Covid 19 coronavirus: Big Read – What went wrong at Waitakere Hospital?

Three older nursing home residents are dead and seven nurses who cared for them at Waitakere Hospital have been infected with Covid-19. Kirsty Johnston reports on what went wrong.

Nurses in the hospital ward who cared for six older Covid-19 patients received only three hours to prepare, after it was discovered that the patients’ nursing home had no backup plan and the situation had turned every increasingly “insecure”.

The decision to transfer sick residents from St Margaret’s nursing home in West Auckland to Waitakere Hospital was made in the midst of a “difficult, evolutionary and intense” time, exacerbated by staff shortages, PPE problems, poor communication , an investigation into how the nurses arrived. to catch the virus has revealed.

It occurs when seven hospital nurses are confirmed to have Covid-19. Three of the patients have died.

READ MORE:
• Covid 19 coronavirus: Waitematā DHB nurses in St Margaret’s rest home worked on hospital shifts
• Coronavirus Covid 19: Son of Te Atatu resident of the nursing home waiting for the results of the virus test
• Covid Coronavirus 19: Ambulances and security descend on Auckland’s St. Margaret nursing home
• Covid 19 coronavirus: two new cases today, both linked to St Margaret’s

The report, produced by independent panel members, including Waikato DHB chief nurse and midwife, and a representative from the New Zealand Nurses Organization, sets out the chain of events that led three nurses to become infected.

It describes how the worsening situation at St. Margaret’s evolved so rapidly that senior officials were not informed of the decision to relocate residents until they were on their way.

He said that despite daily meetings between the nursing home and the health board’s incident management team, it had not been discussed what would happen if it was not safe to manage residents on the premises.

As concerns over staff increased, it became apparent that residents were unable to stay at the house over the weekend. “As a result, the decision to transfer residents had to be made quickly on a Friday, which is not ideal,” the report said. Admission routes were not followed, increasing confusion.

Staffing Concerns and Dismissed PPE

The report says that a nursing list for the new room was quickly developed, bringing together staff from all units that had not necessarily worked together before. However, because the hospital was so understaffed, some nurses worked in all wards.

Despite multiple staff concerns, this would spread the virus, she continued until the nurses got sick, despite an earlier review.

When the patients arrived on Friday, April 17, they were placed in an overflow room, according to the report, rather than a negative pressure room, because they were not believed to be critically ill.

However, this turned out to be a poor choice, as the patients deteriorated rapidly to the point that they needed a high level of comprehensive nursing care.

One required oxygen, everyone was confined to their beds. They were incontinent, everyone coughed and couldn’t follow instructions. They all depended entirely on the staff for their personal care.

The report found that nurses had access to full personal protective equipment (PPE). But there was one problem after another. For example, because medical staff did not go to the ward, staff had to leave patient rooms several times in turn to call the geriatrician. They also had to go find equipment and medicine.

This took nurses a long time and not standard practice. It also meant that nurses had to put on and take off PPE up to eight times per shift.

“It is well known that putting on and taking off PPE, in particular taking off, is a high risk of viral transmission, and therefore it is important to try to minimize the number of times this occurs,” the report said. “This needs to be balanced with the need to ensure that staff are not unnecessarily exposed for prolonged periods in closed rooms with confirmed Covid-19 patients.”

Also, some of the PPE did not fit or were uncomfortable. The velcro tabs on the back of the dresses were easily loosened, creating gaps on the back.

The initial glasses provided were a frame with a removable lens. The lens was a hard plastic that could move when removed. Initially, the lens needed to be cleaned. The alternative glasses provided a few days later had a disposable lens. Later, the glasses were changed to glasses that did not fit some staff members, who had to wear a tie to keep them in place.

The original N95 masks, the gold standard, sold out and were replaced by a different type of N95, which did not fit. Despite asking for more of the original type, the nursing manager in charge was told that they were not needed, and that “N95 was reserved for high-risk areas” and the room was deemed “low risk.”

The changes in supply, combined with overwhelming and constantly changing information about the PPE, made the staff stressful, according to the report.

The panel praised the manager and geriatrician for advocating that the nursing staff have a constant supply of high-quality PPE, and said DHB needs to listen to staff concerns.

“With the high viral load of patients with poor Covid along with their incontinence and their needs for complete care, this area should have been considered a high-risk area, automatically receiving N95 masks,” he said.

‘We are deeply saddened that these nurses have become infected’

The report described one day, April 20, detailing it as “particularly busy and challenging.”

One patient deteriorated rapidly during the day with progressively increasing oxygen needs, he said.

“One of the patients died and had to be placed in a waterproof body bag, which was different from the standard bag.”

“This was a particularly stressful time for staff as some patients were ill, confused, incontinent, and requiring complete attention. This was the only time that the three nurses who tested positive for Covid-19 worked in the room on the same day. “

In an appendix from the Auckland regional public health service, he said those three nurses, and the four colleagues who would later become infected, were likely to get the virus from that ward; or spread from person to person.

The report says the nursing staff provided exemplary care to the six patients in the ward; They were compassionate, professional and worked to ensure that patients received the best possible care, according to the report.

Waitemata District Board of Health Deputy Executive Director Dr. Andrew Brant said the report would be used to improve how similar situations would be handled in the future and apologized to staff.

“We are deeply saddened that these nurses became infected with Covid. They were being disinterested in caring for others in the midst of a difficult, evolutionary and intense situation at St. Margaret’s,” he said.

“We recognize their professionalism in caring for St. Margaret’s patients and regret that they became ill in the course of their work.”

The report said earlier backup planning could have helped manage the situation.

For example, the neighborhood team could have been configured, familiarized with the processes in the neighborhood and the scenarios practiced.

Brant said: “Although we prepared as best we could, admitting Covid-positive St Margaret residents has put stress on our DHB and staff.

“The report released today shows that our staff was well trained and personal protective equipment (PPE) was worn at all times. We have also had confirmation that preparations at Waitakere Hospital were well underway to receive and care for Covid patients. “

“Clearly, however, there are some things we could have done better and learned from.”