Baptism by Fire – Preparing Ward 16 for COVID-19
Written by Abbey Cameron
Since Northland DHB Acting clinical nurse manager for Ward 16, Renju Mathew began his role five weeks ago he has undergone a baptism by fire, taking over the reins just as they became the designated COVID-19 Ward at Whangarei Hospital.
Because Renju had already worked on Ward 16 as a clinical nurse educator and associate clinical nurse manager, he was able to quickly put his organisation skills to the fore and prepare his team to cope with all that a pandemic brings.
He started with getting staff on board by setting them at ease regarding all the misinformation about COVID-19 in the media and social media.
Using his education skills Renju along with the Infection Control Specialist and Clinical Nurse Educator then taught staff how to use personal protection equipment (PPE) appropriately and explained the infection control guidelines set by the Ministry of Health and World Health Organisation.
FAQs were created for the staff to refer to by the clinical nurse educator who Renju said worked hard to consistently address the teams questions - because every day they were dealing with new scenarios.
Posters were put up around the ward as a constant reminder of the procedures required going in and out of each room to ensure everything was done correctly at all times.
"It hasn't been easy. These are tough conditions. We prepared five weeks back and were the first in Northland hospitals to set up an environment with completely separate zones."
To do this, they had to utilise the existing layout and Renju commends the Building Services team for creating the Red and Green Zones in a very tight timeframe.
Then ten negative pressure isolation rooms were created to minimise the risk for staff and to isolate well patients from COVID-19 patients. A negative pressure isolation room incorporates a ventilation system designed so that air flows from the corridor into the negative pressure room. However, contaminated air from the negative pressure room cannot escape back out to other parts of the ward.
These rooms were then fitted with intercoms to enable patients to speak to someone in the nurse's station at any time without a nurse having to come into the room. Renju points out that this not only helped the patient feel connected but assisted the nurses in planning their delivery of care throughout their shift while meeting all the patient's needs. It also saves a lot of PPE, which has to be disposed of every time anyone leaves the isolation rooms.
A Red Zone roster was created, so staff knew when they were needed to work to help alleviate burnout.
Renju said his staff don't usually hesitate to come and talk to him but to iron out any issues; he created a focus group to ensure everyone’s views were captured – including the healthcare assistants and those working after hours and on night shift. He was adamant that all staff could have input about what needed doing, how they would fix issues, and how they were going at any stage.
"Staff welfare has been of utmost importance. The incident management team (IMT) has been great at looking after us - they've even provided us with refreshments."
Another measure which has proven successful is having a circulatory infection control nurse acting as a runner within the Red Zone. They provide a second check on people coming and going to ensure PPE standards are consistently up to the mark— and support if there is anything needed from within of the Zone.
"It's been a lot of work, but it's been a whole hospitals' work - from those on the frontline providing care, to IMT, Acting Director of Nursing & Midwifery, Nurse Director Acute Care, planning, infection control, service managers, the team leader, operations, welfare, the senior nursing management team of Ward 16, communication, and many more.
"The only reason why it has all gone so well is because of teamwork. As we all know, this is a pandemic. And everyone plays their role in it and is supportive. We are happy that we work in this organisation."
Renju said they have been fortunate to have the Department of Medicine clinical director Dr Lucille Wilkinson on board to guide them through.
Dr Wilkinson agreed that everyone has been amazing and those that needed to have stepped up to lead.
"It hasn't been one leader. So many people have gone in and done amazing work. I look at what our registrars have done - working beyond expectations and developing templates now used for a lot of the activity happening around the country.
“We've been very lucky so far. It's just extraordinary the number of people who put in extra hours and time to think about how we prepare the facilities, like the builders.”
Dr Wilkinson says although things may move towards being a bit more normal in the coming weeks – the key is to remain prepared to get back up to a high level of readiness at any point in time, in a sensible way.
She said she couldn't be prouder of how the situation has been handled. Especially after the staff initially felt well-placed anxiety from all the false information on social media, making some of them very frightened.
She highlighted Renju's extraordinary leadership and ability to keep the nursing staff moving forward and prepared at all times.
"Also, my junior doctors and my senior colleagues who kept on going even though we were all reading things online, which made us quite scared. It shows an immense amount of bravery and courage."
"You have to be honest with your staff and be transparent. You have to say, ‘look, this is what we know and this is what we don't know’. There's no point making stuff up about a virus that we're only just learning about. This is how we're going to best prepared and accept that people's worries are well-founded.
"It's OK to say we are feeling stressed or not sleeping so well. All those things are needed in this sort of environment because a lot of people are going through the same things.
"Five weeks ago in pre-lockdown, we were in very uncertain times. We sort of look like we're coming out the other side and we're not dealing with large numbers of presentations. Now we have to decide what happens next."
Dr Wilkinson said now they could look at some of the decisions they have made along the way and question whether they should have done things differently. She said that they had learned a lot and maybe they should be looking at doing virtual clinics going forward, but overall, this has been the best team-building exercise ever.