On the frontline: “We can hear nurses’ laughter again”

Lisa Church, Director of Nursing and Family Services at Thames Hospice in Windsor, tells ehospice how the charity is managing during the pandemic.

Since the outbreak began have you been working more closely with local hospitals?

We have three daily phone calls with our main hospital trust which is Wexham Park Hospital in Slough, where we discuss which patients we can take from them. The first call is at 9 am where we find out if any patients can be transferred that day. We take patients that are at the end of life as we always have done, both non-Covid and some of the Covid patients that are end of life and that have no real need for massive high flow oxygen. We take patients from the hospital every day, and we care for them here with good symptom control.

How are you keeping patients with Covid-19 separate from the rest of the patients?

I’ve divided our IPU into two, and I've been really lucky to be able to do that because we have two entrances - one goes into the main IPU, and that's for ‘cold’ or non-Covid patients. That keeps them  away from the ‘hot’ Covid end, and everything to do with those patients can go through a totally different door, so if the patient dies, the funeral car can go to that entrance.

What changes have you made in terms of families visiting?

If you don't reduce the footfall then visitors can pass the virus on to the staff and the patients. It happened here before the guidance to limit visitors came out nationally – ten nurses went off sick on the back of one particular patient who had been on the non-Covid side and then became symptomatic, and this was before the nurses on the non-Covid side had PPE. Six doctors out of nine also went down with Covid-19, so we had to reduce visits to protect staff and patients.

It's really important to be specific on timings. Visiting for non-Covid patients is an hour a day, anytime between 2 and 5 pm. We police that by asking visitors to wear PPE and reminding them that the mask should only be worn for an hour. When time’s up they do tend to leave so that’s working well. On the Covid side they can come in for 30 minutes. Patients are tired when they’re at the end of life with Covid, so we’re finding that that's enough time.

What has access to PPE and testing been like?

Getting PPE was really challenging at the start, we really had to beg and borrow from everybody to get it. Now it’s coming through, and we’ve had a really good response from the community and other hospitals. People are donating visors, and B&Q donated 30 sets of goggles. The NHS supplied us with surgical masks but other than that it’s all come from donations. I’ve been really taken aback by the kindness of people who’ve really tried to think how they can help.

We didn't have testing for quite a long time. Then we were in the gold category for testing – there’s bronze, silver and gold, and gold is where 50 per cent or more of your staff contract Covid-19. I contacted our CCG and said I didn’t know how we were going to keep the hospice running unless I could find out whether those members of staff could return to work. So because of the loss of nurses and doctors we had all at once we were granted testing earlier than some others, everybody got tested and I got some of the staff back as a result. It really is so important to have testing.

How have home visits and community services changed due to the pandemic?  

We run a two-system approach for the community. One is our rapid response service, which are nurses and paramedics. They are called out for emergencies, and they support patients at home by setting up syringe drivers and helping them with symptoms.  The second service is the community palliative care team. They’re CNS (clinical nurse specialists) in palliative care and they can care for patients over the phone. They have very good knowledge of symptom control, can adjust medication, and do triaging. They work closely with the response team and coordinate whether someone needs a visit.

Are you doing anything differently to alleviate patient stress during the crisis?

The biggest thing that’s happening is that we've had a donation of tablets for Skype and Zoom calls, so they can speak to their family anytime. We want to keep that going afterwards because it's great for them, I can see the difference it makes when people can see their sons and daughters or mums and dads. When they’re having their wash in the morning I’ll hear somebody say, ‘I was speaking to my daughter at 3 o’ clock yesterday!’ and you know it’s just totally raised their mood.

Are staff doing anything specific to keep their spirits up?

I think we’ve come out of a bad place, and are now in a very good place. The bad place was not having the knowledge of what was going on, and not knowing what the hospice’s role was going to be in this whole thing. It was about the worry over PPE and worry over their families. Morale was low, and they set up a Whatsapp group and were texting each other, which was winding them up more and more.

All the senior management that have nursing backgrounds put on uniforms, went down into the IPU and helped them nurse the patients.  We’ve shown that we are in this together and that's really raised their morale, and we're seeing a lot of nurses are much happier. Now that the sun’s out they sit in the garden at lunchtime, two metres apart, and you can hear their laughter again.

For more information visit Thames Hospice