Background to learning

As in any other clinical inpatient setting, staff in the mental health and learning disabilities use appropriate PPE when performing close contact interventions with patients, potentially for an extended period of time. This could include comforting and de-escalating distressed patients, administering medication, taking physical observations, providing personal care, dealing with blood and bodily fluids, and, as a last resort, restrictive physical interventions.

Prior to the COVID-19 pandemic, clinical staff in mental health and learning disabilities would not routinely use PPE beyond these interventions and a concerted drive to train staff in the techniques of donning and doffing was put in place.

The trust has adapted to reflect evolving IPC guidance through the different stages of the pandemic and developed confidence in staff understanding of the PPE requirements for different procedures. The trust had classified all its mental health and learning disabilities inpatient wards as being on the medium risk pathway.

Early in the pandemic communication was important to reassure and inform patients about the changes they would see. Staff who may have previously worn their own clothes changed to scrubs/uniform, and masks were constantly worn to prevent the spread of infection to and from the wearer. Patients also had the option to wear fluid resistant masks (FRSM), based on risk assessment. A patient survey captured their views about these changes with most demonstrating an understanding of the need to work in this new way and welcoming the protection that it afforded them.

Needing to be alongside a patient (within 2 metres) for a prolonged period to deliver care or interventions may require, depending on risk assessment, the use of PPE by staff members. This involved eye protection, disposable apron, gloves in addition to FRSM. In order to have on hand all of the PPE that might be required, the matron team came up with the idea of the Pocket PPE Pack: a simple solution to enable safe donning of PPE without interrupting the delivery of care, treatment and intervention.

Working with colleagues in the PPE hub, packs were made up of reusable safety glasses, disposable apron and gloves, all in a small freezer bag. Each ward was given packs for nursing staff on duty to carry in their pocket. This meant that if they found themselves in a dynamic situation that required the use of additional PPE, based on a risk assessment of the patient or the situation, they had it readily available. This has improved staff confidence and has meant that they are able to respond appropriately to the dynamic situations that can develop on mental health and learning disabilities wards.

Some items of PPE, if obtained by a patient with mental health issues or a learning disability, can prove to be risk items in themselves in that they could be used to self-harm or harm others.  This means that they cannot be left unattended around the ward.  Having the small pocket PPE packs on staff’s person mitigates that risk.

Learning and advice to be shared

The success of the Pocket PPE Packs has meant that now all clinical staff have their own pack. It means that mental health and learning disabilities units have been able to retain some of the character of informality in a challenging time, whilst also protecting patients and staff from transmission of infection when delivering care and interventions. The PPE pocket packs have been rolled out across the inpatient mental health and learning disabilities services in the trust.

Would it be beneficial to retain these changes?

It is important to ensure that infection prevention and control guidance is followed during and beyond the COVID-19 pandemic. The risks of virus transmission to patients and staff, additional to those already faced in their day-to-day work, can be mitigated using appropriate PPE. The trust has also identified Pocket PPE as a solution for staff working in the community in crisis response services who may be in contact with acutely mentally unwell people, who are unable to maintain two metre distance.

This case study is by Helen Courtney, Modern Matron, Humber Teaching NHS Foundation Trust. For any further details, please contact: england.1professionalvoice@nhs.net