ABSTRACT
Background: Due to the steep increase of Covid-19 cases in March 2020, we established a PC ward for dying Covid-19 patients to support emergency/ intensive care medicine in the event of capacity shortages and to create a dignified PC. The station was up and running within 3 days, with both PC team members and volunteer nurses from non-palliative care units working together. Aims: To explore: How did staff and stakeholders experience the ward's ad hoc implementation? What are the lessons learned? Methods: A qualitative study was conducted (May-November 2020). 29 semi-structured interviews were led with PC staff, voluntarily enlisted staff and management, transcribed verbatim and a qualitative content analysis was performed. Results: Patient care and team collaboration were rated positively. Whereas the volunteers had the role of open-minded learners, the PC staff was considered as experts in end-of-life care and approachable instructors. The joint induction training proved to be central. This included a kick-off meeting and equipment training, the familiarization with the ward, training at the patient's bedside by the PC team as well as the support of the nursing/medical management. Named challenges were yet: On the volunteer side an adaption to PC routines and a different culture of care;balancing the high standards of PC against the backdrop of pandemic conditions on the PC team side. Also, criticism was levelled at the rapid opening of the ward as sufficient capacities at the other Covid-19 stations led to a low occupancy of the ward, staff overcrowding and frustration. Conclusion: Our study shows the possibility to establish an ad hoc acute PC unit, where PC staff in a short time can successfully train volunteers. Nevertheless, due to the unpredictable dynamics of a pandemic, management and staff should be prepared for both scenarios: a low as well as a high occupancy of the station and the burden that comes along with each challenge.
ABSTRACT
OBJECTIVE: The COVID-19 epidemic has had a strong impact on the entire healthcare sector in France with priority being given to research for new therapeutic options for COVID-19. Nevertheless, continuity of care for patients suffering from other diseases represents a crucial challenge, and clinical research is no exception in this respect. This study aims to assess the impact of the strict Covid-19 lockdown on non-Covid-19 clinical research in the French University Hospital of Strasbourg. MATERIALS AND METHODS: Clinical research activity (non-Covid-19) from the point of view of pharmacy department was estimated and compared to the pre-lockdown period. The impact of lockdown was assessed through five indicators: site initiation visits, the initiation of experimental therapies in non-Covid-19 patients, the delivery of non-Covid-19 investigational medical products, the number of drug shipments to patients' homes, and the number of monitoring or closure visits. RESULTS: During the study period, the number of site initiation visits decreased by 90%, total inclusions by 72%, and delivery of investigational medical products by 30%. During the lockdown period, 15 treatments were sent to patients' homes. Monitoring activity decreased by 98%. CONCLUSIONS: Although the COVID-19 outbreak has created an incredible momentum in the field of clinical research, research not focused on SaRS-CoV-2 has suffered greatly from this situation. The impact on patients is difficult to estimate but should be further investigated.