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COVID Oximetry at Home – Stop:Start simulation

To access resources related to this work you will need an account for the FutureNHS Collaboration Platform. Further information about how to register or join workspaces can be found at the bottom of this webpage.

Requirements for setting up COVID Oximetry @Home

A document outlining the CO@h national brief and Standard Operating Procedure (SOP) can be found on FutureNHS Collaboration Platform. It provides a starting point for understanding what a CO@h service is and the requirements and expectations linked to it.

Key steps to onboarding and reviewing patients – Oximetry at Home scripts and Call Handler Flowchart

Please note, you will need an account for the FutureNHS Collaboration to access the links below.

Risks for clinically vulnerable people

  • Consider what comorbidities and other warning signs there might be? What previous treatments have been tried in the community? What support do they have at home?
  • Call Handler flowcharts can be accessed through the FutureNHS Collaboration Platform. Please refer to page 16 of the clinical competency guidance for the saturation categorisation flowchart and adult assessment pathway.

Exertional tests

  • A lot of SOPs suggest exertion tests can be useful in decision making but be aware that these are not objectively standardised tests and clinical discretion should be used when choosing which patients to use these with. Concerns include exhausting the patient and causing them to deteriorate and so they should be used with caution.
  • Further evidence on the efficacy and safety of rapid exercise tests for exertional desaturation can be found The Centre for Evidence-Based Medicine website.

Angry patients

Anxious patients

  • It is important to express empathy, especially for anxious patients. It will improve communication and safety. Further guidance on communication can be found on the RCGP website.
  • Giving a patient a ‘golden minute’ to explain their concerns and what they need can be a good way of starting a consultation. Further information about consultation models can be found in this article.
  • Read a GMC article about understanding communication failures involving doctors.

Remote consultation guidance

  • It is important to ask open questions. Using the ‘golden minute’ to encourage the patient to describe the problem or explain their concerns. Further information about consultation models can be found in this article.
  • Framework for history taking via the unfamiliar format of telephone consultation. Further RCGP guidance can be found on the RCGP website.
  • Read this GMC article about understanding communication failures involving doctors.

Safety netting

  • When safety netting, consider not overloading patients with information, particularly those who are older or feeling particularly unwell. Could you send written information and check understanding by asking them to repeat the information back to you?

Other methods include:

  • Services through which you can send text messages with a linked COVID diary and leaflets for safety netting
  • You can read the National safety netting leaflet on the FutureNHS Collaboration Platform.

Using clinical judgement

  • There is some evidence that pulse oximeters may underestimate blood oxygen levels in individuals with darker skin. However further research is required to understand the causes and implications of this. Clinicians should take this into account when assessing participating patients and, wherever possible, recommend that patients record a baseline oxygen saturation at onboarding. It is important to also ensure that you use your clinical judgement in assessing patients, monitor trends of both oxygen saturation readings and symptoms, and remain vigilant for other signs of deterioration. Read more about this in this NEJM article.
  • It is important to pick up on red flags e.g. check if they can speak in sentences, observing to see if tachypnoeic.
  • NICE website.
  • A list of those at higher risk from COVID19 can be found on the NHS website.

Using an oximeter

  • It is important to check that the oximeter is working. The patient should have information about this (resources can be found on the FutureNHS Collaboration Platform and on the HSJ website). Is there a regional number for them to call if the oximeter stops working?

Speaking with a third party

  • What might influence which of these you choose?
    • Availability of telephone interpreters, clinical urgency of situation, consent obtained previously for that family member to speak
  • Family members can sometimes answer for patients rather than translating. However, this is not always a bad thing especially in older/confused pts. Where possible, try to get them to ask the patient and make sure the patient is in the same room at the start of the call.
  • Is it appropriate to use a relative to translate? Guide the conversation towards use of formal vs informal interpreters if necessary, i.e., their English is not good enough, you are concerned that they are answering without asking the patient
  • Consider use of interpreter to gain consent e.g., languageline or having patient speak enough English to give consent or continuing without consent
  • Good practice when speaking to a third party
    • Encourage patient participation when communication is an issue, ensuring that you are not just speaking to the third party.
    • Be careful of using technical language and break down information. Ask them to repeat back what they have understood.
    • Consider your local options for sending written information to the patient or their family. E.g., through text messaging service or email
  • Could the same be done for a patient with learning difficulties if a relative or carer answered the phone? This may still be a suitable communication method for someone with learning difficulties. Ensure that the patient is included in the dialogue and in the same room for the phone call, preferably on speaker phone. Resources for caring for patients with a Learning Disability can be found here.  

Deciding whether to admit a patient

  • Further information about the National Early Warning Score can be found on the RCP website.
  • Further information about a soft signs of deterioration tool (Significant 7) can be found on the UCLPartners website.
  • Further considerations include: access to social support, their disease trajectory, how they feel, patient choice and any presence of other worrying signs and symptoms such as chest pain, drowsiness, poor fluid intake, poor urine output.

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Accessing the FutureNHS Collaboration Platform

Oximetry at Home resources can be accessed through the FutureNHS Collaboration Platform.

  • For registered members: log on and click on My Workspaces, then Find a Workspace and search for NHS@Home Forum.
  • For new members to the platform visit https://future.nhs.uk/system/home, register for an account (as below) and request access to the NHS@Home Forum and National Deterioration Forum. 

a) Registering for an account

FutureNHS is open to anyone working in health and social care. You can become a member if you are invited to join a workspace by a workspace manager, or self-register on the platform if you work for a trusted organisation like the NHS and have an @nhs.net, @*.nhs.uk or @phe.gov.uk email address.

If you have a different email to these, you can request an invitation to join the FutureNHS platform through our new members page.

b) Joining workspaces

Once you have registered as a FutureNHS member, you will be able to search for and join more workspaces.

Open workspaces are available for any member to join freely, and restricted workspaces operate on a membership basis, where workspace managers can invite individuals or existing FutureNHS members can request to join. All open and restricted workspaces are searchable to all members, helping FutureNHS users to connect with other users, share information and build their communities

Contact

If you have any difficulties accessing the resources above or need accessibility support, please contact alexandra.hellyer@uclpartners.com