STAFF are beginning to feel detrimental effects from working on a designated Covid-19 ward.
That is according to the Healthcare Inspector Wales (HIW) who conducted a remote quality check of Ward 11 at Glan Clwyd Hospital.
The independent inspectorate and regulator of healthcare in Wales said it became clear to them, through discussion with ward management, that staff are beginning to feel detrimental effects from working on a designated Covid-19 [ward] throughout a pandemic and said it is important that Betsi Cadwaladr University Health Board (BCUHB) continues to maintain existing and explore further support mechanisms for its staff as the pandemic progresses.
The 24 bed respiratory ward, which has been used throughout the pandemic, comprises of four non-invasive ventilation (NIV) restricted rooms and two negative pressure isolation rooms.
The check of the ward – on August 26 – was conducted as part of the HIW’s programme of assurance work. During the visit, HIW considered how well the service manages and controls the risk of infection and reviewed infection control policies, infection rates and risk assessments.
In the Quality Check Summary, published on September 23, the HIW said: “We found that access to the ward was restricted. We were also told that staff and patient movement between wards has been limited, unless absolutely necessary, to limit the risk of transmission to other areas of the hospital.
“We were told that there were facilities on the ward to isolate patients where required and that isolation risk assessments were carried out, which includes identifying use of the correct PPE and signage to notify staff of the level of risk.
“Non-Covid-19 related infection rates on the ward appeared low. We were told that infection incidents are reviewed by the ward management and that learning is shared with the nursing team”
An area of improvement was identified after the HIW saw evidence that an internal IPC audit that was conducted by the Infection Prevention Team in July 2020.
The local audit highlighted a number of issues.
HIW were concerned were that no action plan had been produced in response to the audit and evidence of remedial action had only been provided on a piecemeal basis for a small number of the issues identified by the audit, therefore only limited assurance was available that remedial actions had been put in place and that any learning had been shared following the audit.
This issue was dealt with through the HIW immediate assurance process.
Positive findings were outlined in the report which included the ward environment being designated into red and green zones dependent upon the Covid-19 status of the patient cohort. This enables staff to further limit the risk of transmission.
Standard patient visiting arrangements to the ward had been suspended during the pandemic and a process for visiting had been introduced for end of life patients.
Tablets were provided for patients who were unable to receive face-to-face visitors due to the suspended visiting arrangements, and staff had taken the time to assist patients in contacting their friends and relatives.
The HIW found the ward had sufficient stocks of PPE and that regular training for donning and doffing the equipment was available for staff.
Inspectors were told there were no known incidents where any of the patients on the ward had contracted Covid-19 as inpatients in the hospital and patients, discharged into a nursing or residential setting, were tested for Covid-19 prior to discharge, and would not be discharged without having first received a negative result.
The report added: “The ward management spoke highly of staff in how they have responded to the needs of the ward, its patients and in supporting each other during the COVID-19 pandemic.
“We were told that staff were given the option to work in a different clinical area, however only very few staff took up this option. Also, specialist nurses had supported the wider team by undertaking general nursing duties. Whereas medical staff had provided 24 hour on call advice for nursing staff at weekends and had taken the time to contact families personally in the event of having to deliver bad news.
“We were told that mechanisms were in place to support staff, which included check-in calls with staff who are on sick leave and the establishment of a staff support group within the hospital with trained counsellors available every weekday. Staff who have been shielding due to Covid-19 had been subject to an individual risk assessment.
“We were told that bank and agency staff had been blocked booked in advance. This ensures that returning staff are familiar with ward procedures, whilst limiting movement across wards to reduce the risk of transmission.
“We were also told that additional training has been provided for staff in donning and doffing PPE, as well as ‘back to basics’ training to support specialist staff in the transition to providing care for Covid-19 patients.”
The HIW found recent sickness rates on the ward appeared to be stable.
“We were told that ward management have been provided with support by occupational health where required,” the report added.
“We found there was a number of vacancies on the ward at the time of the quality check. However, we were informed that a number of the successful nursing applications were currently undergoing pre-employment checks. It was positive to find that existing agency staff had been successful in being appointed to the ward on a permanent basis.
“We also found there was good scope for career development on the ward, for example we saw opportunities for existing staff to develop into ward management and leadership roles and for other staff to undertake nurse training. It was positive to find that the matron was supportive and complimentary of the ward manager who had only recently been promoted into the role.”
Debra Hickman, Interim Executive Director of Nursing and Midwifery at BCUHB, said: “Covid-19 has presented a once-in-a-generation challenge, and we’re incredibly grateful for the ongoing commitment, professionalism and outstanding care demonstrated by our staff.
“We know how challenging this situation is to staff’s wellbeing and mental health, and as identified in the report there are a number of measures and resources available to help staff cope with the demands presented by Covid. This includes a dedicated wellbeing support service, flexible working arrangements, and daily Covid risk assessments. Additional risk assessment reviews are taking place to support BAME colleagues.
“I would urge anybody who works for the health board and is worried about the impact of the pandemic to speak to their line manager about support available, contact Occupational Health for advice, or look through the resources available to staff listed on the health board’s intranet.”
Click here for the report.