Minimal guidance was available for management of older adults amidst COVID-19 – we adopted a new approach on our dementia assessment unit with leadership resulting in good outcomes despite challenges that dementia care can create with infection control.

Our patients are older with multiple co-morbidities and lack capacity around care. Psychiatric nursing staff have minimal physical health experience; rarely will they need to employ strict infection control procedures. Knowing the high risk of mortality of our patients, we reacted to reduce transmission while maintaining high care standards in the least restrictive manner.

We changed the functioning of the ward to reduce transmission. Formerly split into a male and female ward, we instigated a mixed-gender 4 ‘pod’ system. A step-wise model of confirmed, suspected, step-down and negative cases was developed. We held educational sessions on virology and handwashing to create understanding of why PPE is essential. Regular meetings brought together evidence and opinion with the MDT. From the onset, we followed WHO advice on 14 days isolation in contrast to our Trust’s policy of 7 days. This example of leadership lead to reduced transmission and mortality. We kept a high index of suspicion and low threshold for testing.

12 out of 21 patients acquired COVID-19; 3 died. No patients who tested negative on admission went on to test positive, suggesting the model was appropriate. We completed a retrospective study analysing symptom profile, clinical frailty and survival. We measured effect of improvement by discussing with the MDT how they felt the model was working to ensure effective leadership.

Clear leadership ensured procedure followed evidence as quickly as possible and allowed for a flexible approach; We maintained high standards of multidisciplinary psychiatric care without raising levels of COVID-19 or staff burnout.