As an experienced nurse and manager, I remember my incognisant confidence that I was ready for this COVID monster. I was still confident at the time of the dreaded outbreak announcement. I was already dealing with a large RSV outbreak with 10 staff off and 16 residents in isolation, and to top that I also had the virus.

How much worse could it be than this?

Well, I was just about to find out.

Covid hits harder and faster than you think

Pandemic plans can’t articulate the resiliencies and requirements needed when you lose over 50% of the workforce. And it was actually much worse than that. I had only 8 members of the original team and not one RN. I asked more of these remaining staff than was reasonable and they all exceeded expectations in work and kindness.

I’d like to say that this experience made me stronger but in truth, it almost broke me.

Before this event hit, I had the idealistic view that the DHB would be my knight on a white horse. I thought that they would be there to save the day in this kind of situation, but I was about to be disappointed.

A Covid outbreak is unlike any other the stakes are higher, the tension is greater, and to add to this I had no staff.

My story does get better. We had a homecare company that sent a variety of healthcare workers and professionals to cover the roster. To them, I will be eternally grateful.

I started this blog by talking about my experience, but my experience was nothing compared to the challenges the homecare staff encountered as they entered an aged care facility for the first time to find us at our worst moment. We were mostly unprepared to support them for the physical and emotional work we asked of them.

Doggy-paddling in the deep end

Initially, when given our staffing package for the day, we were not given names, “6 coming this morning Cara, 4 this afternoon, 3 tonight.” The relief that there would be staff on the floor…phew. When you’re underwater and someone throws you a rope you don’t ask questions: you just grab it and hang on.

This was in no way enough staff to run a facility. Even though we had the numbers, imagine all your staff being new and no-one, no way and no time to orientate them. I needed extra staff to fill PPE trolleys, move the pallets of PPE delivered to the door daily, empty the bins, clean nightingale tables and put linen away, provide clinical governance, but there weren’t those people. I would find myself spread so thin that hours of the day would be lost in a blur of cold coffee and adrenaline rushes.

My experience lasted just over three weeks and in that time I developed a range of handwritten, reactive resources for these staff that I have converted to downloadable documents. Primarily they were created to manage the risks to staff, the facility and the resident, but I did take the opportunity to say thank you on nearly all of the documents to compensate in a small way for my inability to do this in person.

Finding our feet and meeting the team

As the days went by, I wanted to identify who the workers were and know their profession. There were a few reasons for this. As a new staff member helping that day, I believed their minimum expectation would be that we could identify them by name and be aware of their qualifications and skill level in relation to the job we were expecting them to do.

With my manager’s hat on, skill mix was a safety concern. We became that aware speech-language therapists and medical administration staff were being asked to deliver care with no experience in providing hands-on personal care to the elderly.

Secondly, I attempted (as reminded at daily meetings) to cohort staff as much as possible, even isolate dementia residents. This a huge untenable gap between gold standard and reality. But the simple logistics of no-one being there to meet the staff when they arrived was an issue. If they were lucky they might meet a Big Bird look-a-like (that’s me) as they entered the building, otherwise they were left to fend for themselves.

Outbreak resources

Welcome, are you here to help?

My first resource was the ‘Welcome, are you here to help?’ sheet. This resource was further developed to add answers to the question they all asked as they arrived: “where am I working?” and the second question was always “what is the Wi-Fi password?”.

I went on to further develop this resource to add where they could eat and that a meal was provided. In time I added the codes to cupboards with key codes and the storage etc., and most importantly who they reported to.

You can download ‘Welcome are you here to help?’ here.

Who should I talk to about this?

There was a day when I arrived and as I walked around the facility I saw PPE trolleys empty and the staff going from resident to resident wearing the same gown. AHHHH!!!

In the interest of staying calm and the old adage of seeking to understand, the staff explained that the trolleys had not been filled as all the staff were all new and they didn’t know who to ask. I realised that we needed a resource for improved communication to help new staff out and improve compliance.

This resource is a list of staff, identifying their role, cell number and two reasons why you would want to contact them. These were positioned throughout the facility with excellent results. Not only did this improve compliance, but now the workload appeared to be more evenly distributed. Staff knew who they needed to contact and for what reason, instead of just saying “I’ll ask the manager.”

You can download ‘Who can I call if I have a problem’ here.

Easy fixes for big problems

Shift planners were developed in A3 with simple instructions of what was expected on an hourly basis, guiding overwhelmed and disorientated staff. One-page care plans for resident doors were developed and joined later by a one-page “10 drinks a day chart” which the staff ticked when a resident had a drink. This sheet of paper reduced the incidence of dehydration and successfully reduced UTI symptoms.

I learned that the essential focus in a crisis is to recognise the impact uncertainty has on the people you rely on to provide day-to-day care. In these times, empathy and compassion for the staff and residents was my focus. As a manager, my job was to help them do their jobs. The resources I made and tested are now available for all who would like to download from our website.

I also recommend that you download the Australian Government’s first 24-hour checklist.

Don’t get me wrong, there was a lot I would do differently given the chance. I admit I didn’t get it right in many areas, but these resources really worked, and as the days and weeks went by it got easier. The best advice is to be ready. Prepare all outbreak resources ahead of time. And as a thank you for reaching the end, if I can offer any last pockets of wisdom: label all doors that are not identified as a resident’s room. This is instant orientation for all who enter the building.

Cara Kelly is Bug Control New Zealand’s Senior Consultant. Having managed a COVID outbreak, she is keen to help facilities in New Zealand reduce infections and better manage outbreaks. Bug Control have been working tirelessly to support IP Leads in Australia and New Zealand with their new roles. If you want to see what we’re up to, sign up for a free one-month trial of our IPC Lead Program.

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