Your inpatient stay during the coronavirus (COVID-19) pandemic

Introduction 

Chelsea and Westminster Hospital NHS Foundation Trust is proud to be one of the top performing and safest trusts in the UK. We employ more than 6,000 staff over our two main hospital sites, Chelsea and Westminster Hospital and West Middlesex University Hospital, and across a number of community-based clinics within North West London.

We want to provide you with the very best care and help you to be as healthy as possible. To do that, it is important that you know what to expect and that we know what matters to you. This way, we can work with you to make sure you have a comfortable and safe stay, and get home or on to the next stage of your care without any delays.

We have changed the way we run our hospitals in response to the coronavirus pandemic to keep our patients, visitors and staff safe.  You may be asked to go to a different site or use a different entrance than the one you expected.  

This booklet explains how our services have changed and explains what your care may now involve. Your clinical team will provide specific information about your ward and your treatment. Our response to coronavirus continues to evolve as we learn more about the disease. We will update this booklet as new guidance becomes available.  (Reviewed 14 July 2020)

Changes in response to the coronavirus pandemic

Changes to our services

We are now working to resume or expand services curtailed during the pandemic. We have made a number of changes to ensure we can treat everyone safely.

Changes to admissions

You may be concerned about being in the same hospital as patients being treated for coronavirus if you do not have the virus yourself.

However, we would like to reassure you we are doing everything we can to separate patients with coronavirus and those who are being treated for other conditions.

Our staff are also following the most up to-date advice on infection prevention control from Public Health England (PHE), as described in this booklet.

Changes on our wards

We made changes to our wards to care for patients with coronavirus together in one place.

Grouping patients who have coronavirus on wards together minimises the risk of spreading the virus.

We aim to provide patients with same sex accommodation. We always try to keep individual bays as same-sex and ensure privacy and dignity at all times.

Stopping the spread of infection in hospital

To stop the spread of the virus we are following advice set out by PHE, using personal protective equipment (PPE) in specific situations, practicing social distancing and increasing handwashing and cleaning.

Hospital zones

We ask all visitors to the hospital to wear a face covering. It is best if you can being your own but if you do not have one a mask can be provided. Very young children and those with breathing difficulties are exempt.

Our hospitals have been set up in three zones, identified by three colours—red, green and blue.

Red zones care for our highest risk patients and patients entering these areas will be accompanied by staff wearing full PPE. Green zones are medium to low risk areas and blue zones are clean zones.

Each zone has different PPE requirements. Staff have been trained to ensure they wear the correct PPE as recommended by PHE.

In blue zones from 15 June, staff will be wearing masks. These will not be the same masks they have used in clinical areas.

In red and green zones:

• If a staff member is more than two metres away from a patient but within a patient care area they will wear a surgical mask and may also wear eye protection
• When performing direct patient care, staff will wear a disposable apron, a surgical mask, disposable gloves and eye protection in most circumstances.
• When carrying out high risk procedures, staff will wear a visor, respirator mask, a gown and disposable gloves

We know it can be harder to hear staff speaking when they are wearing masks and when you cannot see their facial expressions. Let staff know if you cannot hear or understand them clearly. Please let us know if you are hard of hearing or lip-read or have any other communication difficulties.

Patients may be required to wear certain types of PPE as instructed by staff while in red and green zones, when moving between wards, when being taken home from hospital, or while awaiting a coronavirus test result.

We will provide you with these, if needed, and you can ask anytime if you would like a fresh mask.

Clean your hands regularly

To help reduce the spread of infection, including coronavirus, you should wash your hands with soap and water often and for at least 20 seconds. Where soap and water are not available, please use hand sanitiser gel.

Please wash your hands (or apply hand sanitiser gel):

• before eating—ask a member of staff if you need any help and a hand wipe will also be provided on your meal tray to make hand hygiene before eating easier
• thoroughly with soap and water after using the toilet
• before entering or leaving a ward— hand sanitiser gel dispensers are near the entrances to all wards

Always avoid touching your eyes, nose and mouth with unwashed hands.

Testing for coronavirus

To make sure we are doing all we can to reduce the spread of coronavirus, all patients in our care will be tested for coronavirus.

Many patients with coronavirus will have symptoms—such as a new continuous cough, a high temperature or a loss of taste or smell—however, people can also have coronavirus but not have any symptoms (asymptomatic), or can be in the very early stages of coronavirus infection and go on to develop symptoms later (pre-symptomatic).

We know that patients with both asymptomatic and pre-symptomatic coronavirus infection can pass the virus on to others.

The test for coronavirus test is done using a swab. The swab is used to sample your throat and nose. The test will only show if you have coronavirus at the time the swab was taken, but will not tell you if you have had coronavirus previously.

We have different requirements for testing if you attend as an emergency or an elective (planned) admission. Staff caring for you will explain the correct process for you.

Keeping in touch with your family

Permitted visitors

• Adult wards: One named visitor per patient can visit during 3-7pm seven days a week. This must always be the same person. 
• End of life care patients who are negative for COVID-19: Can have more than one family member visiting at any one time. End of life care patients who are positive with COVID-19 can have one family member visiting wearing appropriate PPE. Visiting times need to be agreed locally.
• Maternity: One birth partner as before, but they can now visit for the antenatal, intrapartum and postnatal stay, but cannot stay overnight in the antenatal and postnatal period. In exceptional circumstances a woman may be able to have a second birth supporter (please discuss this with your midwife if you feel this applies to you) and this would need to be agreed by the Head of Midwifery. Partners can also be present for scan appointments. Children are not allowed to attend appointments or be present in the maternity units.
• Paediatric wards: Two family members can visit if they live in the same household, they can both visit together. They must always be the same people.  

• one birth partner

Please speak to the nurse or midwife in charge of the ward or unit to consider any exceptional arrangements.

Any visitors who are allowed must:

• not come to the hospital if feeling unwell, including any cold or flu symptoms
• wash or gel their hands as soon as they enter a ward or unit
• follow the additional measures that will be requested by our staff if visiting a patient with an infection.
• Wear appropriate face coverings or mask

Virtual visiting

With the support of our hospital charity CW+, we are giving wards tablets for patients to use for virtual visiting if they do not have access to their own device. Speak to staff on your ward for more details.

A message for you

If your friends or relatives would like to send you a message via email that you would like us to print for you, they can visit the A message for you page and fill out the online form.

What you need to know about your care

Our clinical teams

During the pandemic, some staff have moved from their usual role or area to work in other roles or areas where they are needed.

They will all have the training and skills needed for the work they have been asked to do but they may be less familiar with the environment.

Four important questions to know about your care

There are four key questions that we need to make sure you always have the answers to:

• Why am I in hospital?
• What’s happening today? (eg “I’m having a scan” or “I’m going to be reviewed by an occupational therapist”)
• When am I leaving hospital?
• What needs to happen before I can leave hospital?

If you don’t know the answer to any of these questions, please ask a doctor at the ward round or a nurse on your ward.

Taking part in clinical research

With our close links to Imperial College London, many of our clinicians are involved in research. This helps us to develop and offer new and better diagnostics and treatments. There are already several trials and studies underway relating to coronavirus, and more planned in the near future.

You may be invited to take part in a clinical trial. It is your decision whether to participate and, if you decide not to, it will not affect your care in any way.

Getting better and staying well

Food choices

Medications may change the taste of food, make you feel nauseated (sick), or you may find it difficult to swallow. If you don’t have much of an appetite, try eating little and often and, if you miss a meal, please do speak to a member of staff who can order a snack box for you.

Our standard menu has a range of choices, including at least one vegetarian option. You should have a menu at your bedside and, each morning, the ward host will ask you which meals you would like for that day.

You can also ask for special menus:

• cultural needs, eg halal or kosher
• specific dietary needs, eg gluten-free
• modified texture menus for patients with difficulty swallowing

The ward host can also help answer any questions about the menu. A range of drinks and snacks are available between meals and before bed. Drinks include hot drinks such as tea and coffee and cold drinks such as water, milk and squash. Snacks include biscuits, cakes and fresh fruit.

If you are not eating and drinking well, nursing staff can make build-up milkshakes and soups for you. We will offer you hot and cold drinks throughout the day. If you need more, please ask.

Help with eating and drinking

We can help you with your meal—for example, opening any packaging and supporting you to eat. We use red trays to let staff know which patients need help with eating or that the amount of food they eat needs to be recorded.

Try to sit out of bed and in a chair for all your meals, as this helps improve digestion and reduces the risk of food going down the wrong way.

Staying active

Getting up and moving is important. It helps maintain muscle strength and fitness and for you to remain as independent as possible. It also helps with your breathing by allowing you to use more of your lung capacity. If you feel strong enough, you should try to stand up and walk. Speak to a member of staff if you need help and you should only attempt to stand up and walk if you are feeling strong enough.

If you do not feel strong enough, try to do exercises in the chair or bed. If you have coronavirus and you would like more information on chair or bed exercises, breathing exercises, or permission to walk around the ward, please speak to a nurse.

Getting a good night’s sleep

Sleep and rest supports healing and recovery. Being in hospital can make sleeping difficult because of different noises and interruptions disturbing you at night.

We will make sure we play our part at night by lowering the ward lights and limiting unwanted sounds such as telephones and monitor alarms, talking quietly and only disturbing you if really necessary. We can give you an eye mask or ear plugs if you are having trouble sleeping— ask a member of staff if you would like them.

Please talk to us if you have any worries or concerns that are keeping you awake. If you need more support, we can arrange it for you so please don’t be afraid to ask.

Looking after your emotional wellbeing

Serious illnesses can be distressing for patients and their friends and relatives. The pandemic is creating additional stress and concern for many.

Understanding the normal responses to a stressful experience can help make sense of what you are going through. This may be during the illness or in the days, weeks or even months after. Some normal physical and emotional responses might include:

• feeling vulnerable, emotional, on edge
• intrusive thoughts or flashbacks
• disrupted sleep
• avoiding things you previously enjoyed
• loss of appetite or ‘comfort eating’
• headaches or muscular tension While we each manage things in our own way, there are some things that most people will find helpful, such as:
• talking about what has happened— you are less likely to experience lasting effects if you can talk about what has happened
• spending time with people you trust— this will need to be via telephone or video while social distancing measures are in place but it is still important and possible
• being gentle with your self— understand that it could take time to recover
• taking care of yourself—get enough sleep and eat well, but avoid drugs and alcohol as they can numb feelings but may prevent you coming to terms with what has happened

For tips on supporting mental wellbeing during coronavirus and links to NHS approved sites, please see Every Mind Matters.

If you have concerns about your emotional wellbeing, you should speak to your GP.

Planning for leaving hospital

When is it ok to leave hospital?

When you no longer need acute or specialist care, your discharge plan will be put in place so you can go home.

You may still need considerable rehabilitation or support to help with daily living but this will generally be better provided at home or possibly in a community hospital, nursing home or care home.

Once you are able to continue your recovery at home, a member of staff will explain what is going to happen next and provide you with supporting information.

Getting ready to leave hospital to go home

Most patients can return home after their hospital stay without needing a lot of additional support in place. Once you have an expected date for discharge, please make arrangements to travel home.

You may need help getting home. If you have a relative or friend who can collect you from hospital, you should arrange this with them ahead of your discharge date.

Patients with certain conditions or needs will be able to use hospital transport—please ask your ward staff if you think you might be eligible for this.

If possible, ask your family or friends to help make it easier to go back home by:

• bringing in clothes and shoes for you
• stocking your fridge and cupboards with essential items
• putting the heating on, if needed
• making sure you have your house keys
• making sure you have enough money for the first few days

It is also important that, where possible, your family or friends are able to support you on the day you go home. Please try to keep two metres’ distance from others. We know this might not be possible in some situations.

What happens if I’m not well enough to return home?

We will provide those patients who are moving into a care or nursing home after leaving hospital with information about the next stage of their care. We can support you to share this information with your relatives via email.

Unfortunately, patients will not have a choice of which home they will be discharged to at this time. This is a temporary measure and the placement can be revised once restrictions related to coronavirus are lifted.

You will be assessed in the care home by health and social care professionals with the aim for you to return home when this is possible.

For now, any new or increased care and support services arranged as part of your discharge will be funded by the NHS and, therefore, are not subject to financial assessment for a contribution by your local authority.

However, should you require ongoing care and support from adult social care, once the NHS funding has ended, the local authority will carry out a financial assessment for any contribution you need to make towards that care.

Helping patients who need support to leave hospital

We have discharge teams at both our hospital sites, available seven days a week, to help patients with complex needs. Otherwise, your ward team can help you to understand your options.

Home First and discharge to assess

These are community services that allow you to leave hospital as soon as you are well enough and to have your discharge assessment carried out at home. We want to make sure that you only spend as much time in hospital as necessary.

A member of the community care team will assess you at home within two hours of leaving hospital to make sure you have the right support to help you recover.

They will talk to you and see if you have any additional needs and ensure you are fully supported in carrying out daily activities such as washing, dressing and preparing meals.

The kind of support you could be offered includes:

• equipment to help you at home
• regular visits from a home care worker, if required, to help build your confidence in doing things for yourself
• a goal and plan for your care and recovery.

How long you receive support depends on your needs. You will be reviewed a few days after you get home and, if you need ongoing support, we will refer you to follow-up services in the community.

Leaving hospital—on the day and next steps

We try to make sure as many hospital discharges as possible take place in the morning before midday. This means you have the best part of the day to settle into the next steps for you. It also means that we make best use of our inpatient beds by ensuring they are ready for new patients.

Please make sure you ask us for any medical certificates you may need before your day of discharge so, for example, you can have time off work to recover. You should also know who to contact once you get home if you have any urgent questions or concerns.

We look to get all of these actions sorted out early so that we don’t delay your discharge. We also try to make other practical arrangements, such as transport, in good time.

Discharge for patients with coronavirus

Patients who are discharged with symptoms of coronavirus or have tested positive for coronavirus will be given information that is relevant to your current living situation, including self-isolation guidance.

It is important that you read and follow this advice as you may still have live coronavirus in your body after your symptoms have cleared up and you are ready to go home. A member of staff will go through this information with you to help you understand what you need to do when you leave hospital.

Extra help and services

Carers

We recognise the importance of working in partnership with carers so that they receive the support they need to help our patients. Speak to the nurse in charge if you have a carer or if you are a carer.

Dementia support

Being in hospital can be difficult for patients with dementia. We have a dedicated older adults team who provide additional support, advice, information and bespoke care planning for people with dementia and their families. Anyone can refer an inpatient to the older adults team, including carers, family members or patients themselves.

Patients with learning disabilities

We advise all patients with learning disabilities to bring a carer on the day of your admission to help us understand your needs and preferences. Please also bring your hospital passport if you have one.

Spiritual and pastoral care

Our multi-faith prayer rooms on both hospital sites remain open 24/7 but allow only two people at a time to prevent the spread of coronavirus.

Chaplains work as part of the wider healthcare teams across our hospitals and can provide patient-centred care to those of all faiths of no faith. The chaplaincy team is available 24/7.