The Covid Oximetry at Home work (sometimes called a "virtual ward") describes an enhanced package of care for individuals with confirmed or suspected Covid-19 who are at risk for future deterioration. NHS England and Improvement has written to all CCGs and trusts to encourage the development of local CO@H projects, as outlined in this SOP.
The package of care involves the remote monitoring of the individual's condition through providing regular contact with a local health care team who will reassess the individuals symptoms (including oxygen saturation levels). This close monitoring enables the individual to remain at their usual place of residence whilst allowing early signs of deterioration to be identified and escalated quickly and appropriately.
This material has been designed primarily for use across the South East AHSN network by colleagues within the Wessex AHSN, Kent Surrey Sussex AHSN and Oxford AHSN regions. Colleagues from regions beyond the South East are also very welcome to make use of this toolkit in setting up their own local approaches to remote monitoring.
NHS England and NHS Improvement is working with Academic Health Science Networks and local areas to support the continued set-up of 'Covid Oximetry @home' services (also known as 'Covid virtual wards'). This is one of the priority goals for the additional £150m General Practice Covid Capacity Expansion Fund and is already used in many areas to help detect earlier deterioration of people with Covid-19, both in the community and in care homes.
For more information about the support available to set up local Oximetry @home services, join the FutureNHS platform: https://future.nhs.uk/NHSatH/grouphome
All CCGs can continue to request oximeters for local use by emailing firstname.lastname@example.org. Allocation will take account of local infection rates and previous requests.
As individuals with Covid-19 who are at risk of poorer outcomes can be identified by reduced oxygen saturation levels, Covid virtual wards (CVWs) provide opportunity for health care teams to identify those who require further treatment (including admission to hospital) quickly, and is an approach that has been linked to improved mortality rates and the number of Covid-19 patients requiring intensive care admission and ventilation.
Below are links to some resources that further explain the use and benefits of CVWs.
Using the experiences of CVW pilot sites developed during the first surge of Covid-19, there are six key steps that are recommended you follow to support you to set up a CVW.
1. Engage the local pathway through your AHSN
2. Form a stakeholder delivery group
3. Design and agree your model; this includes example standard operating procedures
4. Develop your implementation strategy and implement it; this includes examples of system wide strategies
5. Request pulse oximeters early; guidance on where to get pulse oximeters and how to manage logistics
6. Developing a local learning system
As the use of CVWs is a new approach that should be adjusted according to local need, an important part of developing a CVW is the consideration of how lessons you learn are shared both internally and externally. To support teams in sharing and using learning from CVW implementation, a national learning system is operating via the FutureNHS National Deterioration Forum where additional resources are shared and questions raised via a discussion forum.
As Covid virtual wards are developed around the country, it may become more practical to develop local/regional learning systems. If you work in Hampshire, Dorset or on the Isle of Wight, contact us at Wessex Patient Safety Collaborative for further details.
If you work in an area not covered by Wessex, please see the bottom of this page for contacts for KSS and Oxford AHSNs.
Effective measurement is central to understanding the quality of care being provided, and to supporting any efforts to improve care measurement can show us important information on:
• How well our current process is performing
• Whether we have reached our aim
• How much variation there is
• Small tests of change
• Whether the changes made have led to improvement
• Whether a change has been sustained
These resources provide evaluation of virtual ward models and examples of patient experience surveys.
Should you require any help with measurement and evaluation methods, please contact your local Patient Safety Collaborative:
Resources including patient information leaflets and videos, including multilingual versions
To help you set up your virtual ward, this section includes top tips, case stories, training videos and e-learning to support the management of deterioration in care home and domiciliary care settings, e.g. Restore2TM
Please note that this document is being regularly updated. The latest version will appear here.