COVID-19
The pandemic has changed everyone’s working life in some way this year and despite still going into the same hospital every day, my role has been vastly different. After doing contract work the majority of 2019, I was looking forward to developing in my new role as Surgery/ Gastro dietitian. Well, covid arrived and surgeries were cancelled! The surgery ward and IBD clinic I covered were now closed and cancelled too. As some staff went off shielding and others at high risk worked from home or office based, I felt like one of the few dietitians still stepping on to wards every day.
Prior to Covid, each of us dietitians seemed to have our own nice caseload- surgery, gastro, stroke, medicine for elderly, diabetes… Post covid the wards were split into Covid vs Non-Covid. The Covid wards are separated into Green, Amber, and Red zones. Green for hallways, Amber where the patients notes were kept, and Red in covid positive patient areas.
I know some dietitians at other hospitals have been gearing up in full PPE to brave the wards, however at my hospital, dietitians have been conducting remote reviews via telephone (for ICU) and entering only up to Amber zones in order to preserve PPE for those who absolutely need it. There had been a lot of mask scarcity in the beginning and even the waiting list to get FIT tested for an airborne N95 mask was weeks. Once people were tested, the masks which fit them (as there are various types) would often run out so there would still be no way for them to enter covid areas safely. My line manager also straight up told me I’d likely fail the fit test anyway as the masks are generally too large for those with petite faces (I still have to get my glasses in the children’s section!). :P
The other unfortunate aspect is that our hospital is still paper based! Ouch! We can collect some patient data via electronic record however our main entries are still handwritten on paper. Patient records were not allowed to leave the Covid wards either so the information for our assessment was dependent on the information we could gather from a terribly busy ICU nurse when we were able to get them on the phone!
ICU
We very much felt like an inconvenience ringing the ICU wards (which increased from 2 wards to 4 wards during the peak) knowing how busy they were. We’d often phone multiple times to catch them the moment they weren’t wrapped up treating the patient,then spout out all the patients info we needed as quickly as possible. After completing our assessments, we place them in an envelope, walk them over to the Critical Care corridor and drop them off to the ICU/HDU runner who would pass off our delivery to the next person going in.
The Covid ICU patients brought about a different challenge. ICU patients are often sedated, ventilated, and receive nutrition and medications via feeding tubes. It’s the dietitians job to determine their requirements and account for additional fat calories from sedatives.
One moment that sticks out is watching as the ICU ran out of one of the main sedatives- propofol. 2% propofol is typically given and has been for the amount of time I’ve been qualified and seeing ICU patients. It provides approximately 1.1 kcal/ml. Suddenly there was a shift to 1% propofol (due to running out of the 2%). Less sedative, meant increasing the amounts required so I was seeing much higher amounts of calories than usual from non-nutritive sources and kept checking my calculations. Next they ran out of the 1%! As I began to freak out, I was made aware that there are other sedatives to fall back on such as remifentanil and midazolam. Thank goodness!
Patients in the ICU with Covid were also needing to be proned- meaning turned belly down to improve oxidation to the lungs. This may be typical in hospitals that specialize in respiratory conditions, however it’s not the norm in ours.
Thankfully the British Dietitic Associations Critical Care group worked diligently to release free trainings and guidance for dietitians working with these patients.
MASKS
June 15th, it became compulsory in the UK for staff to wear surgical masks in all hospital areas. As more of the general public began entering the hospital grounds too, this made sense, however we all couldn’t help but think it felt a bit backwards starting to wear masks at that point rather than the 2 chaotic months prior. We had been previously been wearing masks on the wards, but not on the grounds, in the hallways, or in our office. Yikes!
We now gel and mask up as we enter the hospital for our shift.
It’s been hot the past days, so I’m feeling for all the staff who have a much more physical job and have to wear all the PPE. Our hospital/ office is without AC so we are sitting, dripping with sweat behind our masks and I’m constantly trying not to fog up my glasses! I’m always happy to be home and breathing freely again!
5 MONTHS OF COVID (August 2020)
Five months on, we are yet again in a different phase. The workers who were shielding have now been told to return to work and some office based workers may gradually be returning to the wards again. Surgeries have re-commenced and with it we now have “ultra-green” wards where the surgical patients and staff are kept separate from the rest of the hospital.
Our clinics are transitioning from telephone to video calls which seems pretty cool. I’m not sure when I’ll be covering clinic again though as I’m still needed on the wards, but I now get to help surgery patients again.
We can’t predict what will happen next, but we are all just hanging in there and trying to keep sane. During a time that’s been full of constant change, we all seem much more mentally drained and rather grateful that the on-going lockdown gives us an excuse for more quiet and relaxed weekends.
9 MONTHS OF COVID (December 2020)
As 2021 approaches, Covid remains a big deal and we’ve had a number of dietitians who have tested positive (some with symtoms and wome without) and had to be isolated. A few weeks ago they rolled out mandatory twice weekly swab testing via the lateral flow test. Staff are assigned 2 days per week to swab at home before work so I have the pleasure of swabbing myself on Mondays and Thursdays for 12 weeks.
In August, I was the first dietitian to be FIT tested and thus have been the main dietitian responsible for covering ICU and HDU. (What about the surgery and gastro wards I’m meant to be covering? Yes, trying to help cover those too!). The regular, white N95 mask did not fit my small face so I was fitted for an alternate one that suctions to my face instead! Thanks goodness I have done some breath work because the feeling can seem a bit suffocating at first and the first time going in I definitely felt panicky. Now I slowly breath in and out when there and can’t help wanting to say “I am your father.”
Due to our paper based system, I’m still trying to find the most efficient way to work and keep record as nothing is allowed in our out of the HDU ward. For now, I’m information gathering on the ward and typing it all the computer to send back to the office for calculations and assessments. It’s not the best place to be hanging around with limited space so I will often go elsewhere where I can breath easier to do my work and drop off to the runners outside the ward later.
Our clinics are up and running again (virtually) and surgeries are happening again as well. Never a shortage of work in the NHS!
