COVID-19 Support

Guidance document FAO Derbyshire and Derby CCG area (North)

Latest revision: 11th April 2020

How Ashgate Hospicecare services have changed in response to the COVID-19 Crisis in respect of end of life patient flow, complex palliative care needs and wider community and bereavement support.

Author: Hayley Wardle, Director of Quality and Patient Care, hayley.wardle@ashgatehospicecare.org.uk, 01246 568801

COVID-19: summary of action taken to date

Inpatient Unit

  • Inpatient Unit at Old Brampton operating as usual with isolated individual patient bedrooms and clinical corridor for suspected and confirmed COVID-19 patients, with separate entry.
  • Our clinical and nursing team are supporting COVID and non-COVID patients with complex end of life needs and are prepared for any potential increase in COVID-related activity in both bedded and community settings.
  • PPE measures in place for clinical staff and patient visitors; with secure units for PPE storage and inventory kept.
  • Visitor numbers restricted.
  • All teams that can work remotely are doing so. This includes clinical, medical and community care staff who are working remotely via our secure system on Microsoft Teams and SystmOne supported by our on-site administration team.
  • Daily Board Rounds and weekly MDT meetings continue in both bedded and community settings remotely supported by digital solutions.

Community

  • Community Palliative Care Specialist Nurse Triage Service continues 7 days a week 9-5pm.
  • Telephone specialist palliative care advice and support in place by specialist nurse and therapy teams for palliative and end of life patients and their families.
  • Community Palliative Care Specialist Nurses continue to support assigned practices with input to community MDT’s across North Derbyshire, remotely where possible.
  • Specialist Palliative Care social work support continues, remotely where possible.

Bereavement support

  • Counselling and bereavement support are enabled remotely. We offer specialist support to children, families and adults around loss and grief.

Lymphoedema Services

  • Our Specialist Lymphoedema clinics are currently suspended on site but advice and clinical direction continues in consultation with patients and the wider primary health care team.
  • Urgent new referrals are continuing to be accepted and managed by the team.

Care home support

  • Our End of Life Care Facilitators have worked with CCG End of Life GP lead and other providers to develop resources to support care homes.
  • Production of a good practice guide for care homes during the pandemic that has been approved and sent to all care homes via the CCG,
  • Development of a verification of death package for care home staff that has been adopted by DCHS/DHU to train staff to verify during the crisis.

Other measures

  • Staff in vulnerable groups are no longer patient facing and socially distancing, supported to work remotely where possible.
  • Training support packages developed to incorporate COVID related requirements.
  • Connections made into wider Health and Social Care system and involvement in system escalation calls and capacity and demand planning daily.

Services currently suspended

  • Hospice-based Day Hospice
  • Supportive care hubs
  • Out-patient clinics including clinic-based specialist lymphoedema services
  • Complementary therapy
  • Face-to-face counselling and spiritual care 

Managing future increased demand due to COVID-19

In order to manage increased demand as a result of the COVID-19 crisis, staff previously working in suspended services are being redeployed where appropriate and retrained to bolster inpatient and community teams to enable the increased work below:

All patients

  • Increased Advance Care planning discussions and completion of Recommended Summary Plan for Emergency Care and Treatment (ReSPECT).
  • Continued face to face assessments for patients with the most urgent and complex needs where needed.
  • Continued arrangement of fast track care through CHC and referral to other agencies (Marie Curie, Blythe House and Helens Trust).

Inpatient Unit

  • We have agreement to flexibly open additional beds on our Inpatient Unit if needed, for patients requiring either step up or step down care for specialist palliative care needs to support both the hospitals and community providers.

Community

  • Ashgate Social Workers are working with colleagues from Derbyshire Local Authorities to support the most vulnerable in our communities affected by end of life concerns and impacts. This ranges from financial, emotional and practical support, specialist assessments and interventions and consultations with generic colleagues to give them resources and appropriate interventions.
  • Triage continues of referrals from primary care and from hospitals when patients are being discharged home to die, including specialist palliative care advice at point of contact and referral to other internal and external services where necessary.
  • Increased advice from specialist Occupational Therapists and Physiotherapists to arrange urgent equipment and for symptom management for patients at end of life, including face to face visits where necessary.
  • Our Community Palliative Care Specialist Nurses and Therapists are undertaking telephone holistic needs assessments focusing on specialist palliative care management of complex symptoms including COVID-19.

Increased support weekdays 9-5 to health care professionals via contact with their allocated Palliative Care Specialist Nurse and through dial in to GP Palliative Care meetings as well as responding to requests for advice coming in via central admin.

Staff and volunteers

  • New and more innovative use of trained volunteers in a range of roles such as community companions/buddying roles undertaking bereavement support, and psychological/well-being support for isolated patients on our caseload.

Medical Team

  • Our medics are focused on supporting the Inpatient Unit, which is accepting patients who are COVID 19 positive and negative who have complex symptoms or are needing end of life care that cannot be provided in the community.
  • They are undertaking additional domiciliary (face-to-face visits) for patients who have complex, refractory symptoms or severe levels of distress as well as telephone consultations to manage complex symptoms and to keep patients out of hospital.
  • Outpatient Specialist Palliative Care clinics continue as before but held by video or telephone to support patients with complex symptomatology.
  • The team are facilitating and supporting discussions with regards to Advance Care Planning and treatment escalation plans with the Ashgate Hospicecare CNS and community teams to prevent inappropriate hospital admissions.
  • They continue to provide telephone advice calls to other Healthcare professionals e.g. GP’s, District Nurses and Community Matrons.
  • One of the Ashgate Consultants has now relocated to support the Specialist Palliative Care Team at CRH with symptom management and Advance Care Planning Discussions and a further member of the team (Ashgate Speciality Doctor )has been released to support her work as an End of Life Medical lead in Care Homes. They are both working to improve symptom management and to facilitate rapid discharge from the acute sector to the hospice/care homes/community.
  • The medical team are using digital, remote working technology to hold complex MDT discussions with the community and to train and educate other healthcare providers.

End of life guidance and support for other health professionals

Bereavement support

  • Our Supportive Care Team will offer training and consultation to external agencies and guides/helpful resources.
  • Plans in place increase both counselling and support offers via the website over the coming weeks.
  • Development of additional support and resources for care home staff.
  • Bespoke psychological support delivered to colleagues working in the hospital and care homes as required.

Adaptions to services to support patients and families during COVID-19 

  • Spiritual care provision includes advice, conducting funerals, offering telephone and video link support. We are continuing with the remembering events but doing this virtually with counsellors on hand for immediate support.
  • Counselling offer includes telephone counselling, online and video linked sessions. We are supporting a number of bereaved people remotely who previously attended drop in sessions.
  • Preparation of psychosocial support, resources and virtual spaces to support staff dealing with trauma and stress due to the impact of COVID-19, this offer could potentially be widened out as an offer to other organisations.
  • Clinical team briefings and training on national guidelines regarding symptom management of death through COVID-19.
  • Where possible, additional hospice at home support added to the system, provided by redeployment of our Palliative Care Support Workers when agency cover is not available.

Care homes

  • In the process of developing virtual support for care homes for advice and support via Zoom/ECHO technology.
  • Assisting the CCG and Local Authority in developing contingency plans for care homes.
  • Making contact with residential homes to try to establish needs and address in conjunction with Local authority colleagues.
  • The Palliative Care Specialist Nurse team and End of Life Care Facilitators will be on the staffing rota for the county wide 24/7 advice line providing support for care homes and other professionals via 111 services.
  • Assistance with development of SOP’s and other helpful resources.

For more information on any of the services or resources listed above please contact Hayley Wardle, Director of Quality and Patient Care, at hayley.wardle@ashgatehospicecare.org.uk or 01246 568801

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