COVID-19 FEATURE
Capturing the learning
Occupational therapists who helped staff the reopened London Nightingale as a step-down facility during the second wave of the COVID-19 pandemic reflect on their two-month learning experience
On Boxing day 2020 , Laura Stuart-Neil received the call to say that there were plans to reopen the London Nightingale in response to the second wave of the COVID-19 pandemic – this time as a step-down facility , with North East London NHS Foundation Trust working as the host organisation .
The next day she found herself at London ’ s Excel Centre , part of a team of contractors , military personnel and NHS staff , discussing what the clinical model would be and what the hospital design and build needed to look like .
And two weeks later , the second London Nightingale opened its doors . A nurse and AHP-led unit with GP input , providing stepdown , community hospital type care . It operated for the next two months , helping to relieve the pressure on London ’ s acute hospitals , which were very under pressure at that time .
In this article , some of the occupational therapists who worked at the unit reflect on their journey and learning .
Staffing The therapy team at the Nightingale consisted of occupational therapists , physiotherapists , speech and language therapists and dieticians . Most therapists , including the occupational therapists , were from different backgrounds and specialties .
In the first weeks , the team started implementing specific procedures and proformas to guide clinical reasoning and organisation of teams and treatment . This consistency and co-ordination between therapists worked well .
The differing staff working in such an intensive environment at times meant that a high level of organisation and communication was required . This enabled good relationships between therapists and supporting each other was equally vital .
A good rota and timetable of staffing and timed handover days meant we were always kept up to date with any changes in a fastmoving environment .
The team worked in a multidisciplinary way ; this included the AHP director as part of the senior leadership team and a matron working as a clinical matron .
The occupational therapy model We worked under the supervision of leads and referrals were overseen by therapists working together with our nursing colleagues . There was a high level of collaboration between different professionals within the Nightingale .
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Working in the Nightingale was a unique experience full of adventure , challenges , and a lot of learning , and probably something that we will never experience again , we hope .
A form was used to enable close joint working between occupational therapists and physiotherapists , which meant we often completed initial screens together , assessing patients ’ functional mobility , transfers and occupational performance .
We used standardised assessment tools , such as Barthel and 4AT , alongside functional assessments such as washing and dressing , kitchen and stairs assessments . Therapists would then review the referral goals and form treatment and / or care plans to work towards these . We often made contact with the patient ’ s family to provide updates as part of our role , to ensure families were kept well informed .
Challenges Staffing however , was a challenge . Therapists worked over a seven-day rota ; this meant that many of the staff had a primary job during the week , but were working extra hours in an effort to support the Nightingale and help to relieve the pressure on the NHS . There was more availability of physiotherapy staff than occupational therapists ; physiotherapists supported functional assessments such washing and dressing , kitchen assessments , equipment ordering and discharge planning during the week , because there was not always an occupational therapist on duty .
The limited availability of staff presented communication challenges with the multidisciplinary team , with a potential lack of continuity and consistency with a patient ’ s treatment plans and the need of being up to date with training , which was at times quite hard . It made it more difficult to establish the role of occupational therapy .
Some staff came from a considerable distance away and were provided with accommodation in order to facilitate them to work in the hospital .
Providing short-term and intensive rehabilitation to support hospital discharges from across the 32 London boroughs was challenging , as was the environment , which had no natural lighting
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