Following today’s Cabinet meeting, staff are advised of the following:
Staff are reminded that operational decisions are still being taken through the process of the Bronze / Silver / Gold command structure.
Any changes or updates to operational procedures will be decided at Gold Command or the Covid Executive meeting and will be communicated through the regular Covid Staff Updates.
Any operational issues should be escalated following the below process.
Management of patients admitted to hospital
Testing of asymptomatic patients for COVID-19:
As of 27 April 2020, all patients requiring inpatient admission (i.e. at least admission overnight) require testing for COVID-19 regardless of symptoms or clinical features of COVID-19.
Therefore, even if the patient does not fulfil the case definition, send samples for COVID-19 testing, in addition to usual investigations appropriate to the patient’s clinical condition.
The test must be carried out without delay at the point where decision to admit is made.
For asymptomatic patients, COVID-19 test can be requested on Medway (under test name COVID-19 Novel Coronavirus PCR and on the ‘Test required’ drop down, select ‘Asymptomatic admission screen’).
Note the Medway request form and specimen must be accompanied by a completed form E28.
Patients who are tested on admission but do not have clinical features of COVID-19 do NOT need isolation in side rooms (unless they also have another reason to require this e.g. another infectious disease requiring isolation precautions or infection alert such as MRSA/VRE/CPE).
Pre-existing inpatients do not need testing for COVID-19 unless they have relevant clinical features.
Patients with symptoms/signs of COVID-19:
The case definition(updated regularly) now includes any patient requiring admission to hospital with clinical/radiological evidence of pneumonia, acute respiratory distress syndrome or influenza like illness (or develop these after admission).
If a patient fulfils criteria for a possible case, do the following immediately:
- Isolate patient in a single room with respiratory precautions (if no side room is available, patient can be cared for in a bay).
- Minimise number of staff entering the room.
- Wear the appropriate PPE: Click here to see a summary of PPE to be worn
- Send samples for testing, in addition to usual investigations appropriate to the patient’s clinical condition, as per GOV.UK guidance. COVID-19 test can be requested on Medway (under the test name COVID-19 Novel Coronavirus PCR and on the ‘Test required’ drop down, select ‘SYMPTOMATIC patient test’. Note that the Medway request form and specimen must be accompanied by a completed form E28.
Rapid COVID-19 tests (performed at the Whiston Microbiology Laboratory) are now available for:
1. Patients that are to be discharged to care homes.
2. Pre-operative patients having urgent elective surgery for cancer.
These can be requested on Medway under COVID-19 Novel Coronavirus PCR.
There is now a drop down box to select the test required as shown below;
Use SYMPTOMATIC patient test to request a test for any patient (new admission or existing inpatient) with clinical features of COVID-19.
Use Asymptomatic admission screen to request an admission screen for COVID-19 on any patient who requires at least overnight admission to the Trust who has no clinical features of COVID-19.
Use Clearance swab to request a rapid test for patients prior to discharge to care home.
Use Pre-op cancer swab to request a rapid test for patients prior to urgent elective cancer surgery.
Use Elective pre-op screen (non-cancer) to request a routine test (i.e. not a rapid test) for patients screened at pre-op in advance of their elective admission for surgery/other procedure.
Note that current availability of rapid tests is strictly limited (approximately 20 in total per day) hence these MUST only be used as stated above: Any exceptions MUST be discussed with a Medical Microbiologist on a case by case basis before the test is requested.
Please note guidance related to COVID-19 is updated regularly hence always refer to the most up to date version of the guidance online at https://covid.sthk.nhs.uk/
How long do isolation precautions need to be continued if the patient is COVID-19 positive and in hospital?
Isolation precautions can be discontinued 14 days after the date of the positive test (not date of onset of symptoms) if there has been:
- clinical improvement with at least some respiratory recovery
- absence of fever (> 37.8°C) for 48 hours
- no underlying severe immunosuppression
If patient has severe immunosuppression or has received intensive care during the current admission, isolation precautions must be continued until complete resolution of symptoms or a repeat test for COVID-19, taken more than 14 days after the last positive test, is negative.
In such patients, if the patient is found to be still positive on repeat testing, and they remain as an inpatient, isolation precautions should be continued and the patient retested every 7 days until a negative result is obtained before isolation precautions can be discontinued.
PATIENTS WHO ARE GOING TO INTERMEDIATE CARE / CARE HOME / RESIDENTIAL HOME OR AWAITING A POC (Package of Care)
Some care homes or POC providers will still take patients who have been positive but do not require a negative result, If they confirm that they are able to isolate the patient for 14 days then these patients can then be discharged before 14 days.
The scenarios below need to be used when considering any patients for Intermediate Care or if a care home or provider is unable to take the patient back without a negative result.
1 | Patient is swabbed positive on admission Patient is now well Less than or equal to 14 days from the date of the positive swab Treat as positive and transfer to Newton Remain isolated until 14 days from the date of the positive swab and then re-swab and continue isolation until result available. |
2 | Patient is swabbed positive on admission Patient is now well Greater than 14 days from the date of the positive swab Needs rehab Re-swabbed and is positive Transfer to Newton and continue isolation precautions. Re-swab 7 days after the last positive swab. If remains inpatient re-swab every 7 days until a negative is obtained. Continue isolation precautions until negative results is obtained. |
3 | Swabbed positive on admission Patient is well Greater than 14 days from the date of the positive swab Needs rehab Re-swabbed and is negative Transfer to Duffy or Seddon and does not need to be isolated. |
4 | Swabbed negative on admission Patient is well Needs rehab Re-swabbed and is still negative Transfer to Duffy or Seddon and does not need to be isolated. |
5 | Swabbed positive on admission Patient is well On day 13 – 15; from the date of the positive swab, Re-swab and await results on the ward to prevent an unnecessary transfer. If negative then discharge directly to the Care Home If positive then refer to Newton and isolate, re-swab then every 7 days until a negative is obtained. Continue isolation precautions until negative results is obtained. |
6 | Patient requires step up from Community Step up to Newton and treated as positive, until results obtained, if negative transfer to Duffy or Seddon. If positive stay at Newton |
COVID-19 – VACCINE GROUP RECRUITING FRONTLINE HEALTHCARE WORKERS
The Covid – 19 Vaccine Randomised Controlled Trial Oxford Vaccine Group are recruiting Front Line Health Workers at Liverpool School of Tropical Medicine (LSTM) (subject to final approvals) commencing as early as Friday 15th May 2020.
If you are interested in taking part at Liverpool School of Tropical Medicine, please see Oxford Vaccine Group Volunteer link below. When the Liverpool/Wirral map is added later this week you will be able to access more information and check on line to find out whether you may be eligible. LSTM will then contact you to invite you to a presentation after which you may choose to consent and be screened. (time lines may change as we are still waiting for final approvals).
Please check daily from this weekend to book asap as places are limited: https://covid19vaccinetrial.co.uk/volunteer
FREE WILL WRITING SERVICE FOR NHS STAFF
Free Will writing services are available for NHS staff through Unison and local Will writing companies.
For more information, visit the NHS Offers page on the Covid website: https://covid.sthk.nhs.uk/nhs-offers/ (password: STHKcovid19)
Also, check out all of the other current deals available to NHS staff on this page including Mortgage advice, travel and shopping.
#NHSCovidHeroes
Today, the Seddon Suite superstars are our heroes for their tireless positivity and unwavering support during the pandemic. Seddon Suite is normally a specialist neuro rehabilitation unit, but when Covid hit, the team jumped into action to increase capacity and provide Intermediate Care to free up vital acute beds. Their flexibility and ‘can do’ attitude has enabled the Trust to make crucial changes to services quickly and efficiently – certainly deserving of the hero status.