As the COVID-19 pandemic continues we are all thinking on our feet on what we can do. Services are working together and new hospitals are popping up to reduce pressures.
OSKA has be inundated with requests for emergency supplies and will be supplying 6000 beds to the Nightingale Hospital.
This is a new and evolving virus meaning we are learning of the lead symptoms and effects continuously.
I was signposted to the most up to date research from the Oxford Research Facility on the most common symptoms reported on confirmed patients in the below table:
The column on the left are the most reported symptoms and, as you can see, loss of taste/smell (anosmia) has been reported as a leading symptom. Read article here.
Below are the lead key concerns/challenges I have been asked about these past two weeks:
Medical device pressure ulcers and PPE:
Although this term is not new and has been increasingly reported since the NHS improvement update last year, the increase on patients potentially needing oxygen and/or critical patients needing to be nursed in prone position means greater understanding of prevention in these areas may be needed.
We also have the issue of staff wearing masks for long periods of time so the same principles below for protection may be applied.
Thin hydrocolloid dressinsg such as duoderm thin and use of thin foam dressings such as mepilex lite have been reported to be helpful.
Watch out for excess heat and sweating under the above, recommendations to use a barrier spray or cream (allow to dry) underneath is indicated in best practice.
There has been some great posters being done to show examples of this, here’s an excellent example from Ghent University.
Dermal pads may also be used but in some cases, such as when used with oxygen masks, care must be taken to ensure it is not creating a gap in which oxygen may leak.
Increased admissions to long term care settings:
I have been increasingly learning from clients the speed that your homes are accepting new residents. I have heard some amazing stories how homes are supporting on reducing the pressures to release NHS beds by extending their admission numbers. This means getting staff in rapidly and trained.
Patients returning from hospital to a care setting have been encouraged to self isolate for 7 days. This has been particularly challenging if they have reduced capacity. This has meant increased 1-1 care and need for agency staff.
I have been offering groups virtual tissue viability and pressure care training through the zoom platform, for new starters and existing staff so you feel confident in your processes to prevent pressure ulcers.
Repositioning- prone to assist breathing:
Anyone who becomes unwell, in the community and acute setting, is less likely to be mobile. If any of your residents are self isolating, the need to ensure a repositioning regime is updated along with risk assessments is paramount. For residents that have capacity explain this to them so they can self reposition regularly where possible.
For critically unwell patients or residents with reduced capacity, an enhanced repositioning regime must be in place.
Many reports from acute areas are the need to nurse COVID-19 patients in the prone position to either assist breathing with and without ventilator.
Below are the pressure care guidelines for an adult critical care patient with acute respiratory distress (ADRS) and/or ventilator:
- Ensure optimal positioning of pillows tailored to the patient’s body shape
- Pressure areas should be meticulously checked
- No direct pressure on the eyes
- Ears not bent over
- ETT not pressed against the corner of the mouth / lips
- Nasogastric tube not pressed against nostril
- Penis hanging between the legs with the catheter secured
- Lines / tubing not pressed against the skin
Useful resources:
Guidance For: Prone Positioning in Adult Critical Care
https://clinicaltrials.gov/ct2/show/NCT03125421
TVN Support:
The majority of Tissue Viability Nurses in the community are being asked to work differently or have been temporarily deployed. TVNs are working hard to set up virtual clinics and encourage self care where possible.
There are some free webinars and resources currently being run by TVNs to advise on these temporary models. The advantage, in the long term for this, means it may empower carers and patients to begin feeling more confident in increasingly co-partnering in their own care.
For newly acquired or inherited pressure ulcers it may become increasingly difficult to refer to your local Tissue Viability Team and visits may be greatly reduced.
Most Tissue Viability teams will have access to a NHS secure email or digital platform, I would advise to ask if you are able to refer or meet this way. Even just sharing a picture to help validate a pressure ulcer wound category and gain some management advice.
Many TVNs will already be offering this but if not, do ask the questions as they can sign post you to services and plenty of online resources to support you and the resident.
I can help with training and enquiries. For more information on the challenges Long term Care may be facing in this time and the course content for virtual training, click here to read my COVID-19 Statement.
At this time I wanted to say I’m thinking of all my nursing and carer family, along with the medical staff, allied health professionals, social care and local authority, emergency services and support staff on the front line. You are all my hero’s. I will be rejoining you in the rapid response teams to fight this pandemic. We will get through this and come out stronger than ever. I leave you with this powerful picture I came across on the modern ‘Lady with the lamp’ as we send all our good wishes to the Nightingale hospital.
