Covid story 18

COVID-19 and the impact of temporary Neonatal Unit Closure

Heather Murphy, Northern Ireland

COVID-19 has presented many challenges nationally and resulted in the formation of the Paediatric surge plan within Northern Ireland to ensure the safety and security of both neonatal and paediatric services during a worldwide pandemic. To preserve these services a five step plan was created by the Department of Health, step one of this plan was initiated via the temporary closure of three paediatric inpatient wards, reallocation of intrapartum care in one hospital and the closure of one Neonatal Unit.

The temporary closure allowed local evaluation of the impact on maternity and paediatric services and considered the predicted increased demand in these services alongside the unknown timescale of service disruption, consequently the Neonatal nurse support role was developed. The role involved approximately half of the permanent Neonatal nursing team remaining on site to work collaboratively with maternity and paediatric services, to provide support for midwifery staff to reduce the incidence of infants requiring Neonatal Unit level care, stabilisation and subsequent transfer of infants requiring Neonatal Unit admission. To facilitate this service need throughout the paediatric surge plans, the creation of this role alongside collaborative working, medical and nursing education and staff support were paramount to ensure the safe and effective care of patients requiring stabilisation for ongoing neonatal care who are both non COVID-19 & suspected/ confirmed COVID-19.

The remaining nursing team were redeployed to the hospitals sister Neonatal Unit located one hour and twenty minutes from the temporarily closed unit. Challenges were presented through additional travel time combined with a shift work rota and orientation to a new Neonatal Unit, however redeployment offered the opportunity to work at a busy Neonatal Unit, care for infants requiring a higher care level than commissioned within their home unit and offered additional experience in another Neonatal Unit. Furthermore collaboration with the sister unit can assist cross sector working within the hospital trust, opportunity to undertake additional competencies which are infrequently undertaken in the home unit and temporarily work within a new multidisciplinary team.

Post paediatric surge plans have involved planned reopening of the closed Neonatal Unit which prior to reopening offered the opportunity for ward based reorganisation which would otherwise be highly difficult during normal service, whilst also acknowledging the impact of change projects following the surge plans. Additionally ensuring staff engagement to provide support and evaluate the Neonatal nurse support role following reopening of services.

COVID-19 has directly impacted neonatal nursing staff work life on both hospital sites alongside disruption in staff personal life due the pandemic. Despite the ongoing pressures within neonatal nursing combined with the impact of the paediatric surge plans have highlighted staff resilience throughout an unprecedented time within our speciality. The surge plans have allowed us to continue to provide safe and sustainable care for infants within the Northern Ireland Neonatal Network and collaboratively work with our maternity and paediatric colleagues to provide high quality care.

Following the reopening of the Neonatal Unit there is now focus on maintaining collaborative working within the home unit site, reflection of the continued positive working relationship with the sister Neonatal Unit and supporting staff following the impact of the paediatric surge plans but also remaining aware COVID-19 is ongoing and preparing for a potential second wave and further impact on our infants, families and staff.

Rachel Grech, Senior staff Nurse & Infection Control Link Nurse – Mater Dei Hospital – Malta

As a Senior Staff Nurse and Infection Control Link Nurse working in the NPICU, the Covid-19 Pandemic brought about various challenges. My first thoughts were how this virus was going to affect our vulnerable patients and how we could best protect them, therefore I set about reading up on as much available literature as I could find and communicated online with nurses from other countries with regards to neonates and Paediatrics. The general consensus was that neonates were rarely affected by covid-19 so this served to allay some fears, however I was still extremely anxious. Our staff canteen and lecture rooms were transformed into wards and all available spaces and corridors now housed hospital beds and mattresses, creating an unnerving atmosphere. Infection control took on unprecedented importance and I found myself to be the reference point for the nurses & midwives in all things Covid, using all available communication means to address queries.

My colleagues with previous ITU experience were prepared for the eventuality of having to float to adult ITU. I held mixed emotions, as on one hand I was quite fearful of being in such a situation but on the other hand I felt quite guilty for not being able to help out fellow nurses in other critical units. Another nagging fear was of bringing something home after my shifts other than my uniform. Several of my colleagues found alternative accommodation and we all had a plan B in mind just in case we needed to be quarantined. Initially we had several nurses in quarantine due to recent travel and others who remained quarantined throughout due to being classed as ‘high risk’, so we all had to adapt and work extra shifts accordingly. I was concerned that in the eventuality of an outbreak there might not be enough staff to care for our patients, since our unit is the only one on the island and our relieving pool is extremely sparse.

Initially I was present for meetings with the infection Control and Neonatal teams to discuss various admission strategies, which involved creating pathways from the delivery suite, theatres, A & E and other Paediatric wards. I also helped with the creation/updating of various protocols with regards to parental presence on the unit, the handling of expressed breast milk, and the disinfection & disposal of contaminated items.  It was extremely confusing as pathways kept changing making it next to impossible to keep track of the correct ones.

I was part of a coalition group to carry out certain modifications within the unit. Isolation rooms were stripped down to a bare minimum, item cupboards removed, panelled doors exchanged for glass doors to ensure visibility, appropriate signage was affixed, a communication system was installed and mirrors were fitted to aid with the correct donning of PPE. Centrally located cupboards were installed for all the necessary PPE and various quick access trolleys for difficult airway management were set up. We also assembled packs of collated items to take down to the various ‘Covid theatres’ for caesarian deliveries and a variety of procedure packs. I had to prepare for the eventuality of admitting older paediatric patients which involved procuring unfamiliar equipment and drugs. I even made a trip to the home improvement store to purchase transparent plastic sheeting to prevent aerosolization of viral particles during intubation.

I helped provide simulation training for proning techniques in paediatric ventilated patients and was also tasked with training all the department staff to safely don and doff the necessary PPE. This was not without its difficulties, as simultaneously the nursing & midwifery union was arguing that the PPE we had access to was not adequate, creating a lot of anxiety and mistrust amongst colleagues. This was further compounded by tight restrictions on FFP3 masks. Unfortunately we also had an initial shortage of alcohol based hand rub and wipes with these items being kept under lock and key in the manager’s office; needless to say hand hygiene compliance dropped and I was very worried about the ensuing consequences.

Now that our islands have succeeded in ‘flattening the curve’, I am finally getting used to the new normality of working with a mask and visor throughout my 12-hour shifts. I fear that our patients and parents continue to suffer inadvertently due to the tight restrictions on parent visiting and handling and am currently advocating for this policy to be re-evaluated.