Posts tagged “COVID-19”

Helping the COVID-19 vaccination effort for Scotland – Bernie McCulloch

Posted on December 20, 2021

When the call went out for vaccinators to aid the national effort to respond to the Omicron variant, many of our staff with clinical experience put their hands in the air to help. One of those volunteers is Bernie McCulloch, Portfolio Lead for Healthcare Improvement Scotland’s Community Care programme. In this blog, Bernie explains what’s involved in being a vaccinator, and how people and healthcare professionals alike are rising to the continued challenge of the pandemic.

When the call went out for volunteers, it made perfect sense to me to become a vaccinator.

Taking my teenage son to get vaccinated I saw at first hand the long queues of people keen to play their part to help themselves and others in the continued pandemic. As a trained nurse, who has worked away from the frontline for a number of years, I instantly felt the moral obligation to dust down my skills and answer the call.

For me, the issue at hand is clear: the more people we can support to get vaccinated – especially in the wake of the Omicron variant in the lead up to the festive period – the better for everyone in Scotland. So I jumped at the opportunity to use my clinical skills and experience in a way that can make a real difference.

Getting the right training to make the right decisions

In my role as a vaccinator, I screen individuals, obtain consent and administer first and second COVID-19 doses, boosters, as well as flu vaccines to those who are eligible. Similar to the COVID-19 vaccine, there are different types of flu vaccines depending on age and medical conditions.

The training to become a vaccinator takes place through extensive and comprehensive online courses and through physically shadowing of other vaccinators. As a trained nurse, I’m able to carry out assessments to determine the appropriate vaccine for people; to support this is the Green Book, which lays out all the side effects and contraindications for all vaccines. In addition, our training covers the legal aspects in relation to consent, how to fill in appropriate documentation and how to correctly handle people’s personal information.

Although the training is thorough, at the vaccination centres there is always support on hand: doctors, nurses, pharmacists and healthcare assistants – so, if you ever have any questions, there are other experts to call upon to help make the right decision for every patient. In addition, daily staff huddles, before the centres open to the public, help to ensure that any changes to national guidance are communicated effectively.

The spirit of togetherness

Aside from the feeling of helping to make a difference, it’s hugely satisfying to have patient contact again and reminds me of what it is that we do in the NHS: caring for people when they need it.

Those who turn up at the vaccination centres all want to be there, which is great to see. Sometimes people are spending hours queuing for the vaccine, but they are all grateful and appreciative to the healthcare workers, the volunteers and to the NHS. As a result, I try to make my interactions as person-centred as possible: thanking them for turning up, for doing the right thing for themselves and others, and for making the effort.

This feeling of us all being in it together also extends to those working at the vaccination centres. There’s a real appetite for everyone to help each other whenever it’s needed.

I’m also encountering people under 50, who are not eligible for the free vaccine, paying privately to get the flu vaccine from their local pharmacy. I think this shows how many people are seeing the benefits of vaccination programmes, and the important role they play in keeping them and other people safe.

The festive season and beyond

I continue to carry out my duties with Healthcare Improvement Scotland alongside shifts as a vaccinator. Over the festive period, I expect to undertake more shifts and in all likelihood into January also. But I’m looking forward to it. I hope that every vaccination that’s carried out takes us all one step closer to coming out of the pandemic, maybe saves a life, while at the same time bringing us all a little bit closer together as a society. If you haven’t been vaccinated yet, please come to one of the centres. We’d be delighted to see you. You’ll be helping yourself and helping everyone else around you too.

Bernie McCulloch is Portfolio Lead for Community Care in Healthcare Improvement Scotland’s ihub.

Categories: Uncategorized

Tagged: COVID-19

Long COVID: The importance of holistic care – Dr Tom Fardon

Posted on December 14, 2021

We have learned a lot about Long COVID and its effects over the past year. In our latest blog, Dr Tom Fardon, Consultant Physician of Respiratory Medicine at NHS Tayside, outlines his own experience with COVID-19 and explains the steps he takes to diagnose and treat patients who may be experiencing long-term effects from the syndrome.

COVID-19 is an unusual illness. The range of symptoms is broad, much more so than the original case definition of early 2020 that included only breathlessness, persistent cough, and fever. The range of severity of illness is equally as wide: some people suffer only mild symptoms of an upper respiratory tract infection; some have no symptoms at all; some develop a rapidly progressive pneumonitis requiring ventilatory support – in wave 1 of the pandemic 20% of people who were admitted to hospital with COVID-19 did not survive.

The unprecedented collaboration between scientists, clinicians, and pharma companies around the world has led to the discovery of a small number of treatments that can, and do, improve outcomes. But, most importantly, we now have safe and effective vaccines that protect against infection, reduce severity of disease, prevent admissions to strained NHS services, and reduce mortality.

The new ‘normal’

For most people COVID-19 affects two weeks of their lives, with a range of flu-like symptoms that are unpleasant, but don’t lead to hospital admission, and they will recover. Most people will take a few weeks to recover their fitness, get back to their normal level of activity, and feel “normal” again. People always ask: “How long until I get back to normal?” Everyone is different. Depending on your previous baseline, the severity of your illness, the length of time laid up resting, and your expectations of recovery, it can be a week, two, perhaps six.

For some people, recovery from the acute illness is only the start of the journey. What we have now come to term Long COVID affects somewhere between 5% and 20% of people who have had the COVID-19 infection. The severity of disease does not seem to predict progression to Long COVID. Indeed most of our critical care COVID-19 survivors have not gone on to develop Long COVID, though their rehabilitation has been long, simply due to the severity of their illness.

Offering a service to people with long lasting symptoms following COVID-19 infection is very challenging. Long COVID is a syndrome for which there is no clear clinical definition; no diagnostic test; large overlap with other diseases and syndromes, some of which are ‘diagnoses of exclusion’; and no mechanistic or pathophysiological pathway. Most hospitals do not have an existing team dedicated to the holistic care of people presenting with the symptoms of Long COVID. The symptoms cross speciality borders: cardiology, respiratory medicine, neurology, rheumatology, dermatology, endocrinology.

Emerging Patterns

In NHS Tayside we followed up our patients from COVID-19 critical care areas after wave 1, and we’ve seen a range of people in our outpatient clinics with Long-COVID symptoms. My experience of seeing people with protracted symptoms following COVID-19 infection has shown me a few emerging patterns.

Speaking to people who have protracted symptoms following COVID-19, there are commonalities in their concerns: is this Long COVID? will it get better? how long will these symptoms last? is there anything I can do to get better? will it get worse? and is this how it’s going to be forever?

Steps to diagnosis

Our first step is to rule out other causes of those symptoms. If someone is breathless following COVID-19, have they developed asthma? If someone has chest pain, is their ECG normal? Just because symptoms started after COVID-19 doesn’t always mean that COVID-19 is responsible. A detailed history often reveals mild symptoms prior to COVID-19, and new things can happen at any time.

Step 2 is to look for modifiable causes of symptoms – deconditioning and weight gain are very often implicated, so a gradual return to an exercise programme, with planned weight loss can be very effective. Addressing any psychological issues is also critical.

Aftercare

Holistic care is vital. There is no clear answer to most of the concerns these people have. We simply don’t understand enough about the Long COVID syndrome to give reliable information about the outlook. In my experience it is uncertainty that scares us: once we’re given the diagnosis, the prognosis, the clear plan, we then have a target, something to aim for, a route to take, and a team to support us.

For people with Long COVID we work in an area of extreme uncertainty. Development of multi-disciplinary teams to help people with this wide range of symptoms, and causes has to be a priority for the next 2 to 5 years.

In NHS Tayside the COVID-19 Assessment Rehabilitation Enablement and Support (CARES) service consists of highly specialised physiotherapists, occupational therapists, psychologists, and secondary care consultants, like me. Our approach is to ensure early screening to look for serious conditions known to complicate COVID-19, such as pulmonary embolus, atrial fibrillation, pericarditis; followed by a personalised patient-centred care plan delivered by the team; and early referral to secondary care if there are concerns over developing complications.

My own experience with Long COVID

I had COVID-19 in April 2020, just before I should have been running the Boston Marathon. I had a dramatic loss in fitness over the 2 weeks of illness, and suffered for over 12 months with daily headaches, earache, tinnitus, sore throat, dizziness. Those symptoms have, with time, settled. I have no explanation for why they happened, why they went away, and even whether they were definitely related to my COVID-19 infection. They certainly created a high level of uncertainty for me and my family, adding to what was already a stressful 2020. But it has helped me to have first-hand experience of the uncertainty that people can experience.

Hope for the future

As we approach 18 months of the pandemic we see more people who do recover and return to normality, but as the restrictions are relaxed and infection rates reach dizzying heights across the country, we will undoubtedly see more people with symptoms of Long COVID. It is therefore vitally important that we have clear guidance on the approach to people who present with symptoms suggestive of Long COVID. As the national guideline continues to develop, it will be a vital place for clinicians and the public to look for reassurance and guidance. Most importantly, it’s important that we don’t miss newly presenting illnesses, and equally important we don’t ignore or downplay the symptoms that people are now presenting with. As we wait for more studies that help us to diagnose and treat, this approach will be crucial.

Dr Tom Fardon is a Consultant Physician in Respiratory Medicine at Ninewells Hospital and Honorary Reader in the University of Dundee

More information

Read our SIGN Guideline: Managing the long-term effects of COVID-19.

Categories: Uncategorized

Tagged: COVID-19

Do the Scottish public know how to use antibiotics wisely? – Jacqui Sneddon

Posted on September 8, 2020

Our Scottish Antimicrobial Prescribing Group (SAPG) have spent the last ten years raising public awareness of the threat antibiotic resistance poses. But is the message getting through? SAPG lead Dr Jacqui Sneddon decided to find out, with help from colleagues in our Community Engagement Directorate.

Since 2010, the Scottish Antimicrobial Prescribing Group (SAPG) have led annual campaigns, centred around European Antibiotic Awareness Day on 18 November. The aim is to communicate messages to healthcare staff, patients and the public about the threat of antimicrobial resistance and the need to use antibiotics wisely to protect them for future generations. Staff in health boards and our Public Partners have supported campaign activities tirelessly across hospital and community settings, including schools, youth groups and even Aberdeen Football Club. We’ve also managed to get our own Brownie badge, thanks to one enterprising SAPG committee member developing an awareness raising project for her Brownie pack. But how do we really know if these messages are reaching the public? Is what we’re doing really influencing people’s behaviour around managing common infections and seeking antibiotics from their GP?

Opportunity knocks…

After attending a Scottish Health Council (now Community Engagement) presentation on Citizens’ Panel surveys back in 2019, it struck me that there may be an opportunity to have a Citizens’ Panel survey on antibiotics.

A Citizens’ Panel is a large, demographically representative group of citizens regularly used to assess public preferences and opinions. The Our Voice Citizens’ Panel was established in 2016 to be nationally representative and currently comprises just under 1,200 members of the public from across all 31 Integration Authorities. Since the panel was established, it has gathered the public’s views on around 20 different health and social care topics and has begun to demonstrate impact on ongoing health and social care policy and practice.

Welcome result

Our survey ran earlier this year, and received a 52% response from panel members, so it’s statistically robust at a Scotland wide level. More importantly, the recently published findings make welcome reading for those of us working on safeguarding antibiotics. The majority of the panel had heard of antibiotic resistance, knew that this means bacteria fail to be killed by antibiotics and that overuse of antibiotics is the main cause of resistance. Most people also knew the difference between bacterial infections that can be serious and viral infections that usually cause coughs and colds.

When it came to seeking help when they or a family member was unwell with a suspected infection, most said they would ask a healthcare professional such as a doctor or pharmacist for advice, or consult a reputable on-line source such as NHS Inform. Over 90% of panel respondents had been prescribed an antibiotic at some time and about 40% had needed a second antibiotic, possibly because the infection was resistant. When it came to using antibiotics, most people would complete the course, would not share antibiotics with others and were not likely to try to purchase antibiotics on-line or when overseas on holiday. Respondents also knew which common infections are likely to get better without antibiotics, with the exception of earache in young children which they incorrectly thought would usually need antibiotic treatment.

Looking to the future

We also wanted to know whether the panel were aware of the campaigns run by SAPG and others on infection-related topics. About half of respondents had seen some of the campaign materials, usually in Health Centres. I was pleased to learn that over half of respondents were aware of the “Pharmacy First” service which provides treatment of common infections via pharmacies, and over one in four respondents had used the service. And as a pharmacist myself it was also good to know that the majority of people would be happy to seek and take advice from a pharmacist.

This survey has been helpful for SAPG and I’m sure it will be of interest to colleagues in other UK nations. We’re hoping the details will help us design public awareness campaigns to save our antibiotics. From the survey results, both reinforcing advice about self-care for common infections and highlighting which infections may require antibiotic treatment so that people can consult their GP or pharmacist for advice when necessary look like avenues we may explore in future. Thanks to the Citizens’ Panel, we’ll now be able to target future campaigns more effectively.

The Our Voice Citizens’ Panel Survey on awareness of antibiotic resistance, appropriate use of antibiotics and related public health campaigns report is available on the Community Engagement website.

Jacqui Sneddon is Scottish Antimicrobial Prescribing Group (SAPG) lead with Healthcare Improvement Scotland.

@jacquisneddons @HISengage @SAPGAbx

More information

Visit the SAPG website

Categories: COVID-19 blogs

Tagged: COVID-19

A helping hand to be treated at home – Shirley MacKenzie

Posted on September 2, 2020

Shirley MacKenzie’s mother, Agnes, was able to spend her final months in her own house, thanks to Hospital at Home. Here, Shirley tells us in her own words how much it meant that her mum was able to have her final wish of a peaceful death at home.

My mum Agnes was diagnosed with aggressive B cell lymphoma in June 2019 and she completed her treatment in November of that year.

Over the winter, mum kept in reasonable health, joining in with family occasions and seeing friends. Then COVID-19 changed everything and she became a shielded patient.

Fortunately she was able to maintain independent living, with her family visiting her in the garden and bringing her groceries. We were so lucky with the good weather which made the isolation easier. We were also very lucky to be able to use video technology, and she used this to keep in contact with us daily as well as with the family abroad.

In mid-June she became more unwell, developing extreme tiredness, breathlessness and back discomfort. Because she was became worse over a few days, we contacted the Beatson who directed her to her GP. Mum was reluctant to go to hospital so her GP said he would contact the Hospital at Home service operating in NHS Lanarkshire.

Same day service

A nurse from Hospital at Home came out to visit her the same day. She carried out an assessment, observations and blood tests. Later that morning, a hospital consultant came to the house, retook her history and examined her. The consultant then explained to mum that her very high calcium level, which was related to her underlying disease, was contributing to the deterioration in her symptoms. She said that she could provide some treatment that might offer some improvement to mum’s current symptoms. She then liaised with the specialists at the Beatson about what, if any, additional treatment might help mum’s underlying condition, as well as looking at community resources to provide aids that could help her maintain a safe home environment. These were delivered later that same day.

Later on in the day of her first contact with Hospital at Home, my mum was given intravenous fluids. The following day she received intravenous medicine to help lower the high calcium. At all times, the service’s staff were very professional, helpful, sympathetic and considerate of her wishes. Their communication and explanations to my mother and our family were excellent.

A final wish fulfilled

Initially, my mum picked up a bit following this treatment and a few days later the Hospital at Home service discharged her to the care of her GP and McMillan Nursing Services.

However, she deteriorated quickly in the end and died peacefully at home, being cared for by her family. Her wishes were to be cared for in her own home and to die there, if this was possible. If it had not been for The Hospital at Home services, social services, her GP, and the support of the family, I don’t think this would have been as comfortable or indeed possible to achieve.

Throughout her contact with the service, my mum was aware that the treatment offered was for symptom control and that her disease was progressing. She was comfortable and less anxious in her own familiar surroundings than she would have been in a hospital ward and said she felt more in control. It allowed her to continue to have her family around her – an important consideration for her, especially in recent times.

More information

Visit the Hospital at Home section of the ihub website.

Categories: COVID-19 blogs

Tagged: COVID-19

Rich tea and sympathy – Julie Davidson

Posted on August 18, 2020

While the pandemic has kept us apart, we’ve still found ways to be together when it matters most. As part of our Community Engagement Directorate’s virtual visiting scoping exercise to gather information about how hospital patients and their families stayed in touch when visits weren’t possible, Julie Davidson, a Community Engagement Officer in Dumfries and Galloway, reflects on how she’s learned to value technology when it comes to staying in touch.

There’s nothing better than a chat over a cup of tea and a biscuit. That bit of time between arriving at a meeting and the meeting starting, where you’re making brew and rummaging through the biscuit tin for something good to dunk in it, that’s when you find out the important stuff. It’s when you get to know what’s really going on, get to know your colleagues better and find out how things are with them. But sometimes when you have to make a 140 mile round trip just to get to the tea, the biscuits and the meeting, you do start to wonder if there’s sometimes an easier way of doing things, as much as the effort to travel all those miles is appreciated by workmates and stakeholders alike.

Face to face vs virtual meetings

Back before we had heard of COVID-19, I remember how excited/nervous/curious I was about the possibilities of using NHS Near Me, a video platform which was in many ways a forerunner to things like MS Teams. One day when I realised I wouldn’t make it back from Stranraer to a meeting in Dumfries, NHS Near Me was suggested. I had lots of thoughts about using it. Would I able to contribute as normal? Would my colleagues forget I was there? Turns out it was fantastic. I felt fully involved, and from then on used it when I couldn’t make meetings due to time and distance. It helped me stay connected and attend several meetings in one day. It saved me a day out of the office! Yet I did miss the long drives which helped me gather my thoughts. I missed catching up face to face with colleagues. Can anything beat face to face contact and the interaction it allows?

Well, almost. There’s certainly a lot things it can make easier. Using Near Me worked so well for me, I started thinking it would be great to attend GP appointments this way. Little did I know how prescient that thought was! Near Me has now been used with patients and service users throughout this pandemic, helping people attend GP and hospital appointments from the comfort of their own home. This has been particularly helpful in a rural area like ours, where people rely on public transport, as in our experience, healthcare is often provided in Glasgow or Edinburgh. Now it can be provided in your own front room.

The value of visiting virtually

I support NHS Dumfries and Galloway volunteer peer support group sessions, which have continued through MS Teams during lockdown. Recently we’ve heard emotional stories from NHS volunteers about the impact not being able to visit is having on hospital patients and their loved ones. From having a family member in hospital during this time myself, I know first-hand just how important it is to stay in touch. Technology has provided us with the means to do so. People are Zooming, Facetiming, Whatsapping, Teaming. We’re visiting virtually.

Using technology in this way has been eye opening, and the possibilities are endless. Virtual visiting means it’s now possible for someone at the other end of the country, or indeed the other side of the world, to visit a loved one in hospital without all the stress of travelling and anxiety that you won’t get there at the right time. Now that we are starting to come out the other side of lockdown, will these trends continue? For me, there’s nothing like a face to face catch up, but no one ever said you couldn’t have a cuppa and a catch up virtually. Just watch out for biscuit crumbs on your tablet!

Julie Davidson is an Engagement Officer in Dumfries and Galloway

More information

To find out more about virtual visiting and contribute to Community Engagement’s scoping exercise, go to their website:

https://www.hisengage.scot/equipping-professionals/virtual-visiting/

Categories: COVID-19 blogs

Tagged: COVID-19

The need for speed (and safety) – Rickie O’Connell

Posted on August 13, 2020

In the midst of the COVID pandemic, urgent treatment for cancer patients has continued. As part of our Off-label Cancer Medicines programme, Senior Pharmacist Rickie O’Connell tells us how a two-year test and development programme became a vital part of the response to ensuring patients received the care they needed while staying safe.

In November when I first went on secondment from my regular job as a pharmaceutical analyst with the Scottish Medicines Consortium to be a senior pharmacist for the Medical Directorate’s Off-label Cancer Medicines (OLCM) programme, I knew the work would be challenging. The programme had two years funding to develop and test an approach for improving national consistency in the use of cancer medicines in a way that is different to that described in their licence. I was looking forward to a tough but interesting couple of years. I never imagined we’d be pedal to the metal, trying to put guidance in place so people with cancer could be treated more safely in a pandemic situation.

Responding to the crisis

Patients receiving treatment for cancer were initially considered a vulnerable group for developing severe COVID-19. Not unnaturally, patients and clinical teams therefore wanted, and still want, treatment options that require fewer hospital visits, have fewer serious side effects or that can be taken orally at home rather than in hospital.

Clinical leaders within the OLCM group identified the need for a national governance group to help prevent local medicine governance systems becoming overwhelmed with requests for less familiar treatments which could meet patient’s preferences to avoid hospital visits. Such changes, if carried out at a local level, would likely result in duplication of effort at a time when the health and care system was focused on tackling COVID-19, and could result in inconsistencies in treatments available to people with cancer across Scotland.

A new project for our team

Our OLCM programme team was just four months in to our project at the time, but following this advice we were deployed to work on COVID-19 National Cancer Medicines Advisory Group (NCMAG) to help address this challenge. Like many teams in Healthcare Improvement Scotland, our team has skills in evidence review and project management, as well as links with cancer clinical teams across Scotland, so we were well placed to help.

Things moved rapidly once the group was set up. Within weeks we had all the processes and support tools in place so that clinicians could submit proposals for treatments not routinely available, we could prioritise the work and produce the guidance. We also quickly got all the key players in place, including representatives from regional cancer networks and NHSScotland National Procurement, to ensure there were sufficient supplies of the medicines the group were supporting for use, and also ways to get our advice out to those who needed it. Once issued, the advice would mean that patients could have ready access to cancer treatment options that were not previously routinely available, and with fewer hospital trips.

Going at 90 miles per hour

The benefits of this national approach were quickly acknowledged by practicing clinicians and our team received many proposals in a very short time. Fortunately, our colleagues within the wider Medicines and Pharmacy team and colleagues from Scottish Medicines Consortium kindly supported us through the heaviest workload.

From April to July, the team has been working at a pace I didn’t think was possible. The original aim of our OLCM programme was to produce up to 10 pieces of advice in two years. So far we have produced 21 pieces of advice in four months. It’s not been easy, but knowing the advice we’re producing is benefitting those who need it most makes the effort and long hours worthwhile.

Adapting to changing circumstance

Looking back, the few months have seen a lot of things change. Like most of you, I’m no longer office based, and have swapped the Glasgow commute to working from home. I even have a noisy new colleague – my daughter, Úna, turned one during lockdown and her birthday was a busy day of back to back video calls. Since then she has developed new hobbies of heckling and cyber-attacking daddy during work meetings – the broadband router now hangs high up on the wall out of the reach of her tiny fingers.

And I was right about the secondment. It has been challenging. But I’m glad our team have had the opportunity to contribute, with our individual skill sets, to the care of cancer patients during this uncertain time.

Rickie O’Connell is a Senior Clinical Pharmacist with the Off-label Cancer Medicines Programme and Area Drug and Therapeutics Committee Collaborative

More information

You can find more information about COVID-19 National Cancer Medicines Advisory Group on the Scottish Government website

Categories: COVID-19 blogs

Tagged: COVID-19

Our antimicrobial prescribing team – a big impact for a small team – Jacqui Sneddon

Posted on August 6, 2020

Although the COVID-19 pandemic is still with us, many parts of the NHS in Scotland are keeping their focus on the virus while restarting work that had to be paused. Jacqui Sneddon reflects on the work of the Scottish Antimicrobial Prescribing Group as part of the pandemic response and looks at the way forward.

The impact of the COVID-19 pandemic brought challenges and opportunities for the Scottish Antimicrobial Prescribing Group (SAPG).

Our group works with NHS boards across health and care settings in Scotland to safeguard antibiotics against the global threat of antimicrobial resistance. When both the group’s committee and project group meetings were paused, it meant that that routine work for the group was also suspended.

We’re a small and agile team of just three employees, including me, plus one day per week from our Chair, Dr Andrew Seaton from NHS Greater Glasgow and Clyde, but with a committee of national experts and clinical staff from across Scotland, as well as several project steering groups.

Initially I was seconded to support first the Medicines and Pharmacy team within Healthcare Improvement Scotland (of which SAPG is a part), and then to NHS Lothian to support the ICU pharmacy service. Marion Pirie, our team’s Project Officer, took on part-time work with NHS 24 supporting staff training by role playing real-life patient calls.

Meanwhile, Lesley Cooper, our Health Service Researcher, devoted her time to finalising evidence reviews for two of our projects – penicillin allergy de-labelling and use of antibiotics towards the end of life – which have now been submitted for publication. There was also time to write up our findings from global health partnership work we’d just recently completed with two hospitals in Ghana for future publication.

The issue of COVID-19 and antibiotics

But we couldn’t entirely take our eye off COVID-19.

The pandemic meant that we needed to be sure that use of antibiotics was still appropriate and that clinicians had the information they needed.

Literature reports of overuse of antibiotics in other countries led to SAPG producing advice to support antimicrobial teams in NHS boards to maintain stewardship of antibiotics in hospitals and care homes.

We recognised an opportunity and need to explore the impact of COVID-19 on hospital antibiotic prescribing, given emerging data form China and other parts of the UK, so SAPG led a point-prevalence survey audit examining epidemiological, clinical and prescribing data from eight boards. Data were captured from over 800 patients with suspected or proven COVID-19 across 15 acute hospitals (about one third of all hospitalised patients with COVID-19 in Scotland at the time) during the last 10 days in April. The study generated a huge amount of data that Lesley and colleagues in Public Health Scotland analysed and this provided reassurance that antibiotic use in Scotland was compliant with local guidelines, with lower use in COVID-19 patients than reported elsewhere. Thankfully there was no increased use of broad spectrum antibiotics that drive resistance although the emerging problem of secondary bacterial infections in critical care was observed. One paper has been submitted for publication focused on the epidemiology of antibiotic prescribing in COVID-19 and a second on management of suspected respiratory infections in the context of COVID-19 is underway.

Emerging from lockdown

As we gradually emerge from lockdown, SAPG work has restarted with our first virtual committee meeting recently attended by 32 members. On the agenda as well as the hospital audit data was a discussion of data on GP practice antibiotic prescribing during COVID-19, and hearing about the challenges that antimicrobial teams had faced. All of this information will allow us to continue to learn and will inform the SAPG work programme to ensure the NHS in Scotland continues to use antimicrobials optimally to preserve antibiotics for future generations.

We then turned our attention to our project groups on penicillin allergy and end-of-life antibiotics, to finalise outputs and agree plans for implementation as well as publications on our project development processes. We’re now working with our SAPG Public Partners to produce a patient version of recommendations for use of antibiotics towards the end of life to support patients and their families in shared decision making.

As I reflect on the lessons of the pandemic and the way forward for the group, it strikes me just how much COVID-19 has brought people together – we see that in society, but also within organisations like our own. Our team is contributing to cross-organisational work on older peoples’ systems and primary care where our experience of working with care homes, and with GP Practices will help to inform and support future priorities. 2020 marked 12 years since SAPG was formed and since I joined the organisation. We’ve achieved so much by working in partnership with health and care professionals across the country. Although it’s been a difficult year for everyone, we can only look forward, to continue the fight against antimicrobial resistance, and to face whatever new challenges lie ahead.

Jacqui Sneddon is Scottish Antimicrobial Prescribing Group (SAPG) lead with Healthcare Improvement Scotland.

@jacquisneddons @SAPGAbx

More information

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

Tagged: COVID-19

From making meals to buying them: Volunteering during COVID-19

Posted on July 8, 2020

Supporting people lies at the heart of our Community Engagement Directorate, and for many of our staff, that’s true both inside and outside their working hours. Here, Admin Officer Susan McLaren tells us how her role volunteering with older people has changed during the current pandemic – and why she now recognises the importance of the humble chocolate teacake.

Helping hand

Before I started working as a volunteer, I had no idea of the importance of chocolate teacakes in Scottish society. To me, they were just another biscuit – the one I get offered with a cup of tea each time I give blood. Now I know differently.

Eighteen months ago, when teacakes were the furthest thing from my mind, I started volunteering as a meal maker for a charity called Food Train. In my day job for Healthcare Improvement Scotland’s Community Engagement Directorate, I support my team to engage with people across Scotland and get them involved in health and social care. Community matters to me, and that doesn’t change when I stop working, which is part of the reason I volunteered. As a meal maker, I was paired with an older person in the community called Helen and cooked a nutritious (and hopefully tasty) meal for her once a week.

“In my day job for Healthcare Improvement Scotland’s Community Engagement Directorate, I support my team to engage with people across Scotland and get them involved in health and social care. Community matters to me, and that doesn’t change when I stop working, which is part of the reason I volunteered.”

Then the virus hit and lockdown happened. I quickly realised that Food Train would have a lot of extra demand for their shopping service but may be experiencing a reduction in numbers of their regular volunteers. They’ve been going since 1995 and recently celebrated their 25^th anniversary, but have never experienced anything like this. A quick phone call and I was approved to help with the supermarket shopping service. Now I and a team of four or five volunteers are up and out with the lark three days a week to do shopping for about 140 vulnerable people in my community – all before I start the day job.

Simplicity is the key to shopping for others

When I first started the shopping role I was a bit unsure what to expect, but the co-ordinator for my supermarket shopping was really welcoming and explained in detail how it all works. As with the best things in life, simplicity is key. I am given the shopping list, do the shopping, pop it into crates (that have been sanitised, of course) and it’s then delivered by volunteer drivers throughout West Lothian.

Of course, it’s not always straightforward, especially when things aren’t avaiIable. I now understand the dilemma facing supermarket staff doing the pick for online shoppers – to substitute or not to substitute, that is the question! Luckily all the volunteers are willing to help with suggestions on this – it’s real team work. The one that did stump us for a while, though, was those chocolate teacakes. We had so many shopping lists given to us that contained them that when the factory at Uddingston closed and the shelves were bare we really struggled – I’m sure there were a few disappointed faces when the deliveries arrived. Apparently nothing beats a chocolate teacake with a cuppa! Fortunately production started back within a few weeks and we were once again able to meet the demand – phew!

Making a difference

Volunteering means an early start for me, shopping from 7-8 am (and that is after walking the dog) but the shop is usually quiet at that time and I also get to scope out all the bargains. I feel glad I’m able to help out someone who might be anxious about how they will manage if they can’t get out to shop for themselves. And as volunteers, the people we help have left us in no doubt just how much what we’re doing is appreciated. I recently received a note from one older person we’ve helped which read: “I was so worried about my food and shopping before you called me. Nobody could help me and I’m on my own. Not only do your volunteers shop for me but their wee visits really cheer me up. Wish they could visit every day”.

We’ve also had lovely surprised like a request on one shopping list for a box of chocolates for the Food Train helpers. This was lovely and totally unexpected but really brought it home how much this means. As one grateful daughter said “Knowing you can support my elderly mum is such a relief to me, you are all wonderful”. It’s very satisfying to know that my little bit of volunteering is making such a difference to other people’s lives.

“As volunteers, the people we help have left us in no doubt just how much what we’re doing is appreciated. I recently received a note from one older person we’ve helped which read: ‘I was so worried about my food and shopping before you called me. Nobody could help me and I’m on my own. Not only do your volunteers shop for me but their wee visits really cheer me up. Wish they could visit every day‘.”

Once COVID-19 is over and we’re all living in whatever the new normal will be, I like to think I’ll still be there with my shopping trolley, hunting out those teacakes. Whatever happens, I expect to still be making my weekly visits to Helen bringing her a tasty meal and having a bit of chat as well – it’s as important to her as it is to me. We’ve seen fantastic examples of community spirit during the pandemic lockdown and I look forward to seeing so much of it, not just in my day job, but by all of us, every day, all year round. It will be so important to help us all recover.

More information

You can find out more about the work of Food Train or Mealmakers on their websites: https://www.thefoodtrain.co.uk/ and http://www.mealmakers.org.uk/

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

Tagged: COVID-19

Long journey for travellers to have their voices heard

Posted on June 29, 2020

Community engagement is about everyone in Scotland having a right to take part in decisions about their health and wellbeing. But for some groups this is harder than for others. As part of Gypsy Traveller History Month, Community Engagement Officer Gillian Ventura tells us how important it is for this resilient community to have their voices heard.

Lockdown has been hard for everyone. Staying home, staying safe, doing your bit. It’s a struggle being cooped up when you’re in house with a garden. Imagine doing it when you can’t get things delivered to the place where you live. Imagine doing it when you’re part of a community where family is everything, but you can’t be within two metres of loved ones whose home you could touch if you just stretched out your hand. Imagine doing it when the land your home sits on is no guarantee of permanent residency.

As family and kinship are central to Gypsy / Traveller culture, the reality of lockdown has been particularly challenging. It can be difficult to maintain a two metre distance in a pitch which requires space for at least two caravans to accommodate one family.

“Due to discrimination, many Gypsy / Travellers won’t challenge the system anymore as they feel nothing is really going to change for their community. This means there’s little point in me knocking on doors on a site and asking them about their healthcare and what matters to them. The first step is building a relationship. And that takes time.”

Yet lockdown has simply highlighted the many struggles and inequalities that this community face. Helping to get those struggles voiced at the highest levels is part of my job as one of Healthcare Improvement Scotland’s Community Engagement Officers.

Taking time to engage

There are around 20,000 Gypsy / Travellers living in Scotland. Among them are groups as diverse as Romany Gypsies, Scottish Gypsies / Travellers, Irish Travellers and European Roma. Some will have arrived in the UK as asylum seekers and refugees, fleeing persecution. They all consider travelling and a nomadic identity as an important part of their traditional and contemporary culture. Recognised in law as a distinct ethnic group, they also have the worst health outcomes of any ethnic group, primarily due to poverty and discrimination.

Due to discrimination, many Gypsy / Travellers won’t challenge the system anymore as they feel nothing is really going to change for their community. This means there’s little point in me knocking on doors on a site and asking them about their healthcare and what matters to them. The first step is building a relationship. And that takes time.

I’ve been working with the Travelling community at the Swinhill site in Larkhall for two years now, supporting the work of NHS Lanarkshire’s Keep Well Team, nurses Heather Craig and Sandra Kelly. Gypsy / Travellers face a range of health problems at an earlier age than the general population and it’s important to reach them so they can get the right healthcare and support. They typically live 10 – 12 years less than “settled” people. They have higher rates of anxiety and depression and their suicide rate is six times higher than the general population – this increases to seven times for young Traveller men. Infant mortality is three times higher. Around 42% of Gypsy / Travellers are affected by a long-term condition, compared to 18% of the general population. People from Gypsy / Traveller backgrounds also engage later with health services and can often experience barriers accessing primary care as a result of living in unauthorised areas or moving frequently, having low levels of literacy and experiencing discriminatory attitudes.

“The input of the community and their leaders is vital to this work. There are some strong community leaders among the Gypsy / Travellers, and they play central roles in the Travelling Community Network at local, regional and national level.”

The key to engaging the community has been the site manager, Roy Overend. Roy has been at the site since 2003, and thanks to the great relationships he’s built up with the residents and the Gypsy / Traveller community in Lanarkshire, he’s helped us engage with them and understand the complexities of their community. The on the ground work done by Heather and Sandra has also been vital: by carrying out health checks, monitoring blood pressure, diabetes, addressing issues with mental health and wellbeing etc, they have built a rapport with the community. At first it was just the women from the site that went along, now the guys are coming as well. They all see the benefits and the advice they get opens the door for me to be able to do work around things like Realistic Medicine and What Matters to You.

What matters to them

Through the What Matters To You work, we found that the main issue for the community was accessing primary care services, in particular getting registered with a GP service when they are travelling, which is part of their culture. This work was shared with the Travelling Community Network and also with Scottish Government, to help raise the profile of the issues that matter to the community. Through this, we’re linked in to the Improving the Lives of Scotland’s Gypsy/Travellers (2019-21) action plan, launched by Scottish Government at the end of last year. The five key priorities are: provide more and better accommodation, improve access to public services, better incomes in and out of work, tackle racism and discrimination and improve Gypsy / Traveller representation.

The input of the community and their leaders is vital to this work. There are some strong community leaders among the Gypsy / Travellers, and they play central roles in the Travelling Community Network at local, regional and national level. One lady from the community within Lanarkshire assisted the Scottish Government Person Centred Care Team to develop GP Registration Cards. The Keep Well team worked with the community to promote the cards within Lanarkshire and the wider partners working with Gypsy Travellers.

The Blue GP Registration Cards are a pocket sized card promoting the right to register at GP practices. I’ve been encouraging their use by the community, asking them to keep a card in their pocket or bag so wherever they are, they know they can access GP services. Helping improve healthcare here is all about teamwork, and it doesn’t matter that people don’t know which organisation we’re from or who we work for. It’s about working together to ensure the community gets the health and social care support they need. We’re simply the people who can help them do that.

What matters to me

But this is not a quick job. Gypsy / Travellers enjoy and are proud of how they live – it’s the discrimination and lack of respect and resource that they get annoyed about the most. This lack of understanding from “settled” people can make it harder to engage with them – why should this time be any different? Yet building relationships, persevering, and, most importantly, understanding their culture will, over time, pay off, ensuring better health and social care not just for them but for everyone using local healthcare systems. At a time when Gypsy / Traveller culture is being compromised due to lack of site provision, it’s important to me that their voices are heard.

Gillian Ventura is a Community Engagement Officer with Healthcare Improvement Scotland

More information

Find out more about the Improving the Lives of Scotland’s Gypsy/Travellers (2019-21) action plan

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

Tagged: COVID-19

How the COVID-19 infodemic is changing the way we look at evidence

Posted on June 24, 2020

When COVID-19 struck, Scottish Intercollegiate Guidelines Network (SIGN) had an obligation to support healthcare professionals in Scotland with contextualised guidance on the diagnosis and treatment of a new and emerging disease. Angela Timoney, Chair of SIGN, explains the challenge of developing evidence-based guidance with very little high-quality evidence.

The scale and pace of the COVID-19 pandemic has presented numerous challenges to healthcare professionals. It has also presented a new type of problem for people who seek to aid health and care professionals by making sense of evidence. The so-called infodemic is almost a virus in its own right – the endless circulation of information and misinformation from many different sources and experts causing hope and confusion on an almost daily basis, and spreading with great speed through social media and 24-hour news. In fact, the World Health Organization has said that the infodemic around COVID-19 is almost as dangerous as the pandemic itself.

“The so-called infodemic is almost a virus in its own right – the endless circulation of information and misinformation from many different sources and experts causing hope and confusion on an almost daily basis, and spreading with great speed through social media and 24-hour news. In fact, the World Health Organization has said that the infodemic around COVID-19 is almost as dangerous as the pandemic itself.”

Some steady voices, including the Centre for Evidence-based Medicine and Cochrane, have helped filter this information overload, and Healthcare Improvement Scotland’s Evidence Directorateis providing expertise in evaluating evidence and highlighting the most reliable sources. Internationally, SIGN has been involved in a COVID-19 taskforce as part of Guidelines International Network to reduce duplication of effort. There’s lots of information – but is there evidence?

The need to adapt

Indeed, there is plenty of evidence – it comes thick and fast. But it’s not the robust evidence we need for clinical guidance. We like large, randomised controlled trials; currently, most evidence related to COVID-19 is retrospective and observational at best. It’s fast-moving, incomplete and often from populations that don’t always match with ours. This rapid pace of change means that, even with the best of intentions, outdated clinical guidance can actually do more harm than good.

Over the past 27 years, SIGN has developed an international reputation in producing highly regarded clinical guidelines. We have worked to a robust methodology during this time, but quickly realised that the lack of high-quality evidence related to COVID-19 wouldn’t fit this mould. Uncomfortable as it was, we had to adapt to ensure that our contribution would be meaningful and timely.

Initially, we worked with the National Institute for Health and Care Excellence (NICE) to learn from their development of rapid ‘living’ guidelines within one week. We also collaborated with the University of Glasgow to develop a rapid review to support colleagues in general practice.

“Over the past 27 years, SIGN has developed an international reputation in producing highly regarded clinical guidelines. We have worked to a robust methodology during this time, but quickly realised that the lack of high-quality evidence related to COVID-19 wouldn’t fit this mould. Uncomfortable as it was, we had to adapt to ensure that our contribution would be meaningful and timely.”

We are also supporting the Scottish Government’s COVID-19 Clinical Guidance Cell, a large multidisciplinary group acting on behalf of the Chief Medical Officer, Dr Gregor Smith, to develop rapid, high-quality guidance. Dr Smith recently acknowledged our role: “your willingness to collaborate has resulted in a process that is responsive to clinicians’ need for guidance. It will also ensure that Scotland’s clinical guidance will continue to be highly regarded, and provide our healthcare professionals with much needed support.”

Learning for the future

There’s a common word in all of this: ‘rapid’. In a short space of time, we’ve learned a great deal that we can apply to future guideline development, while retaining our reputation. It is easy to state that we must not ignore the good in search of the perfect, but in the middle of the storm the real challenge was determining not if it was good but ‘good enough’. History will determine if we got that balance right, but it feels that we have and this is reflected in feedback from others.

We’ve seen how guidance can be developed more quickly and without physical meetings, and we’ve also seen how our methodology remains valid; it is still necessary to have debate among multidisciplinary healthcare professionals and involvement from patient and public involvement groups and representatives.

Whether it is producing rapid guidelines, pinpointing where more research is needed or highlighting the most reliable resources, SIGN’s role in Scotland’s response to COVID-19 is vital –by sticking to our founding principles and robust methodology, we aim to continue to be a guiding light for healthcare professionals in Scotland throughout the crisis. We look forward to finding ways that we can take this knowledge and experience to benefit other areas of our work in the future.

Angela Timoney is Chair of Scottish Intercollegiate Guidelines Network (SIGN)

More information

Weekly updates on SIGN’s work throughout the pandemic can be found on the Healthcare Improvement Scotland website.

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

Tagged: COVID-19