4 February 2021

A New Approach to Looking at Reducing Covid Infections

by Francisco Frasquilho, Senior Improvement Advisor and Nicola Ballingall, Improvement Advisor

A new approach to looking at reducing Covid infections is being pioneered in City and Hackney, headed by Becks Lingard (Borough Lead Nurse), Lucy Goody (Gardner Ward Manager), and Claire Ritchie (Modern Matron). The team are meeting daily to progress the work, supported by the QI team. The starting place was to check in with staff around how secure they feel in terms of Covid risks on the ward, building conversations around this to identify areas for change to reduce potential spread of Covid infection.

The team, initially on Gardner Ward, looked at opportunities to build on previous learning from quality improvement work. For example, the team has looked at adapting aspects of the violence reduction and time to think work:

• Testing changes within established safety huddles to form Covid Secure Huddles
• Adapting the Brøset violence checklist to develop a Covid Secure Checklist to focus attention on key infection control activities
• Replicating safety crosses with “Covid Secure” crosses to support staff to share their level of feeling secure around Covid and essentially talk about what influences this
• Welcome letters around Covid and community meeting discussions

The pace of testing and learning is remarkable, even more so because of the pressures staff are experiencing. The Gardner ward team use rapid cycle daily testing, using our QI method to explore these new ideas, and coming back at the end of the day to capture learning. This is supplemented by measurement of whether staff feel Covid secure on a daily basis, and the reliability of Covid secure huddles each day. The team have explored the usefulness of having a Covid checklist to identify what needs prioritising, when to hold Covid secure huddles, and what reduces or improves the feeling of being Covid secure. Talking to Becks Lingard around building on the initial testing, “the biggest learning is that staff felt more unsafe when they weren’t able to properly support the patients to isolate on admission – and that in itself has helped them develop further ideas around letters and community meeting discussions.”

Last week, the Forensic Service started adapting the Covid secure bundle on Bow and Hoxton wards. Building on their learning, Butterfield ward introduced it this week. The three forensic wards presented their work at a QI Breakfast and started an MS Teams channel to share their rapid cycle tests. They have found that huddles are less likely to take place if the responsibility rests on one or two ward leaders, and are now sharing ownership across the team. Bow ward have added a check on staff lateral flow testing, and Hoxton ward staff are now ensuring less common sizes of PPE are in stock for those that need it. Butterfield ward have also iterated the checklist so it captures staff confidence in donning and doffing safely.

The testing continues, with new changes ideas including buddying and using nudges such as stickers.

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