I can distinctly recall the date of the first Covid-19 patient that was admitted to St. Luke’s Hospital in Kilkenny. Ironically, it was on Friday, the 13th March, 2020.
It was so rehearsed, systematic, an ideal scenario in fact – the patient was calmly examined in a dedicated isolation room. ‘Recent travel from China’ read the clinical indications on the X-ray order.
We have come a long way since then. Now we are led by daily algorithms and HPSC updates have dictated new work-flow operational practices for Primary Care centres, ED staff and in turn, radiographers.
Referral criteria for chest X-rays and CT scans have been modified in line with best international practise. Operational workflow arrangements to deal with both COVID and non-COVID work streams have been organised so that the care streams never meet, in order to minimise infection crossover risk.
Digital mobile radiography is the new standard to reduce the transfer of infection. Strict infection control measures are adhered to – “donning and doffing” are the new buzz words for radiographers. We have also introduced a Buddy system to minimise cross infection whilst X-raying COVID patients.
Many patients, either intubated or on admission to the Medical Assessment Unit, appear agitated as the infection takes hold. This makes the whole event of performing a mobile X-ray tense as conversation with the patient is limited. These conditions make it difficult to empathise with the patient.
I am a well-seasoned radiographer and I have found it heart-breaking to work in these circumstances, only to find that, in some cases, the patient has unfortunately passed some days later.
I’m now an expert in PPE. I can discern the quality of good PPE from a mile off. I spend much of my day in a whole white body suit that was not so long ago commonplace on media images we saw from Italy and Spain. Where initially there was one patient, now there are often four to five portables to be performed in a COVID ward.
The suits are hot and difficult to move in but a necessary evil. I keep telling myself that I will never take another free dessert from the canteen again, but my willpower is shocking.
It has been six life-changing weeks since the crisis took hold and there is no sign of it abating any time soon. My physical and mental well-being is tested on every shift. Equally though, valuable lessons have been learned and strong work friendships formed in the face of hourly adversity and crisis.
There have been many days and nights since this crisis started that I have questioned why I ever become a Radiographer. I lost a good friend just last week and discovered this awful news by casually looking up RIP.ie whilst I was on call.
I was not able to attend her funeral or pass my condolences to her family. There is no longer a vent to express the normal phases of grief. I have lost work colleagues and the realisation that I too may succumb to COVID 19 is never far from my mind.
I am not a great cook or champion organiser but since the crisis has begun, Nigella, Kevin Dundun and Nevin Maguire are strewn across the kitchen table. Blobs of flour and egg shells mark my attempts at becoming the next Nigella.
My teenage children can sleep for Ireland but they have, on a couple of occasions, acknowledged what I do for them on the frontline … and that has brought a tear to my eye. I realise I am a radiographer because I worked hard to be one and that example is what I want to impart onto them.
The weeks do pass and I have a diary noting the dates that Occupational Health have phoned to say I was either a close or casual contact. Little else goes into it. My social diary is clear. However, the weather outside is getting better and with that brings hope …
This blog was written by Kate Murphy, Radiation Protection Officer, St. Luke’s Hospital, Kilkenny with support from all the Radiography team in St. Luke’s Hospital.
This has been the most challenging 4 weeks in my 20 years of practice for many reasons.
Looking for certainty at a time of complete and utter uncertainty has led us to reach out and make meaningful connections locally, nationally and internationally which has been a double edged sword. It has brought a lot of meaningful discussion but has also given us a thirst for knowledge and evidence that is emerging but may take months to be conclusive.
In the meantime, we question ourselves relentlessly; trying to reduce our clinical worth to what is deemed essential and non-essential has been exhausting and, at times, a little degrading.
The endless debate on PPE has allowed us to fear our patients. We fear the risk we pose to them. We fear the risk they pose to us. We have also been asked to question our worth to the patient’s care. Do you really need to do your job?
The reality is that rates of under-referring to the HSCP group was prevalent pre-COVID-19. This is not a time to exacerbate this situation. This is a time to come together to prove the integral role we all play in a comprehensive holistic pathway of care.
For the first patient I went to see 4 weeks ago, I was so dysfluent in the process of donning and doffing the PPE, I arrived a little distracted. The discussions on how far to stand away from the patient made it harder to do what has always been a fundamental part of my assessment. To look someone in the eye and apologise that they are in Hospital, but reassure them that they are in the right place.
The second time I went in, it got easier. It has also become easier to offer constructive help to my colleagues; can I schedule my assessment at the same time as they need to be turned? I can help. When do they need oral hygiene done again? I can do this. Are they taking meds? I can assess whether they can manage these orally.
There is a debate raging that oral hygiene may no longer be part of our essential role. I cannot agree with this. Not when I have assessed and treated multiple patients in the last few weeks; some extubated after prolonged ventilation, some on NIV hoods, some on airvo, some self ventilating.
COVID-19 requires a very different approach to normal respiratory conditions. Humidification is not necessarily part of the treatment. Dehydration is common and sometimes life threatening. Oral xerostomia and risk of candida are common.
An essential part of my role has been to ensure that all patients are entitled to oral hygiene via suction toothbrush. It is more common practice to administer oral hygiene via small pink sponge swabs. I’m not sure how this ever became normal. An ex-patient likened it to Christ on the Cross and the sponges of vinegar!
It is undoubtedly more comfortable for a patient to have their mouth cleaned with a toothbrush, and when they are unable to manage their own saliva, the risk that this oral care poses to the lungs is significant and life threatening.
It is essential to raise insight into this and help people understand that the suction toothbrush not only saves the patient from aspiration but also protects the person completing the oral hygiene as it is a closed suction system. Being able to support the Nursing Team so that it can be provided every 2 or 3 hours prevents the build-up of candida on the tongue. This is vital to prevent another source of aspiration and pneumonia.
I have now completed an episode of care with a person who was admitted, although within the younger age category, with multiple comorbidities. He was intubated for 10 days, experienced seizures and delirium as a result of severe dehydration and had not been able to see or speak to his family for 35 days.
What did a week in that pathway of care look like?
Working with my Nursing colleagues to provide oral care, to commence cautiously on oral intake and to determine how to enable the person to communicate basic needs
Working with my Medical colleagues in Infectious Disease, Renal Medicine and Neurology to define delirium versus neuropathy, confusion versus cognitive change and to determine capacity to meaningfully participate in decisions on delivery of care. All of whom are interpreting the diagnostic results analysed and reported from my HSCP colleagues in Medical Science and Radiography.
Working with my Physiotherapy colleagues to minimise risk of aspiration from oral secretions and oral intake, and to enable the best expiratory flow for voice, cough and swallow.
Working with my colleagues in Clinical Nutrition and Dietetics to enable the best regime for nutrition and hydration in the context of a severe oro-phayrngeal Dysphagia.
Working with my colleagues in Pharmacy to ensure the right consistency of oral medication.
Working with my colleagues in Occupational Therapy to enable positioning for therapy and self-feeding.
Finally, the icing on the cake at the end of an intense week, was enabling my patient to have a cup of hot (modified) tea, while we whatsapp video-called his family as I interpreted, so they could understand his dysarthric speech. The joy in the reunion, after 23 days of not seeing each other, was immense.
All in all, not a bad week in the office.
This Blog was written by Aideen O’Riordan, Deputy Speech and Language Therapy Manager, Cork University Hospital
Recent weeks have seen massive disruption to healthcare services as we grapple to meet service need in the context of the COVID-19 pandemic.
Over the past six weeks, the SCOPe Directorate* in St. James’s Hospital has pivoted from primarily in person assessment and review to a teleHealth model. This Blog will set out the key enablers that made it possible to achieve this change at pace.
* The SCOPe Directorate is the HSCP clinical structure in St James’s Hospital consisting of the five departments of Medical Social Work, Speech & Language Therapy, Dietetics, Occupational Therapy and Physiotherapy.
Our SCOPe team is no stranger to digital developments having led the digital transition from paper to electronic patient records (EPR) with all documentation transitioned by end of 2016. This improvement project was highly structured and a SCOPe EPR QI team managed implementation and governance.
The vision has always been to progress patient engagement, teleHealth solutions, shared records, patient portal etc. in structured phases.
Looking back, our experience and vision laid the foundation for digital readiness in the HSCP workforce, giving us a big head start when news of COVID-19 emerged.
Our Journey to a teleHealth Model
In early March, the SCOPe eHealth QI team had a brainstorming session to explore the potential of teleHealth to support patient care as the situation evolved.
Services identified as potentially suitable for transition varied as HSCP staff work across all episodes of care including ED, in-patients and outpatient clinics.
Over the course of the following week, the SCOPe directorate moved to provide urgent assessment and review to all OPD services using a generic teleHealth platform.
Electronic appointments and an EPR are already in situ in St. James’s Hospital so the immediate need was to provide a safe, secure substitute for the face-to-face component of the therapy assessment.
Colleagues in the IMS department provided invaluable support including:
organising app demonstration
enabling of infrastructure
provision of licences for staff
Concurrently, the SCOPe team worked to develop:
flow around implementing the teleHealth application
mechanisms for measuring activity while supporting staff in the introduction of the teleHealth app
Our Learnings So Far …
Feedback has been positive as the teleHealth model allows ongoing contact with patients who require HSCP input.
There is an acknowledgement that it is not ideal for all patients. However, staff report that they are getting better at identifying those patients for whom a virtual teleHealth clinic will work best and at adjusting their communication style to aid rapport development.
In some cases, the teleHealth clinic exists alongside a telephone clinic depending on the patient’s technological abilities.
There have been teething problems with Wifi /4G availability on the patient side and clear instructions are required on how patients can best manage their device for camera visibility.
This use of digital solutions to facilitate ongoing patient management is happening in parallel to the use of virtual tools to facilitate department communication and training.
Where social distancing cannot be observed, significant value is added by the inclusion of virtual video conferencing for education sessions on clinical preparations for the COVID-19 emergency, in-services, journal clubs and meetings.
There is a learning curve with using this technology … a need for collective understanding that technology may fail, cameras may freeze and small visitors may make an appearance in the feed of those working from home!
While it is not always as successful as a group face-to-face meeting, it is a very acceptable alternative when staff can’t all be present in the same room, at this time.
As well as this, a campus-wide staff communication tool has been implemented in the last two weeks. This has also proven very beneficial for urgent communication from the hospital leadership team and this secure confidential messaging service can also be used to support communication in relation to clinical information.
Most of all, it is clear that the well-plotted transition to EPR created the conditions for readiness amongst the HSCP workforce in the following crucial areas:
While teleHealth developments in St. James’s Hospital were already under development, COVID-19 greatly accelerated implementation! By far the greatest asset has been the staff who were required to be ‘early adopters’ of change, learning as part of the doing rather than ahead of implementation.
It has been a huge undertaking and SCOPe HSCP have adapted admirably, motivated by the fact that these changes would lead to effective alternatives to direct patient care for service users.
This Blog was written by Joanne Dowds on behalf of the eHealth HSCP Advisory Group. Joanne is a clinical specialist physiotherapist working in the ICU of St James’s Hospital.
Over the last few weeks, I have seen first-hand the vital role HSCP are playing in response to the COVID-19 pandemic.
HSCP are carrying out diagnostics and disease monitoring
HSCP are delivering specialist treatment and rehabilitation
HSCP are providing psychosocial and practical supports to patients and their families
HSCP services are needed at each stage throughout the patient journey and as such, it is incumbent on us to ensure we have the necessary information and resources to undertake our roles.
In my last Blog (on April 5th), I focused on general resources available to HSCP in the context of the COVID-19 pandemic. Today, I am sharing more resources, relevant to specific professions* within the HSCP group.
Unfortunately, it is not possible to represent all 26 HSCP disciplines in one blog post. Therefore, I have included a sample of professions from the therapy, diagnostics and social care domains of the HSCP group. If your profession isn’t included and you would like to share resources, please do so in the comment box below. We would be delighted to hear from you.
INDI has provided learning resources on COVID-19 to assist dietitians being redeployed to hospital wards and ICU clinical roles. These resources are accessible to members and non-members of INDI (via the guest login). The INDI website also has a range of resources on healthy eating for all ages, from older adults cocooning at home to young children and families. These are for the public, carers and health professionals.
Abbott Nutrition has shared a webinar, recorded in 2018 with Irish ICU dietitians entitled ICU Nutrition Made Simple. A range of pertinent questions are addressed including: the nutritional requirements through the different phases of critical illness, the requirements of the obese critically ill, refeeding syndrome in ICU, indications for parenteral versus enteral nutrition and how best to monitor to monitor patients with complex needs.
Clinical Dietetics online provides a course on Mastering the Nutrition Care Process which can be accessed via the free 1-month trial (membership is $5.99 per month thereafter). Registration with this site also includes updates, blogs and discussion fora, accessible via the dedicated app.
The ACSLM provides links to information and guidelines for their members as well as highlighting relevant podcasts and other resources. See https://acslm.ie/?p=3756 for details.
The newly released Oncall Buddy app, developed by Consultant Respiratory Physiotherapist Stephanie Marshall and Physiotherapist Iain Loughran is another great free resource for those working in respiratory.
Finally, Physiopedia offer a free Coronavirus Disease Programme on their trial account. However, caution must be exercised due to variances in terminology and policies between the UK, US and Ireland.
The American College of Radiology has published guidance for radiology departments to support adaption of work flow practices, particularly in relation to infection control.
Other educational opportunities are available on Radiopeadia and on MRI Online, the latter providing a free course on COVID-19. This course demonstrates the typical CT scan findings of COVID-19 pneumonia and how the findings progress over the course of the disease.
The IASW has developed a COVID-19 Resources section on https://iasw.ie/covid-19 which is regularly updated with new and emerging information and supports for social workers. A guidance document for the medical social work profession response to COVID-19 has also been developed to support social work which plays a pivotal role in bereavement work with patient, family and staff support.
* Please be aware that information and guidelines in this area are changing rapidly. Although these resources are up to date at the time of writing this blog, they may be superseded by new guidance in the coming days and weeks.
This Blog was written by Éadaoin O’Hanlon on behalf of the eHealth HSCP Advisory Group.
“The best part of learning is sharing what you know”
Vaughn K. Lauer, Author
What does COVID-19 mean for me?
How will COVID-19 affect my clinical practice?
How can I best support my patients?
And protect my own health?
Since the outbreak of COVID-19, my head has been filled with many questions. As a physiotherapist working in an acute hospital, I am used to caring for patients with respiratory conditions and am accustomed to working in a critical care setting.
However, that does not mean that I am any less daunted by this novel disease. From speaking to HSCP working in other settings across Ireland, I know I am not alone. The outbreak of COVID-19 is without a doubt a massive challenge for all HSCP, especially for our many colleagues who have been redeployed to unfamiliar roles in unfamiliar settings.
Thankfully, there is help out there! HSCP can and should harness the potential of online education and resource sharing to enable rapid upskilling.
A video on the correct donning and doffing PPE is presented and is essential viewing for all frontline staff. This video can be found on hseland.ie along with further guidance on hand hygiene and infection control.
For those HSCP deployed to manage patients in critical care and ICU, the Society of Critical Care Medicine provides a free online education programme: ‘Critical Care for Non-ICU Clinicians’.
The HSE Critical Care Programme has resources available online for staff being redeployed to Critical Care. These include an orientation manual and free online education modules. While these are designed for nursing staff, some sections are applicable and valuable to HSCP.
The Health Education England (HEE) e-Learning for Healthcare site also has a Coronavirus Disease Programme, which is now free to access without registration.
If you are looking for further clinical guidelines, the National Institute for Health and Care Excellence (NICE) has released a number of rapid guidelines and evidence reviews to support healthcare staff.
In addition, the HSE has launched a Clinical Guidance and Evidence repository for COVID-19. This provides a repository of the latest research evidence to equip clinicians in Ireland to respond to the coronavirus pandemic. It includes clinical guidance, evidence summaries and an online facility to request a rapid evidence review in relation to specific clinical questions regarding COVID-19.
Another central repository to be launched this week is from the National HSCP Office. This will enable a sharing of COVID and non-COVID resources with the intention of reducing duplication of effort for HSCP at this time.
Learning from the Italian COVID-19 Experience
As COVID-19 is a novel disease, there is huge value in connecting with countries like Italy, in the peak of the pandemic, to gain from the emerging learning there.
The Pediatrica Intensiva podcast gives a great insight into the Italian experience. It includes interviews with intensivists about the realities of managing the COVID-19 outbreak and caring for critically ill patients.
The International Society for Quality in Healthcare also has a webinar and podcast which shares the experience of Dr Francesco Venneri, a clinical risk manager and emergency front line worker in Tuscany.
These recommendations are not exhaustive and we welcome any suggestions you have on generalresources that could assist HSCP at this time. Please share using the comment box below.
Stay tuned for our next Blog on profession-specific on-line resources.
– this blog was written by Éadaoin O’Hanlon on behalf of the eHealth HSCP Advisory Group.
“Just as Penicillin was the wonder drug to emerge from WWII, perhaps we’ll look back on the COVID-19 Pandemic as the inflection point for teleHealth.”
Dr Mark Lewis, MD @marklewismd
eHealth is a broad term which refers to the use of information and communication technologies in healthcare. In late 2018, digital leaders, representing the HSCP group and the National HSCP Office, came together to lead eHealth developments for the health and social care professions.
In the context of the COVID-19 pandemic, health systems are looking to rapidly expand the use of digital solutions across a number of different care areas and settings.
In this, the first in a series of eHealth-related blogs, we will set out the starting point for those of you currently grappling with deploying this complex service change at speed and, in particular, we will explore teleHealth considerations.
These unprecedented times require disruptive thinking and innovation.
* * * * * * * *
Digital Solutions – the Starting Point
Digitally enabled services offer huge opportunities to continue to provide high quality care, reaching patients in the community. In addition, for those HSCPs in isolation, digital tools can enable them to continue to work effectively.
Digital solutions always begin as well thought-through quality improvements, underpinned by sound Quality Improvement (QI) principles including a) being clear on the intended change and b) establishing how it will be determined that a change is indeed an improvement.
Technology serves as an Enabler, not the disruptor. It is important, too, to consider measures which will demonstrate improvement.
From our experience, keeping the service users at the centre of the plans is vital to ensure any change ultimately improves experience and outcomes for them.
HSCP are well versed in QI methodology with large numbers now trained and routinely leading QI projects in their work environments.
* * * * * * * *
Our Top Five Considerations for teleHealth Solutions
Prior to COVID-19, the need for teleHealth was outlined in Sláintecare action 10.3.3. ‘To provide teleHealth solutions to support delivery of care in the community closer to patients and their families’.
Aligning with this action, the HSE Service Plan 2020 has prioritised the adoption of a telehealth strategy.
Many HSCPs have already begun to design and implement teleHealth solutions and there has been a definite acceleration in the past fortnight.
So, what are the top five considerations for teleHealth solutions?
Telephone vs Video consultation. Consider what is actually needed. Not all clinical interactions will need or can be delivered via video consultation, while a combination of both might be needed in some areas.
What use-cases are appropriate for Video consultations?
Routine chronic disease check-ups
Counselling and psychological support
Any condition where trade-off between attending in person and staying at home favours the latter
Choose a solution that meets privacy and security requirements, and ensure that you have a secure network/wifi connection. The quality of the connection is also important – better connections mean better consultations!
Liaise with your ICT department about requirements for set up – do you have a laptop or PC with speakers, microphone and webcam? Will you need a headset to keep hands free for writing or interacting with patient resources?
Ensure that you design and plan the QI process for your teleHealth clinics before you start. Don’t jump in to making calls. Consider:
Where will clinics take place? Is the environment set up appropriately?
How will teleHealth clinics be scheduled?
What information will the patient need in advance to prepare them for the appointment?
How will consent be obtained and recorded? Measures taken in response to Coronavirus involving the use of personal data, including health data, should be necessary and proportionate. Decisions in this regard should be informed by the guidance and/or directions of public health authorities or other relevant authorities. See https://www.dataprotection.ie/en/news-media/blogs/data-protection-and-covid-19 for further information.
How will you document the consultation?
How will follow up be arranged?
Consider what the patient will have to do to take part, you should aim to minimise the set up requirements on their part as much as possible as digital literacy can vary.
Ensure that HSCPs delivering clinics have appropriate training on use of any new technologies.
* * * * * * * *
The National HSCP Office is compiling an online repository to collate and share eHealth and clinical HSCP resources to reduce duplication of effort at this time. Watch out for updates, it will be live on 3rd April, 2020.
This post was written by the eHealth HSCP Advisory Group.* Stay tuned – our next blog will address eLearning opportunities.
(*Members include Marie Byrne, Heather Cronin, Meabh Smith, Deirdre Gilchriest, Claire Browne, Joanne Dowds, Julie O’Connell, Fiona Maye, Orla Maguire, Ruth Reidy, Kate Murphy, Sarah Moore, Eileen Heffernan, Paul Ryan, Éadaoin O’Hanlon, Siobhan Keohane, Alison Enright).
“There is no power for change greater than a community discovering what it cares about.”
Margaret J Wheatley, Author & Speaker
A very warm welcome to HSCPshare.com, a new format for connecting Health and Social Care Professionals (HSCP) with one another, all 16,000 of us throughout the Health Services!
Set up by the HSE’s National HSCP Office, we hope this new format will add to our existing communications, helping to share information and learning from within and outside the HSCP community.
The HSCP Share Blog has been in the planning process for a little while and special thanks to the HSCP Communications Advisory Group and the eHealth HSCP Advisory Group for their invaluable assistance.
The process was somewhat accelerated in the past fortnight, though, as we found ourselves in extraordinary times, dealing with the new reality of the COVID-19 pandemic.
Very quickly, it became clear that nowis the time for sharing and inspiration, while we deal with unprecedented challenges which require new thinking and approaches.
Our five main aims for this blog are to:
Share knowledge and promote organisational learning
Hear points of view from HSCP and other HCPs in practice, academia and management
Assist in developing networks of practice
Raise visibility of HSCP service impacts and consider opportunities for further impact
Enable collective dialogue
You can follow the blog by going to www.HSCPshare.com and adding your email address to the ‘Follow’ box.
We’re also on twitter – @WeHSCPs. Please do follow, share and contribute – this is your opportunity to showcase your work, its impact and to learn from others.