20:13:44: we have a query on agp on non covid wards particularly suction and whether this should be done on open wards 20:15:32 Universities who feel their final year students have met the required standards and done enough and have a sufficient breadth of experience will be put forward onto the HCPC temporary register and they can work as band 5 support workers(if they want to) . They will be encouraged to continue their academic studies as a priority so they can graduate with their degree and join the full HCPC register and will be able to become a fully registered chartered physiotherapist. All registrants must have met the required standards. 20:16:29 This eligibility will be decided by each university as every course is structured in a different way and this approach is supported by us here at CSP and HCPC. 20:16:52 Link to HEE student info https://www.hee.nhs.uk/sites/default/files/documents/AHP%20student%20support%20guide%20Covid-19.pdf 20:17:55 Quite a lot of the COVID patients are having a strong cough with a lot of sputum 20:18:29 https://www.csp.org.uk/news/coronavirus/students-higher-education-institutes information for students and 20:18:47 Thanks 20:19:17 advice is helpful thanks... what about full PPE for AGPs in nonCOVID patients. should we be using full PPE 20:20:28 We have had numerous members telling us that patients post covid are producing a lot of sputum throughout their rehab. one of our physios was covered from her chest to feet in phlegm the other day- are others also seeing this? 20:21:49 Thank you for that clarification, it was really useful. If you have a Covid patient with underlying lung conditions (e.g. COPD) or are productive, who you have to do ACBT etc with, does that constitute AGP as the guidelines seemed to suggest this was an AGP and today our head respiratory nurse said she viewed it as an AGP. 20:22:55 going back to my original question - on the ward I am on (+COVID ward recently off ventilation) when mobilising them, some cough ++ producing sputum - so I wanted to check that this is classes as a ‘droplet’ and surgical mask ok if so 20:23:06 thanks that’s really helpful my sense check was should be managed in side rooms if require suction 20:23:34 Our critical care physio's are reporting that the patients who have been ventilated, paralysed and proned for several weeks, are the patients who then have secretion problems. There are also some patients who have pre-existing lung conditions who are normally productive - they seem to become more productive with Covid, but often already have tools to self-manage their secretions. 20:27:33 maybe not risk assess for the ward, but for each patient? 20:28:41 Hi, could someone clarify if known how long before COVID patients are deemed non infective? we have been told 8 days but I am not sure did you just say 14 days? 20:30:28 This is where there is some confusion in the public domain, as the likes of Govenrment ministers seem to be isolating for 7 only days from having symptoms! 20:31:24 Would it be worthwhile considering if the patient could wear a mask for the ACBT? May or may not be practical, depending on the individual and amount fo secretions? 20:31:57 I think it’s important to remember that we are not expecting to eliminate risk, but reduce risk within reasonable levels. 20:32:30 I was told today that patients can still be COVID+ for 3-5 weeks depending on how ill they have been. This came from our infection control team 20:37:24 face to face MSK consultations now have very strict criteria. I work in primary care alongside GPs, they also stress the importance of face to face consultations only when 100% necessary. 20:37:45 https://www.csp.org.uk/news/coronavirus/private-practiceindependent-sector/private-practices-independent-sector-faqs#remote 20:38:01 Regarding risk assessments, remember that PPE is the last line of defence not the first thing you do. Prior consider asking is the procedure essential? How can it be modified in its delivery, eg increasing distance from patient as mentioned etc. 20:38:07 Hence, private practice face to face, for me, should follow the same guidelines. Many private practice colleagues I know are utilising virtual forums and successfully too. 20:40:11 From Angie Logan : we’ve also got patients with LTCs who’s rehab has stopped or never started, ems. stroke & neurology who are at risk of deteriorating. 20:40:48 i have offered my services to the NHS but it has been around 4 weeks - are the CSP working with NHS trusts re timescales and deployment areas. 20:40:49 can I clarify... are other trust treating AGPs with full PPE even in nonCOVID patients, or just those suspected and confirmed? 20:41:44 what have people found to be the main problems for paediatric pts? 20:41:45 We need rehab to be modelled, planned & funding. 20:42:08 At UHP in Plymouth ALL AGPs require Full PPE, including non-suspected cases 20:42:33 thanks 20:42:36 At North Bristol we’re treating AGPs with full PPE for ALL PATIENTS 20:42:48 👍 20:44:09 why is it that testers are wearing full boilersuits because of the risk of being coughed on in the outdoors, testing staff, but ward staff on Covid positive wards are not allowed the same PPE? 20:44:09 Please join us at the #physiotalk twitter chat pm Monday eve 27/4 at 8pm as we'll be discussing how we can maximise opportunities for the students to join the workforce to contribute (where they want to) in band 3 roles and how we can look at new opportunities for supervision models to enable these students to keep learning , Perhaps they could help meet the #rehab challenge? 20:44:48 We have had frail elderly patients that are covid positive in our community hospital (most of them didn't require acute admission so I appreciate that they must not have suffered so severely). They have presented a common theme of extreme fatigue for 14 days and then have started to pick up and have been able to participate in rehab and have done well and gone home. 20:45:06 do you think most of the rehab will be in hospitals 20:45:18 yes I registered nationally - and a nearby county has my cv - maybe we need to be prepared for rehab services ASAP? 20:48:20 Our experience is that most patients have issues with Fatigue, Breathlessness, Anxiety, Deconditioning and Delirium. Some people are recovering comparatively quickly but others are taking time to wean from traches and requiring quite intensive rehab (staffing and time wise) both in ICU and on the wards 20:48:36 any experience with peads from others. it has been very quiet in Bristol children’s hospital. 20:48:47 Thats really helpful. Perhaps we could have a phone chat some time? 20:49:22 We've been told not to see any community rehab patients. Concerned about the risks of patients not getting the rehab they need. Also need to consider how and when to safely start seeing them again 20:49:50 of course 20:50:15 One of my concerns is identifying the patients in the community who have had Covid, who may require rehab/support (including to enable return to work in due course). They may well have not sought any help during their self-isolation....I guess they may pop up through GP services with unresolved breathlessness and fatigue. WIthout testing, we have no idea how big this cohort of people might be, but we still need to think about planning to meet their needs. 20:52:05 absolutely, this is a big problem, particularly the longer this waiting for the peak period goes on and whilst it is critical to not overload the NHS re COVID, what is the longer term impact on funding and services and, of course, patients! 20:52:45 My wife works in falls prevention and the knowcj consequences in terms of morbidit, mortality and cost is going to be huge 20:53:07 just wondered what others have experienced with staff coming back to work? I’ve had a few of my team test positive who have tried to come back as feel okay at home but have struggled to even work for a few hours 20:54:13 Needs to be a whole MDT approach as my Dietitian colleagues have a lot of concerns about the nutrition for all of these people needing rehab 20:54:27 I am currently off and have been asked not to return until I feel completely normal.. my worry is how do I know when my symptoms have gone, I don’t want to infect my colleagues. I’m on a Covid ward 20:54:35 I totally agree, In our community hospital we have been asked to get our patients out as quickly as possible to free up beds ready for the surge from the acutes (still waiting), We have sorted care for the patients but we are aware they aren't going to get the same level of therapy input at home. I am going to keep a record of those patients that require rehab and see if we can work with community teams to ensure they get the rehab they need as soon as possible. 20:54:45 Is there any update on NHSE work on post covid rehab that Sally Singh has been involved with? 20:55:55 It's the same in our area - the only visits our community rehab team have been able to do are those that help prevent hospital admission. 20:56:18 We have also experience this with some staff and have found they have been off for a second period of time after coming back too soon. Am wondering about a phased return 20:56:26 Return to work: probably a discussion with HR and local managers in these uncertain times, and perhaps a phased return? 20:56:50 staged return surely... with trial and error 20:57:09 I have been on a phase return and that has really helped me doing a shorter day then ensuring I rest fully and nap to restore again, each day getting better 20:57:51 maybe even some working from home on non-clinical tasks too? 20:57:54 Definitely phased return and conversation with manager, plus get your steward involved!! 20:58:30 thanks everyone. Had put them on a phased return but it still wasn’t cutting it. I think people worried about not coming back despite it still being very quiet. 20:58:38 thanks 20:59:18 is anyone taking furlough in the NHS? 21:00:27 From Angie Logan : SW Peninsula meeting today was MDT. Work in Cornwall is also MDT. very important. 21:01:25 From Angie Logan : Rehab will be in different settings, but biggest drive for home-based but may not all be face to face. 21:01:41 Hi, think it will be difficult to judge and just got to go on what feels best and then reassess 21:01:42 I have a second job that normally works well in conjunction with my primary job, but this service is with community, and they are redeploying me. they are not sure where to put me... I would be interested in furlough. 21:01:43 We're using this as an opportunity to widen our CCU MDT to include OT, Dietitians and SLTs. We're also looking to link in with our Major Trauma Co-ordinators. 21:01:48 We are having patients discharged to hotels in Cornwall and are still working on getting Physio/OT input sorted.. 21:02:10 Telerehabilitation will be key. 21:02:37 Our trust have put together some guidance on furloughing staff but they’re reluctant to call it that. There are lots of boxes you have to check to be applicable for it and they feel it is only likely to affect “4 or 5” staff 21:02:48 CSP App Library has just launched and there is some useful info on there 21:02:50 From Angie Logan : it’s a huge cultural shift for all of us. 21:03:03 In Wiltshire they are working up a deconditioning pathway, is this something others are doing? 21:04:30 Our elderly frail have generally been quite resilient 21:05:03 It's been those middle aged with co-morbidities who have required ICU and required more intensive rehab 21:05:09 totally agree with that. I am on the same kind of ward with very similar presentations. 21:05:35 From Angie Logan : can you share more about the pathway? 21:06:41 We have a team at Torbay starting to work on a fatigue type pathway 21:07:27 At Derriford our catchment area includes East Cornwall and West Devon. To that end we're linking in with the Community Respiratory teams to provide follow up services and potentially some limited Outreach from ICU, to help facilitate discharges 21:09:39 Yes please 21:09:50 IS anyone talking to therapists outside of the southwest to see if these pathways have already been written, ie london 21:10:19 IMO the key is going to be linking in with as many other specialty colleagues as possible. From experience in Rheumatology, there were many ME/CFS patients who would need weeks/months of non-exercise related treatments (pacing, energy conservation etc) before exploring exercise, or indeed progressive exercise treatments. Again, case by case basis I think. 21:10:21 Bath Centre for Fatigue services are working on post-Covid advice. 21:10:31 Good point. I am not sure. I will find out. 21:11:31 From Angie Logan : angie.logan@plymouth.ac.uk agree. The SW Peninsula COVID rehab is not speciality/condition specific, it’s rehab & MDT 21:13:38 We have expert OT colleagues who head up the BCFS. I am sure they would be keen to link in with the MDT working group with their fatigue mgt rehab knowledge and insight. 21:13:42 We have the full MDT in critical care in Truro and it works really well. OT, Physio, DT and SLT 21:15:46 True, my guys in ESD (O) were keen to support in the hotels but Tina was concerned they would get overwhelmed. Tbf they have been pretty busy just moving the trauma out of SMH 21:16:14 sorry guys. ignore that! 21:19:38 Hello, has anyone had experience of adults with learning disabilities coming into hospital with COVID-19? I am a community LD physio 21:20:54 Given the symptoms described in this group of patients including PTSD and anxiety how are the experts in the evidence base for treatment being included in planning 21:21:33 Forgot to add our MDT includes a Psychologist :) 21:24:09 heres a link to Lancashire teaching hospitals online covid MDT rehab support package .. also tweeted the SW group https://www.pslhub.org/learn/coronavirus-covid19/tips/lancashire-teaching-hospital-covid-19-supporting-your-recovery-post-discharge-from-hospital-r2104/ 21:26:06 Please do think about how students can help your teams and if you can offer them learning in support worker roles there is a funding stream to support this! More hand on for rehab input! Thanks all 21:26:23 thanks all! 21:26:29 Thanks, this was really useful. 21:26:34 Thanks 21:26:35 thank you! 21:26:41 Thanks you!