SOP: Face-to-face Clinics Covid-19 Alert Level 2
Author: Margie Campbell
Created date: 13/05/2020
Reviewed date: 13/05/2020
Revision date: 29/05/2020
LIST OF CONTENT
Personal protective equipment (PPE) and social distancing
Current PPE Stock
Before the appointment
At the appointment
After the appointment
Hazards and risks
Managing Hazards and Risks
Guide to cleaning clinical equipment and rooms
At Covid-19 Alert Level 2 we intend for our clinicians to be based in the clinic and doing some face to face (F2F) clinics. We anticipate that many of our clinician’s consultations will still be done by telehealth. However, we understand that many patients will have an expectation of being able to have, and wanting to have, a F2F appointment. Tele-health appointments will be offered for patient’s who are classified as high-risk or who feel more comfortable to do so.
Minimum precautions to reduce the general risk of transmission of acute respiratory infections are:
· Maximum of 1 visitor allowed and only when absolutely necessary i.e. parent of patients under 18yo
· Where possible we will continue to avoid prolonged close contact with patients
· Frequent handwashing and drying (or hand sanitiser if no access to soap and running water), especially after direct contact with ill people or their environment
· Keep hands away from face (eyes, nose and mouth)
· Everyone should practice cough etiquette (maintain distance, cover coughs and sneezes with elbow, disposable tissues or clothing and wash and dry hands immediately)
· Adhere to standard infection prevention and control practices in a health care environment
· Request that all patients suffering from respiratory symptoms, or who have any illness, should stay home and delay their appointment/procedure until they are well
· Patients with respiratory infections should not enter the clinic and should be directed to either Healthline or to their general practitioner.
Parties to whom the policy is relevant:
· Support Staff
We will continue to run consultations via our Telehealth platform as well as seeing patients’ in rooms. Clinicians will be based in the clinic to allow for the assessment of more acute cases F2F, those who required hands-on management, or as requested by patients.
Examples of when these sessions may be needed:
1. The assessment and management of a patient who is thought to have an acute neurological, muscular, ligament, or tendon injury
2. A patient who requires an orthotic device to be fitted to ensure that their problem is adequately treated
3. Patients who have not had a F2F consultation during their treatment course and who have a different requirement for a clinical review
4. Patients who have passed the triage questions and who do not want to have a telehealth consultation
PERSONAL PROTECTIVE EQUIPMENT (PPE) AND SOCIAL DISTANCING
Despite the assumption that a Level 2 environment has no/limited community transmission of COVID-19, we need to ensure that our patients and staff are as safe as possible as the clinic environment has us exposed to a wider group of people. It is important that we continue to make use of common-sense practices and personal protective equipment that protect healthcare workers from infection and prevent the spread of infection from patient to patient. In the context of COVID-19 it is even more important that we reinforce adherence to standard precautions as this will protect frontline health care workers regardless of whether they need to wear PPE when providing care.
1. Hand hygiene
2. Use of personal protective equipment (e.g., gloves, masks, eyewear) where needed
3. Respiratory hygiene/cough etiquette
4. Patient and practitioner placement
5. Safe handling of acupuncture needles and other sharps
6. Sterile instruments and devices
7. Safe handling of linen and laundry
8. Clean and disinfected environmental surfaces.
The correct use of PPE can reduce the spread of infection when used correctly and in the appropriate context. Incorrect use of PPE has the capacity to cause harm, rather than good, and may contribute to an increased spread of disease. If PPE is not used properly health care workers can put themselves, patients, their colleagues, family/whānau and community at greater risk. See Appendices for more information from the Ministry of Health.
CURRENT PPE STOCK
We have currently sourced the following equipment:
1. Surgical masks
It is important that we know how to put on (don) and take off (doff) PPE (including masks). See Appendices for more information on donning/doffing PPE.
Note: Clinicians can use masks for more than one patient. They should not be used for more than four hours (or less should they become damp and moist). They should be removed prior to eating and drinking or if they become soiled. They should not be reused. We will encourage patients to bring a mask to their appointment.
The following process is required to minimise unnecessary patient contact and to respect the Alert Level 2 guidelines.
BEFORE THE APPOINTMENT
1. Where possible all initial appointments will continue to be via telehealth. If a patient does not wish to have their consultation via telehealth, and passes the screening questions, then they will be offered an appointment.
2. If, after their initial appointment, a clinician determines that the patient will require a F2F appointment they will book them for a follow up in our clinic.
3. All patients who are booked to have a face to face clinic will be given written and/or verbal information about their appointment including:
a. The importance to reschedule should they be/become unwell
b. The process involved with their appointment
c. The need to wait in car until their appointment time
d. The need to wash/sanitise their hands upon arrival
e. The need to limit the number of people who attend their appointment
4. All patients booked for a F2F consultation must confirm that they have no symptoms of COVID-19 or risk factors for developing COVID-19 prior to confirming their appointment
5. All rooms to have hand washing materials, hand sanitiser and available PPE.
AT THE APPOINTMENT
1. Signs detailing risk factors for COVID-19 and the need to not enter the clinic will continue to be posted throughout the clinics
2. At all times we will limit the number of patients that are in our waiting room.
a. Patients should wait in their car until their clinician is almost ready to see them
b. The patient will be called or texted by the clinic admin team when their clinician has taken the patient before them. During this call they will be asked the booking checklist again and asked to confirm that they have no current symptoms or risk of illness
c. Anyone who answers yes to any of the checklist questions should not enter the clinic. They should be offered a telehealth consultation or re-booked. They should also be advised to contact Healthline or their GP.
d. All patients, and their support person (max 1 allowed), should wash their hands or use an alcohol-based hand sanitiser on arrival
e. Patients will check in to the waiting room and will be advised to practice social distancing
f. They will be called into the waiting room by their physiotherapist when they are ready
g. Any support people attending the appointment should be recorded in the client notes by the clinician
3. During all consultations our clinical team should:
a. Ensure that they are running to time
b. Limit face to face contact where possible (less than 15 minutes)
c. Ensure social distancing where possible (2m separation is advised)
d. Practice fastidious hand washing before and after seeing the patient
e. Avoid touching their face
f. Use gloves, surgical masks and eye protection as needed
g. Be careful with handling of equipment including keyboards, dictaphones and phones.
Note: There will also be a marked line on the floor to limit patient contact with the reception desk. Reception staff can be provided with PPE to use as needed. Where possible reception staff can work off-site rather than on reception. We do not currently have N95 masks and are not equipped to see patients who are thought to be at high risk of having COVID-19 or who currently have the virus.
AFTER THE APPOINTMENT
1. Where possible the patient should not go to the reception desk
a. Bookings should be done by the clinician or arranged via email with the appropriate administrative team member
b. Reception staff to be provided with PPE to use as needed
c. Ensure that there is a mechanism to ensure social distancing from reception – positioning of patient chairs, screens, tape and table at reception
d. Contactless payment options available e.g. PayWave, online payments
2. Fastidious hand washing
3. Any clinic equipment touched by the patient/visitor including chairs and plinths should be wiped down between every appointment
4. Any clinic equipment handled including keyboards, dictaphones and phones should be wiped down appropriately at the end of the morning session and at end of day.
5. Staff should consider a cover for their mobile phones during their consulting day which can be removed at home time
6. Staff should remove the clothes they’ve been treating in and change into a fresh set of clothes only when exiting the clinic. Placing the clothes into a plastic bag that can be disposed of or else placed into the washing machine to be laundered.
7. Clothes should be washed after every day in the clinic in a hot wash
8. Staff should note the number of different disposable PPE used to help monitor stock levels.
HAZARDS AND RISKS IDENTIFIED
· Sufficient resources, for example PPE, to deal with expected numbers of patients at this Alert Level 2
· Social distancing between clinician and patient during consultation
· Social distancing between administrative team members and patient
· Appropriate distancing and interactions between staff
· Ensuring clinic equipment isn’t double booked to increase patient wait time
· Ensuring surfaces are wiped down after patient use
· Ensuring soiled/contaminated clothing and personal items don’t come home with staff
· Cleaning surfaces between patients and/other room users
MANAGING HAZARDS AND RISKS
Potential Hazard/Risk Hazard
Sufficient resources, for example PPE, to deal with expected numbers of patients at this Alert Level
· Staff to note number of disposable PPE items used each clinic.
· Management to monitor rate at which PPE are used and order more when suppliers have more stock available.
· Extra supplies of antibacterial and antiviral spray so not to run out
Ensuring clinic equipment isn’t double booked
· Clinicians and support staff to manage all bookings to ensure equipment isn’t double booked
Social distancing between clinician and patient during consultation
· Patient information sheet to clearly state max of one visitor allowed to attend with the patient.
· Place patient chairs away from the clinician’s desk.
· Clinician to approach patient only when necessary and then resume distancing practices.
· Record names of any support people attending the appointment with the patient on patient notes.
Social distancing between administrative team members and patient
· Signs on entry points to the clinic to warn “No Entry” until appointment time.
· Appropriate spacing of chairs in waiting room · Hazard tape to define distancing from all administrative areas.
· Patient information sheet to clearly state that the physiotherapist will meet the patient on arrival in the clinic and to limit the time spent in the waiting room
Appropriate distancing between staff
· Ensuring food isn’t shared between staff at this Alert Level 2
· Ensuring staff are well and work from home (via telehealth) if unsure
· Ensuring staff room isn’t over crowded at lunchtimes – consideration of lunch in own rooms
· Staggering appointment times and rosters so that physiotherapists’ are not in close contact with each other
Ensuring patient notifications are received
· Notifications provided to the patient at: a) Time of booking – booking confirmation and patient information sheet
b) Morning of appointment stating to wait until appointment time
Ensuring soiled/contaminated clothing and personal items don’t come home with staff
· Provision of clear use of PPE and washing instructions
Cleaning surfaces between appointments and/other room users
· Antibacterial and antiviral spray is provided with individual bottles for each room – surface spray and hand sanitizer
· Clinician and administrative staff to be instructed how to wipe down surfaces
· Gym surfaces to be wiped after each use
· Clinician and administrative staff to be instructed to bring minimal possessions to and from the clinic.
GUIDE TO CLEANING CLINICAL EQUIPMENT AND ROOMS
Equipment and surfaces must be cleaned between each patient using either disinfectant wipes or antibacterial and antiviral spray.
1. Gloves should be worn when cleaning all equipment and surfaces
2. If using wipes, allow the surface to air dry
a. If allowing the equipment/surface to air dry, this must be for a minimum of 3 minutes
3. If using antibacterial/antiviral spray, please wet a paper towel with the spray (do not spray directly onto electrical equipment) and wipe the surfaces and equipment
a. Once cleaned, wet a clean paper towel with water to wipe the surfaces and remove the spray residue
4. All wipes and paper towel must be disposed of in the bin
5. If you have queries about the best cleaning material to use on a specific piece of equipment, please contact the managing partner/general manager.
Please see a guide to areas requiring regular cleaning and the responsible staff group.
Responsible staff group
Administration Staff room All staff to ensure used items are put in the dishwasher or bin
Computer keyboards and work surfaces
All staff that use a workstation
Clinical staff using area
Clinical staff using equipment
All clinicians using area with patients
Changing rooms and toilets
Clinical staff using area
Current advice from the Ministry of Health regarding the use of PPE can be found here: https://www.health.govt.nz/system/files/documents/pages/covid-19-guidelines-use-ppe-frontlinehealth-care-workers-7apr20.pdf
PPE: how to put it on and remove it safely: www.health.govt.nz/ppe-health