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COVID oximetry@home implementation: Phase 2 rapid implementation

Patient pathway and inclusion criteria

Key tasks

  • Agree patient pathway
  • Agree inclusion criteria
  • Is there a clear referral process for your COVID Oximetry @ Home service?
  • Is there a standard operating procedure to support you and your staff to deliver your COVID Oximetry @ Home service?

Further information

Key learning from pilots:

difficult to do non-verbal assessment using telephone and video consultation alone. Some patient groups are difficult to monitor remotely e.g. homeless community; monitoring using an app only model is not sufficient for all populations.

You can access example SOPs on the FutureNHS collaboration platform.

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Agree staffing/ delivery model

Key tasks

  • Have you agreed on how your COVID oximetry@home service will be delivered?
  • Have you considered how patients will be supported over a 24/7 period?
  • Have you identified what needs to be included in patient packs to deliver the COVID oximetry@home service effectively?
  • Do you have support from your local leaders to develop your COVID oximetry@home service?
  • Do you know how much additional money you will need to set up your COVID oximetry@home service?
  • Is there funding available to you to support extra staffing to deliver your 24/7 COVID oximetry@home service?
  • Do you know how you will need to start up your COVID oximetry@home service?
  • Do you have the staff you need to deliver your COVID oximetry@home service?
  • Do your staff have the right skills to be able to deliver your COVID oximetry@home service?
  • Have you shared your pathways with the regional ambulance service? And have these been agreed?

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Pulse oximeters/ logistics

Key tasks

  • Do you know how many pulse oximeters you will need for your COVID oximetry@home service?
  • Do you know which areas already have pulse oximeters, and where the gaps are?
  • Establish contact with NHS @ Home team to identify existing pulse oximeter distribution and logistical processes
  • If you need more pulse oximeters do you know how to request them? How to apply for pulse oximeters
  • Do you have an agreed process to deliver and collect pulse oximeters to patients?
  • Are you aware of the Fire & Rescue Service (FRS) – oximeter storage and delivery offer?
  • Are you happy with the process of decontaminating pulse oximeters?
  • Is there a process in place for patient troubleshooting/ replacement?

Further information

FAQs around pulse oximeters collated from pilot sites and learning webinars by Oxford AHSN*:

How many pulse oximeters do we need?
As a rough guide and suggestions from pilot sites
• 30 per GP practice (8,000 population)
• 300 per acute trust (600,000 population)
• 1 per 25 care home residents
Care homes may have already been supplied with pulse oximeters during the initial pandemic so it is worth checking with your system.
Can patients use their own?
Yes. All products, provided they are CE kite marked, are safe to use in the 90%+ range (they may be less accurate below 90), but don’t use smartphones as oximeters.
Make sure you provide education information with any device – see patient information videos and leaflets within the Covid-19 Virtual Ward toolkit.
Can paediatrics use the devices?
No. Most devices are suitable for people aged 16 and over. Specialist equipment designed for paediatrics and specialist team assessment should be considered. Covid-19 cases requiring escalation are rare in children, but it is important to consider other conditions such as sepsis that require immediate support.

* FAQ are evolving as we learn, this guidance is dated 13 October 2020.

You can find a presentation from NHS Volunteers using pharmacists as distribution hubs here.

In support of the response to COVID19 the Fire & Rescue Service (FRS) has undertaken a number of additional activities aimed at protecting the most vulnerable, including the delivery of essential items such as medication and medical supplies. As part of this national undertaking Fire & Rescue Services have been made aware that they may be asked to assist partners to securely store a quantity of pulse oximeters for community use; they are also able to assist with the safe delivery of these essential medical items should that be required. Clinical Commissioning Groups can contact their local FRS to further discuss local arrangements through local FRS websites.

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Care homes/ domiciliary care

Key tasks

  • Continue to promote and support care providers in RESTORE2TM virtual training
  • Look for more information and book onto training
  • Watch RESTORE2 video for GPs and PCN leads (in development)

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Communication

Key tasks

  • Agree communications plan
  • Agree training information for healthcare professionals
  • Do you know how you will communicate your COVID oximetry@home service to colleagues?
  • Have you linked in with your organisation’s communications lead to promote the COVID oximetry@home service?
  • Do you have access to patient information leaflets in different formats and different languages respecting cultural and physical needs?
  • Do you need to develop information posters and leaflets to share how patients and staff can use your COVID oximetry@home service?
  • Review existing materials/ resources developed to support implementation of COVID oximetry@home models
  • Identify additional materials required by local teams to implement models
  • Identify language need of, and formats for, supporting patients to use CVW model (including safe and appropriate use of oximeter, patient diary and safety netting i.e. escalation)
  • Identify how you will involve patients and carers in the development of materials

Further information

Useful links:

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Digital

Key tasks

  • Do you have an IT system that allows you to document, monitor and share patients’ symptoms?
  • Do you need extra digital resources to support you in delivering your COVID oximetry@home service?
  • Liaise with NHSX to ensure appropriate support for digital implementation

Read our recent blog on: Five questions to help you select the right digital solutions for remote monitoring during COVID-19 
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Sharing and learning

Key tasks

  • Do you know how you will receive and review patient feedback to review the COVID oximetry@home service?
  • Do you know how you will regularly review new best practice resources to ensure information and knowledge is up-to-date?
  • Have you identified opportunities for sharing your learning and best practice approaches with other clinical colleagues?
  • Have you considered sharing your learning with other local and national Collaboratives and networks?
  • Develop FAQ following lessons learned by implementing teams

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Read other sections of the implementation toolkit or return to the COVID Oximetry at Home landing page

Phase 1
Phase 1: preparing the system
Phase 2
Phase 2: rapid implementation
Phase 3: ongoing sustainability