TTRNA updated on NCRHA Covid-19 preparedness: Concerns still persistncrha

In Photo from left to right in clockwise manner: Dr. Gerald Hutchinson – Professor Psychiatry, COO – Ms. Stacey Thomas , GM Industrial Relations – Mr. Rawle George, Nursing Supevisor (Ag.) – Ms. Selima Mohammed, GM Nursing – Ms. Claudette Fraser Udika, TTRNA 2nd Vice President – Ms. Letitia Cox, TTRNA President – Mr. Idi Stuart, NCRHA CEO – Mr. Davlin Thomas. (Not in photo Dr. Paul)

The Trinidad and Tobago Registered Nurses Association (TTRNA) met on Friday 3rd March 2020, with the North Central Regional Health Authority (NCRHA) CEO – Mr. Davlin Thomas, and his executive management team, to discuss the measures they are putting in place for treating with Covid-19 disease in the Region.

While many issues were raised, the Association focused on four (4) main areas that were of concern to our members in light of the recent exposure of staff to confirmed Covid-19 patients at Eric Williams Medical Sciences Complex (EWMSC). They included, but were not limited to the following:

  1. Quarantine/Pandemic leave
  2. Transportation of suspected/confirmed Covid-19 patients between facilities.
  3. Treatment and housing of suspected/confirmed Covid-19 patients prior to transferring out to Caura and Couva facilities.
  4. Quarantine/Housing of Nurses treating suspected/confirmed Covid-19 patients.

 

  1. Quarantine/Pandemic leave

Ambiguity prevails over NCRHA granting any leave outside the usual sick leave. The Association was initially assured by Dr. Paul that if staff is placed on mandatory quarantine after coming into direct contact with positive Covid-19 patients without the use of full PPEs, and develops symptoms within 7days post monitoring, quarantine leave will be utilised, which would not affect the person’s sick leave.

However, the CEO refuted said position and reiterated the position made by the Minister of Labour last month. Therefore, at the NCRHA, staff who develop any symptoms, will be required to utilise their sick leave in the first instance. If staff, becomes ill later in the year, consideration will be given by the NCRHA on how that will be treated with. This remains a serious concern for the Association

What was made clear, is that the national policy of placing persons who are suspected of coming into direct contact with positive patients, does not now apply to nursing personnel, and by extension healthcare workers. A new draft policy has been prepared and awaiting to be adopted. In the interim, the NCRHA will be following this new protocol.

However, 48 hours after the meeting, TTRNA was notified that all staff who were exposed, have now been placed on mandatory quarantine at home. TTRNA understands that the situation is a fluid one. Nevertheless, it sees the fluctuating, almost daily policy changes as not helpful in generating confidence amongst staff and by extension the population they care for.

  1. Transportation of suspected/confirmed Covid-19 patients between facilities

ncrha 2

Head of Global Medical Response of Trinidad and Tobago (GMRTT), Paul Anderson, Health Minister Terrence Deyalsingh display the one isolation pod (iso-pod) which will be used for any suspected cases of COVID-19. Photo by Jermaine Cruickshank. Retrieved from https://trinidadexpress.com/news/local/stop-the-panic/article_738b9e9c-5e85-11ea-a769-8f3a142bb8da.html

 

The Association has been following intently the daily media briefings held by the Government and the Ministry of Health. The Association has not heard of any changes to the original policy provided on the Wednesday 4th March 2020 by the Minister of Health, therefore, GMRTT ambulances remain the only means to be utilised for transporting Covid-19 patients.

The Minister and head of GMRTT assured the National population, that the sole iso-pod (in photo above) is sufficient to cater for all transfers in Trinidad, and it will be shared between GMRTT fleet of ambulances. NCRHA management held a divergent view though from what was publicly stated by the Minister of Health. NCRHA will be using the non-emergency transport vehicles, currently used as Ambulances, to transport suspected and confirmed patients between health facilities. The CEO indicated that the previous policy was impractical.

However, barring any change in policy or laws, TTRNA will be advising our members to desist from accompanying patients in these transport vehicles as it is not within your job specifications or part of Government policy.  

  1. Treatment and housing of suspected/confirmed Covid-19 patients prior to transferring out to Caura and Couva facilities.

The Association expressed our grave concern and recommended solutions as to the way forward in managing admissions. This is post the incident last week where two (2) patients who eventually tested Covid-19 positive after spending considerable time on Adult Cardiology Ward 2 in EWMSC. The subsequent exposure of these nurses who were not wearing required PPE’s to treat such patients due to delayed diagnosis, is indeed unfortunate and should be prevented from reoccurring.

The Association recommended robust screening at A&E Department, side rooms to be identified on each ward to house patients in the first 48-72 hours while monitored for developing symptoms, and having assigned staff donned with appropriate PPEs to care for these patients. These patients will eventually be moved into the general population of the ward once no symptoms develop and they are still in need of hospitalization.

If one symptom is present upon admission and patient requires hospitalization, then the patients should be immediately tested and housed at Caura until receipt of results. TTRNA hopes these recommendations will find favour with management.

  1. Quarantine/Housing of Nurses treating suspected/confirmed Covid-19 patients.

The Association was pleased to be informed, that preparations are underway to provide facilities for nurses at Couva Multi-Training facility and at Caura Hospital to allow nurses to be housed away from their homes, after treating with patients. This has been an issue the Association has been lobbying for as our members have been contacting us with the challenges they have been faced with since taking up duty at these facilities. What was not made clear, is if this will be mandatory for staff to be quarantined following a cycle on duty, or if it is solely voluntary. TTRNA will be closely monitoring the progress of these facilities and related policy.

Other issues

The CEO confirmed that NO ADDED incentive/remuneration is being given to nurses who are working in these high risk areas. The basic and specialization POOL RATES would apply. Neither Government nor the RHAs has considered or approved any different rates. TTRNA will be submitting our detailed proposal for Hazard Allowance to the Ministry of Health and Ministry of Finance, for their consideration. This document will be in addition to what the Association submitted more than two (2) weeks ago to the Ministry of Health, without any response.

TTRNA also expressed concerns regarding rotation of staff in these units, cleaning of wards, availability of PPEs, and flexi-time for staff. TTRNA was surprised to learn that there are NO GM pool nurses (or nurses working without proper contract) at Caura or Couva hospitals. This is due to the number of complaints coming from new nurses, who would have been called out to work with the region after being at home for 2 years plus. They indicated to us that they have not been given any official document or contract that spells out the terms of employment. TTRNA will be contacting these nurses to confirm the validity of the Region’s assertions.

The CEO elaborated on a number of other initiatives being under taken by the NCRHA. Some of these include the interventions being made by Dr. Hutchinson, as he rolls out psychological support for staff. This is inclusive of a hotline phone number. Also Arima Hospital should be coming on stream in the not too distant future.

TTRNA thanks the CEO of NCRHA – Mr. Davlin Thomas, for meeting with the only Nurses Union in Trinidad and Tobago, to provide clarity on a number of issues affecting our large membership. TTRNA sees this new interaction between the NCRHA and the union, as a progressive measure to allow both sides to present their perspectives While we may not always agree, the mutual respect and cordial relationship, would be for the benefit of all parties.  

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