Health & Social Care Committee 26.11.13 Agenda Item: Purpose: For Information
Western Isles Health Board
Winter Contingency Plan 2013-14
Version 6.1
Colin Gilmour Author Associate Chief Operating Officer – Primary Care
Date of Consultation process issue August - October 2013 Winter Planning Group Joint Liaison and Planning Group (circulated) APF Date of review Review process April 2014 Winter Planning Group
CONTENTS
1 INTRODUCTION ...... 3
2 COMMUNICATION ...... 3 2.1 Media 3 2.2 Staff and public 3 2.3 Communication with the Scottish Government 4
3 PREVENTION OF ILLNESS AND HEALTH PROTECTION ...... 4 3.1 Monitoring Uptake 5 3.2 Pneumococcal Vaccine 5 3.3 Staff Flu Immunisation Programme 5 3.4 Norovirus 6
4 SURVEILLANCE & MONITORING (System Watch) ...... 6
5 AGREED PLANNED INITIATIVES FOR 2013/14 ...... 8 5.1 Management Arrangements 8 5.2 Additional Contingency to Increase Bed Capacity within Western Isles Hospital for the whole of Western Isles 8 5.3 Elective Demand, Capacity and Activity 9 5.4 Contingency measures for hospital & community staffing 9 5.5 AHP Support 10
6 „OUT OF HOSPITAL CARE – PREVENTING –ADMISSIONS AND ENSURING EFFECTIVE DISCHARGE COORDINATION‟ ...... 10
7 AMBULANCE NON-EMERGENCY WEEKEND SERVICE ...... 11
8 OUT OF HOURS GP AND COMMUNITY PHARMACY SERVICES ...... 11
9 ESCALATION PLANS ...... 11
10 TRANSPORT ...... 12
11 OPERATIONAL CONTINGENCIES/PROTOCOLS ...... 12
12 CONCLUSION ...... 12
13 APPENDICES ...... 14 13.1 Appendix 1 Winter Flu Campaign 20013/14 14 13.2 Appendix 2 Cancellation of Elective Admissions - Escalation Plan 15 13.3 Appendix 3 Bed Capacity Escalation Plan 18 13.4 Appendix 4 Major/Adverse Incident – Re-deployment Protocol 21 13.5 Appendix 5 Out of Hours Service 22
Capacity Planning ...... 24
NHS 24 Communication Contingency with NHS Western Isles ...... 24
NHS Western Isles Communications with NHS 24 25 NHS Wstern Isles Internal Communications 25 NHS Western Isles Communications with the public 25
I.T. and Telephony ...... 26 I.T. 26 NHS 24 26 NHS Western Isles 26 Telephony 26
Referrals between services ...... 26
Reporting ...... 27 Routine Reporting Out of Hours Service ...... 27 Incidents 27 NHS 24 Reporting 27
Finance ...... 27 13.6 Appendix 6 H1N1 Immunisation Plan 28 13.7 Appendix 7 Joint Discharge Policy 34 4.1 Expected Date of Discharge 34 4.2 Process of Discharge 34
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1 INTRODUCTION
This Winter Plan outlines the provision for services during the winter period and has been informed by a multi-disciplinary EPPHICG with representation from partner agencies and system wide health professionals.
The plan also takes account of the possibility that an outbreak of flu or other seasonal illness will place above-normal demands on services during this period. A separate plan exists for the management of Pandemic and the Outbreak Control Plan (hospital) The key objectives of the NHS remain to:
continue to provide the full range of emergency, elective and primary care patient services throughout the winter period. continue to work in collaboration with our partner agencies to provide enhanced protection and services and support to the vulnerable groups, particularly older people. enhance the ability of staff to face the challenges of the winter period efficiently, effectively, safely –with no avoidable patient events and with confidence.
The aim of this plan is to outline how we can continue to deliver and maintain services throughout the winter period.
2 COMMUNICATION
2.1 Media The Communications Manager will lead, co-ordinate and respond to any press enquires over the winter period. The Communications Manager will also liaise closely with CnES and the Police as necessary.
All out of hours media enquiries will be dealt with in line with NHS Western Isles‟ Media Policy.
Communications will also involve close liaison and coordination with NHS 24.
Appendix 5 contains details of the „Out of Hours Communication, Contingency and Escalation Procedures for NHS Western Isles which provides details of Out of Hours and NHS 24 plans in relation to the local health system. Coordination & liaison with NHS 24 will be led by the Primary Care Manager.
2.2 Staff and public Communications with staff, including the publicising of this plan, will be achieved via use of established mechanisms including Slàinte staff magazine, Finger on the Pulse Staff Bulletins, NHS Western Isles‟ Intranet, and internal posters and leaflets.
Effective, proactive use will be made of local media, including broadcast media (TV and radio), local, regional and community newspapers, social media and website to advise members of the public of local arrangements. Particularly, in respect of the Influenza vaccination programme; Out of Hours and special arrangements associated with holiday / festive periods for GPs, Pharmacies & Dental Services.
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2.3 Communication with the Scottish Government The Nurse Director/Chief Operating Officer as lead will forward SITREPs to the Scottish Government and to local & Regional Planning Groups as requested. In line with the Preparing For Winter 2013/14 NHS Western Isles will provide immediate notification of significant service pressures that will disrupt services to patients. Outbreak and Hospital or multiple ward closure must be HIIAT assessed and communicated with HPS, Scottish Government HD as appropriate. Exception reports will include, for example:
o closure of a hospital to emergencies for any reason, o unplanned closure of a ward or a number of beds, o cancellation of elective procedures because of a lack of capacity, o trolley waits exceeding 12 hours, o significant outbreak of infection, or o significant increase in expected demand
NHS Western Isles has a number of plans which inform of contact with the Scottish Government including Infection Control Outbreak Control Plan (Hospital) 2012, Multi Agency Pandemic Influenza Plan 2009, Major Emergency and Major Incident Policy and Procedures 2009.
3 PREVENTION OF ILLNESS AND HEALTH PROTECTION
Coordination of the Seasonal Influenza and Pneumococcal population Immunisation programme is led by the Department of Public Health. The programme will run from 1ST October until 31st December 2013. Vaccination will be available until 31st March 2014.
From 1st October 2013 the seasonal flu vaccination programme will begin a phased extension to children (2-17years).
The local Health Protection Team leads the coordination of the seasonal Influenza and Pneumococcal Campaign. There are a number of project strands being developed.
A key area of work will be on the preparations for and implementation of the extension of the seasonal influenza vaccination programme to children (2-17years). During the 2013/14 season all children aged 2 and 3 years on 1st September 2013 will be offered the vaccine by their GP. There will be a pilot school based programme which will include all primary school children in the Uists and Barra delivered by community nursing staff. The aim of the pilot is: o To test the delivery model o To gauge the impact on schools o To test communication o To investigate costs, workloads and the logistics of delivering a school based programme Work will continue for this year to improve uptake rates in the over 65‟s, as well as for those in the younger „at risk‟ groups, and health care staff. The Midwifery service are providing all pregnant women with an information pack on the seasonal influenza vaccine women are advised to attend their GP for vaccination. The Western Isles NHS Board H1N1(v) Influenza Vaccination Plan developed in 2009 will be adapted in accordance with epidemiological evidence and implemented in the event of a
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pandemic situation (found within the Western Isles Pandemic Influenza Plan 2013 – see Appendix 6). To aid communication a Seasonal Influenza Website has been developed. Public material can be accessed through the Western Isles internet site and professional materials via the intranet. The web site provides a one stop shop for information and materials to support the vaccination programme and updates on the local situation. Coordination of practice-based activity & sharing of best practice is undertaken via meetings with local Practice Manager & Practice Nurse Networks.
The National Scottish Immunisation Recall System invitation letter and public health information leaflet will be distributed to all relevant members of the population during September and October 2013.
Contingency arrangements are in place to undertake a „catch-up‟ programme in the event of poor response to the routine programme and subsequent increases in circulating virus post December 2013, if necessary. A communication pathway for vaccine supply issues is provided in Appendix 1.
3.1 Monitoring Uptake Health Protection Scotland (HPS) will take the lead in monitoring uptake on behalf of the Scottish Government and will provide monthly uptake data from October 2013 to January 2014. These reports will be circulated by HPS to the Scottish Government and NHS Boards. The Board Immunisation Coordinator will disseminate the reports to Practice Managers. Final uptake figures for seasonal influenza vaccination will continue to be based on GP payment data, which will be available from PSD Claims for Payment following the end of the financial year
3.2 Pneumococcal Vaccine Pneumococcal vaccination continues to be recommended for those in the at-risk groups and those aged over 65 years. The vaccine will be offered to those people who reached 65 years of age before 31st March 2013, those eligible but did not want to avail themselves of the vaccine last year, and new “at risk” groups. This programme, which is combined with the flu vaccination programme, starts on 1st October 2013, and finishes on 31st December 2013.
3.3 Staff Flu Immunisation Programme The Scottish Government Health Department Circular SGHD/CMO (2012)06 informs free seasonal influenza immunisation should be offered by NHS organisations to all employees directly involved in delivering care. Social care providers should also consider vaccination for staff.
Influenza immunisation is highly effective in preventing influenza in working age adults. In addition, influenza immunisation may reduce the transmission of influenza to vulnerable patients, some of whom may have impaired immunity and thus reduced protection from any influenza vaccine they have received themselves. It may also prevent illness related staff absence and as such is an important element of winter contingency planning.
The uptake rate for seasonal influenza vaccine amongst health care staff continues to be low in line with other health boards in Scotland This programme is led and coordinated by the WI NHS Occupational Health Department
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Activities to improve uptake take into account the wide geographical area and disparate nature of staff groups and will include:
Distribution of information and FAQs to all relevant personnel in WI NHS Board and General Practice through the use of Bulletins and the WI NHS Board Seasonal Influenza web site. Occupational Health Clinics at Western Isles Hospital and Uist & Barra Hospital. Improved reporting and monitoring of uptake and sickness rates coordinated via Public Health. In line with SGHD/CMO (2012/)06 a seasonal flu staff vaccination champion has been identified to promote and support the vaccination of staff.
3.4 Norovirus
Health Protection Scotland provides advisories on Norovirus outbreaks, control measures and practical considerations. The decision Tree is used and patient information given regarding relatives and carers attending A and E.
Interagency Health Protection community work includes preventative and control advisory support and regular weekly links to care homes to identify numbers and early identification of infective cause. Locally this is interpreted through the National infection Updates dashboard which feeds into CMT updates/reviews . Outbreak Control Plan and the Key Infection Prevention and Patient Flow Policies this include escalation plans for confinement and escalation.
Local control measures include daily checklists to ensure norovirus measures are in place. Enhanced cleaning of the patient equipment and NHS WI patient information leaflets and advisory on sudden onset nausea and vomiting – Guidance for relatives and visitors
NHS Western Isles runs an effective norovirus awareness campaign on an annual basis to remind members of the public that they should not visit a hospital if they have experienced symptoms of norovirus in the last 48 hours. The publicity materials also remind the public of the symptoms, how to avoid spreading norovirus, and what steps to take if they catch norovirus.
The Board also includes up to date information and advice on its website, on hospital information screens, on Social Media sites and circulates national publicity materials (posters and leaflets) where available.
In terms of visiting restrictions as a result of cases of norovirus, NHS Western Isles uses the above channels to communicate information to the public and also issues all mail user bulletins to staff so that staff are aware of restrictions/arrangements. Staff attending outbreak meetings are also responsible for cascading, as appropriate, relevant information to their teams/staff.
4 SURVEILLANCE & MONITORING (System Watch)
Guidance on Winter Plans emphasise the importance of timely surveillance and monitoring and in particular reporting via national System Watch predictive modelling system and also the regular winter reporting submissions to the Health Delivery Directorate. The Public Health Intelligence & Information Services Department (PHIIS) updates System Watch every week with hospital admissions data. In addition there is local real time reporting available. This will be further developed as part of eHealth Strategic Objective on real-time Management Information (MI).
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Local winter reporting to EPPHICG can be made available by PHIIS based on this data and other surveillance reporting including Health Protection Scotland surveillance data and other local intelligence. This will potentially include the following types of monitoring information:
. NHS24 call frequencies . Ambulance call outs . Mortality levels . Hospital admission rates . Emergency admissions and bed number predictions . Influenza infection levels . influenza-like illness and acute respiratory illness consultation rates . Antiviral prescribing . Staff Sickness levels . National and local Norovirus levels
A combination of System Watch, HPS national and local surveillance as described above will be regularly monitored and reported to both the coordinating group and operational teams as required. In addition to the above, the PHIS department supply regular weekly A&E datamart activity. Routine MI is available for this should it be requested along with a range of other regular MI as part of T10 workstreams.
The software developed to monitor the pandemic of Influenza A (H1N1)v to allow a more comprehensive picture of Influenza-like illness (ILI) and Acute Respiratory Infection (ARI) consultation rates across Scotland and within NHS Boards is to be used throughout the coming flu season. The surveillance enables early warning of potential clusters and outbreaks of influenza or other respiratory illness. This is particularly useful for this coming season as it is unknown which of the flu strains is likely to be dominant.
All GP practices have been provided with an electronic means of collecting data on patients presenting with ILI and ARI s. GPs are requested to accurately record and code consultations with patients who may be suffering from ILI and ARI. This data is extracted overnight and sent automatically to Health Protection Scotland (HPS). The data is collated to provide a local and national picture of ILI and the volume of flu-related work being experienced by practices. The information will provide early warning of changing patterns of illness and will allow for better and more focused planning to deal with clusters and outbreaks, including support for practices when needed. HPS will feed back the data to NHS Boards on a weekly basis.
HPS have recruited 100 GP practices to the enhanced sentinel swabbing scheme. The Western Isles is represented on the scheme by Group Medical Practice which serves 25% of the population. The scheme provides weekly Board and National level data on the number of swabs submitted and the number of samples positive for Influenza virus to Boards.
Antiviral prescribing is to be in line with the current NICE Technology Appraisal Guidance 58 – use of zanamivir, oseltamivir and amantadine for the treatment of influenza endorsed for use in Scotland by NHS QIS http://www.nhshealthquality.org/nhsqis/1096.html
HPS provide a weekly summary of all the data analysed which includes Hospitalised laboratory confirmed cases of Influenza virus, GP consultations, NHS 24 daily call for ILI and ARI and Influenza specific calls and death data.
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NHS Western Isles is in regular contact with both HPS and the Pharmaceutical Advisor in respect of both supplies of vaccine and prioritisation.
5 AGREED PLANNED INITIATIVES FOR 2013/14
5.1 Management Arrangements General Managers will be responsible for ensuring that there is sufficient management support available to the clinical areas at all times, including holiday periods and will identify and communicate these arrangements to their staff groups.
The Senior Manager and Public Health on-call (24 hr) rotas are available and are held at the Reception, Western Isles Hospital. In planning these rotas provision will be made to ensure that non-clinical Senior Managers can access senior clinical advice where appropriate and / or necessary.
Trigger points for contacting & informing Senior Manager support are indicated in the Escalation Plans in Appendices 2 – 4
5.2 Additional Contingency to Increase Bed Capacity within Western Isles Hospital for the whole of Western Isles An escalation policy is in place to re-designate beds or ward areas as necessary. This would:
Provide additional in-patient capacity within Western Isles Hospital for acute medical admissions/elective surgical admissions Aim to eliminate medical and surgical „boarders‟ outside their speciality wards Minimise the number of transfers of patients within Western Isles Hospital Areas that can be opened for temporary use during winter pressures or major incident include 4 beds in Medical 2, 4 beds in Medical 1, 6 beds in Surgical, 3 beds in Erisort, 2 beds in Clisham Ward , and 1 Bed in APU.
The Senior Nurse and Capacity Planning & Performance Manager will be responsible for identifying: the need for additional beds the appropriate patients for transfer to these clinical areas. This will require close liaison with other Departments, e.g. Infection Control to ensure additional beds are safe from an infection control point of view – particularly if during a flu or norovirus outbreak
The responsibility for 24 hour bed management procedures lies with the Capacity Planning & Performance Manager who reports to the Associate Chief Operating Officer (Secondary Care). Escalation Plans are provided in Appendices 2 - 4
Boarding Out to other ward specialities will be kept to a minimum. Criteria have been agreed previously and are in place.
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5.3 Elective Demand, Capacity and Activity Western Isles Hospital Theatre and OPD will reduce elective activity over the festive period but accommodate scope lists (if available) and ortho/fracture clinics in line with the following timetable:
Medical clinics are not scheduled for the festive period. Urgent patients can be seen in the Medical Assessment Unit over this period.
Tuesday 24th December 2013 Fracture Clinic (Out-Patients) Orthopaedics Clinic (Out-Patients) Urgent Scopes only (Theatre) if required Wednesday25th December 2013 PH Thursday 26th December 2013 PH Friday 27th December 2013 Urgent Surgical Clinic (Out-Patients) if required Urgent Gynae Clinic (Out-Patients) if required Urgent Scopes only (Theatre) if required Saturday 28th December 2013 No scheduled elective work Sunday 29th December 2013 No scheduled elective work Monday 30th December 2013 Fracture Clinic (Out-Patients) Orthopaedics Clinic (Out-Patients) Urgent Scopes only (Theatre) if required Tuesday 31st December 2013 Urgent Surgical Clinic (Out-Patients) if required Urgent Gynae Clinic (Out-Patients) if required Urgent Scopes only (Theatre) if required Wednesday 1st January 2014 PH Thursday 2nd January 2014 PH
There will be no scheduled elective work in Uist & Barra Hospital over the festive period.
5.4 Contingency measures for hospital & community staffing Additional staff will be required to staff contingency beds or during periods of sickness or incidents.
Western Isles Hospital and Community Health and Social Care Partnership (CHaSCP) will identify suitable staff that could be called in or redeployed during incidents or at times of increased demand / reduced staffing due to sickness etc.
Staff training needs will be assessed and contact details retained within the Nurse Bank database. Deployment of staff will be dependent on experience and service needs. Suitable areas for redeployment will be agreed with the individuals as part of this mapping exercise.
In the event of severe weather incidents staff will be redeployed to assist in the areas nearest to their home address.
The Medical Director is responsible for ensuring there are sufficient members of consultant staff on site over the festive period in order to deal with increased demand.
A Major/Adverse Incident – Re-deployment Protocol is provided in Appendix 4
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5.5 AHP Support AHPs do not provide an on call service and do not work public holidays, they proactively plan and prepare for patient discharges to ensure there are no delays in pre discharge assessments.
The SALT staff will be covering ward patients and any outpatients / community patients with swallowing difficulties, as a priority, during the festive period. The OT Service ensures that there are sufficient staff to maintain a service that focuses on supporting safe discharges and avoiding preventable admissions. The Community Equipment Service organizes the provision of basic equipment to satellite stores throughout the islands for use by Community Nurses etc over the Christmas fortnight. Breakdown of equipment provided through the CES is covered through the service contract with CnES. The central contact point is Faire Call Centre. The dietetics department provides out of hours guidance on the intranet site for if an enteral feed is to be started when the department is closed. Copies of the starter regimen are also available to pick up from the dietetic office as are Freego pumps. Patients discharged on a feed the week before Christmas and over the festive period two weeks‟ worth of feed and equipment are provided. The Podiatry service will continue to provide a reduced level of service over the Christmas & New Year period. The priorities are patients who have ongoing care of foot ulceration (High risk) and those attending the Western Isles Hospital. Any scheduled rural clinics over this period these would be cancelled in the event of staffing issues affecting our ability to meet the demands of our High Risk patients. An extra clinic has been added for emergencies between Christmas and New –year. This will enable the department to respond to emergencies to prevent hospital admissions. The Radiographers on call rota for the Christmas and New Year period will be issued for Western Isles Hospital. On call service from home will be provided by Radiographers for all overnight periods and for public holidays and weekends as per normal arrangements. The rota will be provided to switchboard in advance of the holiday period. Consultant Radiologist cover out of hours will be provided via the obligate network with NHS Borders. On call cover in Uist and Barra Hospital will be provided from 9am until 9pm, 7 days per week as per normal arrangements out with the Radiographer‟s core hours.
6 „OUT OF HOSPITAL CARE – PREVENTING –ADMISSIONS AND ENSURING EFFECTIVE DISCHARGE COORDINATION‟
Preventing unnecessary admissions to hospital is a major element of the contingency plan for winter pressures and requires a whole systems approach. The Health Board and Social Care Departments (as part of the CHaSCP) will work together to ensure patients are able to receive care at home rather than hospital wherever clinically appropriate.
Discharge from hospital is planned as early in the patient‟s journey as possible, clear Expected Dates for Discharge (EDD) are agreed by the multi-disciplinary team in conjunction with patient and carers. The patients discharge is actively managed by the Discharge Planning Coordinator along with members of the multi-disciplinary team.
Other actions in place include:
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The Unscheduled Community Nursing service is based at WIH and responds to NHS 24 calls and supports patients in their own homes during the Out of Hours period avoiding hospital admission where appropriate. The second on call GP will be called as the needs of the service dictate. A Hospital Discharge Policy has been developed in partnership and approved jointly by NHS Western Isles and Comhairle nan Eilean Siar (See Appendix 7) The Festive Period breakdown of equipment provided through the Community Equipment Store is covered through the service contract with CnES. The central contact point is Faire Call Centre.
Additional actions which will be considered include:
Additional support from GP and Community Nursing staff to support specific treatments for patients within the homes which would otherwise necessitate admission. This may include revision of care plans, overseeing of treatment programmes and / supervision of staff Funding is available to allow Third Sector partners to provide short break respite/ care for individuals if an informal carer becomes ill to reduce the need for individuals to be admitted to hospital or to require home care packages if their carer becomes ill over the winter period.
7 AMBULANCE NON-EMERGENCY WEEKEND SERVICE
As the Scottish Ambulance Service do not provide a non-emergency weekend service patients can be sent home by private car, taxi or other suitable vehicle and Third Sector transport systems.
An islands wide Ambulance Users group is being convened and both initiatives will inform the wider planning of patient transport arrangements.
8 OUT OF HOURS GP AND COMMUNITY PHARMACY SERVICES
The rota for Out of Hours Community Pharmacies in Stornoway is available at NHS24, Stornoway Police Station, A&E Department Western Isles Hospital, GP Out of Hours room at Western Isles Hospital and at all GP Practices in Lewis and Harris.
There is a specific „Out of Hours Contingency, Escalation and Communication Plan‟ (Appendix5) which provides details of provisions for Winter 2013/14.
As GP surgeries will only be closed for 2 days each week over the holiday fortnight there will not be any “drop in” surgeries. However a second GP will be available if there are any periods of high pressure.
9 ESCALATION PLANS
Contingency plans have been developed in relation to bed capacity, and in respect of staff sickness for all wards and departments. These are included at Appendices 2 - 4
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10 TRANSPORT
Two Health Board 4x4 vehicles are available and can be deployed to assist with transporting staff. Assessment and decision rests with the on-call Executive/Senior Manager.
In addition to the two Health Board 4x4 vehicles, additional transport arrangements can be coordinated through Northern Constabulary.
11 OPERATIONAL CONTINGENCIES/PROTOCOLS
This plan should be read in conjunction with the following policies & protocols:
Western Isles Health Board Multi Agency Pandemic Influenza Plan – 2009 Influenza immunisation for health and social care staff Arrangements for 2012/13 Green Book Influenza vaccination for 2013/14 flu season PGD for Trivalent Seasonal Influenza Vaccination 2012 Communication Pathway for Influenza Vaccine Supply 2012/13 – Appendix 1 Western Isles NHS Board H1N1(v) Influenza Vaccination Plan – November 2009 NHS Western Isles Outbreak Control Plan (Hospital) 2013 Escalation Policies for: o Cancellation of elective admissions – Appendix 2 o Reduced bed capacity – Appendix 3 o Staff sickness – Appendix 4 o Out of Hours – Communication, Contingency and Escalation Procedures 2011-2012 – Appendix 5 Joint Discharge Policy for Hospital Patients in the Western Isles 2011– Appendix 7 Major Incident Procedures (MIPLAH & MIPSI) 2009 BCP Management Procedures Attendance During Adverse Weather Policy Major/Adverse Incident Redeployment Policy Business Continuity – Critical Incident Protocols and Procedures
12 CONCLUSION
The Winter Planning Group will continue to meet over the winter period. Assessment and decision- making may be required at very short notice as challenges emerge for the system. Ad hoc meetings of the appropriate membership/groups will be convened as required.
The Winter Plan continues to endeavour to provide a comprehensive mix of contingencies that will effectively support services and enhance their ability to respond to the challenges which may arise for the system over the winter period.
Evaluating initiatives implemented continues to be regarded by the winter contingency group as a crucially important element of the entire winter planning process in that it provides the group with essential guidance upon which to base effective future planning. A formal review meeting will take place in April 2014 to review the plan.
Any queries regarding the plan should be directed in the first instance to:
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Mr Colin Gilmour Associate Chief Operating Officer – Primary Care
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13 APPENDICES
13.1 Appendix 1 Winter Flu Campaign 20013/14
Communication Pathway with respect to Influenza Vaccine Supply
13.2 Appendix 2 Cancellation of Elective Admissions - Escalation Plan
Introduction:
The decision to cancel any elective activity must be approved by the Chief Executive or a designated deputy. The chair/lead of the Hospital Planning Team is responsible for communicating with the Chief Executive.
Elective admissions will be cancelled in response to „MAJAX‟, severe weather, staff shortage (e.g. flu outbreak,), and bed crisis (increased admissions).
Key points in the escalation plan are as follows:
₃ Increased demand for beds, with Medical bed capacity within the hospital unlikely to meet demand – implement Bed Management Capacity Plan (traffic lights system from Business Continuity Plan).
₃ Increased sickness levels and downtime associated with extraordinary events (e.g. severe snow), with insufficient nursing staff placing increased demands on existing staffing levels – implement Staffing Plan (traffic lights system from Business Continuity Plan).
₃ Cancellations will be managed by Clinical Teams who will have the responsibility for clinical prioritisation of patients in their care (e.g. routine patients may be discharged to allow for urgent elective admissions such as cancer patients).
₃ Cancellations may be treated as a Major Incident depending on severity and organisation‟s ability to operate under extreme conditions.
Responsibilities of the Hospital Services Planning Team:
The role of the Planning Team is crucial in the co-ordination and management of patient flow. The Capacity Planning & Performance Manager and Senior Nurse will work closely with the Medical Director and Clinical Colleagues to ensure that elective cancellations are minimised, and where elective cancellations have to be made, clinical staff have prioritised patients on their lists.
The Planning Team will assume that all patients are suitable for decanting unless informed by the appropriate consultant (with specific reasons). The decanting status of all patients should be documented and reviewed in the patient‟s nursing notes.
Decisions to move patients will take account of known or suspected infectious status so that appropriate action can be taken. Beds closed for reasons of infection should only be re-opened if authorised after the Outbreak Control Team obtain advice from the Infection Control Team
Clinical Staff:
Clinical staff should review their wards and identify patients who may be suitable for decanting, taking account of possible reduction in Ambulance Service and Carers Services (CnES), and advice from ICT where infections suspected or confirmed. Consultants to prioritise planned elective lists (e.g. cancer patients).
Escalation Plan: Traffic Light System:
Code Green:
On a daily basis,
• Ward Managers to meet at 09:00 am to review current bed-state, together with planned discharges/transfers, elective admissions and possible discharges/internal transfers.
• Senior Nurse will advise Capacity Planning & Performance Manager on any nursing staff issues/difficulties that may affect capacity within the hospital.
Code Amber:
Capacity Planning & Performance Manager /Senior Nurse/ CSN (Out of Hours)
• Attends clinical area/support area causing code amber status to establish requirements to revert back to Green Status
• Initiates remedial action or calls Emergency Escalation Meeting
• Identifies intermediate beds
• Accelerates arrangements for community support to facilitate discharge
Medical Staff
Review patients previously assessed as not suitable for decanting or discharge.
Consider transfer to intermediate care, discharge with urgent pre-planned outpatient tests/follow up.
Senior Charge Nurse
• Supports ward staff and Senior Nurse/Capacity Planning & Performance Manager
• Acts as a source of advice/communication for ward nursing staff
• Makes decisions regarding the deployment of staff according to availability and service need taking consideration to protect essential services.
Ward Staff
• Arrange for identified patients to be transferred
• Review patients waiting transport for discharge or transfer, seek to bring forward transport arrangements
Code Red:
Capacity Planning & Performance Manager /Senior Nurse/ CSN (Out of Hours)
• Attends area causing code red to establish requirements to revert back to code green
• Informs Associate Chief Operating Officer (Secondary Care), Medical Director
• Calls Emergency Escalation Meeting
• Calls urgent ward rounds and patient reviews
• Informs GP‟s
If Elective list cancellation is approved, liaises with appropriate consultants; Patients will be contacted before 5.00pm by Medical Secretaries/Admissions Desk, after 5.00pm by Capacity Planning & Performance Manager /Senior Nurse/ CSN (Out of Hours)/Planning Staff.
Associate Chief Operating Officer (Secondary Care)
• Informs ND/COO and Communications Manager • Informs Senior Manager on-call
Medical Staff
• Review patients previously assessed as not suitable for decanting or discharge.
Consider transfer to intermediate care, discharge with urgent pre-planned outpatient tests/follow up.
CSNs
• Supports ward staff and Capacity Planning & Performance Manager.
• Acts as a source of advice/communication for ward nursing staff
• Makes decisions regarding the deployment of staff according to availability and service need
• Identifies intermediate beds
• Accelerates arrangements for community support to facilitate discharge
• Liaise appropriately with ICT for advice
Ward Staff
• Arrange for identified patients to be transferred
• Review patients waiting transport for discharge or transfer; seek to bring forward transport arrangements.
13.3 Appendix 3 Bed Capacity Escalation Plan
Western Isles Hospital Bed Management Plan (Bed Capacity Escalation Policy)
1 Bed availability will be recorded daily using latest version of „Daily Bed Status‟ at:
Green Amber Red 0800 1300 1700 2200
By the Senior Nurse (Senior Nurse, Clinical Support Nurse or the nominated Registered Nurse bleep holder – providing 24 Hr cover).
2 The total available bed compliment at each of the above times will inform necessary action. Maternity, Clisham, and APU beds excluded.
3 The codes of red, amber and green will be used to describe the bed state and any action necessary. The code will be recorded on the daily bed state.
Code Trigger Points for Action Action (number of available beds).
Green >9 acute adult beds No action required, whilst total beds available are above 9 available acute adult beds.
(Aim for minimum of 2 HDU, 3 Surgical, & 4 Medical) . Amber 4 – 9 acute adult beds . Ensure bed state is accurate by visiting all wards available . Ascertain expected discharges. If sufficient discharges (i.e. sufficient to create more than 9 (including 2 HDU available beds) are definite - take no further action. Beds) . Liaise with nurse in charge of ward re asking patients to wait for completion of discharge arrangements in a day room/sitting area if available. . All adult beds must be used flexibly in such circumstances with less acute beds being filled to free up acute beds. . Inform A&E, medical, surgical and orthopaedic consultants of the situation. . Possible discharges to be expedited. . During normal hours the Senior Nurse will inform the Associate Chief Operating Officer (Secondary Care) and Capacity Planning & Performance Manager of the situation. . Out of hours the Senior Nurse will inform the Manager on Call. . Consider using HDU beds for routine admissions (ensuring 2 available for emergencies). . Consider utilizing „contingency beds‟ throughout the hospital, using crisis care as appropriate.
Remain at Amber, whilst total beds available are in the range „4 to 9‟ acute beds. . Red <4 acute adult beds . Follow the action plan as per code amber. available. Plus: . Use HDU beds for admissions (ensuring 2 beds (aim to keep 2 HDU available for emergencies or patients identified to Beds available) be moved down stream). . The Senior Nurse will utilise beds in contingency bays using crisis care as appropriate. . The Senior Nurse or deputy will contact all GP practices alerting them to the hospital‟s position. . The Senior Nurse or deputy will inform the A&E dept. . The Senior Nurse or deputy will explain the situation to ambulance control. . During normal hours the Senior Nurse will inform
the Social Work Dept and the Community Care Team and ascertain residential and nursing bed availability. . Consultant staff will be informed and asked to expedite patient discharges wherever possible. . The Hospital Operational Management Group and available consultant staff will meet urgently and discuss: cancelling elective admissions; liaising with a mainland hospital to take emergencies for a given period; ensure waiting list targets are maintained (plan corrective action as necessary), health and social care collaboration to provide extra facilities within the community; Liaise with Communications Manager in relation to press statement/queries. . If a mainland hospital agrees to take emergencies this should be confirmed by email. . Extensive communications will occur between WIH consultants and mainland receiving counterparts for each patient to be transferred. . The A&E Dept does not close but continues to treat and stabilise patients until their next place of care is determined and arrangements made. . Whilst the bed-state remains in a code red situation the above team will meet twice daily. . Notes will be taken of these meetings with decisions recorded. . All relevant staff will be informed as per communication strategy when the situation eases.
Remain at Red, whilst total beds available are less than 4 acute adult beds.
13.4 Appendix 4 Major/Adverse Incident – Re-deployment Protocol
1. Introduction Situations may arise when the organisation faces challenges or events which could impede or prevent the delivery of core service functions.
Eg Major accident/incident Pandemic Flu and Outbreak.
Industrial Action
1.1 In the event of any of the above, the overriding priority of the organisation will be the continued delivery of safe care and services, albeit to possibly a restricted range. 1.2 The delivery of safe care and services in the event of specific and or numerous staff shortages may require the re-deployment of these staff accurately into alternative functions to those for which they are employed.
In such an event careful consideration and risk assessment will be undertaken to best match available staff to gaps in service.
Managers will take into account: Risk Skill set required Competence of those staff available Confidence of those staff available Training (subject to available time)
1.3 Following the above, available staff may receive a reasonable management instruction to re- deploy. Clear instructions will be given and discussed with individual employees prior to re- deployment. Any situation requiring these steps will be kept under constant review.
1.4 Initiating such re-deployment will be the decision of the on call executive manager.
13.5 Appendix 5 Out of Hours Service
The following section includes a separate document.
Out of Hours Service
Communication, Contingency and
Escalation Procedures
Winter Period November 2013 - January 2014
Contents
Capacity Planning ...... Error! Bookmark not defined.
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Communications ...... Error! Bookmark not defined.
I.T. and Telephony ...... Error! Bookmark not defined.
Referrals between services ...... Error! Bookmark not defined.
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Finance ...... Error! Bookmark not defined.
Capacity Planning
Capacity within the Out of Hours Service within NHS Western Isles has been considered in detail. The number and type of calls dealt with by the local service during the same period in the years 2006/07 to 2012/13 have been reviewed together with the projection of anticipated call figures undertaken by NHS 24 and, as a result of this review (details at Annex A), the following capacity plan has been agreed.
Practices will be closed on Wednesday 25 December, Thursday 26 December, Wednesday 1 January and Thursday 2 January, but open as normal on Monday 23 December, Tuesday 24 December, Monday 30 December and Tuesday 31 December. It has therefore been decided that “drop in” surgeries will not be required but that there will be a second GP available to be called out if there are any periods of high pressure. This will relieve any pressure on the on call doctor and, where appropriate, alleviate some of the pressure on the A&E Department. Normal working capacity throughout the Western Isles includes an ongoing arrangement with NHS 24 for no patient to wait more than 40 minutes for triage. Where NHS 24 cannot achieve this the call is passed, untriaged, to the on call GP.
The anticipated number of calls during the winter period is not anticipated to exceed the capacity of the existing staffing levels. Information from previous years demonstrates that the existing on call arrangements are adequate to deal with all out of hours calls if NHS 24 were unable to provide triage. Winter rotas will be distributed and it is expected that these will all be filled using local GPs. There is historical evidence that GPs are willing to work with the Board in order to fill all the out of hours shifts. There is a local multi agency pandemic influenza plan and the out of hours manager and GP OOH Lead will act in conjunction with this to mobilise existing resources from within the existing GP resources if required. Agency cover will be provided if there are insufficient local resources.
There is a local register of GPs available to be contacted at short notice should demand exceed capacity or where there are adverse weather conditions making travel to rural areas difficult. There is also a plan for actions to be taken in the event of severe weather warnings.
Where NHS 24 enters the advanced amber state or greater NHS Western Isles will take back all calls after consultation between the GP OOH Lead, Highland Hub and NHS 24. Communications NHS 24 Communication Contingency with NHS Western Isles
NHS 24 has put communication contingencies in place in the event that their traffic light contingency plans are evoked. These communications are as follows:
. Green State – “Business as usual”, communications will be as per normal activity. . Amber State – “Peak volume period”, partner communications commenced when callback queues and timing will significantly impact partner workload. Agreement made between NHS 24 and NHS Western Isles that once advanced amber state is reached, then NHS 24 will contact the Primary Care Manager when the decision to move NHS Western Isles to “local triage” status will be considered and agreed, if required. . Red State – “Not sustainable although within safety parameters”, partner communications informing them of the “red state”, with additional information of when telephone conference will commence using the pre-arranged dial-in details. The Primary Care Manager will be the responsible person within NHS Western Isles for undertaking the telephone conference, and discussing the outcomes with the relevant personnel.
. Flashing Red State – “Clinical safety compromised”, partner communications informing them of the “flashing red state”, with additional information of when telephone conference will commence using the pre-arranged dial-in details. The Primary Care Manager will be the responsible person within NHS Western Isles for undertaking the telephone conference in conjunction with the GP OOH Lead. Both these individuals will be responsible for agreeing the actions required locally and for ensuring all relevant parties are fully informed of the decisions reached and actions required within NHS Western Isles. . Major Incident – escalation procedure the same as for flashing red state detailed above.
NHS Western Isles Communications with NHS 24
In order to keep NHS 24 aware of problems associated with technological or capacity issues within NHS Western Isles the centres within NHS Western Isles will make contact with NHS 24 via the Primary Care Manager in the event of an I.T. or telephone failure, to allow alternative arrangements for contact to be made whilst resolution to the problem is sought.
NHS Wstern Isles Internal Communications
The Primary Care Manager will be contacted, as required, by the Highland Hub via telephone.
In the event of the requirement by NHS Western Isles to evoke its emergency contingency plans, the Primary Care Manager will liaise closely with the on call Executive and together through discussion, appropriate actions will be identified.
The PCECs in both Lewis and Uist are co-located with hospital A&E services and it has become accepted custom and practice for the teams to work together. The local geography has made it essential for on call GPs to have direct access to local Ambulance Services and where a call is triaged as “dual response” by NHS 24 the situation is assessed locally taking into account the location of the nearest responder.
NHS Western Isles Communications with the public
The Health Board website and Social Media sites will contain up to date information for the public. A free local newspaper is published on a monthly basis and an advert will be placed in it during the month prior to Christmas giving details of all emergency services including details of access to medical, dental and pharmacy out of hours services. This will also outline times when GP surgeries will be closed, remind patients of the necessity to check stocks of regular medication, and give brief advice about over the counter medication which it may be advisable to purchase prior to the festive period e.g. pain killers. There are two local radio stations, one broadcasting in Gaelic and the other predominantly broadcasting in English, both of which are willing to include information about local services in conjunction with local news broadcasts. These services would also be used if it was not possible for patients to contact NHS 24 and the local community alarm system was needed to take calls for onward transmission to the relevant GP on call.
NHS Western Isles will refer to and refresh its „Know Who To Turn To‟ campaign to highlight to the public where they should go for treatment or help if they are unwell. The aim of this is to prevent inappropriate attendances at the Emergency Department.
I.T. and Telephony
I.T.
Contact details for the on-line clinician system are prominently displayed in the PCEC.
NHS 24 NHS 24 will contact NHS Western Isles via the Highland Hub in the event of an identified fault within its system.
NHS Western Isles In the event that there is a problem during the out of hours period which requires local resolution there is a list of on call IT staff held at the hospital reception as per normal contingencies.
NHS Western Isles will ensure that the Highland Hub has all the dedicated contact details for the Primary Care Manager and GP OOH Lead during the winter period.
Telephony
There is a dedicated telephone line at the Lewis PCEC. Each GP has a mobile telephone, most of which use the Vodaphone network. An additional mobile telephone is available in the PCEC which works on the Orange network should the Vodaphone coverage be disrupted. Details of these numbers are currently held at the Highland Hub.
Referrals between services
Medical arrangements have been fully described within the capacity planning section. In addition to the increased capacity the Medical staff are alerted locally, by the Department of Public Health, to any increased incidence of sickness and/or diarrhoea or other Public Health illnesses that may impact on capacity within the service. The duty Doctors within the Centres may contact the Department of Pubic Health or on call Consultant in Public Health Medicine in the event that they may have concerns in relation to apparent increased incidences of illness or symptoms relating to Public Health.
Arrangements for Pharmacy Services and medicines supply for the festive period are as follows:
. Information on Pharmacy opening times and out of hour rota service is available within the PCEC and at NHS 24. . A review of the stock of prescription pads in the PCEC has been undertaken and additional stocks are available from the Primary Care department during office hours or by contacting the Primary Care Manager. . Additional medicines top up arrangements have been put in place . The general population will be reminded through the local media of the need to ensure that all repeat prescriptions are filled in advance of the critical time periods. Practices will also be asked to be aware of renewal dates for repeat prescriptions and make appropriate adjustments prior to the festive period. This should minimise the number of PCEC visits for prescription filling thus allowing resources to be targeted in a more efficient/effective manner.
As part of the winter contingency planning within Out of Hours, each member of staff will be sent a flu information leaflet and contact details for the flu immunisation clinics being run throughout NHS Western Isles. It is hoped that as many staff as possible will agree to receive flu immunisation. This will hopefully reduce the level of staff sickness absence rates, attributable to flu like symptoms, during the festive period.
The Social Work department can be contacted via FAIRE, the local alarm system, on 01851 701702. This telephone is manned 24/7 and staff have access to the duty social worker for each area and other council services.
If a patient requires hospital admission the PCEC for both Lewis and the Uists is located within the hospital A&E departments and staff in both areas currently work very closely together.
There is an Unscheduled Care Community Nurse based at the Lewis PCEC from 8pm until 8.30am and, if the call were triaged as requiring district nursing input, this nurse would be contacted directly by the Highland Hub. Prior to 8pm any calls requiring nursing input would go through the on call GP who has access to the rota for the on call District Nurse. Reporting
Routine Reporting Out of Hours Service Normal reporting practices within the Centres will continue during the winter period. Any problem identified during a shift will be communicated to either the GP OOH Lead or the Primary Care Manager and. It will be the responsibility of the person to whom the problem is reported to bring the details to the attention of either the NHS 24 Account Manager or Highland Hub as appropriate. This will be undertaken at the earliest opportunity if the problem is deemed to be of a serious nature, otherwise the details may be discussed within the routine meetings between NHS Western Isles and the NHS 24 Accounts Manager.
Incidents All incidents occurring within the Out of Hours services are recorded within NHS Western Isles‟ Datix reporting system. These are collated centrally and a summary report issued to the Manager as required.
NHS 24 Reporting NHS 24 provides regular reports to the Out of Hours service which includes an activity report including key performance indicators, and an Accounts Management Report.
Highland Hub provides regular monthly reports to NHS Western Isles showing a detailed breakdown of activity. Finance
The winter contingencies being put in place have the following approximate associated costs:
Additional standby GP sessions – festive critical time period. 24 hours for the Christmas period at £12.00 per hour 24 hours for the New Year period at £12.00 per hour
Advertising during the pre festive season in the local press = £1,000
The grand total for the successful implementation of the NHS Western Isles Out of Hours Winter Contingency Plan = £1,576.00
Christine McKee Primary Care Manager
13.6 Appendix 6 H1N1 Immunisation Plan
H1N1 Immunisation Plan (extracted from Western Isles Board MULTI AGENCY PANDEMIC INFLUENZA PLAN which was reviewed in 2013)
12.2. IMMUNISATION
Immunisation with an appropriate vaccine would afford the greatest reduction in illness, complications and deaths, and lessening of the impact on health and other services.
An early priority for the Scottish Government will be to attempt to secure supplies of any vaccine against the new strain and to support NHS Boards in organising immunisation of as many people as possible. However, vaccine is likely to be in short supply because (i) vaccine production takes time and is subject to various rate-limiting factors and (ii) demand will be high worldwide.
Distribution of any vaccine that does become available will need to be on the basis of expected maximum benefit and will be organised centrally in order to ensure geographical equity while local arrangements will need to be made for the actual process of vaccination.
As vaccine becomes available it will be given according to nationally agreed priorities. It is likely to be in short supply at least at the early stages of a pandemic therefore vaccination must be co-ordinated through the NHS Board.
12.2.1 Administration of vaccine
Local arrangements will be made for the process of vaccination. It is likely to be administered by a specific initiative via GPs, primary care practice nurses, community nurses and occupational health staff (NHS and Local Authority), bearing in mind that staff resources will be limited and extra assistance may be required. School Nurses, Health Visitors and Nursing Home nurses will also be involved in vaccination and given the appropriate training.
Patient Group Directions (PGDs) that enable an assortment of non-medical staff to administer vaccines and drugs will be instituted and formalised at Board and Division level in advance of a pandemic.
An important part of the vaccination strategy will be to educate the public about the reasons for vaccine not being generally available and manage their expectations.
Even the best influenza vaccines do not give 100% protection: when vaccine and circulating virus strains are well matched, vaccine reduces infection by around 70-80%, hospitalisations in high risk individuals by around 60% and deaths by around 40%
Doctors will be informed about the arrangements for the supply and secure storage of monovalent vaccine when these are known. The precise order of priority groups for vaccination may be changed by the Scottish Pandemic Influenza Implementation Group in light of information on the emerging epidemiology of the pandemic, for instance among different age groups.
Pneumococcal immunisation may prevent some of the complications due to secondary pneumococcal infection following influenza infection and it will be an aim of preparedness planning to improve the uptake of pneumococcal vaccine among the at risk groups.
12.2.2 Pandemic Influenza Vaccination Programme
Activation of the Pandemic Influenza vaccination programme will be coordinated through community services and primary care on the direction of the Nurse Consultant Health Protection.
The precise response will depend on the numbers and risk groups designated for vaccination.
If these follow the usual winter flu designations then the current arrangements for this programme will apply through the already tried and tested mechanism of individual practices in primary care delivering immunisation to patient groups using existing resources.
12.2.3 Occupational Priority Groups
Occupational groups will be immunised through occupational health. The Western Isles NHS Board and Comhairle nan Eilean Siar Occupational Health are represented in the Influenza Pandemic Operational Incident Management Teams. Details of Occupational and „at-risk‟ priority groups for vaccination & supply of anti-virals are provided in the Plan Summary in the first section of this document.
12.2.4 Mass Vaccination
In the event of numbers vastly exceeding usual winter flu arrangements the WIPCC may institute the arrangements for mass vaccination.
These will only be instituted in liaison with the local authority emergency planning officer and on advice from SG and HPS.
12.2.5 Summary of mass vaccination plans
The local authority emergency planning officer maintains a list of venues suitable for mass vaccination Staff will be drawn from infection control, primary care, community nurses and health visitors to man these centres sufficient vaccinators will be trained and vaccinated themselves non mobile populations at home or in residential homes will be vaccinated by the local community nurses non mobile populations in hospital or nursing homes will be vaccinated by establishment nursing staff In the event of vaccine being made available centrally Western Isles Hospital in Stornoway will be the designated point for receipt and distribution of vaccine. This is
different to the usual arrangements with community pharmacies and dispensing practices. The principal pharmacist NHSWI is responsible for secure storage and delivery arrangements for vaccine Staff and trained vaccinators may be re-deployed according to need Local help line numbers will be activated and information provided through the local media
12.2.6 During vaccination programme progress reports will be provided twice daily to the IMT accurate records will be maintained logistical arrangements will be put in place to ensure continuity of supplies and redistribution of vaccine
12.2.7 Post vaccination programme capability to vaccinate those not dealt with during the main programme will be maintained through primary care there will be capability and capacity to deal with adverse events vaccination centre(s) will be prepared for return to normal use.
12.2.9 Antiviral Agents
It is anticipated that antiviral treatment will be as effective in a pandemic as during seasonal influenza. This means that early treatment (within 48 hours of onset of illness) should shorten illness by around one day, may ameliorate symptoms, and should reduce hospitalisations by an estimated 50%, although their effectiveness in reducing mortality in cases of severe disease (including primary viral pneumonia) is not known.
Final decisions on priority groups and strategies for the use of antivirals will be made by the UKNIPC, informed by any recommendations from WHO or the relevant UK expert advisory mechanisms.
Although the targeted and effective use of antiviral medicines or other definitive pharmaceutical interventions is an important countermeasure, they may be in limited supply. When used to treat seasonal influenza, antiviral medicines reduce the length of symptoms (by around a day) and usually their severity, as long as they start to be taken within two days of the onset of symptoms. Whilst it is impossible to predict whether antiviral medicines will be equally effective against a new or modified pandemic virus, it is reasonable to anticipate a similar effect and associated substantial reductions in severe morbidity.
Antivirals have been purchased on a UK national basis and stockpiled. They will be distributed on allocation. Island Boards have been pre-distributed with 10% of their share. In order to meet the requirement that symptomatic patients in the designated groups start treatment within 48 hours of onset of symptoms NHS Western Isles in conjunction with Partner Agencies will ensure logistical arrangements for supply, delivery and secure storage of medication to primary care and produce guidelines for use.
The principles for the use of antivirals will be consistent with the overall principles of managing an influenza pandemic: to minimise serious illness and deaths, to maintain essential services and to minimise societal disruption.
During a pandemic all classes of antiviral drugs to which the pandemic strain is susceptible will be used in the most effective way and in line with National Guidance.
12.2.10 Storage and Distribution of Antiviral Medication
Oseltamavir is the antiviral medication of choice. Arrangements for the central storage and distribution of antiviral medication have been made through the Pharmacy at Western Isles Hospital.
NHS Western Isles will distribute stocks to be held at Uist and Barra Hospital and St Brendan‟s Hospital on WHO declaring an Influenza Pandemic (Phase 4).
Arrangements for advising on shelf stocks of antibiotics, medical supplies and other drugs by hospitals, dispensing practices and community pharmacies are in place and will be cascaded at Pandemic Phase 4.
12.2.11 Other public health or social interventions
At this time, the extent to which spread of influenza can be contained or delayed by the institution of measures to reduce infected and non infected people mixing is not clear, and what may be reasonable at an early phase may not be once the pandemic is fully established.
However, simple advice such as hand washing, encouraging people suffering from the disease to stay at home and reducing unnecessary, especially long distance, travel may achieve some slowing. The following are being kept under review as public health measures, and clear guidance will be issued, based on the advice of the UKNIPC or guidance from the WHO as the evidence evolves or as need arises:
Hygiene including respiratory hygiene and hand washing Travel advisories to restrict international travel to or from affected areas Exit and/or entry screening Voluntary home isolation of cases Voluntary quarantine of contacts of known cases Staff rostering to minimise the impact on staffing if all contacts of a case in a work team are asked to remain in voluntary quarantine Local restrictions on the movement of people, e.g. port health or in a local community or town Restriction of public gatherings, especially mass gatherings School closures The use of face masks by infected people (to reduce droplet spread), by those in contact with infected people or by the general public
Some of these measures may be required as a result of staff absence or the general disruption, or may occur by default because of public concern or other considerations. Voluntary co-operation with recommended measures would be sought. Mandatory quarantine and curfews are generally not considered necessary and are not currently covered by public health legislation.
13.7 Appendix 7 Joint Discharge Policy
Extract from Joint Discharge Policy
4.1 Expected Date of Discharge
The majority of patients in hospital can be classified as requiring a period of time in hospital, which can be estimated or predicted. These are generally patients for whom discharge planning will be straightforward, and where Senior Charge Nurses and AHPs can take on more responsibility for initiating the discharge.
Estimated date of discharge relates to the anticipated length of stay in hospital needed to ensure that all the necessary diagnostic tests are completed, and that the patient has responded to treatment sufficiently to be clinically stable and fit for discharge.
The patient is given a clear “expected date of discharge” within 24 hours of admission by the named nurse. The date is recorded on admission documentation The “expected discharge date” is monitored and reviewed on a daily basis (Western Isles Hospital).
4.2 Process of Discharge
There will be a clear written discharge plan, which is developed in partnership with the patient (and relevant staff involved in his/her care).
Discharge Process
For elective (planned) admissions the discharge plan will be drawn up and explained to the patient prior to admission. In practice this may take place within the Out-Patient Clinic or at the Pre- assessment Clinic.
For emergency (unscheduled) admissions the discharge plan will be drawn up as soon as possible following assessment, with an “expected date of discharge” indicated within 24 hours of admission. The Community Nursing and/or Home Care Service should be contacted for background information.
The patient treatment plan, discharge plan and “expected date of discharge” in effect will form the patient management plan that directs and actively drives their care.
Where the patient is homeless or in poor housing, the Homeless Support Officer or the Out of Hours Service provided by the Hebridean Housing Partnership should be contacted within one working day following admission.
The Discharge Plan will highlight any potential for delay in discharge. The patient management plan will be reviewed on a regular basis, at least daily and the case formally reviewed 24 hours prior to “expected date of discharge”.
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Where the patient is fit for discharge the Discharge Checklist will be completed and the discharge, with minimal exceptions, planned to take place in the morning (ideally before 2.00pm – Western Isles Hospital), with post discharge action plan activated.
In the case where a patient is not fit for discharge a revised management plan (treatment plan, discharge plan and “expected date of discharge”) is completed and the process begins again.
Multi-Disciplinary Case Conference
For discharges, requiring involvement of multiple agencies and complex arrangements, Single Shared Assessment will ideally be carried out prior to admission and a pre-discharge case conference meeting will be required as an integral part of the discharge process. It will be the responsibility of the Senior Charge Nurse/Named Nurse to organise and co-ordinate the pre-discharge multi-agency case conference arrangements, including the chairing and minuting of the meeting.
Case Conference Checklist
Patient‟s consent to case conference and sharing of information with other service providers. Start and finish time and names of participants. Patient‟s medical/surgical/suspected or confirmed infection status (if applicable) and social care history. Assessment of patient‟s health and social care needs. Discuss outcomes of assessment with patient. Identify outcomes that need to be achieved by members of the case conference team. Identify tasks needed to achieve outcomes and allocate tasks to members of the team. Patient (and patient‟s informal carer, if appropriate and with the patient‟s agreement) to be offered a summary of the case conference. Set review date.
Where the patient is able for discharge but discharge is subsequently delayed please refer to the Appendix 2
Delayed Discharge Process
As soon as it is anticipated that there is the potential for a delayed discharge, the breach alert process commences. (Appendix 1)
The Senior Charge Nurse/Named Nurse records this in the patient‟s notes.
Arrangements for a case conference with all agency/individuals involved.
The case conference will be held within a reasonable period (and not more than 10 days) from the date recorded in the patient‟s notes.
The case conference confirms the ongoing needs of the patient; the reason for delayed discharge is confirmed and reported to the Patient Journey Facilitator, who will record this for the purpose of statistical returns.
An action plan for patient‟s discharge is drawn up, agreed and implemented.
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