Our launch webinar · 2020-06-22 · AGENDA COVID-19 in Care Homes: A Regional Response Tuesday 9th...
Transcript of Our launch webinar · 2020-06-22 · AGENDA COVID-19 in Care Homes: A Regional Response Tuesday 9th...
East of England
Population Health Research Hub
EoE PHResH
Our launch webinar:COVID-19 in Care Homes –A Regional Response
9th June 2020
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AGENDA
COVID-19 in Care Homes: A Regional ResponseTuesday 9th June 2020: 16.00 – 17.00
16.00 – 16.10 Introducing the EoE Population Health Research HubProf Carol Brayne, Director, Cambridge Institute of Public HealthIan Wake, Director of Public Health Thurrock
16.10 – 16.20 Using research evidence to support the delivery of care in response to COVID-19 in Care HomesProf Claire Goodman, Centre for Research in Public Health and Community Care,University of Hertfordshire
16.20 – 16.35 Guidance on COVID-19 in Care Homes Dr Smita Kapadia, Public Health England – East of England
16.35 – 16.45 Sharing Local Learning & Findings:Essex SARS-CoV-2 Care Homes SurveyAnna Starling, Essex County CouncilLocal Authority Responses to COVID-19 in Care Homes in the East of EnglandDr Tara Berger-Gillam, Public Health England – East of England
16.45 – 17.00 Question & Answer Session and What’s Next?
East of England
Population Health Research Hub
EoE PHResH
Introducing the EoE Population Health Research Hub
Prof Carol BrayneDirector, Cambridge Institute of Public Health
Ian WakeDirector of Public Health, Thurrock
East of England Population Health Research Hub
EoE PHResH
Aim: A regional hub of public health practitioners and researchers in the East of England who address regional population health challenges and inequalities through collaborative networking and action
Objectives:1. INFORM: by catalysing research in response to local challenges
and increasing the visibility and accessibility of population health research
2. STIMULATE: action by increasing the utility of population health research within the region through translation and evaluation
3. FACILITATE: dialogue and links with expertise, the transfer of knowledge and evidence, and the development of new research collaborations within the region
PHE East of
England
ADPH East of
England
Servicebased
practitioners
Academia
Our partners include:
COVID-19: Our Hub Actions
COVID-19 Research in the EoE
Research BitesRapid Evidence Reviews
& Syntheses
Hub Newsletter
Coming Up:
Mapping Academic Skills & Capacity for Support
Include, but are not limited to the following:• Immunity after COVID-19: a briefing
• Interventions to mitigate the spread of COVID-19 in the community: a rapid review
• What models have been used to separate the management of patients who would normally be in hospital, with COVID-19 and those without COVID-19, in other countries? An Options Appraisal
• What are the mental health impacts of infectious disease epidemics on relatives and informal carers of affected individuals, and on relatives of health workers? What interventions are available to support them?
• Systematic review of guidelines for the management of intensive care during the COVID-19 pandemic
VISIT OUR WEBSITE: https://adph.org.uk/networks/eastofengland/eoephresh/
Connect with the Hub
Visit our Website: Email Us:
Dr Angelique [email protected]
Caitlin [email protected]
Follow Us:@eoe_PHResH
Subscribe to our Newsletter:
https://adph.org.uk/networks/eastofengland/eoephresh/
https://adph.org.uk/networks/eastofengland/newsletter-
signup/
East of England
Population Health Research Hub
EoE PHResH
Using research evidence to support the delivery of care in response to COVID-19 in Care Homes
Prof Claire GoodmanCentre for Research in Public Health and Community Care, University of Hertfordshire
Using research evidence to support the delivery of
care in response to COVID-19 in Care Homes
Claire Goodman
Centre for Research in Public health and Community Care UH
Lead Ageing and Multimorbidity theme NIHR ARC East of England
Background
Prof Mary DalyCOVID-19 and care homes in the UKhttps://www.gtc.ox.ac.uk/news-and-events/news/covid-19-and-care-homes-in-the-uk/
PLANNING• March 3rd NHS action plan• April 15th Action plan for adult social care• May 15th Care home specific plan TESTING• Late March testing for NHS• May 11th portal for care homes testingDEATHS• March 5th First death reported• April 20th Care home deaths included in statisticsPPE• May 15th Specific guidance for care homes and new
route to access supplies for care homes
Care homes hiding in plain sight….
https://ltccovid.org/2020/05/14/the-invisibility-of-the-uk-care-home-population-uk-care-homes-and-a-minimum-dataset/
• COVID-19 exposed gap in data intelligence and prioritisation of needs
• Need for linked routine health and social care data with information from care homes, available in real time.
• During pandemic lacking data = difference between a rapid, effective response and high infection and death rate.
• Post COVID -19 collated, accessible data on residents’ health and service use could support planning & care tailored to residents’ needs,
• DACHA Study design, develop and implement a minimum dataset for UK care homes, report 2024.
• A MDS as a resource, not just regulation or cost containment..
• Making care homes part of a data system a priority post-COVID
History
• Care home staff initiated WhatsApp group
• Not sustainable membership> 256 participants
• Sector driven questions triggering research based resources for care specific issues
Example earlyquestions:
Apart from Personal Protective Equipment …….
- Isolating people who walk with purpose? How can it be done?
- When is restraint ethically defensible and what type?
- People coming in and out of hospital/community. Who is high risk for introducing COVID? Who is not?
- Anticipating decline and getting meds organised in time.
- Managing stressed and potentially grieving relatives remotely
- When is it okay to hug a resident?
From rapid review to heuristics
Alternatives to physical comfort
When residents don’t understand social distancing
Uncertainty around residents’ care
Dealing with multiple deaths
Supporting families at a distance
Hydration
Questions sharedRapid review of
research evidence & CH studies
First drafts & internal review
Reading level
Frontline staff Feedback on what
works
Presentation for multiple formats
(app, hard copy) & track use
Top Tips for Tricky Times: Supporting staff following multiple deaths in care home
environments
1. It is okay to grieve. Sometimes grief felt by staff is as real as the grief of residents’ family.
2. Time to talk about feelings and emotions is important for staff. Managers can support staff to do this in
one to one meeting.
3. Other ideas include a time of reflection, sharing stories and memories with each other.
4. Note what you did well in caring for the resident. That might be especially important when family can’t
be present.
5. Some staff may be new to experiences of death – they might need more support.
6. Could staff use a bereavement support line? Or make links with local hospices; staff could benefit from
the expertise they offer.
7. Rituals that involve gatherings won’t be immediately possible. Plan a Memorial Day to remember the
residents who have passed away in the past 12 months.
8. The effects of grief can accumulate rather than lessen with each death. Experiencing many deaths in a
short space of time can be overwhelming and lead to prolonged grief. It might feel unreal.
9. Staff can experience ‘compassion fatigue’. It shows as emotional and physical exhaustion. It can
impact on being able to care for residents and on relationships with colleagues. The above tips can help
manage this.
Author: Kathryn Almack
28th May 2020
Top Tips for Tricky Times
Work supported by NIHR ARC East of England, NIHR ARC Kent, Surrey and Sussex. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Top Tips for Tricky Times:
Providing physical comfort and reassurance to care home residents during COVID-19
1. How doll therapy can help: Dolls can have positive effects, improve a resident’s mood and calm
them.
2. Personal: Each resident should have their own doll to keep in their room.
3. Life-like: Soft texture and open eyes.
4. Ownership: Do not take dolls away but be aware if a resident becomes tired from looking after a
doll.
5. Person-Centred: Dolls may not be suitable or wanted by all residents. Dolls should be left out for
residents to choose.
6. Contamination: to reduce cross-contamination and confusion, important staff know which doll
belongs to which resident.
7. Attachment Residents may like them one day but not the next.
8. Concerns: Staff and relatives may worry residents are being treated like children. Reassure them
that dolls can be a source of comfort.Top Tips for Tricky Times
Elspeth Mathie and Frances Bunn 27.05.2020
Work supported by NIHR ARC East of England, NIHR ARC Kent Surrey and Sussex NIHR. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Very specific
Harwood RH, O’Brien R, Goldberg SE, Allwood R, Pilnick A, Beeke S, Thomson L, Murray M, Parry R, Kearney F, Baxendale B. A staff training intervention to improve communication between people living with dementia and health-care professionals in hospital: the VOICE mixed-methods development and evaluation study. Health Services and Delivery Research. 2018;6(41).
NB Not for reproduction final versions not yet available
Summary
Collaborative: changing research focus from what ‘ought to be done to ‘how it can best be done’ with care homes
Work in progress: 8 top tips reviewed by frontline staff with changes, now with designer
“Live” documents
Not a substitute for other sources of guidance
Found little care home specific “implementation ready” research evidence.
Helping pressurised staff organise their thinking might also :
Reassure staff they are not missing something
Be a resource for staff to use with inexperienced and junior staff
Top Tips for Tricky Times University of Hertfordshire Claire Goodman, Kathryn Almack, Frances Bunn, Angela Dickinson, Melanie Handley, Elspeth Mathie, Andrea Mayrhofer, University of East Anglia Tamara Backhouse, Diane Bunn, Anne Killett, University of Kent Ann-Marie TowersClaire Goodman, Elspeth Mathie, receive support from the National Institute for Health Research (NIHR) Applied Research Collaboration East of England (EoE). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Care Home Care WhatsApp and Covid-19 Care platform foundersWren Hall Anita Astle, Royal Derby Hospital Professor Adam Gordon, Nottingham & Nottinghamshire CCG David Ainsworth, PerCurra at Home Gill Heppell, Landermeads Care Home Ros Heath, Sears Healthcare Dr Richard Adams, The Manor Residential Home Hitesh Chavda, NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG Donna Nussey, My Home Life and National Care Forum Professor Julienne Meyer
DACHA is funded by the National Institute for Health Research (NIHR) Health Service Research and Delivery programme (HS&DR NIHR127234) and supported by the NIHR Applied Research Collaboration (ARC) East of England. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.DACHA is a collaboration between the Universities of Hertfordshire, Cambridge, East Anglia, Newcastle, Leeds, Nottingham, Kent, Exeter, The Health Foundation, NIHR ARC East of England & National Care Forum
East of England
Population Health Research Hub
EoE PHResH
Guidance on COVID-19 in Care Homes
Dr Smita KapadiaPublic Health England – East of England
Public Health management of COVID-19
in care homes for the elderly
A collaborative effort!
Dr Smita Kapadia
PHE EOE Health Protection Team
09 June 2020
For PHResH
Overview
Controlling outbreaks
• Reflections on our journey in the East of England
Guidance
• General principles of management
• Key interventions
Contact Tracing (T&T)
Road to recovery….
Priority settings
Vulnerable residentsHigh incidence of
transmission & deaths
Complex health care landscape
Availability of testing & PPE!
IPC skills & workforce
Latest numbers by UTLA
Controlling outbreaks: reflections from the EoE
• Care Homes Group
HPT & LA
• Joint SOP on outbreaks
Care Home cells (LA & CCGs)
• Ongoing management & follow up
Two-way communication
COVID-19 care home outbreaks reported to PHE
20th April 2020
Key guidance documents
Regional:
• PHE East of England HPT Care Homes SOP V4
• CRC local guidance documents
National:
o COVID-19: how to work safety in care homes (PPE focus):
https://www.gov.uk/government/publications/covid-19-how-to-
work-safely-in-care-homes
o COVID-19: adult social care action plan:
https://www.gov.uk/government/publications/coronavirus-covid-19-adult-
social-care-action-plan
Case definition: community settings
Community case definition
• New continuous cough
or
• High temperature
or
• A loss of, or change in, normal sense of taste or smell (anosmia)
*Atypical presentations in elderly residents*
What constitutes an ‘outbreak’?
• “A care home reporting one case or death in a resident or staff
with respiratory symptoms, or fever will be entered as COVID-19
Situation, regardless of laboratory confirmation.”
• HPT is alerted to outbreaks by various sources:
o Care home staff or management
o GPs and Practice Nurses
o Local authorities
o CCGs and community IPC teams
o Cluster detection, e.g. via FES & NEW* post code cluster alerts!
Outbreak management
- Notification to PHE
- Initial risk assessment & Infection Control advice
- Advice on interpreting guidance (there are so many!)
- Swabbing! (symptomatic & asymptomatic)
- Safe handover to LA cells for follow–up management
HPT RiskAssessment
Care Home Inform PHE Health Protection Team
(HPT)
Care Home Update Capacity Tracker
HPT Contact LA hub to Arrange Testing of all
symptomatic residentsand handover follow-up to local cell as per
joint SOP [ref]
CCG/LA Hub to Initiate Whole Home Testing
Via DHSC Portal or locally agreed
arrangements (refer to DHSC letter and SOP)
Suspected Outbreak 1 or More Residents or Staff
Whole Home Testing RequestedNo Symptomatic Residents
DHSC National Portal/ Local process
Care Home Residents and
Staff Swabbed
Symptomatic and Whole Home Swabs
Local Laboratory
Pillar 2 Laboratory
Results to HPT
Results to Local Swabbing
Service
As per National Process
Care Home to Advise Resident /GP/CCG
IPC
Advise Care Home of Results
Care Home Swabbing Process East of England 12-5-20 v4.2
Symptomatic Care Home Residents Swabbed
https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested
PPE advice on a page!
Clinical
Gloves
Plastic
Aprons
Fluid
Resistant
Mask
Eye
protection
Period of use Single use Session of care
Direct contact with
resident ✔ ✔ ✔Assess
risk
Resident coughing
(within 2m) ✔ ✔ ✔Assess
risk
No direct resident
contact ✗ ✗ ✔ ✗
Communal areas✗ ✗ ✔ ✗
Summary : Complex situations / settings…..
- Schools, Care homes, homeless hostels, work places – offices, food
production/packing/other industry/essential infrastructure, Hospitals
PHE’s role:
- Undertake individual risk assessments, work with LA, NHS & other colleagues
- Make judgement calls! (yes that’s why we are here!)
- IMTs only where absolutely essential
- Make appropriate use of local and national SOPs
- Keep updated (constantly!!!)
Road to recovery?....☺
- Integrating contact tracing into the existing suite of Public Health actions
- Raising awareness on guidance for employers on staff-isolation, as part of test & trace
- Care Home support plan by Local Authorities
- Investing in workforce & digital innovation
COVID-19 care home data outputs
Frequency Disseminated to
Table showing number of care homes
reporting a suspected or confirmed
outbreak to PHE (East of England)
Daily
PHE
NHS E/I
DsPH
LA Heads of Public Health
LA Consultants in Public Health
LA/CCG Care Home cells
Line list of named care homes reporting
a suspected or confirmed outbreak
(East of England)
Daily
PHE
NHS E/I
DsPH
LA Heads of Public Health
LA Consultants in Public Health
Graph showing suspected or confirmed
outbreaks by day and principal context
Table showing new and total care home
outbreaks by upper tier local authority
(East of England)
Daily
East of England Dashboard
Access provided to PHE staff and
external stakeholders (e.g. LAs)
Weekly number and percentage of care
homes reporting an outbreak (LA,
regions and PHE Centres)
Weekly
https://www.gov.uk/government/statist
ical-data-sets/covid-19-number-of-
outbreaks-in-care-homes-
management-information
New Guidance
Letter issued 5 June – Guidance on Aftercare needs for Covid19 patients
https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/06/C0388-after-care-needs-of-
inpatients-recovering-from-covid-19-5-june-2020.pdf
Letter issued by DHSC 5 June – Extension of eligibility to access whole care home testing from 07 June
2020
050620 Factsheet -Care Home Testing Expansion.pdf
2020-06-05_Extension of eligibility for whole care home testing.pdf
Acknowledgements
• Members of the Care Homes Support Group
• Lynsey Emmett (Sr Scientist, Field Epidemiology Services, East of England)
• LA & NHS colleagues for their input & support in managing outbreaks
East of England
Population Health Research Hub
EoE PHResH
Sharing Local Learning and Findings:
Essex SARS-CoV-2 Care Homes Survey
Anna Starling Essex County Council
Anna Starling and Dr Eleanor White
Essex Care Home Testing Pilot
• April - 22% of care homes in England reporting an outbreak.
• London study found 40% residents positive, 43% of whom reported as asymptomatic.
• Whole care home testing pilot to better understand situation in Essex.
Essex Care Home Testing Pilot-Background
• 15 of 290 care homes in Essex were recruited during week commencing 26 April 2020.
• Residents were eligible for swabbing regardless of symptoms, care home staff were
eligible if they considered themselves fit for work.
• Swabbing - 1st and 14th May 2020 by a locally commissioned service.
• Care home manager interviews
Essex Care Home Testing Pilot-Methods
Essex Care Home Testing Pilot-Results
Staff:
Total staff: 632
Total swabbed: 471
(74.5%)
Residents:
Total residents: 462
Total swabbed: 443
(95.9%)
Results:
Positive: 8 (1.7%)
Void: 4 (0.8%)
Asymptomatic
positive: 8
(100%)
Symptomatic
postitive: 0
(0%)
Results:
Positive: 23 (5.2%)
Void: 6 (1.4%)
Symptomatic
postitive: 2
(8.7%)
Asymptomatic
postitive: 21
(91.3%)
Total swabs
performed: 914
• None of the residents who were asymptomatically-positive developed symptoms in the 14
days following swabbing, as reported by care home managers.
• The staff members who had positive swab results were re-swabbed between days 9-11,
the repeat swabs were all negative.
• Staff member data is pending.
Essex Care Home Testing Pilot-Results continued
• Symptoms are insensitive method of detecting Covid-19 in care homes.
• The infectivity of those who are asymptomatically positive remains unknown.
• There is a continued need for use of PPE for personal care.
What does this mean for future testing in care homes?
Essex Care Home Testing Pilot-Discussion
East of England
Population Health Research Hub
EoE PHResH
Local Authority Responses to COVID-19 in Care Homes in the East of England
Dr Tara Berger-GillamPublic Health England – East of England
Methods
• Registrars recruited from EoE local authorities using regional registrar networks.
• Additional input sought via direct email from local authorities with no registrar presence.
• Conversations took place via Skype between 5th and 26th May 2020.
• Data recorded using modified Donabedian framework.
• Data recorded in a table and sent to respondents for validation and permission to share.
Responses from 6 local authoritiesKey findings:
• Aims. Setting up structures and ongoing management of care homes. Some LAs reported a focus on proactive identification and prevention of outbreaks.
• Structures. LAs are generally operating a care homes outbreak cell, but vary in who leads. Often collaborative between ASC, PH and CCGs. In some areas lead by PH, in others, PH attend in an advisory capacity. Some are firmly established, while others are still setting up structures.
• Processes. LAs are in regular telephone contact with homes. Most are using RAG rating. All have established regular communications with homes.
• Outputs. One LA reports commissioning an additional 400 community beds within 5 days, and establishing a provider hub within 2 days. Key activities for LAs are: coordinating access to PPE and testing; providing or interpreting guidance for homes.
Results
Challenges:• Working between agencies, including
understanding different structures and managing data-sharing
• Lack of clarity surrounding testing availability and processes. Lengthy turnaround time
• Interpretation of guidance
• Availability of data from PHE
• Limited IPC capacity
Challenges & Opportunities
Opportunities:• Cross-agency working accelerated
• Development of clear data flows
• Learning from other agencies
• Building on good pre-existing relationships with homes
• Shift in focus to prevention
East of England
Population Health Research Hub
EoE PHResH
Question and Answer Session
Please write your questions in the Q&A section of the Webinar
East of England
Population Health Research Hub
EoE PHResH
Next Steps
Tweet today@eoe_PHResH#eoe_PHResH