Analysis

What innovations in care for older people have emerged during pandemic?

British Geriatrics Society seeks to learn from successes and failures during COVID-19

British Geriatrics Society seeks to learn from successes and failures during COVID-19

  • A British Geriatrics Society report is calling for examples of best practice during the COVID-19 pandemic to become commonplace nationwide
  • Themes of the report include urgent primary care response, multi-agency support for care homes, person-centred advance care planning, safe, effective and timely transfers of care, virtual clinics and digitally-enabled care
  • The report also emphasises the importance of rehabilitation and optimising recovery

COVID-19 has undoubtedly presented enormous challenges for nurses and other healthcare professionals caring for older people.

But it has also created opportunities for innovations in practice to flourish in unprecedented times.

Now

British Geriatrics Society seeks to learn from successes and failures during COVID-19

  • A British Geriatrics Society report is calling for examples of best practice during the COVID-19 pandemic to become commonplace nationwide
  • Themes of the report include urgent primary care response, multi-agency support for care homes, person-centred advance care planning, safe, effective and timely transfers of care, virtual clinics and digitally-enabled care
  • The report also emphasises the importance of rehabilitation and optimising recovery
Picture: iStock

COVID-19 has undoubtedly presented enormous challenges for nurses and other healthcare professionals caring for older people.

But it has also created opportunities for innovations in practice to flourish in unprecedented times.

Now the British Geriatrics Society (BGS) is calling for local examples of best practice during the pandemic to become commonplace nationwide.

View our COVID-19 resource centre

Learning from successes and failures during the pandemic

Lucy Lewis

In the BGS’s new report, Capturing Beneficial Change from the COVID-19 Pandemic, it urges that health and social care must learn from the successes – and failures – of recent months.

‘Older people have paid a terrible price during the pandemic and thousands of families across the country will never be the same again’, the report states.

‘We must ensure that the thousands of deaths have not been in vain and that we emerge from this crisis stronger.’

Many of the innovations that have emerged have real potential if the right resources are in place says BGS nurses and allied health professionals council chair Lucy Lewis.

‘Much of the red tape and bureaucracy, which usually means things take a long time to develop, went out of the window in a short space of time,’ she says.

Finding the innovations that make ‘the new normal’

Organised around ten areas, the BGS report responds to calls from NHS England and NHS Improvement to submit examples of innovations that should be retained, as health and social care looks towards a ‘new normal’.

While the focus is on England, many of the themes are relevant to all four nations, says the report.

These include: urgent primary care response; multi-agency support for care homes; person-centred advance care planning; safe, effective and timely transfers of care; virtual clinics; and digitally-enabled care.

Examples highlighted in the report include the repurposing of a ward at Nottingham University Hospitals NHS Trust to deliver dedicated end of life care in an acute hospital.

Many innovations driven by the pandemic could have longevity

Remote monitoring has become
increasingly important. Picture: iStock

Another case study featured in the report was the remote comprehensive assessment and advance care planning of the Kent Community NHS Foundation Trust frailty team.

At the start of the pandemic, some team members had to shield themselves, but they continued to contribute by undertaking comprehensive assessments and treatment escalation plans remotely from their homes.

Although many of the innovations were driven by specific circumstances, they could have longevity, says Ms Lewis, although evaluation is essential.

‘A lot are things that need to be done anyway,’ she says.

‘In some ways it’s a silver lining, but it depends on whether we can convince commissioners to continue with some of these projects. All of those included in the report are good examples of things we should take forwards.’

Embracing digital technology to inform care

Many projects are using digital technologies, including virtual clinics and remote and mobile health monitoring.

‘It has a place but it depends on the individual,’ says Ms Lewis. ‘If technology is already part of someone’s life and they’re using it then that’s great, but we also need to think about how we support people who may be less familiar with it.’

One example highlighted in the report where technology was vital was Pathfields Primary Care Network in Plymouth.

During lockdown, staff at the practice used an existing computer programme to identify patients living with frailty who were not otherwise on the government’s shielding list.

Clinicians contacted patients with severe frailty to discuss advance care planning, while social prescribers telephoned patients with moderate frailty who were housebound to provide information and advice about staying healthy, active and connected at home, as well as to offer support to access food and medicines during lockdown, if required.

Patients with mild frailty but not housebound were sent health and well-being information by post and text message.

University College Hospital’s repurposed paediatric ward

Video calls help staff and patients' relatives to stay in touch. Picture: iStock

When a paediatric ward at London’s University College Hospital was repurposed during the pandemic to manage adults with acute illness, including some with dementia, staff decided to stay as a team and care for them.

Although they were trained for paediatric care, staff customised their skills of nursing children and their families for a new patient group, with their work highlighted as an example of innovation in age-attuned acute care in the British Geriatrics Society (BGS) report.

‘Staff were concerned about getting it right and making sure all the patients were safe. A lot was different to what we would usually do. But they coped extremely well, providing brilliant care’

Allan Watkins, acute paediatrics charge nurse, University College Hospital

Initially it was a daunting prospect admits Allan Watkins, charge nurse on acute paediatrics.

‘The only person who was dual trained was me,’ he says.

‘Staff were concerned about getting it right and making sure all the patients were safe. A lot was different to what we would usually do. But they coped extremely well, providing brilliant care.’

Allan Watkins

Dealing with children’s families meant the team was accustomed to providing regular updates and they used these communication skills to help worried relatives who were unable to have face-to-face visits.

‘We’re used to sharing as much information as possible with people,’ says Mr Watkins.

Technology helped everyone stay in touch, with video calls.

The ward’s play team also decided to stay on to help, with an initial plan to support the clinical staff as runners. But that idea quickly changed as they began to channel their expertise towards keeping an adult audience interested and motivated with games, art materials and magazines.

‘Adopting a holistic approach and enriched care environment could help prevent and manage delirium in acute care, with considerable benefits for patients, families, staff and the system’

British Geriatrics Society report

The ward’s play team provided
activities for patients

‘We even had a party on VE Day,’ recalls Mr Watkins. ‘We had Union Jack bowler hats and cakes, with a video link for those who couldn’t leave their cubicles.’

Staff were able to adapt techniques used to help children who are struggling to sleep for a patient who had dementia with a similar problem.

‘We use gentle flashing lights to help calm children because they can be really distracting,’ says Mr Watkins. ‘They worked well for this patient too.’

Tangible benefits included improved experiences for patients and staff. The report states: ‘Patients felt less isolated and displayed reduced levels of distress or agitation.

‘Adopting a holistic approach and enriched care environment could help prevent and manage delirium in acute care, with considerable benefits for patients, families, staff and the system.’


Long-term health effects of lockdown

Rehabilitation is now becoming a major focus for healthcare professionals, with optimising recovery among the report’s themes. Projects include a multidisciplinary telephone screening tool, developed by Airedale, Leeds and Hull NHS trusts, to identify the rehabilitation needs of COVID-19 survivors, once they return to the community.

‘We also need to look at how we help people recover from the loneliness they’ve experienced while isolating at home for a long time,’ says Ms Lewis.

The impact of lockdown on people’s mental and physical well-being has been visible in practice, she believes, with deconditioning becoming more common.

‘If there is another lockdown, we need to think about how we manage it better this time,’ she says.

Innovations infographic
Sources: Age UK, British Geriatrics Society, Office for National Statistics

Showcasing the strength of the nursing profession

While nurses can help to drive progress, training and development are vital, she believes.

‘We need to be cautious that we’re not giving people roles in a crisis situation that they shouldn’t be in,’ says Ms Lewis.

In particular, she believes it has identified the need for advanced practice.

‘There is a gap between those at band 6 and consultant nurse level,’ she adds.

Ms Lewis says nurses have responded to the pandemic in ways that showcase the profession’s strengths.

‘It highlights their ability to step up, adapt to challenges and embrace change in uncertain times,’ she says.

‘It’s the person-centred approach that nurses do so well. It also shows the resilience nurses have. Many will have had challenges in their home lives, alongside crisis management in their workplace.’


Further information

British Geriatrics Society (2020) Capturing Beneficial Change from the COVID-19 Pandemic


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