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REMEDY : BNSSG referral pathways & Joint Formulary

COVID Oximetry @ Home Virtual Ward

Checked: 21-10-2021 by vicky.ryan Next Review: 20-10-2022

COVID Oximetry pathway

Silent Hypoxia is a key COVID risk: leading to significant clinical implications. Patients in certain at risk groups may therefore benefit from oxygen monitoring at home.

The Oximetry@home service can monitor patients who have been diagnosed with COVID-19 and who are symptomatic but not requiring admission, in the following groups:

Clinical judgement is to be applied if the patient does not fit in the above criteria

From 2nd March 2021, Sirona will also be reviewing all those with positive results who are clinically at risk and those aged over 50 using test results available centrally and EMIS notes. They will proactively contact clinically suitable patients to add to the oximetry@home caseload. Sirona staff may have to contact GPs if there is a question around suitability for the service, but we anticipate that these contacts will be few. GPs, care homes, Severnside, SWAST and the Acute Trusts can, of course, continue to refer into the service as normal.

Onboarding

Patients to be provided with a pulse oximeter, safety netting information and contact details to report oximetry readings and symptoms

The patient information leaflets that are given to patients alongside their machine.

Monitoring

  1. Patients will report their SPO2 readings to SPA twice a day (at 08:00 and 15:00) for 14 days, both during weekdays and weekends
  2. Patients on an amber pathway will be monitored by Sirona clinicians
  3. Patients on a green or amber pathway whose SpO2 drops to 92% or lower will be advised to call 999 stating they are on the COVID virtual ward
  4. Patients on a green pathway whose SpO2 drops to 93-94% during in-hours (8:00-18:30) will be contacted by SPA to check their state and will then contact their GP via the back phone for further assessment M-F or OOH on weekends
  5. If patients on a green pathway experience a SpO2 drop to 93-94% during out-of-hours (18:30 - 8:00) the patient will contact 111.

Discharge

Patients will be discharged from the virtual ward after 14 days if their SpO2 levels remain 95% or higher

 

Referral

Patients with SpO2 92% or lower should be assessed for suitability for hospital admission (i.e. reasonable expectation that this will improve mortality from COVID illness for hospital admission for treatment for COVID-19)

Patients suitable for admission will be called through to the IUC weekday professional line (0117 2449283 Monday to Friday 8:30 – 18:30) or 999 if clinically appropriate

Patients with SpO2 93% or higher will be referred to the COVID Virtual Ward via BNSSG SPA: 0300 125 6789 or by emailing the referral form to sirona.bnssg.covidvw@nhs.net The service runs 8am - 6.30pm. Referrals are triaged and patients are contacted as soon as the referral is received within those hours. Referrals received out of hours are triaged at 8am the following day.

The EMIS Covid Pulse Oximeter Electronic Patient Referral Form is available for use on the OneCare EMIS Resource Publisher, or for download and manual import into your EMIS system at https://teamnet.clarity.co.uk/Library/ViewItem/ec9e74d2-b7ad-4b57-bca9-ac9a00d742bd

Treatment escalation plan (TEP)

When making a referral please give some information about treatment escalation planning. The Sirona team need to know that the patient is for escalation of care and what this might be.

The process is that, if the patient has a deterioration in O2 sats, then this will escalate care to the GP or 999 and there needs to have been agreement that the patient would be for some further step up of care such as oxygen or medication or HDU/ICU/ventilation. Patients with a DNAR in place may still be suitable for oxygen or other intervention so can still be referred.

 

Secondary Care Step down virtual ward

Patients who have had an admission in an acute hospital setting with Covid-related illness who are, determined by secondary care Consultants to be, safe to be monitored at home will be discharged to the Sirona-led CVW for ongoing monitoring. There are clear criteria for admission and escalation which have been approved by all parts of the system. Escalation will be to the referring hospital team

Patients will continue to be given a pulse oximeter by the referring clinical team, in addition to information and guidance on its use, they will have access to the InHealth care remote monitoring system, to input their symptoms and saturation levels.

Please see the new Standard Operating Procedure, Referral form and Patient information leaflet (which provide details of re-admission criteria and pathways.

 

Resources

Full version of the RECAP-V0 score (REMOTE COVID-19 ASSESSMENT FOR PRIMARY CARE)