Support for operational challenges during patients COVID-19 recovery

Information for professionals to help with operational challenges

Consensus statements from expert panels

  • Joint work is necessary to refer and receive referrals by recognising and prioritising nutrition and assessing dietary-related issues and nutritional needs.
  • Remote working must include user friendly instruments to enable dietitians and HCP navigate recovery hand-in-hand with patients.
  • Given the emerging field, some lessons can be learned from evidence in palliative care, cancer, immunological functions (e.g. role of histamine and mast cells), neurological implications and anecdotal reports from long COVID support groups.
  • To improve health services, healthcare staff should gather generalised and specific information, it is also important to refer to the evidence base and learning generated from other countries.
  • To involve healthcare professionals effectively we can empower nurses to be first-line contact and other HCPS across health and social care services for further support.
  • There is a need for improved education and training, greater awareness and leadership from HCP's beyond COVID-19, and to recognise and tackle biases and prejudices.

 
Impact of social distancing

Coordination and consistent messaging

Health systems (e.g. GP, pharmacy, nursing) should be better coordinated, share information and follow clear guidance to address recovery needs for COVID-19 patients. Messaging from healthcare staff and operational staff should be provided in a consistent way.

There should be:

  • online resources, webinars, updated and emerging evidence (1)
  • clinical networks and hubs (2) to increase effectivity of operations and systems.


Department links

Departments could have a good link between them, clear documentation and record-keeping and communication. Communication between professionals need to be improved and care should focus on holistic and comprehensive approaches.

To ensure strong links between acute and community settings (3) some solutions are:

  • Healthcare workers should be trained, and resources allocated (4).
  • Multidisciplinary control should be prescribed at least for six weeks post discharge (5).
  • Redeployment of staff and upskilling (1).
  • Have access to helpful information from CCSG.
  • Ensure effective information sharing, clinical records (for baseline measures) and use MDT virtual or in-person meetings (6).
  • Work closely with physiotherapist or other healthcare professionals.

Virtual consultations

Remote rehabilitation is currently used and encouraged (3, 7). Bear in mind that people may not have access to the COVID-19 app (those who have a phone may have been excluded due to the need for a positive PCR test), may not have a phone and may not engage with digital technologies (2). Access to long COVID clinics and virtual support is still limited so it is vital to provide access to this.

Nutritional support is essential to improve outcomes during the recovery phase. Essential nutritional advice for people living at home should be given through consistent written or online information (4, 8).

Use of telehealth should consider:

  • Throughout the period of home care, healthcare personnel should perform regular (e.g. daily) follow-up (face-to-face visits or phone interviews for symptoms).
  • For patients treated in the community, various websites give advice on general health and symptoms – see our Understanding symptoms during your COVID-19 recovery patients page.
  • Support healthcare staff by identifying nutritional needs early. Multidisciplinary teams should be asking subjective questions to patients using systematic and consistent approaches.
  • Alerting nurses when dietitians not allowed to enter wards as well as disseminating at multidisciplinary team staff meetings to reinforce the importance of screening and addressing nutritional needs (1).

For those without COVID-19 but indirectly affected, consider nutrition-related risks such as interruption in nutrition support services, increased unemployment with limited financial resources, sedentary lifestyles and higher consumption of unhealthy foods (9).

How to reach out to patients who do not access telehealth

  • GP surgeries particularly for those who have COVID-19 living at home and have long COVID.
  • Make sure GPs and A&E staff are fully informed , as well as anyone interacting with them.
  • Clinicians and/or nurses who triage could find out how many COVID-19 sufferers there are in the practice and how are they getting on. They can also flag up issues with GPs when relevant.
  • Healthcare staff who have first patient contact (Occupational Therapists and Physiotherapists) to disseminate information about appropriate evidence-based resource.
  • Telephone help line.
  • Publicity through: TV and radio ads or interviews in relevant shows.
  • Leaflets in public areas: pharmacies, waiting rooms, supermarket, schools, gyms. Post these to patients.
  • Healthcare worker home visits and agencies.
  • COVID app, Zoe app.

Useful knowledge hub links

Reviewing and partnerships

  • Protect time to review frailty, dementia management and delivery in care homes.
  • Review process of care to assess what approaches to support recovery work and why. Secure pathway or resource approvals.
      – A solution for this is leadership, adopting a system thinking approach to learn how to triage from the first phone call. Ensure to address policy resistance or potential overlap of services in acute and community settings. Key stakeholder involvement to promote and enable MDT training to assess how appropriate was the community team in following up patients. Update GPs with aspects of care provided in acute settings (1).
      – For more examples of good practice see BAPEN and British Dietetic Association (BDA) websites.
  • Work in partnership with patients to address their needs.
  • Assign clear responsibility to healthcare staff for following up, for instance transferring some responsibility to physiotherapists, nurses, pharmacists, etc.
      – A solution for this may be to outline a clear pilot period for this clinic and points of review at months 1, 2 and 3 using KPIs and review with finance to fund staff and service delivery going forward (1).
  • Provide patients with robust information on pathways and advice to request and raise concerns with HCP to delineate tailored health goals. Helping patients to identify reputable information online and in social media channels may be particularly important in the context of telehealth.

Lockdowns and accessibility

During lockdowns, whilst social distancing measures are still in place and to deal with patients with accessibility issues, healthcare staff should aim to:

  • use short phone and video calls but frequently to assess the provision of recommendations and resources
  • inform patients what services can support them and how can they self or refer into a service. Thus, this will educate and empower patients to self-manage their conditions
  • adapt resources for people with learning disabilities
  • listen to patient desires and concerns – do not neglect due to age or due to recognising more mental health symptoms. These for instance should be considered and linked to long COVID-19 rather than treated as a symptom
  • protect time to support patient recovery
  • be mindful of cultural and ethnic aspects associated with diet
  • avoid using medical jargon to communicate with patients.

Raising awareness

There is a lack of awareness (particularly across vulnerable groups and ethnic minority groups) about resources available to support, some potential solutions are weekly newsletters sent out with a COVID-19 related topic

  • to confirm via telephone or multidisciplinary team meetings, matrons, lead nurses
  • to increase levels of resourcing on wards
  • peer learning support and research (1)
  • to supply training on how to support clinicians on post COVID-19 symptoms and longer-term impacts on nutritional management
  • to increase networking at an organisational level
  • to recognise unpaid carers and how their feedback can improve health and social care – more information can be found on the Care Quality Commission website.

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References

(1) Lawrence V, HIckson M, Weekes E, Julian A, Frost G, Murphy J. A UK survey of nutritional care pathways for Covid-19 patients post hospital stay. Journal of Human Nutrition and Dietetics. submitted.

(2) National guidance for post-COVID syndrome assessment clinics (6 November 2020) [Internet]. Patient Safety Learning - the hub. [cited 2021 Jan 9]. Available from: https://www.pslhub.org/learn/coronavirus-covid19/guidance/national-guidance-for-post-covid-syndrome-assessment-clinics-6-november-2020-r3465/

(3) Cawood AL, Walters ER, Smith TR, Sipaul RH, Stratton RJ. A Review of Nutrition Support Guidelines for Individuals with or Recovering from COVID-19 in the Community. Nutrients. 2020 Oct 22;12(11):3230.

(4) Barazzoni R, Bischoff SC, Breda J, Wickramasinghe K, Krznaric Z, Nitzan D, et al. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clinical Nutrition. 2020 Jun;39(6):1631–8.

(5) Eekholm S, Ahlström G, Kristensson J, Lindhardt T. Gaps between current clinical practice and evidence-based guidelines for treatment and care of older patients with Community Acquired Pneumonia: a descriptive cross-sectional study. BMC Infect Dis. 2020 Dec;20(1):73.

(6) COVID-19 rapid guideline: managing the long-term effects of COVID-19. :35.

(7) Iannaccone S, Castellazzi P, Tettamanti A, Houdayer E, Brugliera L, de Blasio F, et al. Role of Rehabilitation Department for Adult Individuals With COVID-19: The Experience of the San Raffaele Hospital of Milan. Archives of Physical Medicine and Rehabilitation. 2020 Sep;101(9):1656–61.

(8) Brugliera L, Spina A, Castellazzi P, Cimino P, Arcuri P, Negro A, et al. Nutritional management of COVID-19 patients in a rehabilitation unit. Eur J Clin Nutr. 2020 Jun;74(6):860–3.

(9) Mechanick JI, Carbone S, Dickerson RN, Hernandez BJD, Hurt RT, Irving SY, et al. Clinical Nutrition Research and the COVID-19 Pandemic: A Scoping Review of the ASPEN COVID-19 Task Force on Nutrition Research. JPEN J Parenter Enteral Nutr. 2021 Jan;45(1):13–31.