Sep 2021 - Foresight Newsletter

Sep 2021 - Foresight Newsletter

SEPTEMBER 2 0 2 1

ED I T I ON 9

COVID-19 ADULT IN-PATIENT WITH ACUTE SEVERE BEHAVIOURAL DISTURBANCE

IN THIS EDITION:

Caring for COVID-19 patients with acute severe behavioural disturbance The link between COVID-19 and Sepsis New diabetes management guidelines and charts Involving the Carer in caring for our cognitively impaired patients Accreditation update COVID-19 PPGs What did you think of this issue? Give us your feedback.

A quick reference flowchart is now available to assist clinicians caring for COVID-19 adult in-patients with acute behavioural disturbance in NSLHD facilities. The information detailed in the process flowchart meets an important identified need and enables clinicians to continue to provide safe, high quality, best-practice care, whilst protecting themselves and others from harm, reducing the risks of transmitting COVID-19. The flowchart was developed with assistance from numerous medical, nursing, geriatric and mental health specialists, and refers to existing policies, procedures and guidelines. Reviewed and approved by the NSLHD Clinical Advisory Group (CAG) and the NSLHD Drugs and Therapeutics Committee (DTC) it is now available for immediate use in NSLHD healthcare facilities where patients with COVID-19 are being cared for. It is accompanied by an FAQ fact sheet on section 62 of the Public Health Act and its capacity considerations in the management of COVID-19 patients.

Comprehensive Care Standard

Preventing and Controlling Healthcare Associated Standard

These documents are now available on PROMPT:

COVID -19 Adult In-Patient with Acute Behavioural Disturbance

Click image to download in full

Public Health Act – section 62 order for COVID-19 patients -FAQs

SEPTEMBER 2 0 2 1

ED I T I ON 9

Recognising and Responding to Acute Deterioration Standard

The leading organisations Global Sepsis Alliance (GSA), the European Society for Intensive Care Medicine (ESICM), and the Society for Critical Care Medicine (SCCM) have emphasised the importance of recognising that patients critically ill with COVID-19 have viral sepsis, despite some differences from sepsis caused by other pathogens. THE LINK BETWEEN COVID-19 AND SEPSIS

WORLD SEPSIS DAY SEPTEMBER 13

The European Society of Intensive Care Medicine (ESICM), The Global Sepsis Alliance (GSA). & The Society of Critical Care Medicine (SCCM). Reducing the global burden of sepsis: a positive legacy for the COVID-19 pandemic? Intensive Care Med 47, 733–736 (2021). https://doi.org/10.1007/s00134-021-06409-y COVID-19 as cause of viral sepsis: A Systematic Review and Meta-Analysis Eleni Karakike, Evangelos J. Giamarellos-Bourboulis, Miltiades Kyprianou, Carolin FleischmannStruzek, Mathias W. Pletz, Mihai G. Netea, Konrad Reinhart, Evdoxia Kyriazopoulou medRxiv 2020.12.02.20242354; doi: https://doi.org/10.1101/2020.12.02.20242354 References: The likely long term outcomes after severe disease caused by COVID-19 are not unlike those resulting from other causes of sepsis, such as difficulty swallowing, muscle weakness, poor memory and concentration, fatigue and anxiety. Scientific literature demonstrates that longer-term effects of sepsis, known as post-sepsis syndrome, occur in up to 50 per cent of sepsis survivors. Patients critically ill with COVID-19 satisfy the diagnostic criteria for sepsis and exhibit a similar phenotype and pathology to that of sepsis caused by other pathogens. Patients with severe COVID-19 suffer from multi-organ dysfunction, including acute respiratory distress syndrome (ARDS), vasodilatory shock, acute kidney injury, coagulopathy, and impaired brain, heart and gastrointestinal function; these represent the common clinical manifestations that characterise sepsis. In addition to that, most of COVID-19 patients receive steroid and/or immunomodulatory therapy which may be associated with an increased risk of secondary infection. A 2020 systematic review confirmed that 85 per cent of adults critically affected by COVID-19 develop sepsis, and the prevalence of sepsis among hospitalised COVID-19 patients was 40 per cent.

MANAGING DIABETES PATIENTS NEW GUIDELINES AND INSULIN CHARTS

Medication Safety Standard

Diabetes - Guideline for the management of Diabetic Ketoacidosis in Adults Insulin infusion (Diabetic Ketoacidosis) medication chart (NS11608B) - order from Design and Print. An updated guideline in conjunction with a new insulin infusion chart is now available to assist staff in assessing and treating non-pregnant adults with diabetes who present with diabetic ketoacidosis (DKA). Diabetes: Procedure for the Standard Intravenous Insulin Infusion for Use in Non-Pregnant Adults Standard Intravenous Insulin Infusion medication chart (NS11608A) - order from Design and Print. For standard IV insulin infusions (not for DKA), the procedure has also recently been updated. The standard IV insulin infusion medication chart (NS11608A) is to be used in conjunction with the below procedure to assist staff in treating non- pregnant adults who require a standard IV insulin infusion. Over the following months, the Diabetes Education Team will be providing education to the Diabetes Champions and ward nursing staff.

DKA IV Insulin Infusion chart (NS11608B)

Contact the Diabetes Education Team for any inquiries. Phone RNSH ph: 9463 1441, Ryde ph: 9858 7580, Hornsby ph: 9485 6133, Mona Vale ph: 9998 6125

Standard IV insulin infusion chart NS11608A

SEPTEMBER 2 0 2 1

ED I T I ON 9

Partnering with Consumers Standard

ACCREDITATION UPDATE

INVOLVING THE CARER This month, we continue with the topic of Cognitive Impairment with a focus on how to best involve the Carer in the management of patients with cognitive impairment. These actions will assist in providing quality care aligned with National Standards 2, 5 and 6. Actively engage the Carer in all aspects of the patient's care plan: Carers offer a wealth of expertise and can play a significant role in supporting their family member who has a cognitive impairment, especially when they are in hospital. No one knows the patient as well as their family Carer who can often suggest care strategies to minimise the risk of functional decline and the patient’s level of distress. George has dementia and was in hospital with an infection. Unsettled and frustrated, he was quite abusive to staff. His son, Dave, came in to help settle his father and knowing George loved the cricket, they watched it together. Communication and Care Cues (CCC): The CCC is endorsed for use across NSLHD to capture information so staff have strategies to engage with, reassure and settle cognitively impaired patients. In the example above, a nurse asked Dave to complete a CCC form. With greater confidence and knowledge from the information provided by Dave, the staff were able to settle and engage with George during his hospital stay. Carer Support has developed a process with Health Information Services (HIS) to priority scan the CCC form into the patient's eMR. As soon as the Carer has completed the form, a copy can be made and the original is to be sent to HIS in priority scan envelopes provided by Carer Support. Carers @ the bedside: For unsettled, cognitively impaired or end- of-life patients, their Carer (mum/dad or husband/wife or son/daughter) may stay at their bedside. This is to be adapted as required to comply with COVID restrictions. A Carer at the bedside can provide reassurance to the patient and assist with a limited degree of care. Carers should be offered a recliner chair to sleep in, linen and meals. Carer ID cards allow staff to readily identify the patient’s carer to offer advice and support. Refer to us: You can refer via eMR, telephone or email us at [email protected]. For more information please visit the NSLHD Carer Support intranet site Delirium: Patients who have a cognitive impairment including an Intellectual Disability are vulnerable to having delirium, which may not be recognised, nor understood by their Carer. Assist with a Clinical Review or REACH call. Inform the Carer about the treatment and provide them with the Delirium brochure, and reassurance.

No assessments were to be undertaken whilst lockdowns are in place in NSW Assessors are not considered essential workers and therefore are affected by the limitations of the public health orders There is currently no provision for conducting assessments in a fully virtual capacity Standards (ACHS), and in the context of the ongoing COVID situation, a decision has been made to postpone the accreditation assessments for Ryde, Royal North Shore and Hornsby Hospitals, originally scheduled for October and November 2021. This decision has taken into account advice from ACHS in relation to the Australian Commission on Safety and Quality in Health Care’s (ACSQHC) directions such that, In consultation with our accrediting agency, the Australian Council of Healthcare These determinations ruled out the feasibility of any onsite accreditation assessments during lockdown or the potential of conducting the assessments as hybrid assessments (virtual and onsite). This decision also respects the pandemic situation being faced by our staff and will allow greater focus on the challenges currently before us. We have worked with ACHS to reschedule our accreditation assessments for the first half of 2022. Relevant General Managers will provide information regarding the rescheduled assessment dates. We acknowledge the amount of work and preparations that have been achieved to date and these delays should not dishearten us or impede our ongoing efforts to strive for continually improving our services and patient care. If you have any inquiries regarding the rescheduling please contact your local facility or service Quality or Clinical Governance Managers.

'I care for my husband, he had a stroke'

'I care for my daughter, she has an intellectual disability'

'I care for my dad, he has dementia'

SEPTEMBER 2 0 2 1

ED I T I ON 9

Clinical Governance Standard

COVID-19 PPGs now on The COVID-19 Clinical Advisory Groups are responsible for the development and approval of NSLHD COVID-19 policy, procedure and guidelines (PPGs). These PPGs are now accessible from the PROMPT document system, where previously these have made available on the Intranet. In Prompt, search for these PPGs using “COVID” as the keyword. Alternatively, turn on the ‘Advanced Search’ function to filter and select “COVID-19 Response” from the drop-down menu under the “Department” category. Contact [email protected] for more information.

New, updated and recent ly publ ished COVID-19 PPGs The fol lowing l inks to documents from the PROMPT document system.

Approval Process for COVID-19 Policy Procedure Guideline Documents COVID 19 Exemption Request for Partners to Attend Birth RNSH COVID 19 Medical Model DB5 COVID 19 Paediatric Code Blue RNSH COVID 19 Paediatrics Plan RNSH COVID 19 Precautions for Surgery RNSH COVID 19 Emergency Airway Management and Tracheal Intubation RNSH COVID 19 Protected Code Blue RNSH COVID 19 Treatment Guideline COVID -19 Adult In-Patient with Acute Behavioural Disturbance The medical model of care for adult acute medical patients with COVID-19 at RNSH Guideline for Appropriate Use of Cardiac Investigations in Patients with COVID-19 RNSH

POLICIES, PROCEDURES AND GUIDELINES New, updated and recent ly publ ished distr ict wide PPGs The fol lowing l inks to documents from the PROMPT document system.

Clinical Governance Standard

Calculating Ideal Body Weight for Children Aged 2 to 18 Years Old Carer Identification and Recognition for NSLHD Diabetes - Guideline for the management of Diabetic Ketoacidosis in adults Drug and Alcohol Intake Prioritisation and Clinician Response for Patients that Did Not Attend Haemodialysis/Peritoneal Dialysis: Home Assessment Visit -NSLHD Haemodialysis/Peritoneal Dialysis: Home Therapy Haemodialysis: Blood borne virus (BBV) screening and management in the acute, satellite and NSWBig Red Kidney Bus (BRKB) Management of Drug and Alcohol Intoxication and Withdrawal in Inpatient settings – NSLHD Methadone and Buprenorphine/Buprenorphine-Naloxone Prescribing and Dispensing for Opioid Dependent Inpatients of NSLHD Nasogastric Tube Management and Use (Adults) Paediatric Peripheral Intravenous Cannula Management (Hospital, Clinic or Home) Electro-Convulsive Therapy (ECT) Procedure - HKMHS

SAFETY ALERTS New , u p d a t e d a n d r e c e n t l y p u b l i s h e d

Clinical Governance Standard

Safety Alert (SA) - Requires immediate attention and action Safety Notice (SN) - Requires risk assessment at the district level Safety Information (SI) - Ensuring that lessons learned from state-wide, national or international sources are shared actively across NSW health system ​SN:018/21 - ​Myocarditis and pericarditis after mRNA COVID-19 vaccines - ​Issued ​18 Aug SN:017/21 - Illicit cocaine containing high levels of lidocaine (lignocaine) - ​Issued ​13 Aug ​SA:001/21​- Critical disruption to the supply of tocilizumab - Issued ​9 Aug ​SN:016/21 - ​Identification and monitoring of Post-Injection Syndrome Olanzapine Pamoate long-acting Injection (updated) - ​9 Aug ​SA:002/21 - U​ rgent stock preservation of tocilizumab injections for COVID-19 patients required - Issued ​ 31 Aug ​SN:019/21 - F​ low sensors used in selected GE healthcare / datex-ohmeda anaesthesia machines- ​ Issued 30 Aug ​SI:004/21 - Povidone-Iodine Solution Use in NSWHospitals - Issued 19 August Medication Safety Updates Medication Safety Updates including medication shortages are available on the CEC website. The most recent medicines affected include Tocilizumab, Bivalirudin, Gentamicin 10 mg/1 mL, Trimethoprim-sulfamethoxazole 80mg/400mg injection

For more information, contact: [email protected]