NHS statement

29/03/2020

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Information for home parenteral nutrition (HPN) patients

Updated 27 March 2020 with the latest government advice on keepng yourself safe

Help us to help keep you safe during the COVID-19 pandemic

Your hospital clinical teams, homecare providers and the national NHS bodies are working closely together to ensure your service continues with minimal disruption throughout this time. This information is to help you understand what measures are being put in place by your hospital clinical teams and homecare providers to protect you and continue to provide a safe service. The government is urging everyone to pull together and there are things that you and your family can do to help as well. Over the next few months the pressure on the NHS and the homecare companies will be unprecedented. As it is not known how the situation will develop, the NHS and homecare providers are planning for all possible situations.

The plans your hospital and homecare providers are already putting into place include

Introducing a new doorstop procedure for deliveries. This is available on the NCHA website. Please see below for more details on the changes that have been put in place for your deliveries.
When required staff will wear protective equipment and follow the national guidance on this.
Ensuring you/your child has a supply of alternative products in your home at all times.
For patients who have nursing, your homecare provider may contact you to ask you or a family member to consider being trained on part or all of your procedures. This will be discussed with you before it is initiated.
Your homecare provider may contact you to ask you if there are aspects of your daily or weekly care routine that you or a family member could take on in the short term, for example a weekly dressing change if this is undertaken by a homecare nurse.

How you can help the NHS

Please continue to follow the government’s advice on regular hand washing and social distancing. All the government advice including travel advice and advice for employees is available here: www.gov.uk/government/topical-events/coronavirus-covid-19-uk-government-response and health information for members of the public is available here: www.nhs.uk/conditions/coronavirus-covid-19/
Please only order your usual amount of ancillary items. The amount of nutrition you need clinically has not changed. Ordering more than you need only places more pressure on the NHS and puts other patients at risk.
If you have nursing care, please consider which aspects of your care you or a family member could undertake temporarily.
Please do not stockpile or share ancillaries.
Please ensure your home parenteral nutrition (HPN) provider has a current email address and mobile number for you. If you wish to set up an additional ‘contact’ for your homecare service at this time, please let your HPN provider know.
Please be understanding if there are changes to your delivery times and days or if changes to your nursing visit window.
If you feed fewer than seven days a week, please understand if there needs to be changes to the days of the week you feed if nursing capacity is reduced.

Deliveries

If the items being delivered do not need to be refrigerated and are not heavy, the driver will now be advised to leave the items in a secure place with prior agreement with you.

You do not need to sign for your delivery. Your driver will ring the bell and wait at a distance for you to answer the door. You will be asked a series of questions and the driver will sign to confirm you have received your delivery. Delivery drivers will not leave products unattended, in full view.

For deliveries into the home, you, and all other members of your household, should move to another room while the delivery takes place. Although many of you have regular drivers and this social contact is important, at this time please do not interact with your delivery staff unless it is absolutely essential. It may not be possible for you to have the same drivers you usually have.

If you have items that need to be returned, please contact your homecare provider before leaving anything for the delivery driver.

Keeping yourself safe

The government is regularly updating its guidance on at-risk groups. In light of the latest information your hospital teams now consider that patients on HPN are a high-risk group, as you/your child have significant organ impairment (GI) and a central venous access device in place. This advice is endorsed by the British Society of Gastroenterology. It advises you to follow the guidance on 'shielding' stringently, as outlined by the government, and you are strongly advised to stay at home and avoid any face-to-face contact for at least 12 weeks in the first instance.

This can be challenging but the consensus is it is the best way to keep yourself/your child safe.

For advice on how to keep yourself as safe as possible plese visit: www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

Staff entering your home

Homecare providers and hospitals are already working to find ways to reduce the need for staff to enter your home as a precautionary measure. This may mean there are aspects of your usual daily or weekly care routine your homecare provider may ask you to take on in the short term; for example, a weekly dressing change if this is undertaken by a homecare nurse.

The main aim of all the steps is to protect you, the drivers and the nurses and prevent the spread of coronavirus.

Seeing staff use extra protective equipment where needed, may be upsetting and may also raise issues of confidentiality. However, in order to protect you and those involved in your care, protective clothing may be required in line with the government’s guidance. All steps will be taken to do this as sensitively as possible.

Before entering your home, homecare staff may contact you to check if you, or anyone in your household has symptoms of COVID-19 and are self-isolating for this reason. This will allow them to take the right precautions for all concerned, before they enter your home.

The protective clothing may appear different from time to time as suppliers change or alternative supplies are used. All clothing will have been assessed as appropriate.

Alternative products as a safety measure

Hospital teams and homecare providers are already planning ahead to ensure that you/your child’s treatment continues as usual with minimal disruption. However, for you/your child’s safety, everyone involved in your care wants to ensure you have an alternative product ready in your home in case it is needed; for example if a high number of homecare delivery drivers become sick or if the homecare pharmacy team do not have enough staff and are unable to make or supply the usual parenteral nutrition.

To ensure you/your child has a supply of alternative products in your home at all times, your healthcare team will have arranged for a supply of multi-chamber bags and/or fluids for you to use only if your normal delivery or products are not available. This is a safety measure, to ensure that you already have something in your home ready to use. You will be notified if these need to be used. There may be some people excluded from using these, individuals will be notified.

Your healthcare team will make the closest match possible, as even this would be better than nothing in the worst-case scenario of you having nothing to infuse. If your child was usually receiving a separate fat bag, information will be provided for ‘all-in-one’ bags. If you have had a reaction to a MCB in the past, you will be given the option of having them and managing the reaction. For example, if they made you feel sick, you may decide you would rather put up with some nausea rather than have no feed at all. If the reaction you had was severe ,then you will have to have IV fluids and oral supplements. Although this is not ideal, in the worst-case scenario it may be the only option.

Please do not stockpile ancillary items, you will be supported with maintaining an adequate supply. The NHS and homecare providers are working together to ensure the balance between demand and supply is as stable as possible. You may receive additional supplies if your delivery frequency needs to change.

For us to support you and maintain an even supply into the home, please do not share your supplies with other patients or family members.

Patients who have nursing care

Your homecare provider may ask you or a family member to consider being trained on part or all of your procedures, if possible. This will be discussed with you before it is initiated. This would reduce the need for nurses to enter your home during a time when you may have increased anxiety about social contact.

If the nursing workforce becomes reduced, it may be necessary to change your infusion time to 24 hourly per feed to ensure your homecare nurses can continue to visit as many patients as possible.

Holidays

Government restrictions and guidance are being updated regularly. Please see PINNT’s advice on travel.

Latest government and health advice

For all the latest government advice please visit: www.gov.uk/government/topical-events/coronavirus-covid-19-uk-government-responseand for health advice for members of the public visit: https://www.nhs.uk/conditions/coronavirus-covid-19/

Thank you for your support and patience throughout this.

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