Expert Witness on the frontline of Covid response in Advanced Nurse Practitioner role

For the last year Advanced Nurse Practitioner and Jane James and Associates Expert Witness Catherine Cooper has been at the forefront of her GP practice’s efforts to keep staff and patients safe and since December, the monumental endeavour to vaccinate a patient list of around 20,000. She talks about the challenges that she has faced.

The nurses from Catherine Cooper’s busy GP practice filed into a meeting room, while she, alongside colleagues, prepared to deliver the tough proposition she had to put to them.

The practice had already overcome the many and varied challenges of managing an unstable vaccine and the difficulties of booking appointments for the frail and elderly members on their patient list, in order to administer 1,000 Covid vaccinations per week. But now they were being asked to triple that effort.

“We were being asked if we could do 3,000 vaccinations per week and we had 45 minutes to decide. I wasn’t sure what the answer from the nurses would be,” recalls Catherine. “We put it to the nurses, and they said, ‘bring it on’. That was typical of what has been an amazing attitude and approach to getting this done.”

It was, and continues to be, one more challenge at the end of a testing year of anxiety, stress and hard work for the staff there. Catherine, who has been at the practice for three years, has been at the centre of this, as Infection Control Lead.

“I completed an RCN infection control module and I lead in Infection Control across the whole practice, which means cleanliness, as well as policies and procedures in terms of how we prevent spread of infections to our patients,” she says. “This means what we do with clinical waste and how we deal with the laboratories at the hospitals, as well as correct use of PPE and with samples and so on”.

“Covid landed on my desk, which brought it all into focus. I’ve learnt a lot about how to do risk assessments for staff and how to react to changing situations. It has been a rapidly evolving picture to say the least.”

The vaccination programme began in December for her small-town practice in Wiltshire, which has 13 GPs and a patient list of approximately 25,000. “The vaccination programme has been continuing alongside all of our usual work and trying to manage that at the kind of pace we are working at, is a tremendous effort,” she says.

“Normally we would have maybe 9,000 flu vaccines delivered, and we’d run up to four really large clinics to get them all done. But this is different. It is every week, all week for the foreseeable future, as well as the normal volume of work, and that is proving to be a challenge because people are tired.”

Due to the instability of the Pfizer vaccine, administering it at the pace needed to stay ahead of the pandemic, has been a test of rigorous procedure and meticulous organisation for Catherine and her colleagues.

As Catherine says, “The main challenges with the Pfizer vaccine to begin with, were using it within 120 hours of it coming out of the freezer in Bristol. When we received it, we had around 72 hours to use it. You have to handle it very carefully because it is quite unstable and if you move the vials about too much, you risk de-naturing the vaccine”.

The introduction of the Astra Zenica vaccine, which is more stable and has a longer expiry date, has made the whole process easier but because of the careful procedures put in place even delivery of that has become far more efficient.

By the end of February, the practice had administered approximately 7,000 doses out of a total of the approximately 20,000 that it estimates it has to get through.

Catherine states, “It has been tricky to get the process working well but everyone has been committed and when I recently spent a day doing vaccinations, we were down to one every three minutes.”

This shaft of light seemed unthinkable 12 months ago, when Catherine first began receiving information about a flu-like infection in Europe that was causing concern among public health experts.

“I was doing some work with the CCG on infection control, so I was quite close to the infection control lead for Wiltshire CCG, who started to send out information about this virus that people were saying was like flu initially, and it was all going to be fine,” she recalls.

“Then we started hearing that it wasn’t like flu, so we started to look at what we would do if we began to have potential patients, bearing in mind it was winter and we had patients coming in with Covid-like symptoms all the time.

“I remember in Iate February or early March, I was starting to get quite twitchy about things and I recall sitting down with the clinical lead and saying, ‘actually this is going to be rather bigger than we think it is’.”

She began daily staff briefings at the practice to share updates on keeping staff and patients safe. She says: “I remember a particular briefing when I asked if anyone was worried. Most people put their hands up, but the anxieties were very different for each person.  I have taken it quite personally, that I am responsible for keeping every member of staff safe but of course I can’t eradicate risk, all I can do is minimise it.”

A testament to how well she has done is that not a single member of the 120 staff at her practice has caught Covid, although Catherine believes this is also down to the herculean effort of all the staff to embrace change and adapt quickly.

Another vivid memory is of the first patient to arrive at the surgery with potential Covid symptoms. The man, who was in his eighties, was brought in by car by his daughter. “She had the foresight to wait in the car with him, so I went out,” says Catherine. “He had had a sudden onset of breathlessness. I just remember thinking ‘right, this is probably it’ and it was. He was very poorly, and he ended up in hospital and sadly he did die.”

Catherine spent nearly seven years in the army, and it was her military medical training that came to her aid in that moment, and many later, when panic would have been an understandable response. “I needed to lead from the front and bring people with me, the last thing I needed was people panicking,” she says. “Because of what I did in the army and going back to biological and chemical warfare exercises, my overall response was to calmly get on with the job.

Looking back at the year, she remembers last Spring as the busiest and most uncertain time. “I was being asked by the practice to give all the relevant advice and I found that was very difficult because the advice from Public Health England was changing so quickly,” says Catherine. “I’d come out of a meeting in the afternoon with one set of guidance and by the time I went to bed that night, it had changed. They just didn’t understand how the virus was transmitting or even who was transmitting it.”

She has seen two more surges of cases, late last summer and in mid-January this year. “We started to see cases ramp up in the second and third week of September when the schools went back and I remember thinking to myself, ‘this is probably not going to go well’,” recalls Catherine. “Everybody who had been in lockdown was suddenly trying to catch up on all the things they had put on hold. A lot of patients with less serious complaints came out of the woodwork, as well as a lot more with Covid.

“The other spike was around the third week of January and that would have been because of families getting together at Christmas.”

Dealing with the response to a pandemic would seem to be enough to keep anyone’s days occupied but at the same time Catherine has been looking after her two teenage children, studying for a Master’s degree and researching and producing Expert Witness reports for Jane James and Associates, just as she has done for the past six years.

“I tend to do Breach of Duty liability reports that relate to Nurse Practitioner or Practice Nurse care, looking at cases where I’m asked to give my opinion on whether the care a nurse delivered in a particular situation fell below the standard expected”.

“Latterly, I have had repeat business from solicitors and what I like about my expert witness work is that it is interesting, and every report is different. I have to evidence my report based on national and local guidelines and protocols, so I learn something every time I do it.”

She is also on hand to share her experience and provide guidance for some of Jane James and Associates’ newer expert witnesses, something she enjoys. “I will go through the case with them and talk about what other evidence they might need, because not everything is always there, like a nurse’s qualifications or local policies,” she says. “They will draft their report based on their opinion and I will help them test that opinion and make sure they are familiar with the procedure, so they meet all the timelines.”

Testing her knowledge and experience to help settle cases and further cement Jane James and Associates’ reputation for accuracy and transparency, is a source of pride and enjoyment for her.

She says: “I find the work rewarding and it is not lost on me that it is important for the Courts to have expert guidance. I get a lot of satisfaction from providing an opinion based on 30 years of nursing. It makes me feel ‘perhaps I have got an opinion that will aid the courts decisions and that all the hard work has been worth it!’.”

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