Friday , December 4 2020

The Covid-19 safety review in hospitals highlights concerns about staff fatigue

Concerns about nurse fatigue and emotional stress during the coronavirus pandemic have been raised by the authors of a review on the transmission of Covid-19 to the hospital.

BEHIND new report from the Healthcare Safety Investigation Branch (HSIB) documents an investigation into the risk factors contributing to nosocomial Covid-19 infection.

“We had serious mental health problems that we detected from employees … someone tried to commit suicide because he was so upset.”


This is due to concerns from leading scientists earlier this year about the number of people infected with the virus upon admission to hospital, and from observations and interviews with six acute trusts in July and August.

Investigators said they wanted to understand factors such as staff welfare, infection prevention and control (IPC) measures, and personal protective equipment (PPE) that could affect transmission in hospitals and identify future risk reduction options rather than criticizing current practices.

In its findings, the HSIB noted the “significant fatigue and emotional stress associated with Covid-19 activity” experienced by staff.

The report said: “One of the trusts reported on the investigation:” … we had some serious mental health problems that we discovered from employees … someone tried to commit suicide because he was so upset about it all. “

“Another staff member told the investigation, ‘I look back and think,’ How the hell did we do this? ‘but it has had some personal cost to the people so we have a lot of people who are still in a real recovery period i would say and it has affected staff health and wellbeing so we have people with very high levels of stress. “

HSIB warned that such fatigue and emotional anxiety “may affect the NHS’s ability to alleviate nosocomial Covid-19 infections and its ability to respond to further increases in Covid-19 activity.”

Therefore, he called on NHS England and NHS Improvement to investigate and evaluate this.

HSIB also said it would be “beneficial” for local NHS organizations to share effective strategies to deal with staff fatigue and emotional well-being.

Following Covid-19, Nursing Times launched Covid-19: Are you okay? campaign to raise awareness of nurses’ mental health needs during and after a pandemic.

According to the trusts involved in the investigation, the nursing and medical rotations have been altered to meet the new demands of the pandemic.

One trust told HSIB that staff turnover was “completely changed so that you have more senior decision makers around the clock, which helped ensure that only patients who really needed to be in hospital were admitted.”

However, the report noted that they found “a few examples” of syndromes altering clinical or non-clinical rotation in a way that “would solve the risk of fatigue.”

“We know NHS staff are doing everything they can to treat and protect patients, but challenges are to be expected in the global crisis.”

Dr. Layla McCay

Staff involved in the investigation explained that working in 12-hour shifts “has become more difficult” due to “increased demands on the healthcare system and the increased need to wear various PPE, often in a warm and poorly ventilated ward environment.”

Although the report also found that some workers still preferred the 12-hour shift schedule as they might have more time away from work after the turnover is complete.

Other findings of the review concerned the shortage of IPC staff, including nurses.

The report cited one trust that found it “very difficult” to hire infection control nurses who could not fill a position in the past 12 months.

“IPC specialists played a key role in the response to Covid-19, but the availability of this type of knowledge varied across reference trusts,” the report reads.

“There is a lack of IPC staff across the country and a common understanding of their role and national IPC requirements.”

It was recommended that NHS England and NHS Improvement develop a “National IPC Safety Assistance Program” for Covid-19 that would focus on “leadership, IPC technical support, education, practice, guidance and reassurance.”

While the trusts said PPE levels are now “satisfactory”, there have been some concerns that there will be “PPE challenges at each subsequent peak of Covid-19 activity,” the report noted.

He added that “lack of clarity”, coupled with “changing guidance” on the use of PPE during a pandemic, had created “concern for staff, patients and families”.

“Proactive risk management of IPC and PPE can help ease future pressure from additional increases in Covid-19 activity,” the report reads.

Commenting on the investigation, Kathryn Whitehill, HSIB’s chief national investigator, said: “We know how profound the virus has had a personal and organizational impact; our intention is not to criticize the NHS response, but rather to provide a safety perspective that supports their efforts as cases increase and enter winter.

“Hospitals have been asked to strictly adhere to PHE guidelines for infection control and the NHS is offering support sessions to ensure effective implementation.”

NHS spokesman

Ms Whitehill stressed that the spread of Covid-19 is not only a threat to patient safety, but is also “a huge burden on the workforce”.

Meanwhile, Dr. Layla McCay, director of the NHS Confederation, said: “This report reflects the concern we hear constantly from health leaders across the NHS who are extremely committed to addressing the challenges posed by the spread of infection in the hospital.”

This includes “variable” guidance on PPE and personnel “exposed to exhaustion and burnout,” she said.

“We know NHS staff are doing everything they can to treat and protect patients and have shown remarkable resilience and fortitude, but challenges are to be expected in a global crisis that healthcare has never faced in more than 70 years. -year history – she added.

“That’s why we’re glad that the emphasis is rightly and productively on improvement and learning, not on blame.”

When asked to respond to the report, an NHS spokesman said: “Hospitals have been asked to strictly adhere to Public Health England’s guidelines on infection control, and the NHS is offering staff support sessions to ensure it is being implemented effectively, while infection data is also being implemented. posted so that the trust can share its knowledge with others to help control the virus. ‘

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