mix of illnesses and issues seen by the UK ambulance services. There's also never been more different care pathways. It can sometimes be hard to know what the best thing to do is. Choice fatigue, along with patients sometime presenting in the same way as others can lead crews to make some challenging decisions. In this podcast from General Broadcast, some of the patient safety team sit down to talk about what's important when leaving a patient at home and what safety netting needs to be in place. General Broadcast covers the whole of the Ambulance service, from clinical to non-technical skills, from best practice to learning from incidents and more.

As well as designing specific products, ergonomists and human factors specialists can help understand how the space within which we work can be best designed. This can help encourage effective communication in a workplace, as well as considering the comfort of all those present.  The Chartered Institute for Ergonomics and Human Factors have come together with stakeholders involved in the care of neonates to design a space that is safe for newborn babies and staff that care for them.

In her latest blog, Claire reflects on the last few months working as a critical care outreach nurse during the pandemic and looks to the future and how we can transition into the new 'normal'. She urges us all to work together to redesign our health and social care services, building a service that meets all our needs. It's been a busy few months to say the least. Preparing for the pandemic, sourcing correct personal protective equipment (PPE), redeploying staff, acquiring new staff, making ventilators, redesigning how we work around the constraints, writing new policies, new guidance, surge plans, and then the complex part… caring for patients. If I am honest, when this all started it felt exciting. Adrenaline was high, motivation was high, we felt somewhat ready. There was a sense of real comradeship. It felt like we were all working for one purpose; to safely care for any patient that presented to us in hospital. We were a little behind London by about 2–3 weeks, so we could watch from afar on how they were coping, what they were seeing and adapting our plans as they changed theirs. Communication through the ITU networks was crucial. Clinical work has been difficult at times. The initial confusion on what the right PPE to wear for each area added to the stress of hearing that our colleagues in other places were dying through lack of PPE. The early days for me were emotionally draining. However, this new way of dressing and level of precaution is now a way of life for us. I have come to terms that I am working in a high-risk area and I may become unwell, but following guidance and being fastidious with donning and doffing helps with ‘controlling’ my anxieties in catching the virus. Some parts of the hospital remained quiet. Staff had been redeployed, elective surgery cancelled and the flow of patients in the emergency department (ED) almost stopped. I remember walking through ED and thinking: where are the people who have had strokes? Have people stopped having heart attacks? Are perforated bowels not happening anymore? The corridor in ED is usually full. Ambulances queuing up outside, but for a good few weeks the ambulance bays were deserted. The news says over and over again "we must not overwhelm the NHS". I always have a chuckle to myself as the NHS has been overwhelmed for years, and each year it gets more overwhelmed but little is done to prevent winter surges, although it's not just winter. The surge is like a huge tidal wave that we almost meet the crest of, but never get there, and emerge out the other side. I sit in the early morning ITU meeting. We discuss any problems overnight, clinical issues, staffing and beds. We have seen a steady decline in the number of ITU patients with COVID over the last week or so. The number of beds free for COVID patients were plentiful. We have enough ventilators and staff for them. This is encouraging news. I take a sigh, thinking we may have overcome the peak. In the next breath, the consultant states that we don’t have any non COVID ITU beds. We have already spread over four different areas and are utilising over 50 staff to man these beds (usually we have 25 staff). So that’s where the perforated bowels, heart attacks and strokes are. The patients we are caring for had stayed at home too long. So long, that they now have poorer outcomes and complications from their initial complaint. These patients are sick. Some of the nurses who are looking after them are redeployed from other areas; these nurses have ITU experience, but have moved to other roles within the hospital. This wasn’t what they had signed up for. They were signed up for the surge of COVID positive patients. I’m not sure how they feel about this. As the hospital is ‘quiet’ and surgical beds are left empty, there is a mention of starting some elective surgery. This would be great. It would improve patient outcomes, patients wouldn’t have to wait too long, so long that they might die as a consequence. However, we don’t have the capacity. We have no high dependency/ITU beds or nurses to recover them. We would also have to give back the nurses and the doctors we have borrowed from the surgical wards and outpatients to staff ‘work as normal’, depleting our staff numbers further. Add to the fact that lockdown has been lifted ever so slightly, the public are confused, I’m confused. With confusion will come complacency, with complacency will come transmission of the virus and we will end up with a second peak. If we end up with a second peak on top of an already stretched ITU and reduced staffing due to the secondary impact on non COVID care, the NHS will be overwhelmed. This time we will topple off that tidal wave. It’s a viscious cycle that I’m not sure how we can reverse. My plea, however, is to ensure we transition out of this weird world we have found ourselves in together. We usually look for guidance from NHS England/Improvement, but no one knows how best to do this. The people who will figure this out is you. If your Trust is doing something that is working to get out of this difficult situation, please tell others. We are all riding the same storm but in different boats. I would say that I am looking forward to ‘business as usual’ – but I can’t bare that expression. Now would be a great time to redesign our services to meet demand, to involve patients and families in the redesign – to suit their needs. We have closer relationships now with community care, social care and primary care, we have an engaged public all wanting to play their part. Surely now is the time we can plan for what the future could look like together? The Government has announced that Ministers are to set up a ‘dedicated team’ to aid NHS recovery. We need to ensure that patient and staff safety is a core purpose of that team’s remit and the redesign of health and social care. Would you be interested in being on our panel for our next Patient Safety Learning webinar on transitioning into the new normal? If so, please leave a comment below.

These top tips set out by the Royal College of General Practitioners, are for clinicians conducting telephone consultations to assess and advise patients concerned they may have COVID-19 (Coronavirus).

The purpose of this document, from the Chartered Institute of Ergonomics and Human Factors, is to provide health and social care teams with advice and guidance on the human-centred design of work procedures such as written instructions, checklists or flow charts during this period of 'crisis management' in response to COVID-19 and to support the design and re-design of care services and new ways of working. Implementation of the guidance will contribute to safer and easier to use procedures, which better support how people work and reduce risks to themselves, patients, carers and others. This document outlines ten key guidance points that designers of procedures should address at all stages of its development, implementation and review.

For many people involvement with intensive care is a daunting experience. For some it's part of the care plan after major surgery but for many others it's a sudden and unexpected event.You find yourself in an alien environment unlike any you've known before where patients are connected to all kinds of machines and drips, where you might not be able to tell day from night and where there's constant noise and activity. The people that work in the Intensive Care Unit do an amazing job, but even when patients are on the road to recovery they still have a long way to go before they're fully better. Depending on how ill the patient has been, recovery can take a year or more. Knowing what might lie ahead and also that you're not alone in what you're going through can be a great help for both patients and relatives.  This webpage set up by ICU Steps, include experiences from patients and relatives as they have spent time on the intensive care unit.

Between 25-30 April 2020, three nurses working at Waitakere Hospital, New Zealand tested positive for coronavirus (COVID-19). In the week prior to testing positive, the nurses had been working on a ward caring for a group of elderly patients with COVID-19. The patients were from an aged residential care (ARC) facility in West Auckland.  Key findings: The nursing staff provided exemplary care to the six patients on the ward; they were compassionate, professional and worked to ensure the patients were provided with the best care possible. The decision to transfer the residents was made quickly on a Friday, and staff had a short time to plan and respond putting together a COVID-ready ward. The patients required full nursing care and deteriorated relatively quickly. Consequently, nurses needed to spend long periods of time at the patients’ bedsides. There was no way for nursing staff to communicate with staff outside the patients’ rooms which increased the frequency of donning and doffing PPE. Full PPE was available to staff at all times. However, there were problems with the usability of the PPE and changes in types of PPE provided, which was stressful for staff.

Chartered Institute for Ergonomics and Human Factors has come together with industry and maternity units to redesign birthing pools to ensure they are safe and ergonomical for users. Read the attached case study.

NHS National Services Scotland has produced this video for Primary Care staff to aid safe donning, doffing and disposal of personal protective equipment during the COVID-19 pandemic.

This infographic designed by Public Health England shows how to remove personal protective equipment safely.

This inforgraphic by Public Health England shows the correct order to put on personal protective equipment .

London clinicians have shared their top 10 tips to help prepare NHS staff in other parts of the country facing the COVID-19 crisis. UCLPartners asked clinicians working in a range of specialties across its region, the first in the UK to deal with a major escalation in COVID-19, to share their practical advice to support NHS staff elsewhere in the country preparing for a large number of COVID-19 cases.

More than six weeks into the lockdown and if you were to gauge the mood of the nation, it would be one of fatigue. It started as an all-hands-on-deck emergency situation, but it now transpires that the current work situation for healthcare professionals is not going to change any time soon. This is a marathon rather than a sprint. So how can we better look after ourselves to cope with this new realisation? This BMJ podcast features Dr Caroline Walker, an NHS-based psychiatrist and therapist. Wait until the end for Caroline's simple technique she uses to help when feeling overwhelmed.

International Council of Nurses (ICN) CEO, Howard Catton, expresses his concern for healthcare workers rising COVID-19 infections and deaths due to lack of personal protective equipment. He also speaks of the lack of data which should be collected systematically by governments to better monitor and control the spread of COVID-19 among healthcare workers.

This is issue 30 of HindSight magazine (a publication about the safety of air traffic management). The theme of this Issue is ‘wellbeing’, which has an undeniable link to safe operations, though this is not often spoken about. This issue coincides with the COVID-19 pandemic. The authors of the articles were considering wellbeing in the context of aviation, and other industries. But the articles touch on topics that are deeply relevant to the pandemic. The spread of the virus and its effect on our everyday lives has brought the biological, psychological, social, environmental, and economic aspects of wellbeing into clear view in a way we have never seen before.

Provides guidance for both employers and staff on promoting positive mental health and supporting those experiencing mental ill health in the workplace Mental Health & Wellbeing in the Workplace is a valuable resource for those in the workplace wanting to look after their physical and mental wellbeing, and those looking for guidance in managing staff with mental health issues. 20% off for key workers! use code MWKEY The importance of good mental health and wellbeing in the workplace is a subject of increased public awareness and governmental attention. The Department of Health advises that one in four people will experience a mental health issue at some point in their lives. Although a number of recent developments and initiatives have raised the profile of this crucial issue, employers are experiencing challenges in promoting the mental health and wellbeing of their employees. Mental Health & Wellbeing in the Workplace contains expert guidance for improving mental health and supporting those experiencing mental ill health. This comprehensive book addresses the range of issues surrounding mental health and wellbeing in work environments – providing all involved with informative and practical assistance. Authors Gill Hasson and Donna Butler examine changing workplace environment for improved wellbeing, shifting employer and employee attitudes on mental health, possible solutions to current and future challenges and more. Detailed, real-world case studies illustrate a variety of associated concerns from both employer and employee perspectives. This important guide: Explains why understanding mental health important and its impact on businesses and employees. Discusses why and how to promote mental health in the workplace and the importance of having an effective ‘wellbeing strategy’. Provides guidance on managing staff experiencing mental ill health. Addresses dealing with employee stress and anxiety. Features resources for further support if experiencing mental health issues.

To match the increasing demands that the coronavirus pandemic will place on critical care, new and flexible models of care are required. This document: states principles for deploying and redeploying staff to match the needs of a critical care department, independent of where this care is delivered sets out indicative staffing ratios and competencies suggests professional groups that could potentially form part of this new workforce during times of surge and super-surge. This guidance is correct at the time of publishing. However, as it is subject to updates, please use the hyperlinks within the document to confirm the information is accurate.

This month’s Private Eye podcast is all about COVID-19. The Eye’s medical correspondent, Dr Phillip Hammond, discusses the latest developments, plus some faint lights at the end of the tunnel.

Eleanor Balme and colleagues in this BMJ article discuss the findings of a review that they have undertaken into the need for, and potential of, resilience training in doctors.