By Emilie Kerslake, Dr Hina Iftikhar, Dr Seema Alaee, Dr Rachel Kaminski, Dr Charlie Sharp

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Background and Problem

As part of our planning response to the Covid-19 pandemic, the

Associate Chief Nurse Craig Bradley at Gloucestershire NHS

Foundation Trust proposed the use of yellow lanyards for staff

with additional respiratory care skills. The initiative led to an

additional team of specialist nurses working together,

educating, training and supporting Trust wide health care staff in

managing patients; albeit outside of their speciality.

The early identification of the yellow lanyards enabled staff who

were caring for patients with Coivd-19 to easily identify those

staff with the additional respiratory skills to gain support. Staff

wearing the yellow lanyards were expected to meet a set criteria.


Our role particularly focused on non-invasive training

(Continuous positive airway pressures) a leadership

strategy employed by the Trust to manage COVID-19

patients with high FiO2 requirement in a respiratory high

dependency unit (HDU) setting. The respiratory HDU was

relocated and expanded to 31 beds compared to a normal

capacity of 10 and all patients requiring non-ventilatory

support only were managed on it unless deemed at high


We also liaised with our lung physiology department daily

for equipment calibration and programming enabling us to

manage the quick turnover of patients admitted.

Additionally we offered training opportunities to all staff

including NEWS monitoring, documentation, adequate use

of personal protective equipment, oxygen management,

initiating Hi-Flow nasal oxygen, and escalation of patients

to intensive care alongside delivery of conventional

respiratory care.


Our strategies upskilled healthcare worker to manage the

ever increasing case load of COVID-19 patients using

enhanced decision making, critical thinking and improved

communication skills preparing them to work in the ever

changing environment. The Yellow Lanyard Team was an

asset during the pandemic available 24/7 and successfully

managed patients to recover from their illness