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Realities of an outbreak in aged care

26th October 2020

Speaking at Leading Aged Care Services (LASA) 10 day congress this week, Verity Leith, Benetas' General Manager Residential Services, shared her experience of preparing for COVID-19 and the critical lessons learnt. As originally published by Hello Care.

Benetas executive and crisis team initially met on the 5 March to discuss the pandemic and the implications if an outbreak occurred in one of our aged care homes.

Dr Catherine Joyce, Benetas' General Manager of Quality, Outcomes and Research chaired the meetings, which were held weekly from March until June, and continue fortnightly.

The team gathered information from a variety of sources, including the lessons learned in New South Wales after the Dorothy Henderson Lodge and Newmarch House outbreaks, industry webinars, and CDNA and DHHS guidelines, as well as information from LASA and the Aged Care Quality and Safety Commission.

Different areas of the organisation were involved in the planning, including procurement, property, wellbeing and pastoral care, to ensure all angles were covered.

It became apparent soon into the exploration that initial thoughts of a COVID outbreak being similar to a flu outbreak were soon determined “far from the truth”, and specific tools and guidelines were developed. An infection control specialist was brought to review their plans, which Ms Leith describes as “invaluable”.

Infection control education and training programs were implemented, covering handwashing, outbreak management, infection prevention and control, and correct use of PPE. Donning and doffing practice stations were established and were required to be practiced daily to make sure staff were taking the necessary steps.

This “discovery phase” identified major themes: governance, preparation, resident care, communication, infection prevention and control, workforce supply, and employee wellbeing.

"It was challenging keeping up with all the information provided by various agencies, sometimes contradicting each other," Ms Leith said.

Employee welfare was also a major concern, and though the team tried to anticipate the challenges employees would face, it was only when they were in the midst of an outbreak that they could really understand how challenging the reality was. Regular meetings enabled staff to ask questions and learn from their experience.

A ‘plan on a page’ was an A3 plan that could be used in the case of an outbreak. A more detailed ‘step-by-step’ ‘how to’ plan went in more detail about what was required. Both were to be actioned immediately by staff as soon as a case was identified.

The fist outbreak

Benetas' Altona Meadows aged care home was the first outbreak on 7 July, and requiring the organisation to put it's plan and preparation into place.

"The first 24 hours were extremely intense,” Ms Leith said. “Additional resources were essential, and a large amount of activity went on in the first 24-48 hours."

DHHS was overwhelmed at the same time, so could offer little assistance. Benetas had to trust its own knowledge and implement the procedures they had in place.

“Don’t wait to be advised by DHHS, or any other body, about what to do,” Ms Leith said acknowledging the challenge of providing direction in a high pressure environment.

Ms Leith also told attendees not to underestimate the “huge” level of communication required. The nominated point of contact for each resident in the home was called daily for 12 weeks, and received daily written updates for the entirety of the outbreak.

Staff were not allowed to work between homes, even if that meant going short at times during a stressful environment.

“This was challenging but it’s absolutely critical due to the rapid spread of infection," she said. “As part of this, you have to expect high loss of regular staff and establish a large casual bank not working elsewhere who can step in if needed," she said.

A process at the time with state-wide staff shortages was challenging.

Ms Leith advised that pre-approval of new employee contracts to speed up the recruitment process but made it clear that management had to be prepared to send staff home if they have been working elsewhere.

"In an outbreak the home must be very strict with screening all entrants,” Ms Leith said. "When it comes to infection control and prevention measures, you must move hard and fast to contain the spread."

A buddy system For “extremely tired” employees

Every shift, PPE and hand hygiene training was conducted for all of the home's employees. This included training and establishing clear expectations for all contract catering and cleaning staff.

The team setup a buddy system to support employees through this behavior change transition.

"There's a lot of new protocols required and staff get extremely tired working in full PPE every shift," Ms Leith said.

"The PPE buddy and spotter system helped workers to look out for each other to ensure they were using the PPE properly which was obviously imperative."

A Checklist For Success

Looking back on their plan, Ms Leith said doctors should be consulted prior to an outbreak to determine how they can continue to provide services. Ms Leith also advised providers to know which hospitals will take residents if needed, and those that don’t.

"End of life medications should be available for all residents with confirmed cases," Ms Leith said. "Homes have to be prepared for a residents’ condition to deteriorate rapidly and you don’t want them to be forced to wait for relief when they need it most."

Paper-based care plans, food and fluid charts were pinned to all residents' doors. The team also closely monitored weight loss, deconditioning and pressure injuries.

"Make sure that your teams continue to monitor weight loss, deconditioning and pressure injuries," Ms Leith said. "Eating in your room each day is not conducive to eating, and weight loss becomes prevalent."

"It's also important to get people onto pressure relieving mattresses as quickly as possible to prevent pressure injuries," Ms Leith advised.

Managers were visible on the floor and were not hidden away in the office, which made the staff feel grateful of the manager’s support. "The fact they were rolling up their sleeves and doing what had to be done made staff feel they weren’t alone," Ms Leith added.

"Every day, the wellbeing team rang staff with a positive result, staff who had been a close contact, or staff awaiting results at home. Wins, no matter how small, were always celebrated," Ms Leith said.

Appreciating those on the frontline

“We worked hard to celebrate the employees by recognising the efforts they made with chocolate, high energy drinks, pastries delivery by very appreciative families, flowers, anything we could do to let them know we were very grateful and aware of how hard they were working during this very difficult and long 12 weeks.”

Staying track was difficult because things moved so quickly. Daily huddle meetings were essential to discuss who was unwell, what staffing looked like, and anything that needed to be addressed. An afternoon meeting was also helpful to plan for the evening. The team also received daily updates like the residents and their families to stay across latest developments.

Appreciating those on the frontline

With a fast moving environment with many external and internal stakeholders involved, keeping clear records was never more important.

Documentation doesn’t have to be “pretty”, but keep everything together, Ms Leith said.

A ‘battle board’ was a useful tool recommended by the Defence Force. It involved a whiteboard with a plan of the home with photos of residents so as you move residents around you can move the pictures of the faces so you know where everyone is.

Different zones of the home can also be colour-coded, which was what we did and was very helpful.

Find out more on Benetas' COVID-19 Updates and Management.