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Chief Nurse's Blog

Chief Nurse’s Blog

Date of release: 12 June 2020

Latest News: Ann-Marie Cannaby Blog

In this week’s blog I want to focus on community nursing and their changing role during the COVID-19 crisis. Community services are important as they provide care to people at home or in their locality, enabling them to stay at home rather than come into hospital. The Primary Care Network and Adult Community Nursing services have worked tremendously hard to adapt to the demands forced upon them by the pandemic and their services have undergone significant changes.

To adapt to healthcare needs, the ten practices and their teams within our Primary Care Network (PCN) were divided into three groups based on their geography within Wolverhampton. All patients were telephone triaged for signs of COVID-19 prior to being given appointments. It has meant patients have had to move from their usual practices, but generally this has been well received. There have been lots of telephone work offering reviews that would support ongoing care, ie contraception, along with calls offering support to the vulnerable etc.

We have also been able to support some staff to work from home who couldn’t see patients face to face. The new ways of working allowed flexibility for patients to be reviewed safely by all nurses and clinicians within the groups. I am incredibly proud of how the nurses have embraced the changes.

Work has been undertaken to ensure appointment times have been standardised, each group has worked collaboratively with a designated lead GP and discussed ways of delivering care to ensure optimum safety is maintained. Examples include:-

  • Remote medication reviews
  • Medications delivered by injections changed to oral administration where appropriate
  • Timings for postnatal check and baby immunisation have been realigned to reduce visits to the practice
  • Telephone and video consultations to reduce patient visits to the practice

Advanced nurse practitioners have been supporting GPs, undertaking both face-to-face reviews and remote consultations. Remote access to IT systems has allowed clinicians and allied healthcare professionals to continue supporting patients. These include a First Contact Physiotherapist to support with musculoskeletal problems and Pharmacy prescribing team.

Babylon and the deployment of its COVID-19 Care Assistant app has supported the PCN to manage some calls that may have come through from patients regarding COVID symptoms. Further work is being developed with Babylon to support Primary Care in the future.

Our ‘Care Co-Ordination’ hub (formerly known as WUCTAS and Call Handling) has been developed. This is a central point of access into services, with centralised referral, triage, troubleshooting, activity recording and the latest development seeing centralised clinical allocation of caseloads. This new software, called e-community, goes live imminently and will revolutionise the way clinical caseloads are proactively managed and patients are allocated. The hub is managing all unscheduled call requests and troubleshooting for patients. This is already releasing valuable clinical time, as previously a frontline clinician would undertake this role.

The Babylon app is also being delivered via the Care Coordination hub, and is facilitating online referral, telephone triage and in some instances video consultations for patients symptomatic of COVID-19. The additional Ask A&E app has also gone live this month.

Mobile working has been adopted by all community nursing and therapy teams. Technology is being used to remotely ‘huddle’ and undertake daily safety briefings, which has reduced travel time for staff and increased clinical capacity. Additional features on iPads have been swiftly enabled to include fingerprint recognition, Facetime, iMessage and Microsoft Teams. This has supported with remote consultation from specialist teams, to include tissue viability reviews of wounds to support with categorisation and differential diagnosis. This rapid review has supported patients to receive the right treatment at the earliest opportunity.

Self-testing devices have been introduced for monitoring in the anti-coagulation service to avoid trips to clinics. This allows those patients able to self-monitor to do so. Blood levels are monitored via an app, then the patient can be dosed by a nurse remotely.

Due to reduced patient contact, we have implemented befriending services called ‘Safe and Well’ and ‘Check and Chat’. This has supported patients and care homes with remote reviews and offered support despite nursing teams not being as visible, ensuring patients are safe and know how to escalate any concerns.

All of the changes implemented during COVID-19 have ensured we have enough nursing resource to manage our patients that need most support in the community setting. This was to either keep them out of hospital or facilitate a quicker discharge.

Staff have found the changes positive – non-patient facing clinical roles have been created for staff that needed to shield which was part of the plans within the Community Transformation Programme anyway. COVID afforded us the opportunity to do this. Use of technology has been seen as positive by staff, as it has allowed them to reduce travelling time/distance, released more time to care, but still maintain quality and safety and a sense of teamwork.

Recently there have been some changes to my immediate team in the Deputy Chief Nurse post. We have said farewell to Martina Morris, who has left a really positive mark on the Trust, doing some fabulous work with the Patient Advice and Liaison Service (PALs) and chaplaincy service, and she led the CQC inspection. Along with Vanessa Whatley, she also supported me personally throughout the COVID-19 crisis and I am grateful to both of them. Replacing Martina is Yvonne Higgins. Yvonne has vast experience, previously working in the CCG while during the pandemic she has supported ICCU at RWT. I’m sure you join me in welcoming her to our team.

Take care

A Teaching Trust of the University of Birmingham