Response of UK community hospitals to the COVID-19 pandemic: an appreciative inquiry.

INTRODUCTION: The 500 community hospitals in the UK provide a range of services to their communities. The response of these small, mainly rural, hospitals to the COVID-19 pandemic has not yet been examined and so this study sought to address this gap. METHOD: Appreciative inquiry was used to understand staff perspectives of how community hospitals responded to the COVID-19 (SARS-CoV-2) pandemic. A total of 20 organisations participated, representing 168 (34%) community hospitals in the UK. Qualitative interviews were conducted, with a total of 85 staff members, using an online video platform. 30 case studies were developed from these interviews. RESULTS: Staff described positive changes that were made in the context of the fear and uncertainty experienced in the pandemic. Quality improvements were reported in a wide range of services and models of care such as the use of the inpatient beds, and the access and management of urgent care services. Rapid changes were made in the way that services were managed, such as communications and leadership. Programmes of accelerated training were offered for existing and redeployed staff. Attention to staff health and well-being was a feature and there were a variety of innovations designed to support patients and their families. The impact of the changes was viewed as strengthening of integrated working between staff and sectors, the ability to rapidly innovate and improve quality, and the scope to use local decision-making to make changes. CONCLUSION: Staff of community hospitals described innovative and rapid quality improvements in their community hospitals in response to the pandemic. The case studies illustrated the features of community hospitals, showing that they can be resilient, flexible, responsive, creative, compassionate and integrated. The case studies of quality improvements are being used to encourage sharing and learning across community hospitals and beyond.

Drug Instruction Chart completion – improving our service during COVID-19

IntroductionAs part of discussions at the Nurse Independent Prescriber Group, we agreed to focus on the team’s use of Drug Instruction Charts because:They are widely used for end of life care prescribing.They are used in an anticipatory way.They are used by staff outside of our service to initiate treatment.There were particular challenges during COVID-19 due to some prescribers working remotely;historically, our charts have been completed by hand.MethodWe developed an audit tool with two parts:Part 1 – Completion of form – all patient details complete;legibility;additional information documented (e.g. estimated glomerular filtration rate [eGFR], transdermal medication also in use).Part 2 – Appropriateness of prescribing – drugs prescribed were appropriate in line with diagnosis, prognosis, risk, renal function.The audit was carried out by the head of community services and an associate specialist/consultant in palliative medicine.We also created a process to enable remote completion of the Drug Instruction Charts. This was far from simple, involving many staff with IT skills and access to additional software (and a determined Medical Director!). A Standard Operating Procedure for electronic completion of Drug Instruction Charts was developed to ensure robust governance.ResultsResults were input into a spreadsheet developed by the hospice data analyst. Each prescriber submitted Drug Instruction Charts they had completed. Results were shared with each individual prescriber for their learning. Overall results were shared with all prescribers.ConclusionsCompliance with the form and appropriateness of prescribing were overwhelmingly positive but there are improvements that can be made to practice. The process of developing the electronic chart was in itself helpful as it opened up discussions about electronic completion of ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) form, as well as governance. The implementation of electronic completion of the charts means that prescribers working remotely or on call can now complete Drug Instruction Charts in a timely way, improving experience for patients, families and staff.