The COVID-19 pandemic impacted all NHS services and NHS staff. Unlike many other stoma and pouch care services, which limited their services during the pandemic, ours continued to provide uninterrupted care throughout by successfully streamlining continuous stoma and pouch services for all patients who needed operations or support in acute hospital settings and the community.
However, the beginning of the pandemic brought a lot of uncertainties and called for quick planning and the implementation of many changes in a very short period. Our service transformed into a fully digital service, implementing remote working, digital technologies, virtual clinics, digital patient information leaflets and the publication of a patient self-care handbook.
All this was necessary as our hospital base at the time became a major receiving centre for COVID-positive patients, and surgical patients were relocated to private hospitals to avoid delays in care. Therefore, for the next 2 years, our Stoma and Pouch Care Nursing Team was providing care across three or five hospitals at a time. Around a year into the pandemic it became even more challenging to provide uninterrupted care because we had to relocate to a different hospital for our base.
Furthermore, the longer the pandemic went on, the more staff across the NHS began to feel overwhelmed, burnt out and underappreciated. Our team was no exception and members of staff were feeling the burden of the pandemic and the pressures on our service.
To continue providing uninterrupted care for our patients we ensured that appropriate personal protective equipment was available when reviewing patients in face-to-face outpatient clinics and in inpatient and community settings. The service became paperless, and we introduced flexible and remote working, virtual clinics, digital advice lines, and other digital tools, in order to support patients who could not attend hospitals.
Digital technology
Our nursing team has developed and implemented processes around the use of digital technologies and remote working in stoma and pouch care, including virtual clinics, a digital advice line, remote working, digital services, and patient self-care tools.
We have produced digital information flashcards, which we email to patients and other health professionals, successfully managing complications remotely and empowering patients to self-care.
Some of the digital technologies include:
- Virtual patient consultations
- Telephone consultations and telephone support via advice lines
- Email support for patients
- Digital patient information available to download and email
- Website with updated information
- Video call stoma teaching with family/carers
- Video-recorded step-by-step care plans
- Webinars supporting local and national support groups
- Remote working from home for improved work–life balance, and aid with social distancing restrictions
- Enhanced communication and co-ordination via electronic handovers and paperless documentation
- Virtual teaching for health professionals.
Furthermore, use of digital technologies facilitated our efforts in continuing to provide essential training and support for other health professionals, the wider multidisciplinary team (MDT), and support groups, helping to ease anxieties related to COVID-19 and stoma and pouch care. By doing this, we could ensure that patients were well supported across all hospital sites, as we could not provide a full-time service for all sites due to a limited workforce caused by staff sickness, shielding, and isolation after COVID screening. Furthermore, the implementation of virtual teaching sessions, conferences, webinars, and MDT meetings has contributed to more easily accessible staff development.
Additionally, the digitalisation of the service and the implementation of remote working and working from home helped with social distancing in the presence of limited office and clinical space. Workforce planning was also easier to co-ordinate across multiple sites when all staff were equipped to work remotely.
Virtual services
The implementation of digital services in stoma and pouch care has been of great importance to developing stoma care services where traditionally patients were seen in face-to-face settings. The use of virtual consultations for assessment and management of stoma patients allowed for the delivery of an innovative approach to stoma and pouch care nursing. Virtual clinics and telephone and email advice lines allowed us to use our clinical spaces more effectively, and ensure we support patients in a timely manner and without delays. It has also prevented appointment cancellations – patients who could not attend hospital were offered a remote consultation.
Ensuring that continuous services were maintained throughout the pandemic and that patients were fully supported has relieved pressures on busy GP practices and consultants, as well as the emergency department, as we were able to prevent hundreds of appointments and hospital admissions. Digital clinics, as well as telephone and email advice lines, allowed us to mitigate the risks of COVID-19 infections and ease patient and staff anxieties about the potential risks of transmission.
Digital clinics user feedback has revealed that the patients found the remote consultations an appropriate substitute for face-to-face clinics, allowing more flexibility, and savings on transport and childcare costs and avoided absence from work and school.
Patient handbook
A patient handbook was created to ensure patients have the right resources at home to self-manage their stoma when services around the UK were limited. The 182-page book covers topics such as pre- and postoperative care, complication management, living with a stoma, and the cost of stoma care, as well as testimonials from patients. It is structured in such a way as to ensure that patients can be guided and empowered to manage their stoma independently and reduces the need to be seen in clinic by a stoma nurse.
The creation of a stoma care handbook has contributed to an easy transition for patients from hospital to community settings, enabling patients to self-manage stoma care and be guided through all aspects of daily life with a stoma, without having to attend clinics and GP practices. The handbook included answers to frequently asked questions so that minor complications could be managed independently by patients.
Patients and other health professionals have provided feedback on the handbook, saying that it has been an invaluable resource for the independent management of stoma patients.
Benefits for staff
The digitalisation of our services and the publication of our patient handbook have allowed us to continue to support patients throughout the pandemic. It has helped the team to be effective, efficient, and able to maintain an adequate work–life balance, facilitating flexibility in working hours while working across different sites. As a result, patients' needs were addressed in a timely manner with fewer distractions, less room for error and clinical incidents and with fewer patient complaints being raised.
Workforce planning was also easier to co-ordinate across multiple sites. Flexible working, working remotely, digitalisation of services, and producing digital information leaflets, as well as the stoma patient handbook required investment in infrastructure, workforce, and IT literacy education programmes for health workers.
Furthermore, facilitating working from home and flexible working in nursing is novel and innovative, and requires careful planning and investment in IT equipment. Staff were provided with work-from-home bundles – work laptops with a virtual private network (VPN), work phones, and headphones.
Implementing change requires time and skills and a lot of the work done was achieved significantly earlier than anticipated because some members of staff worked beyond their working hours on their own initiative to develop the digital tools and prepare the patient handbook.
It was also essential that patients had access to digital services and could use them. It was crucial that patients were assisted as required so that those who were not proficient with technologies were not disadvantaged.
Overcoming challenges
The Trust management and HR department had concerns because there were no guidelines on remote working. This was further exacerbated by the lack of understanding of how specialist nursing services are run.
Some of the team are originally from overseas and visited their home countries on annual leave. Guided by NHS Employers' recommendations for overseas remote working, we tried implementing remote working from abroad, using our work-from-home bundles with VPN-secured laptops, for staff willing to do bank shifts while away, to ensure safe staffing levels when service staff were on leave. However, we were not able to implement this because of concerns raised by the HR department. There was a lack of understanding of how nursing duties could be performed remotely, without taking into consideration that a large part of clinical nurse specialist roles are desk based, through the use of advice lines, remote consultations and work on research, audits, education, leadership and management.
Lastly, although there are still a lot of challenges, remote working is the future of NHS and there is still a lot of work to be done to ensure it is used to its full potential to ensure that both staff and patients have better opportunities to provide and receive care.
The team were pleased to receive a Silver Award in the Stoma Care Nurse of the Year category of the BJN Awards 2023.