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REMEDY : BNSSG referral pathways & Joint Formulary

COVID Oximetry @ Home Virtual Ward

Checked: 16-05-2022 by vicky.ryan Next Review: 11-05-2023

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.

There is national guidance to support these services NHS England » COVID Oximetry @home

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

  • Patients aged over 16 years and clinically extremely vulnerable who are within the criteria for the Covid Medicines Delivery Unit 
  • Pregnancy (any gestation) who are not fully vaccinated
  • Patients that are suitable for Covid Virtual Ward/step down from Acute bedded units / Emergency Departments/ obstetric units
  • Patients who have been assessed by another HCP e.g. primary care / 111 where a patient is considered to require support to self-monitor (ensuring consideration is given to wider @Home pathways where appropriate) see clinical judgement table below to support

Clinical judgement is to be applied if the patient does not fit in the above criteria and this list is being refined regularly in line with evidence. Current list here:

Unvaccinated or single vaccine

Severe Respiratory Condition e.g. COPD, C.F, Bronchiectasis


BMI > 35 (approx.)

Severe mental illness 

Active malignancy

Chronic heart  disease 

Down’s Syndrome

Homelessness

Black, Asian or an Ethnic minority

Immunosuppressed

On dialysis

Gypsy, Roman or Traveller community 

Diabetes 

Vulnerable (clinical or social concerns)

 

 

Case Finding

Sirona will also review all those with positive results who meet the criteria using test results available centrally from NHS Digital. Sirona will also review all those with positive results who are clinically at risk and those aged over 65 using test results available centrally from NHS Digital. 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.

All patients referred to the Covid Medicines Delivery Unit will also be proactively offered pulse oximetry monitoring @home

On-boarding

Sirona care & health deliver this service on behalf of Healthier Together @home

Patients to be provided with a pulse oximeter, safety netting information and contact details to report oximetry readings and symptoms by Sirona (community referral) or Acute Trust (Acute Trust referral). They will be offered a remote monitoring solution or daily calls to support input readings and allow health care professionals to view any escalation

Patients are encouraged to supportive self-care through this pathway with safety netting from health care professionals to support as required

The patient information leaflets that are given to patients alongside their machine include how to use equipment as well as safety netting/ escalation advice.

Monitoring & escalation

  • Patients will report their SPO2 readings to SPA twice a day (at 08:00 and 15:00) for up to 14 days, both during weekdays and weekends

Usual care pathway

  • Patients on an amber pathway will be monitored by Sirona clinicians
  • 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
  • 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
  • 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.

Amended care pathway (those with severe COPD/bronchiectasis and suitable for amended baseline SpO2 (88-92% target) 

  • Patients on a green or amber pathway whose SpO2 drops to 4%points below baseline or lower will be advised to call 999 stating they are on the COVID virtual ward
  • Patients on a green pathway whose SpO2 drops to 2-3% points from baseline during in-hours (8:00-18:30) will be contacted by SPA to check their state and will then contact their GP for further assessment
  • If patients on a green pathway experience a SpO2 drop to 2-3% points from baseline during out-of-hours (18:30 - 8:00) the patient will contact 111.

Pregnancy Pathway

  • This is an amended pathway reflecting guidance from Royal College Obstetrics & Gynaecologists
  • Patients on a pregnancy pathway whose SpO2 drops to 94% or below will be advised to call 999 stating they are on the COVID virtual ward and are pregnant
  • Patients whose SpO2 drops to 95% will contact their midwifery team
  1. UHBW: Contact Central Delivery Suite 01173425214/3
  2. NBT: Phone Quantock Assessment Unit and be invited in for assessment or advice given over the telephone 0117 4146906 (24 hrs)

Discharge

Patients will be discharged from the virtual ward after 14 days if their SpO2 levels remain 95% or higher for 3 days pre discharge 

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.

If the patient has a deterioration in O2 sats, 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 are admitted to 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 Healthier Together @ Home Covid Virtual Ward 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 should continue to be given a pulse oximeter by the referring clinical team, in addition to information and guidance on its use and safety netting information. Once in the community, staff from Sirona will contact and onboard to the InHealth care remote monitoring system, to input their symptoms and saturation levels.

Please see the new Standard Operating Procedure and Referral form 

Patient information leaflets (which provide details of re-admission criteria and pathways).

Patient Information Leaflet - NBT (Covid Virtual Ward patient diary)

Patient Information Leaflet - UHBW (Covid Virtual Ward patient diary)

This includes a pathway for pregnant ladies with amended escalation process

Resources

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