COVID-19: Working together for RECOVERY

By Marion Evans, Cancer Research Locality Manager; Julie Machin, Supportive & Palliative Care Research Nurse; Alison Bland, Research Nurse; Emily Eaton, Research Nurse and Dr Adam Farmer, Consultant Gastroenterologist at University Hospitals North Midlands NHS Trust (UHNM)

Marion (pictured) says:

‘On 6 April, we all met at County Hospital in Stafford (which is part of UHNM) to receive training for the RECOVERY Trial and to start recruiting to the study. We met the Lead Consultant, Dr Adam Farmer, who showed us around the ward which had been designated for COVID-19 patients - we began recruiting straight away and by the end of the second day we had recruited ten patients - we certainly hit the ground running!

‘Since then we have recruited 50 patients as a result of seamless collaboration between the medical and nursing teams. For example, the doctors have been completing the eligibility criteria as they do their ward rounds and providing participant information sheets as they consult with their patients.

‘This allows the potential participants to be introduced to the study in preparation for us to talk through the trial and receive consent if patients wish to participate. The most difficult thing has been wearing PPE whilst communicating with patients, as sometimes patients find it difficult to hear you.

‘For example, one patient we talked to was deaf but very capable so in order to overcome this, the medical team telephoned the lady’s son following her permission via a written note and also communicated with her via notes. In some cases with very sick patients we contacted the patient’s next of kin to ask for their consent for their loved ones to participate in the study. The nursing team have helped us with communicating the outcome of the randomisation to their patients which has meant we have saved on PPE and unnecessary exposure to coronavirus.’

Alison says:

‘Working on ward 14 at County Hospital, Stafford has been a roller-coaster of ups and downs - the highs of clapping patients out of the ward as they are discharged home to the lows of days where lives are sadly lost. The team as a whole feels the shift in emotions of everyone involved and this can be challenging and something we are having to adapt to.

‘But all of the staff pulling together - research nurses, ward staff, doctors, pharmacy, and many more, is making it a very rewarding experience and the comradeship of all the staff is amazing, at what is a difficult time for everyone. This teamwork has enabled the RECOVERY trial to run really smoothly at this site and our recruitment figures reflect this. ’

Emily says:

‘As a Research Nurse for NIHR Clinical Research Network West Midlands (CRN WM), we are used to going out to placements within well-established teams. It’s like starting a new job every few months! They have working systems, paperwork, routines and professional relationships ready and waiting for us when we walk through the door.

However, since starting our most recent placement at County Hospital Stafford, we have become a brand-new team! And what a team we are.

‘We had no choice but to hit the ground running. Although the RECOVERY Trial was up and running at the Trust’s other site at Stoke, our brief was to get things going at County Hospital. It’s been such an enjoyable, satisfying challenge.

‘We’ve come up with new ideas and new ways of working almost daily, growing, evolving and adapting each other’s existing ideas. Our results speak for themselves; our recruitment process runs smoothly from liaising with the doctors to giving the patients information and receiving consent. We have designed checklists, document trackers, and used an already established whiteboard system and so much more to ensure a seamless service. Enabling us to give our brave patients who are worried, the confidence to participate in this essential research.’

Julie says:

‘Good honest communication is key. We each work part time so may have been out of the loop for days. We have a handwritten communication book in our shared office for updates, amendments and process issues, a WhatsApp group for quick responses, and we are able to swap shifts around each other if something crops up. The ward team are cohesive and enthusiastic and rightly proud of their care, compassion and now their contribution to the RECOVERY trial.

‘Pharmacy are also very slick. They have really clear procedures for study drug management and prescribing, monitoring stocks for the ward, following patients who are transferred to other areas and responding immediately to any requests.’

Dr Adam Farmer says:

‘It has been a pleasure to work with the CRN WM team during the pandemic to help deliver the RECOVERY trial. It really has been a great example of how clinical research can be delivered efficiently, flexibly and safely when it is done as a collaborative process unashamedly positioned at the centre of a patient’s care.

‘It has been very satisfying to involve junior medical staff who have been a key component in delivering the study. I hope they have been bitten by the research bug as I was 20 years ago! Undertaking board rounds three times per day, and having the research delivery team as an integral part of this aspect of clinical care, has been transformative in the early identification and recruitment of participants. We also have taken the time to eat together on a Friday lunchtime – enjoying pizza – which has been great for morale although not so good for our waist lines!’

What have we learnt?

The delivery of the Recovery trial has also been a learning process in terms of different ways of working using a protocol that has a great degree of flexibility written into it. Also working with teams who are motivated and engaged to deliver research, which is a national priority, has been excellent and refreshing.

We are pleased that the study has has shown that dexamethasone, a steroid, significantly reduces the risk of dying from COVID19 for seriously ill patients requiring respiratory intervention - a major breakthrough.

Acknowledgements

A huge thank you to Dr Helen McCreedy, Dr Jaimie Marshall, Dr James White, Dr Sara Church, Dr Ibraham and Advanced Nurse Practitioner Jo Humphries, all of the staff on Ward 14 and most importantly, to all of the patients who have participated.

Dr Farmer has written a letter of appreciation to the CRN WM Chief Operating Officer to express his thanks to the team.

The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR or the Department of Health and Social Care.