THE Intensive Care Unit (ICU) at Warrington Hospital has cared for the very sickest patients during the Covid-19 pandemic.

Doctors, nurses and healthcare assistants (HCAs) have cared for hundreds of patients with extremely complex needs in an environment that has been effectively sealed off from the rest of the hospital - to control the risk of spreading the infection.

At the beginning of the pandemic several of the trust’s most experienced ICU nurses were advised to shield and have been working from home or in non-clinical roles. This meant the trust lost a lot of specialist skills from the team at a time when they were most needed.

ICU teams are working extra shifts, performing complicated and demanding specialist tasks while wearing full protective equipment.

They have cared for patients as changes have been made to the unit. Adaptations ensured patients remained isolated while oxygen, power and waste management systems were upgraded.

The unprecedented demand meant that for long periods during the pandemic ICU didn’t have enough space to accommodate all patients. So the unit had to extend into other areas including operating theatre wards which were adapted for ICU use.

Sadly, ICU staff have seen many of their patients lose the fight against Covid-19.

“We’re only human. It can be heart-breaking and exhausting but you can’t let your heart rule your head, the work still has to be done.” says Lesley Howlett, ICU sister and a nurse of more than 30 years’ experience. “You couldn’t do this job if you didn’t have some coping mechanisms and the support of brilliant colleagues and family. But it’s been really tough, bewildering at times.”

To fill the gaps in the team, nurses from across the trust have volunteered to work in ICU. Some nurses from within the team have acted-up to fill leadership roles, one of whom is Carla Preston.

She’s been amazed by the way junior nurses have performed:

“They’re my heroes those nurses," she said.

"Some of them newly qualified or coming into ICU for the first time. It’s been beyond high pressure but they’ve embraced it, learned so fast. Our shielding team-mates have been working from home doing essential tasks. They’ve helped with training, rotas and sourcing vital equipment like ventilators and elements for dialysis machines. I’m so proud of all of them.”

Due to the risks of infection, the trust had a policy of restricted visiting except for patients in multi organ failure at the end of life.

Lesley says this has been one of the most distressing factors of the pandemic “We ensured families were safe by testing to ensure respiratory masks fitted visitors properly. Wearing full personal protective equipment enabled them to wear full PPE and be with their loved ones.

“It’s devastating for families that they can’t see their loved one when they are desperately ill”, says Lesley. “It’s so hard to tell people they can’t be with their partner, parent or friend at what may be the worst moment of their life, but it may be even tougher to ask them to wear full PPE to say goodbye to their loved ones.”

Carla says the team tried to be innovative to help create connections for loved ones.

She added: “We pass on and read personal messages to patients. We are facilitating many video call conversations. We also introduced our knitted hearts, the patient has one heart with them at all times and their loved ones keep another matching heart.”

The sickest ICU patients can be on a ventilator and have 10 drip (drug) lines, as well as requiring regular antibiotics and even kidney dialysis.

Lesley says supporting these patients is challenging even for the most experienced teams.

She added: “At times, nurses have each been carrying out and monitoring all those procedures for two patients. This requires very high levels of skill and professionalism and means we have to maintain a constant presence.”

“Our patients were never on their own”, says Carla, “We make sure as a team – doctors, nurses, HCAs – that there is always someone there to support everyone in our care.”

Looking ahead there are some really positive things happening for the Intensive Care Unit.

“We’re building a dedicated garden for the unit”, says Lesley, “Getting patients outside when possible can make such a difference to their mood and recovery. It’s something we had planned before the pandemic and hopefully we can deliver it soon.”

The unit is also being extended, integrating with a neighbouring ward to provide more high dependency beds for patients that don’t require full ICU support but need specialist care.

Carla believes the trust will benefit from the experiences teams have gained during the Covid-19 response

“Those nurses and HCAs have been forged in fire," she said.

"It’s been like a fast track for leadership. The skills, confidence and resilience they have will be a fantastic resource for the hospital in years to come. The relationships and faith we’ve built with colleagues across the trust, in every department, means we understand each other’s needs better now.”

Lesley is proud too “This whole trust lived up to our values, under real pressure. We’ve always treated our patients with personal care and dignity. When I stop to think about it, we’re a fairly small district general hospital trust and to do what we have this year is incredible.”