Posted 12 May 2021 - 13:00
Posted 12 May 2021 - 13:00
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How COVID-19 changed our ways of working – for the better
Ward sister Aisling Grant says pandemic innovations will be useful for the future
Ward sister Aisling Grant says coping with the pandemic has brought new learning and innovations
I have worked at the Royal Marsden since 2016, and in November 2020 became a sister on the hospital’s Bud Flanagan west ward, which cares for patients with haematological cancers.
COVID-19 turned the ward’s processes upside down and we had to develop new ways of working to continue delivering treatment while keeping patients safe from the virus, navigate the impact of visitor restrictions and support the well-being of the team.
Before the pandemic many patients would receive treatment, such as high-dose chemotherapy and stem cell transplants, in our ambulatory inpatient unit (AMBIN). This innovative way of providing treatment enables patients to access chemotherapy ambulatory delivery device pumps, also known as ‘chemo backpacks’, which avoid unnecessary inpatient stays and ensure they have more time at home.
Royal Marsden has been able to safely treat patients with cancer throughout the pandemic
Our stem cell transplant patients also use this service, which enables them to spend five extra days at home after high-dose chemotherapy if they meet the right criteria and do not become unwell.
Once COVID-19 hit we had to adapt to minimise the risk of infection and remain COVID- secure. My ward only cared for patients who had been able to self-isolate before being admitted, with other wards caring for patients who were at risk of the virus, including those admitted suddenly or from other hospitals.
Using this system, the Royal Marsden has been able to safely treat patients with cancer throughout the pandemic, but it has meant that patients treated in AMBIN needed to stay in hospital to ensure they safely maintained self-isolation before treatment.
Family members often have vital part to play in the safe discharge of patients
We recently created a more efficient system for patients by splitting the ward to create two pathways, which has allowed us to keep COVID-free spaces while also delivering more treatments. We can now assess and test multiple patients on any day, including for COVID-19, sepsis and other infections.
This ensures they can continue treatment in the hospital, where in previous months they might have been transferred to another hospital if there was not enough space to isolate them. We’ve also introduced time slots for patients receiving treatment via AMBIN, which has meant even less time in hospital than before.
Family members often have a vital part to play in aiding safe discharges of patients – particularly those with complex needs – as many factors require planning, such as washing, dressing and determining what supportive equipment might be needed at home. However, visiting restrictions have made this assessment much more difficult.
Staff mental health is a priority and COVID-19 has brought more pressures
To overcome this we worked more closely with our allied health professionals, including occupational therapy, physiotherapy and dietitians, to plan patient discharges. These teams support us in planning discharges at an earlier stage, including talking to patients while they are still in rehabilitation, phoning family members and liaising with available community support. We also meet as a multidisciplinary team every morning.
My ward has experienced staff shortages due to COVID-19, but because of the support from our allied health professionals we have managed to avoid extending patient stays due to delayed discharges. This cross-team working has been invaluable and has fundamentally improved this process.
Staff mental health has always been a priority, and thanks to funding from the Royal Marsden Cancer Charity we have an exceptional psychological support service for our staff. However, COVID-19 has brought many additional pressures, both practical and emotional, so extra interventions have been needed to care for staff.
Buddy system pairs staff at the start of shifts to support each other in taking timely breaks
To support my team I have placed more emphasis on communication – we have more regular catch-ups and safety huddles and keep in constant communication, so if a nurse’s patient becomes unwell we can quickly share out their other patients, allowing them to concentrate on providing one-to-one nursing care and not feel overwhelmed.
As a nurse it is important to look after and hydrate yourself, so I set up a buddy system where staff are paired at the beginning of each shift to support each other in taking timely breaks. This culture of care has been particularly important for newly qualified nurses, who have started their careers in the most difficult of times.
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It has been amazing to watch them develop and face new challenges with confidence, which in large part is testament to the incredible support they receive from the rest of the team.
My first six months as a sister have been a learning curve, and in the face of pressures created by the pandemic I and many other members of staff at the Royal Marsden have have needed to be innovative in our ways of working. This has ensured we have been able to continue making a difference to people with cancer, and I look forward to taking many of these learnings into the future.
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