Nottingham & Nottinghamshire Covid-19 Response Care Homes and Home Care Toolkit

The Toolkit provides an overview of key areas care home and homecare staff should be familiar with. It is intendedto be used as an electronic quick reference guide suitable for use with adults in receipt of care provision.

Last updated 20.07.2020Always make sure you have the latest guidance by visiting:https://www.gov.uk/coronavirushttps://www.scie.org.uk/care-providers/coronavirus-covid-19

2. Whats New?

3. Admissons and Discharge

6. Testing & Swabbing

5. Infection Prevention Control

4. Personal Protective Equipment (PPE) 12. Emergency Care and Treatment including palliationand end of life plans

11. Medications and Symptom Management

14 &15. Essential contacts and system pathways

13. Death Verification and Grief and BereavementSupport

16. Document Information & Acknowledgements

10. Recognising and Responding to Deterioration

7 & 8. Track and Trace

Whats New? key Messages

Randox Test Kits - PAUSED ! https://www.gov.uk/government/news/update-on-randox-test-kits

Homes which have taken delivery of Randox tests in the last 2 weeks to conduct a 28 day retesting cycle, will be sent replacement test kits automatically so that you can continue retesting.

The replacement kits will be non Randox (sometimes called Kingfisher) kits. Please be aware that thepackaging is slightly different. In preparation please look at the non Randox guidance document on the carehome testing portal https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested#care-home

If you have any further questions please join the regular webinars or contact the 119 helpdesk. Sign up to attend a webinar: https://event.on24.com/wcc/r/2375949/724EF6345473A192F6B9C19334699A29/1077953

Admissions (including re-admissions) to social care settings should not put other individuals enteringor living at the address at risk.All previously untested individuals will be tested prior to discharge and admission to social careprovision. Discharge and admission should not be delayed – test results pending As some care providers will be able to accommodate admissions through excellent IPC and  PPEmanagement, effective isolation strategies and cohorting policies. The home must undertake a riskassessment to ensure a safe discharge can take place(IPC can help with this)For some care providerseffective isolation or cohorting may not be appropriate or available – in these cases the individuals’local authority will be asked to secure alternative appropriate accommodation and care for theremainder of the isolation period

Symptomatic residents or those who have been in contact with a possible case should ideally be isolated insingle occupancy rooms for 14 days. Where this is not practical, cohort symptomatic and confirmed residents (red zones) together in multi-occupancy rooms or one area of the home, away from well residents (green zones). Residents with suspected COVID-19 should be cohorted only with other residents with suspected COVID-19.Residents with suspected COVID-19 should not be cohorted with residents with confirmed COVID-19. Do not cohort suspected or confirmed patients next to immunocompromised residents. When transferring symptomatic residents between rooms, the resident should wear a surgical face mask.Clearly sign the rooms by placing Infection Prevention and Control (IPC) signs, indicating droplet and contactprecautions at the entrance of the room. Key staff should be allocated to look after only unwell or positive residents and if possible use a separateentrance. These staff must not move zones or have breaks with staff on other zones. Key staff in red zonescould be ones who have previously tested positive. Supporting information on zones reinforced through staff allocation and rotation is available atbushproof.com Useful guidance for supporting those with dementia, or who walk with purpose, during COVID can be foundat: www.northerntrust.hscni.net/CLEAR and www.yhscn.nhs.uk/mental-healthclinic/Dementia.phpIsolation of contacts individually in single rooms for 14 days after last exposure to a possible or confirmedcase: This should be the preferred option where possible. These contacts should be carefully monitored forany symptoms of COVID-19 during the 14-day period as described earlier. Cohorting of contacts within one unit rather than individually: Consider this option if isolation in single roomsis not possible due to shortage of single rooms when large numbers of exposed contacts are involved. Residents who have not had any exposure to the symptomatic case can be cohorted separately in anotherunit within the home away from the cases and exposed contacts. Clinically extremely vulnerable residents should be in a single room with ensuite facilities

More than one case - cohorting of all symptomatic residents:

Please notify PHE on 0344 225 4524 or email phe.crc.eastmidlands@nhs.net You can contact your LA/CCG for practical support about what to do next/how to manage, support withrisk assessment etc. Email the IPC teams. Nottinghamshire County - MACCG.IPC@nhs.net or Nottingham Cityncp.ipct@nhs.net and they will call you back in office hours.During evenings and weekends to report an outbreak or gain urgent advice contact PHE on 03442254524.If you have any other  COVID-19 query, please contact the Incident Control Centre on 0115 8831111 oremail on nnestccg.nottsincidents@nhs.net. Phone lines operate 8am to 8pm 7 days per week

https://www.gov.uk/government/publications/coronavirus-covid-19-hospital-discharge-service-requirements https://www.gov.uk/government/publications/coronavirus-covid-19-adult-social-care-action-plan/covid-19-our-action-plan-for-adult-social-care  https://www.gov.uk/government/publications/coronavirus-covid-19-admission-and-care-of-people-in-care-homes

Managing admissions and dischargesSafe admission/discharge principles from NHS to social care settings

Cohorting and zoning

Managing a Coronavirus (Covid-19) outbreak

Published guidance

Result Isolation (if isolation is not possible (See cohorting/Zoning)

Negative COVID-19 result prior to discharge

If possible isolate for 14 days from arriving in the home. Do notrely on a negative results, this is only accurate on the day it istaken, the resident may become positive later

Positive COVID -19 result and14 days isolation completedand is well

No further isolation required in the home

Positive COVID -19 result, withNO symptoms and 14 daysisolation NOTcompleted inhospital and is well

Complete the 14 days isolation in the home. 14 days iscounted from the onset of symptoms Example - If 10 dayssince positive result in hospital, four days are left to completein the home.

Positive COVID -19 result, withNO symptoms and 14 daysisolation NOTcompleted inhospital and is well

Complete the 14 days isolation in the home. 14 days is countedfrom the date the positive test is taken Example - If 10 dayssince positive result in hospital, four days are left to completein the home.

PPE is only effective when combined with good hand hygiene, goodrespiratory hygiene and effective infection control practice. Onlyapproved PPE should be worn. PPE is different to 'Face Coverings - homemade fabric masks are notapproved for use at work as they are not fluid repellent.

Please note that this guidance is of a general nature and that an employer should consider the specificconditions of each individual place of work and comply with all applicable legislation, including the Healthand Safety at Work etc. Act 1974 and should ALWAYS check the latest guidance at GOV.uk which ischanging very frequently.

Correct use of Personal Protective Equipment [PPE] **

** Always check the latest guidance at GOV.UK for the latest PPE guidance;https://www.gov.uk/government/publications/covid-19-how-to-work-safely-in-care-homes https://www.gov.uk/government/publications/covid-19-how-to-work-safely-in-domiciliary-care

The risk of infection transmission increases when used PPE is handled (especially face masks). There is a safe way of applying and removing PPE. Please see videos at: https://youtu.be/-GncQ_ed-9w https://youtu.be/kKz_vNGsNhc

Putting PPE on & taking it off – Safe PracticeTo order emergency personal protective equipment providerscan access the portal to top up their existing supplies forCOVID-19 in an emergency, alternatively, please contact theNational Disruption Service on 0800 919964 or emailnationalsupplydisruption@nhsbsa.nhs.uk. If there are nosupplies available contact the Local Authority oncouncilppe@notts cc.gov.uk for support

Avoid touching your faceAll waste should be disposed of into the waste bin in the residents room as all waste produced in theroom is classed as infectious. Orange infectious waste bags should be used ideally. If not available yellow clinical waste bags orblack household waste bags (in a home care setting) can be used but should be set aside for 72 hours,alternatively full waste bags should be double bagged and put into an external bin that is kept locked atall times.Laundry – use usual detergents and where possible wash infected [suspected or confirmed] itemsseparately from others laundry using a soluble linen  bag Increase general cleaning. It is estimated that viable virus could be present for up to 5 days but less soon soft furnishings. Ensuring that areas are kept as clutter free as possible will aid effective surfacecleansing. Items such as magazines should be single person use only.Clean and disinfect regularly touched objects and surfaces using your regular cleaning products toreduce the risk of passing the infection on to other people.*

*Method: 1. detergent and water followed by a bleach based product diluted to a strength of 1000ppm, ensuring the correct contact times areadhered to 2. a combined detergent and sodium hypochlorite product diluted to a strength of 1000ppm, ensuring the correct contact times areadhered to.

Infection Prevention and Control

Before you come to workDo not come into work if you have symptomsIf  using a car to get to work – use antibacterial spray/wipes for high risk areas before and after travel Come to work in clean clothes with a clean uniform to change into and a separate outer coat/clothes andwork shoes OR Come to work in a clean uniform and bring a clean change of clothes for the end of shiftin a clean disposable bag. Bring disposable bag to store uniform at the end of the shiftUse hand sanitiser 70% alcohol when you leave your vehicle

On arrival at your baseCheck your temperature, only commence work if your temperature is OK  Wash your hands for at least 20 seconds using soap and water, use disposable towels to dry yourhands well. Social distancing must be maintained during break times and on getting to and from work.

At the end of your shiftAppropriate use of PPE may protect clothes from contamination, but staff should change out of workclothes before travelling home. Work clothes should be washed separately, in accordance with themanufacturer’s instructions.Remove uniform and place in disposable bag to take home or use the care home laundry service Wash hands before leavingIf you are unable to change before leaving your place of work ensure your uniform is covered by anouter coat

On arrival homeIf you used your own car  before entering home disinfect the vehicle thoroughly e.g. seat belts and allfixtures inside and outside the car that have been touched Place all clothes or uniform straight into the washing machine and wash at the highest temperature forthe material Wash hands then shower/bath

Before leaving homeOn arrival at workWhen removing PPE in between caring for each residents When changing PPE for different personal care tasks withthe same residentAfter using the toiletAfter breaks and activitiesBefore food preparationBefore eating any food, including snacksBefore leaving workOn arrival at homeHand sanitiser is effective when it contains 70% alcohol orwhere it states virucidal effective

Wash your hands before, during and after allcontact with individuals for a minimum of 20seconds using soap and water. You must wash youhands:

Hand washing is key!

Hand washing techniquehttps://www.nhs.uk/live-well/healthy-body/best-way-to-wash-your-hands/

General infection prevention and control principles

Infection Prevention and Control advice is available 24 hours a day If you need urgent IPC advice at any time or to report an outbreak please contact Public Health Englandon 0344 2254524.You can contact your LA/CCG for practical support about what to do next/how to manage, support withrisk assessment etc. Email the IPC teams: Nottinghamshire County - MACCG.IPC@nhs.net orNottingham City ncp.ipct@nhs.net and they will call you back in office hours.

Call 0300 300 3000 – Testing Coordination CentreConfirm your staff and resident numbersThe Testing Coordination Centre will access the digital portal and book swabs for your homeYou will be offered infection prevention and control support immediatelyYou will be offered support from the Care Home Swabbing team, who will/can attend your home andoffer assisted swabbing for residents, support staff swabbing & train staff in swabbing for future needsWhen your swabs are completed, your swabs will be picked up by the National Testing Programmecourier from your home, and will be transited to the Pathology labThe Care Home Manager will receive the test outcomes directly within 72 hours, and mustcommunicate these to the Testing Coordination CentreIf the test results include a positive, you must inform the GP and PHE, the Infection Prevention &Control teams, alongside the Enhanced Care Home Support teams, will mobilise immediately toprovide you with an increased support offer

If you are a Care Home Manager and you have a symptomatic resident please follow the processbelow:

You will be contacted by the Testing Coordination CentreYou will be asked to confirm your staff and resident numbersYou will be able to agree your preferred date for testing with the Testing Coordination CentreThe Testing Coordination Centre will access the portal and book swabs for your homeYou will be offered support from the Care Home Swabbing team, who will/can attend your home andoffer assisted swabbing for residents, support staff swabbing & train staff in swabbing for future needsWhen your swabs are completed, your swabs will be picked up by the National Testing Programmecourier from your home, and will be transited to the Pathology labThe Care Home Manager will receive the test outcomes directly within 72 hours and mustcommunicate these to the Testing Coordination Centre If your test results include one or more positive incidence of COVID-19 infection you must inform theGp and PHE, the Infection Prevention & Control Teams alongside the Enhanced Care Home SupportTeams will mobilise immediately to provide you with an increased support offer. This will be arrangedthrough the Testing Coordination Centre Testing Coordination Centre:

If you are a Care Home Manager and you have no symptomatic residents in your home you willstill be contacted and offered swabbing for residents and staff. The process will be as follows:

Covid-19 Testing/swabbing Nottingham andNottinghamshire

What to do if you have a suspected positive COVID-19 resident

Care Homes who have no symptomatic residents - Planned Testing Surveillance

For all queries regarding Care Home Swabbing and for access to Care Homes supportedtesting please use the Single Point of Contact

Nottingham and Nottinghamshire Testing Coordination Centre:

Coordination Centre open 8am to 6pm on 0300 300 3000.Email alerts to nnccg.Covid19-testingcell@nhs.net 

How will testing/swabbing work in Nottingham and Nottinghamshire?

The Local Resilience Forum (LRF) Testing Cell, in collaboration with the Care Home Cell, has developeda supportive approach for Care HomesThis ensures we can facilitate local co-ordination support throughout the whole testing process, whilstflexing to accommodate the national policy guidance

routes to testing support for testing follow up support

The planned local approach to the coordination of care home testing is set out below;

The approach is underpinned by the need bring clarity for care homes on;

Voids/Rejected swabs

It is expected that all care homes will have additional swabs to their needs. This is because Care Homesare not expected to swab residents or staff who have had previous positive swabs.Surplus swabs can be used to re-swab residents where a void swab has been issued.It is essential that a courier is booked to collect the swabs prior to taking the swab.Courier details will be supplied to you on initial collection- please contac t the same courier to collectvoids. 

Staffing support offer

It is possible that staffing difficulties may be caused by high numbers of staff swabs returning a COVID-19 positive result or following track and trace contact requiring isolation. An emergency NHS workforce through Sherwood Forest Hospitals bank can be accessed via 0300 3003000, only when you have exhausted your current options which MUST include staffing agencies.Please ensure that you have exhausted all means of covering shifts through in house staff and usualagencies before requesting emergency staffing support.To take advantage of this workforce offer we need you to confirm that you have full indemnity in place.

I was wearing PPE:

I was not wearing PPE or had a PPE breach:

I was wearing PPE whilst the contact was made and/or we have been maintaining socialdistancing (including on breaks): it is unlikely to be considered a ‘close contact’ and the staffmember can return to work.

I was not wearing PPE whilst the contact was made and social distancing was not followed: ifcontact was close or made for over 15 minutes when masks were removed and social distancingwas not applied, then it is likely that this would be considered a ‘close contact’ and self-isolationguidance would apply.

There are two exceptions to this guidance that apply to health and social care staff.

NHS test and trace work to identify the close contacts of a person who tests positive; where positiveresults involve those working in a health or social care setting, the NHS test and trace service mayrefer the case to Public Health England (PHE) who then provide guidance to the health or social caresetting.

1. What if I have had close contact with a resident /service user who has tested positive forCOVID-19?

If a staff member has been caring for a Covid-19 positive resident/service user and appropriate PPEhas been worn, this contact will need to be risk assessed by the managerwith advice from PHE. This is unlikely to be considered a ‘close contact’ and the staff member canreturn to work.

If a staff member has been caring for a Covid-19 resident/service user and they were not wearingPPE or there was a breach in PPE this contact will need to be assessed by the manager with advicefrom PHE. It is likely that this would be considered a  ‘close contact’ and self- isolation guidancewould apply.

2. What if I have had close contact with a colleague at work who has tested positive forCOVID-19?

If a staff member has had close contact at work with a co-member who has been confirmed Covid-19positive, this contact will need to be risk assessed by the manager with guidance from PHE. 

Test and Trace The NHS test and trace service helps trace close recent contacts ofanyone who tests positive for Covid-19 and if necessary, notifies them thatthey must self-isolate at home to help stop the spread of the virus.

Care home and homecare workers should follow the same advice as the general public apart from the exceptionsnoted on the right. Anyone who has had close contact with someone who tests positive for Covid-19 will beexpected to isolate themselves for 14 days, or for 7 days from developing symptoms of Covid-19.

The PHE Health Protection team can be contacted on 0344 225 4524.

‘Close contact’ occurs in a number of circumstances including:• When you have skin-to-skin physical contact with someone with confirmed covid-19• When you have face-to-face contact within one metre of someone with confirmed covid-19 e.g. face to face conversation• When you are within one metre of someone with confirmed covid-19 for one minute or longer without face-to-face contact• When you spend more than 15 minutes within two metres of someone with confirmed covid-19• When you have cleaned a personal or communal area of the home of someone with confirmed covid-19, the first time the cleaning occurs

How can I best protect myself and my colleagues while at work?

• Social distancing: to help minimise future staffing concerns please ensure that in any instance where the use of PPE is not required,for example during a break, strict social distancing measures are applied so that staff remain 2 metres apart. If this is not possible thenconsider staggered break times to reduce close contacts with others wherever possible.

• Hand hygiene: hand hygiene is essential as it reduces the spread of infection. This must be performed before and after direct care,contact with others and frequently throughout the shift including after using the toilet, before eating, during breaks and after contactwith PPE or the environment.

• Appropriate use of PPE: ensure staff are not wearing fabric ‘homemade’ masks at work as these would be considered a breach inPPE use.

I’m a care home manager and I’m struggling with staffing shiftsdue to test and trace, what should I do?

It is possible that staffing difficulties may be caused by health andsocial care workers needing to self-isolate. Please continue to useyour own staff as much as possible to cover shifts or your usualagency supplier.

If you exhaust these options please access the staffing supportoffer via the Covid Care Call Line on 0300 300 3000.

Further information; (links will be added shortly)Management of exposed healthcare workers and patients in hospital settings

Guidance for contacts of people with possible of confirmed Covid-19 infectionwho do not live with the person

Test and trace: how it works

What happens if, once risk assessed, I need to self-isolate as a contact?

It is important that anyone identified as a close contact self-isolates. Asymptomatic contacts may be offered a test for Covid-19if there is a clinical need to do so. Clinical need would be agreed inpartnership with PHE and the manager.

If the test is negative the 14-day self-isolation period muststill be completed. This is because you may have the virus,but it cannot be detected by a test yet.

If the test is positive then the staff member must self-isolateand may return to work after seven days, providing they arewell and have not had a fever for 48 hours. For furtherinformation please see the government guidance.

Risk assessment for assessing a PPE breach is outlined within government guidance available athttps://www.gov.uk/government/publications/covid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings/covid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings (Section 6).

Test and Trace Continued ....

Staffing Concerns following Test and Trace;

Social distancing must be maintained during break times and on getting to and from work.

What does a breach in PPE mean?This may be non-approved PPE such as fabric masks, PPE that was damaged during use, or where there was a breach in PPE while providingpersonal care. Examples that are unlikely to be considered breaches include if a health or social care worker was not wearing gloves for ashort period of time or their glovestore, and they washed their hands immediately, or if their apron tore while caring for a resident/service user and this was replacedpromptly.

Check all individual’s temperature (via ear) B/P, pulse, respirations and if available pulse oximetry twicedaily where possible If temperature is 37.8 or more with or without a continuous cough the individual should be cared for asif Covid-19 positive.If  Oxygen saturation levels have reduced by >2% below their normal, the individual should be cared foras if Covid-19 positiveNote that symptoms can be vague, it could be a general deterioration - a new fall, a headache etc, allshould be treated as possible COVID infection,  the resident isolated for 14 days and a request forswabbing made

For all individuals with possible Covid -19 symptoms seek medical care early. As symptoms can often present atypically or vague.If the individual is showing any other signs such of concern such as breathlessness, agitation, confusion,acute diarrhoea contact: Call for Care – 01623 681691 or  Citycare Monday – Friday 8am-6pm - 01158834863. Weekend and Bank Holiday 8am-6pm – 0782782346 Between 6pm and 8am everyday –Evening and night service 0115 8838151 or 0115 8838152- for support/advice or contact NHS 111 9 *6

Check all individual’s temperature twice daily  (via the ear). <2 visits per day planned – if available family/carer could be trained to undertake this (community nursesshould support education as required)If temperature is 37.8 or more with or without a continuous cough the individual should be cared for as ifCovid-19 positive.If temperature is above 37.8 or more and  the individual is becoming newly confused, poor colour, raisedrespiratory rate and/or they have developed a continuous cough they should be cared for as if Covid-19Deterioration tools are beneficial for use with those supported by Home Care. Our training team will workwith providers to implement RESTORE2Mini or the full RESTORE2 tool. Please contactempscdet@nottingham.ac.uk to arrange your free training.

RESTORE 2 can help you to spot deteriorationfrom Covid-19 related illness or recognise non-Covid-19 related deterioration and act to get yourindividual the most appropriate care and support. RESTORE2 uses three tools (Soft Signs, NEWS2 andSBARD) which when used together can help you toget the help and support you need more quickly. The CCG, Patient Safety Collaborative -AcademicHealth Science Network and Notts AllianceTraining Hub have joined together to work withyou and your teams to help you to use this withyour residents . If you would like to know more and access thefantastic resources, please contactempscdet@nottingham.ac.uk

Recognising and Responding to Deterioration

Home Care and Residential Homes

Nursing Care Homes

Emergency Community Assessment of the Deteriorating Patient Form

Assessment prior to deterioration – can be used now to support decision making when individuals become unwell. Can be completed by care home staff. Complements others forms such as ReSPECT and Advance Care Planning. To be kept in the care record with other ACP/DNAR/ReSPECT forms.

Always refer to the individuals’ advance care plan/Respect form to consider the right course of action in an emergency

During the 'weekly check in' pleaseuse the Restore/News2 scores toidentify individuals you are concernedabout.

Nottinghamshire Area Prescribing Committee (NAPC) host a collaborative strategy forensuring consistent high quality and cost effective use of medicines acrossNottinghamshire.The NAPC website is the ‘go to‘ place for medication guidance and supporthttps://www.nottsapc.nhs.uk/covid-19/ and is updated frequently with new and updatedguidance in a variety of settings including care homes.  Please  refer to our most recent prescribing guideline for End of Life care for Covidpatients.

Bi monthly newsletter is produced jointly with local authority colleagues and contains a range ofinformation for both care homes and home care providers. If you don’t currently receive this but wouldlike to be added to our mailing list please email lisa.ryley@nhs.net

The document  “Guidance on medicines in social care establishments “  provides care homes with lotsof information on medicines management issues.All care home staff who manage medications should be familiar with this local document.  The guidance is currently under review so that it will apply to care homes across both local authorities.Please contact lisa.ryley@nhs.net for a copy.

The British Geriatric Society published best practice guidance for managing the Covid-19 pandemic incare homes The guidance makes 22 key recommendations including palliative and supportive considerationsIt can be accessed at https://www.bgs.org.uk/resources/covid-19-managing-the-covid-19-pandemic-in-care-homes

In response to Covid-19 the government has recently launched a medicines re-use scheme. Some types of medication can be re-used for others with the same prescription even though it was notoriginally dispensed for that individual. The CCG has produced a local guidance document that homes may wish to use to implement thisscheme. For a copy please email Tania Cook taniacook@nhs.net

Care about Medicines newsletter

Guidance on Medicines in Social Care Settings

British Geriatric Society, Best practice Guidance – Care Homes and Covid-19

Medication re-use scheme

The CCG have a  number of pharmacists and technicians who can support both care home  and homecare providers with a range  of areas including medication reviews and ordering processes.Please email taniacook@nhs.net   or cosborn@nhs.net

Questions/Queries? If you have ANY Medication Management queries, please contact our Nottingham and NottinghamshireMedication Management teams via email at  MACCG.NottsAPC@nhs.net (office hours only).

Excellent free training resources have been bought from PrescQIPP, a NICE and skills for care accreditedprovider of medicines management training. There are separate packages, one for care homes and one forhome care providers. The links below explain how to access the training: For home care providers;https://www.prescqipp.info/media/4743/prescqipp_managing_medicines_for_adults_receiving_social_care_in_the_community_e_learning_course_overview.pdf For care homes; Visit the prescQIPP e-learning platform - https://moodle.prescqipp.info/login/index.php For more information or you are experiencing issues registering please contact Tania Cooktaniacook@nhs.net

Controlling symptoms of Covid-19 in Community Settings & NICE Clinical Guidance NG163offer guidance about how to mange Covid-19 treatments and care planning. https://www.nice.org.uk/guidance/ng163 https://www.nottsapc.nhs.uk/covid-19/

Access to free medicines management training for careproviders

Medications and Symptom Management

Symptom Management

Nottinghamshire Area Prescribing Committee

Medications management resources

Medicines Optimisation Support

The ReSPECT document supports people to get theright level of care and support at the end of their lives. · It is one of the ways they or their loved ones can be incontrol at the end. · ALL individuals should be offered an advance careconversation with relatives if necessary or desiredleading to the creation of a ReSPECT Form to recordtheir priorities and escalation plans. · Please ensure, where appropriate, all individuals areoffered the opportunity to have an advance care plan inplace. · If the individual does not have an advance care planyou can discuss this with your nurses or GP. · ANYONE (qualified and unqualified staff] can start aReSPECT form but it will need to be signed by a GP orSenior Nurse. · ReSPECT forms can be signed at weekly MDT meetings.https://www.resus.org.uk/respect/learning/   https://learning.respectprocess.org.uk/#landing

Someone may have severe symptoms and experience a rapiddecline. Early management of symptoms can alleviate any sufferingand it is important to deliver effective medications in effective doses doses from the outset.

The Mental Capacity Act and Covid-19 The Mental Capacity Act (MCA) provides protection and upholds the rights ofpeople who lack, or may lack, capacity to make decisions about different aspects oftheir life. It is important to remember that the principles of the MCA and theDeprivation of Liberty Safeguards (DoLS) have not been changed as a result of thepandemic.You may be faced by unfamiliar situations and decisions, for example,assessing a person’s capacity to be tested for Covid-19 or where public healthrestrictions interface with the MCA. The Government has issued updated guidance on the Mental Capacity Act andCovid-19 - https://www.gov.uk/government/publications/coronavirus-covid-19-looking-after-people-who-lack-mental-capacity. This guidance is to help address these issuesand support you in ensuring the rights of the people you, in turn, support.

Emergency Care and Treatment

It is good practice to ensure all residents are proactivelyassigned an accurate RAG status. In the context of Covid-19 transition from amber to red anddeath may be a few days -hours only.ALL amber & red  should be known to a health careprofessional for registration on EPaCCS - Electronic PalliativeCare Coordination Systems to enable coordinated care andsupport.

https://www.goldstandardsframework.org.uk/gsf-signposting-and-guidance-on-the-coronavirus-epidemic

Symptom Management

You can use technology to get advice from the GP andhold multidisciplinary meetings to support end of lifecare. You can use your personal devices if necessary. Ifpossible have the video consultation in the individual’sroom or somewhere private. This approach can alsobe use after death for verification

https://nottinghamshire.eolcare.uk/ Notts EOL Website

Virtual Assessment

Sign up for NHS Mail so MicrosoftTeams can be used for video

consultations.

If someone is approaching the end of theirlife they need to feel they are mostimportant person in the world—you canease the passage of dying and enable themto have a dignified and peaceful experience

Use the ReSPECT form and ACP to ensurethe right people are there, the ‘mood’ iswhat they like and that they have yourattention. You can then monitor thatthey are pain free, peaceful and also

support their loved ones

Just Breathe!

Advance Care Plan

It's about dying well

Change the pace - your time is thegreatest gift you can give

Gold Standards Framework

Confirmation or verification of death is defined as deciding whether a person is actually deceased.Verification of death can be undertaken by staff who are competent and confident  to carry out thistask. Your organisation/service should have a policy/procedure which will support you to undertake thispractice. You should be familiar with this.

Call for care – 01623 681691 or Nottingham Citycare   OOH – NHS 111 9*6 /NEMS

In Nottingham and Nottinghamshire local guidance – ‘Death administration in the community’ is available,staff should be familiar with this as it supports Verification of expected death practice. It also includes apre authorisation template which will support staff and partners in decision making when verification ofdeath is needed If you do not have a competent/trained person available  to verify death contact:

The person registering a death (known as the informant) can be: •a close relative of the deceased, named the executor of the Will. If a close relative is not available to doso, it’s also possible that the •a relative who witnessed the loved one’s death, last illness or who lives near their residence•the owner of the premises where the death occurred•the relative arranging the funeral with the funeral director or someone else who was present at thedeathDuring the Covid-19 pandemic doctors are emailing death certificates directly to the Registrars (so noneed for relatives to pick up from surgery)

When a person dies of suspected coronavirus (Covid-19) in a residential care setting be aware that thereis likely to be continuing risk of infection from body fluids. Whilst undertaking last offices, it isrecommended that the usual PPE and standards of Infection prevention control precautions aremaintained. You should follow the usual processes for dealing with a death in your setting.Since there is a small but real risk of transmission from the body of the deceased, mourners should beadvised not take part in any rituals or practices that bring them into close contact with the body of anindividual who has died from, or with symptoms of Covid-19. Given the very significant risk for vulnerableand extremely vulnerable people who come into contact with the virus, it is strongly advised that theyhave no contact with the body. Cremation is permitted where the deceased does not have a medicaldevice that requires removal e.g. pacemaker/ICD.

Informing the CQCThe CQC are now recording all deaths where Covid-19 was possible or confirmed Please inform the CQCusing your usual notification form even if the person dies in hospital

Published Guidancehttps://www.gov.uk/government/publications/Covid-19-guidance-for-care-of-the-deceased/guidance-for-care-of-the-deceased-with-suspected-or-confirmed-coronavirus-Covid-19 https://www.gov.uk/government/publications/Covid-19-guidance-for-care-of-the-deceased https://www.hse.gov.uk/pubns/books/hsg283.htm

A grief line has been set up to support staff andfamilies in dealing with emotional distress related toloss of loved ones. The grief line will listen and offer practical supportwhere needed as well as signposting to existing griefsupport.

You can call 0800 111 445   8am til 8pm  7 days per week.

Death Verification

Confirmation or Verification of Death

Death certification

All doctors in primary care AND hospitals NUH, NHCT, SFHFT can carry out death certification. Where anindividual  has been discharged from hospital and dies quickly before any contact with GP, the hospitaldischarging doctor should be asked to complete the death certificate. Doctors can do the deathcertification if they have seen the Individual within 28 days (this can be by video which you are asked tohelp facilitate) or after death.

Death Registration

Care of the deceased - after care

Grief & Bereavement Support

Public Health

T: 0344 225 4524Email:phe.crc.eastmidlands@nhs.net

Infection Prevention& Control

CountyMACCG.IPC@nhs.net

City ncp.ipct@nhs.net

Testing/swabbingTeam

T: 0300 300 3000Email: nnccg.Covid19-testingcell@nhs.net

Enhanced CareResponse Team

(ECRT)

??

CCG Quality Assurance Email:nnestccg.southnottspatientsafety@nhs.net

Quality Improvement(EHCH)Email: d.nussey@nhs.net

Recognising andResponding toDeterioration

Email:empscdet@nottingham.ac.ukEmail: michele.tuttle@nhs.net

MedicationsManagement Team

https://www.nottsapc.nhs.uk/covid-19/

Email: taniacook@nhs.netEm,ail: lisa.ryley@nhs.netEmail: MACCG.NottsAPC@nhs.net

Grief Line

T: 0800 111 445

FREE Gov.uk

https://www.gov.uk/coronavirus

Notts AllianceTraining

Hub/Workforcesupport

??

Local AuthorityQuality and MarketManagement Teams

County -qmm@nottscc.gov.ukCity - CV-19

Nottingham CityWebsite - Ask Lion

Email:www.asklion.co.uk/pro

vidercornercovid-19

Notts Help Yourself

https://www.nottshelpyourself.org.uk/kb5/nottinghamshire/directory/document.page?id=Igc3gkzdlkc

Notts EOL web site

https://nottinghamshire.eolcare.uk/

Care Forum 'We are all in this

together'

https://us02web.zoom.us/webinar/register/WN_CNjlJyX-

Sf6t_sugpWd5vg

WhatsApp GroupCovid-19 Care Group

https://webapp.mobileappco.org/m/COVID19CARE/?

appcode=COVID19CARE

FREE

Essential Contacts

City Care Homes Team City care (city care homes only) can be contacted;Monday – Friday 8am-6pm - 0115 8834863  Weekend and Bank Holidays -  8am-6pm – 07827823465  Between 6pm and 8am everyday – Evening and night service 0115 8838151 or 0115 8838152

Nottingham & Nottinghamshire System Support pathways

Offers care home and home care staff a direct line to a clinician who will be able to discuss any concerns you have for an individual in your care. The 9 *6 option bypasses the call handler algorithm to enable a less formalconversation. It is very helpful to NHS 111 9* 6 clinicians if you use SBARD to communicate theconcern and have and all basic information to hand such as the persons date ofbirth, address, postcode, medications etc. If you are concerned about an individual you can contact NHS111 9 *6.

NHS 111 - 9 * 6

 

Call for Care Call for Care Tel: 01623 781899 (Mid Notts) Option 1 - Admission avoidance (2 hour response) Option 2 - End of Life and Palliative Care Option 3 - Planned Care (non-urgent referrals for all general health services) Call for Care Tel: 0300 0830 100 (South Notts)  Option 1

NottinghamshireHealth Care Trust A-Z

of services Nottingham City Care A-Z of services https://www.nottingham

shirehealthcare.nhs.uk/a-z-of-services

https://www.nottinghamcitycare.nhs.uk/find-a-

service/

This toolkit has been created to be used as an aide memoire/quick reference guide forcare home and home care staff managing Covid-19. This guidance is not mandatory – its purpose is to support staff to deliver high qualitycare for individuals by bringing together best practice guidance and references to keydocuments to support practice all in one place. This guide has been co-developed by Nottingham and Nottinghamshire Integrated CareSystem with contributions from;Nottingham and Nottinghamshire CCGsNottinghamshire HealthCare Trust Nottingham City Care Nottinghamshire EOL Stakeholder Board Nottinghamshire GPs Nottingham University HospitalsNottingham City CouncilNottingham County CouncilSherwood Forest HospitalsICS Clinical Leads Care home and Home care providers Nottingham City and County LA Public Health Colleagues

This guidance was produced in response to the Covid-19 Pandemic. In this fast paced,continuously developing and changing situation, it is expected that best practiceguidance will be updated frequently.

A good practice tip would be to keep an electronic file with this guidance and all thelatest attachments for each of the focus areas available to staff to use as a referenceguide to support Covid-19 EOL care and management. This is a working document and further updates and co-design with sector experts willbe made as required.

Quality ControlThe information provided within the toolkit will be reviewed and updated daily duringthe Covid-19 pandemic.

Information from reputable sources will include (but not limited to); Gov.uk. PatientSafety Collaborative/Academic Health Science networks. UK Resuscitation Council.Nottinghamshire Area Prescribing Committee. Public Health England and Local IPCteams. NHSE/I. ADASS. CQC. Local Authorities and TeamNet

The latest version will be shared as a minimum, weekly and will be version controlledwith the latest date e.g V.280420. 

The content may change to reflect the fluid position of today and the future.

Points of clarification/additional information queries should be directed to  Nottingham& Nottinghamshire CCG - nnestccg.southnottspatientsafety@nhs.net