Introduction Nasopharyngeal swabbing for COVID-19 is now standard for hospital admissions. At Martlets Hospice, a paucity of swabs, and reservations about the invasiveness of swabs in patients approaching the end of life, meant that routine inpatient testing was not implemented until June, when a standard operating procedure (SOP) was written. Post-SOP, patients should have been swabbed as soon as possible after admission, unless they were known COVID-19 positive, were actively dying, or were unable to consent. Our audit aimed to ascertain how manageable routine testing is in a palliative care setting.
Methods 142 patients were admitted to Martlets between 1/4/2020 and 1/10/2020. N =71 both pre and post SOP implementation. All inpatients’ notes were checked for documentation of swab results or why swabbing was inappropriate, and this was checked against the online pathology reporting system ICE.
Results Pre-SOP, 48/71 patients were deemed appropriate to swab. Of the remainder, 16 were known COVID-19 positive, and 7 were actively dying on admission. 44% of patients deemed appropriate were swabbed, of whom 19% tested positive for COVID-19. 50% of those with positive swab results had been asymptomatic, but were swabbed because they had been admitted from high risk hospital wards. Post-SOP, 60/71 patients were deemed appropriate. There were no COVID-19 positive admissions. 70% of patients deemed appropriate were swabbed, of whom 0% were COVID-19 positive.
Discussion Our results indicate that routine inpatient testing is feasible and appropriate in hospice settings. Clear guidelines increase the frequency of swabbing and ensure that only appropriate patients are swabbed. Positive swabs in some asymptomatic patients indicate that particularly in the context of a second wave, routine inpatient testing will be necessary, despite the unpleasantness of the procedure. To reach 100% of appropriate patients tested, integration of our SOP into admission proformas and documentation is being trialled.
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