Search the hub

This version updates the 27 March publication by providing definitions of droplets by particle size and adding three relevant publications.

These guides include: Surgical patients Othopaedics Critical care Endocrinology Trauma Acute General medical Burns Cancer ED Paediatrics NIV Rheumatology Management of COVID positive patients Cardiothoracics plastics Max Fax Vascular Spinal Surgery Radiology Cardiology Muscular Skeletal Haematology Maternity TB.

Going to work for 12 hours, perhaps not having a break, perhaps not peeing for over 8 hours and being put in challenging situations on a daily basis is pretty much the norm for many workers on the frontline ANY day of the year, despite COVID-19. But now we have the pressure of adhering to guidance that keeps changing, confusion on who to test, who to 'barrier nurse', with lack of PPE in some areas. Staff are frightened. Frightened that they will bring coronavirus home to their families, frightened that they will become ill and frightened of the things they will witness in the coming months. Currently there is a petition calling for frontline NHS staff to be tested. We would then know who has the infection, keep them isolated so not to infect the vulnerable. In my hospital it’s taking five days to get a test result back. During those five days, patients are being barrier nursed. Barrier nursing ‘usually’ is a straightforward procedure and one nurse can look after a patient with relative ease. However, when barrier nursing a COVID-19 infected patient who is on non-invasive ventilation or aerosol therapies, it is much more disruptive. It can take two nurses to care for that patient, as ‘donning and doffing’ PPE is time-consuming and risky. The second nurse will act as a ‘runner’, collecting equipment, medication, linen – anything the patient and nurse need. The nurse will also need to take breaks separately to the rest of the team, leaving them feeling isolated. I know the Trust I work in has purchased point-of-care testing for coronavirus, but this won’t be up and running for two weeks. After a 12-hour shift, healthcare workers would then shower (if you are lucky), change their clothes and go home. Simple? No, we are not robots. We are human. We don’t go home, have dinner, have a full night’s sleep and start the next day. We have stuff going on outside work. We carry these stresses with us when we come into work; it affects our ability to ‘do a good job’. Staff are often struggling with outside stressors: divorce, moving house, child care, money and health – mental and physical. These stresses have not gone away since COVID 19 turned up. There are now new stressors in town which are affecting healthcare workers ability to stay focussed and to ‘do a good job’. These stressors are HUGE. Yesterday, the Government stated that they would help businesses with ‘what ever is needed’. That’s great but a loan won’t help in the long run. My husband owns a small business. He is a sculptor and makes small-scale sculptures for the garden and home. He employs six artists. These six people have made the business what it is today. They are talented and creative. One of them has just started a family, one has relocated from abroad to be here, and one has set up a new home. They have become my husband's ‘work family’; they are more than just employees. Yesterday, my husband went into work and told them that he was no longer able to pay them after April. Bigger companies have stopped ordering as there is no requirement for his product due to the restriction on gatherings of people. Smaller companies have stopped ordering as they are uncertain of what the future holds. Never have I seen my husband look so drained. Not only is he witnessing his business that he has worked so hard for collapsing before his eyes, he has had to let down the people that have helped to make it what it is. The mood in our house at the moment is sombre. I don’t want to add to my husband’s stress with my worries about work, so I keep quiet (this blog is helping). We have two boys,12 and 14. They are like labradors, they need lots of exercise. If the country is on lock down for three months they will be climbing the walls!! For anyone who has kids of this age, you know that they eat LOADS. As soon as the cupboards are restocked, they are emptied within 48 hours. I’m struggling to get healthy food for them as the shops seem to have nothing in them. After lock down, we shall know whose been stockpiling as they will emerge after three months overweight with very clean bums! Then there is the issue with childcare. If healthcare workers are to be on the frontline who is to look after the kids? If they are old enough and you leave them at home alone, how can you ensure they eat well, they study, they stay in? If they are young, who looks after them? Grandparents are now not the go-to option. This virus has affected everyone in multiple ways on multiple levels. No, this blog isn’t just about healthcare – it’s about being human. There will be many of us out there with stresses you are unaware of. Please, be kind. Call for action: Please send in any practical tips for barrier nursing patients and advice for staff well-being during this time. Join the conversation taking place on the hub.

This guidance document seeks to provide a framework to help your local simulation-based endeavours achieve the most benefit for the needs in your organisation and department. Further resources and examples of practice to support each domain of the framework are currently being collated for sharing nationally in the immediate future. 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.

The safety of non COVID-19 patients We need to keep all patients safe Healthcare professionals will be focused by this crisis with huge efforts being made into limiting the spread, protecting patients and keeping demand for health services down and to manageable levels. We must not forget about the adverse consequences this will have on others who need our services. We need to assess the impact COVID-19 (CV19) will have on patient safety as existing patient safety issues will be magnified and exacerbated with the rapid escalation of CV19, known causes of these issues such as scarcity of workforce are likely to become even more significant and as CV19 will become the main focus of a large number of healthcare care staff patient safety initiatives that have to date had traction and success may be abandoned for expediency. Patient, carers, family and friends perspective Healthcare staff will be focused on treating the person in front of them and the associated risks of CV19 to that individual. Patients see their whole care journey. They are well placed to identify gaps quickly. The concerns and experiences shared by patients and their families will help us highlight bigger system issues that need addressing quickly to prevent avoidable harm during this pandemic. We need patient stories, we need everyone's and anyone's stories. Knowledge sharing and collaboration for patient safety We are collating insights into the impact on non CV19 patients and patient safety to inform healthcare leaders and afterwards for learning. We are using Patient Safety Learning’s the hub, a dedicated knowledge-sharing platform and community for patient safety, to do this. This has a knowledge repository, communities of practice, news and invites members to share their resources and insights. There is already a dedicated section of the hub that contains resources on coronavirus and CV19: guidance, advice, tips and personal experience blogs. We have set up a separate section on our community and inviting patients, family members and staff to share their stories, highlighting weaknesses/safety issues that need to be addressed and sharing solutions that are working: Stories from patients, carers, families We are inviting people to share with us their stories and: A personal snippet of their life and personality (a photo would be great to make it personal) Where they live What part of the healthcare system they access and for how long have they been using it? What have they noticed that has been different now the crisis has started? E.g. outpatient appointments, collection of medication, GP appointments, cancellation of operations? What impact has this had on them? What are their fears about their long-term health problem in amongst the crisis? Do they feel safe? Do they feel informed? Contact details if they are happy to share. Highlight new areas of unsafe care. What have they noticed that has been different now the crisis has started, e.g. outpatient appointments, collection of medication, GP appointments, cancellation of operations? Some of the issues we’re keen to look at are: Aspects of healthcare that you previously considered safe but maybe no longer be so as a consequence of fewer staff, changes in ways of working, unclear new arrangements etc. In cases of elective intervention and/or appointment being postponed, does the patient/family know the warning signs to call for help? Is there a hotline or urgent clinic for patients to contact? Positive stories as well as negative. Has anything improved since the crisis? For example, has the use of digital/virtual interventions (accessing a GP) had a positive effect? Data and analytics if available to show current trends in safety and adherence. How we can engage with patient leaders to access patients’ stories We are actively promoting the sourcing of insight from patients, families and staff. We will be actively promoting this through the patient safety agencies, patient and family organisations, healthcare systems, social and mainstream media in. We will promote as a campaign through #SafetyStories What will we do with this insight and information? This information will be publicly available on the hub for all. We will review the content and identify themes of concern/worry and highlight as a global resource through regular updates and reports. These will highlight the ‘second victims' of the virus.

Background and scope of guidanceWhat do we mean by extremely vulnerable?What you need to knowSymptomsWhat is shielding?What should you do if you have someone else living with you?Handwashing and respiratory hygieneWhat should you do if you develop symptoms of coronavirus (COVID-19)?How can you get assistance with foods and medicines if you are shielding?What should you do if you have hospital and GP appointments during this period?What is the advice for visitors, including those who are providing care for you?What is the advice for informal carers who provide care for someone who is extremely vulnerable?How do you look after your mental well-being?What steps can you take to stay connected with family and friends during this time?What is the advice for people living in long-term care facilities, either for the elderly or persons with special needs?What is the advice for parents and schools with extremely vulnerable children?

Ten days ago, *Mark developed a mild headache, minor fever and sore throat. He is in Denver and we are in Mexico. We Face timed him every day and his aid, *Sandy, was coming to see him every other day. But then Sandy's husband became ill and as she has been exposed to whatever her husband has, she has to now self-isolate at home with her husband. Mark has had no helper now for 7 days. Mark has access to the US government assistant programme, but unfortunately there are no other aids available right now. So we are trying to get him home as soon as possible, but we can’t until he is symptom free. I am getting ready to jump on a plane. Being isolated and without an aid has caused him periods of considerable paranoia and anxiety. Disabled people at home who rely on home healthcare are now at risk of no help. Fortunately Mark is very good at ordering out food for delivery and is able to walk with his walker to the pharmacy for his medication, but I worry about all the other disabled people who may inadvertently get abandoned in this pandemic due to low workforce. *Names have been changed in this blog to ensure confidentiality.

Today I was nursing a patient on the ward who was very unwell. The test result came back as positive for COVID-19 and the patient needed to be transferred to the intensive care unit (ICU). I was concerned that the masks and other personal protective equipment (PPE) being used on the wards are not adequate for such specialist nursing tasks. I consider (and it is the Trust's good practice guidance) that the mask that specialist outreach nurses should be using are the ones that ICU staff use. Specialist masks are needed for aerosoled treatment. So I use the specialist mask as the patient was going straight to ICU for aerosol treatment. When donning this specialist mask, one of the managers on the ward (someone who has budget responsibilities) said to me "you shouldn't be using that mask as it costs 8 quid." I have been 'covered by COVID-19 all day' and feels like it is just a matter of time before I succumb to the disease. Coming home last night I was convinced that the disease has been transferred to my husband and young sons. I asked my manager if, when the PPE runs out, will we be expected to nurse without a mask and protective clothing. My manager said that it wouldn't come to that. But I don't trust that. If there is not adequate PPE, I don't want to work and I believe that no one should be expected to. I am angry that nursing staff are being put in danger and that this will escalate in the coming weeks. Despite the assurance of the Deputy Chief Medical Office that the UK has "perfectly adequate" supply of PPE, my brother (a paramedic) has bough his own supply of masks as he’s sure that they will run out. It would be gruesome enough to be insufficiently protected if there weren’t enough masks to go around, and there are at the moment, but to be denied the essential equipment on cost grounds is disgraceful. The government are rightly saying ‘whatever it takes.’ Matt Hancock and the Cabinet need to know that their commitment is not being honoured. This is just my experience of course, but it’s clearly symptomatic of a culture that isn’t protecting staff and where trust is breaking down. If there are no staff, there will be no patient care. The sea near the hospital is calm this morning. But it’s like its going to drag back slowly. We know the tsunami is coming and we’re all terrified.

"In one of the most vivid scenes in the Home Box Office (HBO) miniseries 'Chernobyl' (among many vivid scenes), soldiers dressed in leather smocks ran out into radioactive areas to literally shovel radioactive material out of harm's way. Horrifically under-protected, they suited up anyway. In another scene, soldiers fashioned genital protection from scrap metal out of desperation while being sent to other hazardous areas. Please don't tell me that in the richest country in the world in the 21st century, I'm supposed to work in a fictionalized Soviet-era disaster zone and fashion my own face mask out of cloth because other Americans hoard supplies for personal use and so-called leaders sit around in meetings hearing themselves talk. I ran to a bedside the other day to intubate a crashing, likely COVID, patient. Two respiratory therapists and two nurses were already at the bedside. That's 5 N95s masks, 5 gowns, 5 face shields and 10 gloves for one patient at one time. I saw probably 15-20 patients that shift, if we are going to start rationing supplies, what percentage should I wear precautions for? Make no mistake, the CDC (Centers for Disease Control and Prevention) is loosening these guidelines because our country is not prepared. Loosening guidelines increases healthcare workers' risk but the decision is done to allow us to keep working, not to keep us safe. It is done for the public benefit – so I can continue to work no matter the personal cost to me or my family (and my healthcare family). Sending healthcare workers to the front line asking them to cover their face with a bandana is akin to sending a soldier to the front line in a t-shirt and flip flops. I don't want talk. I don't want assurances. I want action. I want boxes of N95s piling up, donated from the people who hoarded them. I want non-clinical administrators in the hospital lining up in the ER asking if they can stock shelves to make sure that when I need to rush into a room, the drawer of Personal Protective Equipment (PPE) I open isn't empty. I want them showing up in the ER asking 'how can I help' instead of offering shallow 'plans' conceived by someone who has spent far too long in an ivory tower and not long enough in the trenches. Maybe they should actually step foot in the trenches. I want billion-dollar companies like 3M halting all production of any product that isn't PPE to focus on PPE manufacturing. I want a company like Amazon, with its logistics mastery (it can drop a package to your door less than 24 hours after ordering it), halting its 2-day delivery of 12 reams of toilet paper to whoever is willing to pay the most in order to help get the available PPE supply distributed fast and efficiently in a manner that gets the necessary materials to my brothers and sisters in arms who need them. I want Proctor and Gamble, and the makers of other soaps and detergents, stepping up too. We need detergent to clean scrubs, hospital linens and gowns. We need disinfecting wipes to clean desk and computer surfaces. What about plastics manufacturers? Plastic gowns aren't some high-tech device, they are long shirts/smocks... made out of plastic. Get on it. Face shields are just clear plastic. Nitrile gloves? Yeah, they are pretty much just gloves... made from something that isn't apparently Latex. Let's go. Money talks in this country. Executive millionaires, why don't you spend a few bucks to buy back some of these masks from the hoarders, and drop them off at the nearest hospital. I love biotechnology and research but we need to divert viral culture media for COVID testing and research. We need biotechnology manufacturing ready and able to ramp up if and when treatments or vaccines are developed. Our Botox supply isn't critical, but our antibiotic supply is. We need to be able to make more plastic Endotracheal tubes, not more silicon breast implants. Let's see all that. Then we can all talk about how we played our part in this fight. Netflix and chill is not enough while my family, friends and colleagues are out there fighting. Our country won two world wars because the entire country mobilised. We out-produced and we out-manufactured while our soldiers out-fought the enemy. We need to do that again because make no mistake, we are at war, healthcare worker s are your soldiers, and the war has just begun." First published on www.telegram.com/news