Tuesday, 22 September 2020

Staff Recognition Week: Developing new ways to deliver pulmonary rehab services

Throughout week commencing 21 – 25 September, we are holding a special staff Recognition Week to say thank you to our fabulous staff for everything they have done over the past few difficult months and continue to do during the Coronavirus pandemic.

The Recognition Week will showcase and celebrate the amazing work of our staff and how they have been innovative in adapting their practices to ensure that our patients and service users have continued to get the very best care and treatment possible throughout this time. The commitment of our staff to making a difference in these unprecedented times is truly inspiring.  You can read about our inspiring staff and how they have adapted during the pandemic below. 

Patients accessing the Trust’s Community Pulmonary Rehabilitation service are a particularly vulnerable and high-risk group for Covid-19, so the teams faced a real challenge in continuing to provide a pulmonary rehabilitation programme.



They shared ideas and work on developing new processes across the county, and with management support the Rushcliffe and Nottingham North East area teams developed a new virtual pulmonary rehab offer for patients living in Gedling, Hucknall and Rushcliffe.

The new pathways include telephone and video consultations, web and paper based programmes, weekly telephone support and patient information leaflets.

Continuing to deliver high quality rehabilitation

Claire Ellis, Cardiorespiratory Physiotherapist, Rushcliffe Cardiorespiratory team, said that the teams were determined to create an innovative approach during the pandemic to continue to deliver high quality rehabilitation

“Previously all our support was delivered face-to-face, so the Covid lockdown was a completely new situation for us,” she said. “The British Thoracic Society provided guidance and resources for moving services to digital provision including the free www.SpaceforCOPD.co.uk web platform and MyCOPD phone app.

“We moved our patients to phone and video assessments and took part in the Trust’s pilot of the Microsoft Teams platform for online consultation, which has worked well.”

The teams also had to assess the digital literacy of their patients to see if the online pathways were suitable for them, with a paper-based option available so that no one was left out.

This enthusiasm, along with their hard work and commitment, resulted in continuing high levels of engagement in the six-week rehabilitation programme. The team have also stayed connected by using Microsoft Teams as their virtual communication tool for handovers and meetings, enabling them all to keep updated.

Supporting mental and physical health

The teams have tried to support people’s mental health as well as their physical wellbeing, reinforcing the government’s guidance on how to keep well during the lockdown as well as encouraging them to be active and prevent the deconditioning that could come with inactivity.

“Where possible a healthcare assistant goes out in full personal protective equipment (PPE) to assess whether it’s safe for individuals to exercise on their own,” said Claire. “Those who are shielding can also be assessed virtually if they have the right IT and medical equipment at home such as a BP and pulse oximeter.”

Patients receiving pulmonary rehabilitation are all given an initial assessment followed by six weeks of support, then reassessment and a plan developed to help them exercise independently and add activity to their daily life.

 

 

Offering the best care in challenging times

As of early September 2020, the Rushcliffe team had been in touch with 95 potential new patients since lockdown and while some chose to defer their treatment until face-to-face classes were available again, many took advantage of the virtual support on offer.

Annabelle, 58, from Calverton said: "I found it really helpful, particularly in the current situation.  It has given me something to aim for, especially with having to write it down.  It has been really good being able to help myself and has given me structure around the GP’s advice to ‘do something’.”

The patient feedback has been positive, with many people pleased to be supported in lockdown while everything felt so insular, with someone available to answer questions and encouraging them to do more.

“We hope that these new ways of working have been a good new intervention in these extremely challenging circumstances,” added Claire, “offering patients a way to optimise their activity safely, and prevent the problems that can be caused by inactivity.”

The teams have also been linking with colleagues in Bassetlaw and Mid-Notts, sharing ideas and developing new processes for patient care.

A shining example

Rebecca Beale, Community Respiratory Physiotherapist, added: “I would like to give recognition to the assistant practitioners who stepped up and supported the pulmonary rehabilitation service during lockdown and the months that have followed.  As with many services both pulmonary rehabilitation and the community therapy service have changed beyond recognition over the past six months.

“Despite never working within respiratory services before, the wonderful assistant practitioners in Nottingham North and East embraced the service and worked fantastically within the team.  With their help we reduced our waiting time by more than half, a feat that would not have been possible without them.

“As they start to return to their usual roles the respiratory team in Nottingham North and East would like to take a moment and give special thanks to these individuals and acknowledge their dedication to patient care and recognise this shining example of true integrated working.”

An extremely positive experience

Karen Chambers, Cardiorespiratory Physiotherapist, Pulmonary Rehabilitation Team Rushcliffe added: “It has been an extremely positive experience to be involved in a team that has embraced different ways of working and adopted new skill sets and in such a short time. This would also not be possible without the support and flexibility of the administration team who have willingly agreed to assist the change in process in any way they can.

While the team and patients recognise that there is nothing like face-to-face contact, Karen says that patients have been grateful for the ongoing contact. “Following the programme, markers assessing exercise capacity and health-related quality of life have shown improvements,” she said, “with one patient from reporting “I can now walk to the GP surgery without getting short of breath”.

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