Clare, the Therapies and Rehabilitation Service Lead at Sue Ryder Neurological Care Centre The Chantry's neuro-rehabilitation unit, describes the wide-reaching effects of the coronavirus pandemic on their care services and how the team had to rapidly adapt to meet the needs of patients and their families during such a critical, unprecedented time.
Sue Ryder The Chantry operates a level 2 neuro-rehabilitation unit in Ipswich, Suffolk. We opened with only three beds in September 2018, then expanded to six beds a year later, when the majority of the current therapy team joined us.
As such the team was working through the ‘storming’ phase of team development and settling into newly developed ways of working when the coronavirus pandemic swept across the UK. The unit is based within a specialist neurological nursing home and so infection control measures to protect vulnerable residents was at the forefront of everyone’s minds.
We were suddenly faced with an influx of referrals, receiving more in one day than we had in the previous month
In rehab we were suddenly faced with an influx of referrals, receiving more in one day than we had in the previous month. At the same time staff sickness escalated and some referrals had to be declined on the basis that we didn’t have sufficient nursing cover to safely care for them.
Our local CCG also contacted us and requested a temporary block contract for all six of our beds. Usually our beds are spot purchased, but as part of this contract it was agreed that we needed to suspend our usual 12 week rehab pathway and instead we were now commissioned to rehabilitate patients to the point that they could safely be discharged home.
In practice this generally meant accepting patients who were currently assistance of two and progressing them to being assistance of one. In accepting patients at the more complex end of our usual criteria we also sometimes provided several weeks of assessment and input before arriving at the decision that we would be unable to make a functional change for these patients and as such they required a nursing home placement.
It was challenging for existing patients and their families
It was challenging for existing patients and their families to accept that they would not receive the full amount of support that they had been expecting and that they would be discharged home at a time when community services were unable to offer rehab, which was also difficult for staff to come to terms with.
As a team we quickly adapted our ways of working, minimising paperwork and maximising efficiency. Our focus became discharge planning and we became creative around how to do this, completing ‘virtual’ access visits via Whatsapp video calls.
We suddenly had to all become more confident with our grasp of technology - working from home if self-isolating or shielding, using conference calls and video for patient review meetings, completing family education sessions via video link and supporting patients to keep in contact with family using a variety of platforms.
Usually, all patients are assessed face to face prior to admission but this was no longer possible. In-depth phone assessments were completed with ward staff but some key pieces of information were not handed over. This, combined with the pressure on acute hospitals to discharge patients, resulted in some safety concerns on transfer.
In one instance, a patient arrived with MRSA, which we had not been made aware of. As such, we innovated further and set up a pre-admission video call with the patient to answer their questions and observe part of a therapy session.
Our working relationships developed and grew
As part of the response to the pandemic we set up a twice weekly conference call with social services and the CCG. This allowed us to build closer working relationships and ensure close liaison between partners.
As a relatively new service, this increased communication allowed us to demonstrate our expertise and efficacy to the commissioners. It also appeared to speed up the referral process and allowed the responsibility around admission decisions to be shared between the group, meaning our working relationships developed and grew.
Our extra work was playing a small but important part in a much bigger effort
Each new admission required careful negotiation between safe staffing, constraints on housekeeping, not overwhelming the team and the ever-present pressure to relieve beds in the acute sector. Although it only amounted to a handful of beds everyone was aware that our extra work was playing a small but important part in a much bigger effort to manage the virus. This vital aim allowed us to keep going when we were exhausted, to put our own anxieties aside and to cope with the disappointment of not being able to provide as much input as we would like.
Everyone in the team needed to step up and go beyond their usual roles
As with the government advice, the situation was changing hour by hour and all staff had to be flexible in adapting to this. The team had to pull together and began to support each other much more readily, putting team priorities above individual workload. As a relatively new team this had been the goal for some time and the pandemic proved to be the catalyst we needed to develop as a team.
Everyone in the team needed to step up and go beyond their usual roles. Due to sickness impacting on our nursing team, our Senior Occupational Therapist, who had previously worked in an extended practice role, was assessed as competent to administer medications and cover elements of the nursing role.
The Rehabilitation Service Lead supported with completing the majority of admission paperwork and completing GP ward rounds via video link. As part of our contingency plans all staff were advised that they may need to assist with personal hygiene if we were particularly short staffed. This type of cross-covering pushed staff out of their comfort zones, but will ultimately lead to closer interdisciplinary team working moving forward.
Seeing rainbows and ‘thank you keyworker’ signs kept us going when we were drained and exhausted
Patients admitted during this period, and their families, were incredibly accommodating and understanding of the limitations on the service. This made our work easier, as did their ‘thank you's’ and appreciation. Seeing rainbows and ‘thank you keyworker’ signs on the drive to and from work, alongside the weekly clap for carers, kept us going when we were drained and exhausted.
As the dust starts to settle, we are starting to be able to re-charge our batteries, reflect on the last few months and review how recent experiences will impact on the service in the future.
Therapies and Rehabilitation Service Lead
Clare is the Therapies and Rehabilitation Service Lead at Sue Ryder Neurological Care Centre The Chantry.