Perspectives

“It was the hardest of all my redeployment roles”

From door shifts on the entrance to the building, to reporting the data on patient deaths, optometrist Rose Wright tells OT  how her day job transformed when COVID-19 arrived at her hospital

people wearing face masks

I work as head of optometry and orthoptics at the Shrewsbury and Telford Hospitals NHS Trust. During the COVID-19 pandemic, while retaining my responsibilities in my substantive role, I was part-redeployed to support other departments in their response to the pandemic.

Redeployment has grown both my network of contacts and diversified my healthcare knowledge and skillset. I have a much better knowledge of PPE and a greater appreciation of the complexity involved in keeping people as safe as possible, while providing data to aid the ongoing management of the pandemic. I look forward to returning to my ophthalmology clinics soon with my new and improved email address book.

My redeployment activities

1/ Door triage

Back in April and May 2020, members of ophthalmology – including doctors, orthoptists and optometrists – rotated door shifts at the building’s entrance while many of the healthcare assistants and staff nurses were needed on the wards. It was fun – you felt like you were really on the front line and helping to protect patients, colleagues and visitors. It was heart-wrenching when you found someone with a high temperature, especially if it was a baby or someone high risk.

It was heart-wrenching when you found someone with a high temperature, especially if it was a baby or someone high risk

 


2/ Hood training

Staff members who failed to fit FFP3 respirator masks, but were required to enter red zones in the hospital – that is, high risk areas containing isolated infectious patients – or carry out aerosol generating procedures, have to wear PAPR units with helmet headtops. These are colloquially known as ‘hoods.’

Staff need user training before they use a hood for the first time, as they need to understand how the unit works, what the automated warning signals mean, and what action they need to take if the signal sounds.

The wearer is protected from aerosolised viral particles by filtered air being blown towards the face using positive air pressure. A belt with a battery pack and P3 filter is worn around the waist. A tube blows filtered air from the belt into the headtop. The positive air pressure prevents external air from being breathed in by the wearer. The wearer breaths filtered air, which can dry the eyes and mouth.

The weight of these hoods was a disadvantage to those with neck and back problems. A big advantage was that patients could see the faces of those they were receiving treatment from.

The hood stock was controlled by the theatre team. It was good to be exposed to another world, consisting of conversations about major surgeries and intensive care. I have the utmost respect for the team as they are the main team that care for the critically ill COVID-19 patients.

3/ FFP3 fit testing

FFP3 respirators are negative pressure devices worn to protect staff or visitors in red zones in hospitals. They are also indicated during aerosol generating procedures including intubation, endoscopy or swallow assessments. They need to be worn with adherence to manufacturer instructions. They must be fit-tested and donned correctly. The straps that go over the wearer’s head must not be crossed. The wearer performs a fit test to ensure the mask has sealed correctly on the face each time they don an FFP3, but this is not an adequate replacement for a fit test.

Fit tests can be done subjectively by taste (a qualitative fit test), or objectively using ambient particle count (a quantitative fit test). I, along with several orthoptists, was trained to perform a qualitative fit test subjectively using Bitrex, a bitter tasting chemical. The wearer was tested in a controlled environment performing several timed actions. If they could taste the Bitrex, the mask did not fit and an alternative mask or a PAPR unit/‘hood’ was recommended. I also fitted visitors with FFP3s so that they could visit their relatives in the ITU. This would always be an emotional time.

The news was on permanently in the room in case of a national incident. Other data such as PPE stock levels would be escalated if required

 

4/ Tactical Commander in the Incident Room

This was a pretty impressive title – and was the hardest of all my redeployment roles. I had previously wondered how the daily statistics on COVID-19 tests and deaths arrived onto the internet. As a tactical commander, I compiled data from several emails and databases and uploaded them to Government websites.

The information relating to COVID-19 patients was retrieved from 8.30am and was uploaded to a complicated form by 10am and submitted for approval. I worked with a loggist and strategic commander. We also had a minute-taker at the peak of the infections. Together we ran the Trust’s incident room.

The news was on permanently in the room in case of a national incident. Other data, such as PPE stock levels, would be escalated if required. The whiteboards were full of tasks and data, which would be updated throughout the day with task lists for the next day and following week.

I never thought I would be sending so many emails to the chief executive. If you needed information from someone, you would email them with a time deadline – I think I may adopt this strategy into normal practice. I also realised that if I rang my department from the incident room, my caller ID had quite an ominous effect.

Redeployment has grown both my network of contacts and diversified my healthcare knowledge and skillset

 

Rose Wright is head of optometry and orthoptics at the Shrewsbury and Telford Hospitals NHS Trust