Ensuring access to staff with advanced respiratory skills during Covid-19

Introduction

In March 2020, as the Covid-19 pandemic hit the UK and it was becoming increasingly clear that there would be a significant impact on the NHS, we started to consider the best way to manage the patients we would be caring for and support staff who may be working under very different circumstances. We had planned for 500 patients with Covid-19 to be admitted to the Gloucestershire Hospitals NHS Foundation Trust across our two sites but, with only two wards with nurses experienced in managing patients requiring complex respiratory care, we realised there would have to be a shift in how we cared for these patients.

Covid-19 was a novel virus and we had to learn in real time what this would mean for our hospital and the patients for whom we would be caring by looking at the evidence coming from Wuhan in China and Northern Italy. We knew that ensuring nurses and other staff felt confident in caring for acutely unwell respiratory patients they might not normally see was vitally important. Preparing our nurses and healthcare workers to care for a significant rise in respiratory patients was a key priority to give the patients the best possible care and achieve the best outcome for everyone.

Yellow lanyards

Our goal was to create a highly visible team of 200 registered professionals with respiratory skills who could provide support to nursing staff across our hospitals. This team comprised registered nurses, specialist nurses, advanced nurse practitioners, advanced clinical practitioners and physiotherapists. We set clear criteria for the skills staff would need to be part of this specialist team, termed the respiratory response team.

Level 1 comprised practitioners skilled in caring for respiratory patients; they would be working in a supervisory role supporting junior and non-respiratory trained staff members. They would need to be:

• Registered nurses deemed fully competent and confident to deliver non-invasive ventilation (NIV) and nasal high-flow oxygen therapy and understand principles of advanced respiratory care, and be working or have recently worked (<18 months ago) in an acute respiratory setting;
• Specialist nurses, advanced nurse practitioners and advanced clinical practitioners who are fully competent and confident to deliver NIV and nasal high-flow oxygen therapy and understand principles of advanced respiratory care;
• Physiotherapists who are fully competent and confident to deliver NIV and nasal high-flow oxygen therapy, and understand principles of advanced respiratory care.

In the early stages of building the team, it was also decided that members – who would be spread across the hospital on various wards caring for patients with Covid-19 – should be highly visible. They would wear a simple yellow lanyard (or yellow tape over any personal protective equipment) that clearly stated ‘respiratory skills’.

Level 2, for senior medical staff, involved respiratory and intensive care consultants, as well as consultants in emergency medicine who had experience of advanced respiratory management.

We created a rota to ensure the ‘yellow lanyard’ team was available to provide 24/7 on-call respiratory support to help:

• Set up NIV;
• Set up continuous positive airway pressure therapy;
• Set up high-flow oxygen therapy;
• Assess deteriorating respiratory patients;
• Ward teams to care for patients;
• Ward teams to care for worried relatives and loved ones;
• Deliver ward-based teaching related to respiratory support, including using humidified oxygen and Venturi masks.

Training and support

Once we had the team in place, we sent out communications to ensure hospital staff were aware of the yellow lanyard scheme.

With many of our 4,000 doctors, nurses and other health professionals being redeployed and working outside of their usual area of care, we also developed an online learning package to support and educate those working on the front line of the pandemic. This was put together in 48 hours in collaboration with the trust’s professional development, e-learning and respiratory clinical teams; it meant all staff had access to key information and support for the respiratory care they would be providing.

The implementation of this scheme happened in a matter of days and we knew it would be a challenge to:

• Embed the new responders in existing and new teams;
• Ensure visibility and confidence among staff.

To address this, we created a programme to ensure the respiratory responder team would be present at ward rounds and available to support any nursing staff working with respiratory patients. This involved twice-daily visits to wards, continuous training when needed and triage phone support.

“A very simple and effective idea which can be easily transferable throughout other trusts”
(Judges’ feedback)

Impact

This initiative involved the entire organisation pulling together at a time of significant crisis and was born out of a desire to make sure our nurses felt safe caring for Covid-19 patients.

Our new electronic patient record enabled us to identify the sickest patients quickly and send in our respiratory experts. Our mobile team of nurses, supplemented with physiotherapists and doctors, could respond to different areas caring for patients with Covid-19, providing specialist support to staff and patients outside the respiratory ward environment. In addition, our online learning package and support from the specialist respiratory team increased the number of nursing staff now trained to deal with respiratory complications.

Our feedback shows nurses felt confident that they could get specialist support rapidly. Comments from nursing staff on the ground included:

“Respiratory yellow lanyard is doing a brilliant job and is very helpful especially at night, we have learnt so much.”

“Thorough teaching session with equipment to show us exactly how to piece everything together. Wish this team was permanent.”

“Met some incredible colleagues during these tough times.”

“Felt supported throughout supporting other colleagues.”

Our approach generated a lot of interest and we were happy to share our work. There have now been >100,000 views of our online learning across 100 countries including the UK, Ireland, New Zealand, Australia, India and China, and our package has been shared and adapted with 52 NHS trusts. This continues to be rolled out.

The yellow lanyard team was in place throughout the first wave of the pandemic until June 2020. Since then, we have developed more specialist nursing roles to bolster our teams. Our training package continues to be rolled out and shared with other NHS trusts, and we are sharing our communications materials and yellow lanyard idea with as many hospitals as possible.

In the second wave of Covid-19, in winter 2020/21, we arranged care in our trust in a different way, as our knowledge of treating the infection grew and the hospital continued to provide other routine care. However, the skills, roles and training package is in place ready to put to use when needed.

Conclusion

What began with a simple idea of a yellow lanyard developed into a wider initiative, of which we are immensely proud. By providing access to our highly visible specialist respiratory nurses and other health professionals, our staff felt confident and supported; the initiative also increased the number of staff with respiratory expertise. Through this unique nurse-led project, involving respiratory specialists from across the trust, we created a team with a wide range of skills to help our trust manage those early months of the pandemic.