How to Manage COVID-19 Dr Nicole Higgins Glen Wallace How to - - PowerPoint PPT Presentation

How to Manage COVID-19

Dr Nicole Higgins Glen Wallace

How to Manage COVID-19

Dr Nicole Higgins Glen Wallace

Acknowledgment of f Country

“We acknowledge the Traditional Owners of the land in which this meeting is taking place, and pay respects to their Elders, past and present and their families.”

Webinar Housekeeping

Muting and Background Noise How to ask a question We are recording this webinar

How to Manage COVID-19

Dr Nicole Higgins Glen Wallace

Objectives

• How to practically prepare your practice for COVID-19 response.
• Access ready made workflows.
• Patient and staff information needs – how to respond.
• Access high quality evidence-based resources.
• Access free up to date policies and procedures.
• Identify staff training needs and risks and options available.
• Access free 'scripts' for your phone messages, and triage 'scripts' for practice reception and nursing

staff.

• GPSA has taken all care, but accepts no responsibility
• Advice for COVID-19 is rapidly evolving and often conflicting
• Best information available to date
• Resources will need to be adapted to your own practice circumstances

Disclaimer

“There is nothing to fear but fear itself”

Fr Franklin in D D Roosevelt

Perspective is is im important

http://www.covid19forgps.com/

• As at 11 March 2020, in Australia –

112 confirmed cases, 3 deaths (COVID-19)

• Those who have died typically:
• Immunocompromised
• Cardio or respiratory condition
• Elderly
• 30 people have died in the last

month on NSW roads and on average the flu takes 200 lives a year in NSW alone.

Perspective is is im important

Apply your own oxygen mask fi first!

What’s in the COVID-19 resource kit?

• Workflows
• Staff
• Appointments
• Role Responsibilities list
• Phone on hold message scripts
• Checklists
• Receptionist
• Practice Nurse
• Consultation Proforma
• Check Clinic procedure – GP
• In House Training Records
• Low Risk Notification Template
• Resource links
• Email to practice patients proforma
• Employment FAQs

Preparing the Practice

• Removal of Multiuse Items:
• Magazines
• Children’s toys
• Signage
• Car Park
• All Entries
• Recorded Phone Messages
• Website, social media, email

Familiarise yourself with the RACGP Pandemic toolkit

Familiarise yourself with Hand Hygiene protocols

In-house training infection prevention and control

Defi fining Roles

Managing Patients

Appointment Workflows

RECEPTION COVID-19 TRIAGE FLOWCHART

Ask ALL patients “Have you travelled overseas in the past 14 days If answer is Yes If answer is No Ensure mask is applied Is the patient UNWELL? Is the patient UNWELL No Is the patient WELL Yes Have they visited a High RISK country? Have you been in contact with anybody suspected of having coronavirus? Yes Usual Care No ISOLATE IN ISOLATION ROOM, ENSURE MASK IS FITTED. NOTIFY GP AND NURSING STAFF Allowed to wait in waiting room with mask fitted properly, Notify GP and nursing staff. Yes No

Managing Patients?

• Patients walking in with symptoms
• Patients symptomatic, but no known COVID-19 contact
• Patients asymptomatic, but known COVID-19 contact
• Phone Triage
• Phone recorded messages
• Work flows – who is doing what?
• Quarantine

Get to your patients before they get to you…

• Use multiple formats
• Social Media – Share explanatory videos
• Direct SMS all patients
• Direct email – email proforma provided
• Appointment booking software

Testing Patients

• Who should be tested Current as of 10/03/2020
• If the patient satisfies epidemiological and clinical criteria, they are classified as a suspect case.

Epidemiological criteria

• International travel in the 14 days before illness onset.

OR

• Close or casual contact in 14 days before illness onset with a confirmed case of COVID-19.

Clinical criteria

• Fever

OR

• Acute respiratory infection (e.g. shortness of breath, cough, sore throat) with or without fever.

Testing Patients?

• Car Park Clinics
• Drive through – remaining in car
• Popup – Tent in the car park
• Make it obvious for your patients where to go
• Provide an alternative to walking in the practice door

Testing Patients?

• Test collection
• Naso-pharangeal swab – each nostril
• Oral swab
• Best done by a trained doctor
• Note: GPs do not have negative pressure rooms
• PPE between test?
• Do I need to change each time?
• Where do I send specimens?
• Local Department of health will be able to advise
• How long do the results take?
• Nationally inconsistent
• What to tell patients while they wait for results?

What do we know about teleconsults so far?

• New item Number pending – Only bulk billed – no private billing
• To be announced tomorrow
• Telephone or video
• Telehealth Script issuing
• Contact local pharmacy – eScript or fax
• Safety netting for variables – risk in missing non COVID related illnesses

Managing staff

• Valid concern
• Compromised staff
• Non compromised staff
• Work alternatives
• Communication is often the first casualty
• Strategies to employ with your staff
• Educate
• Prepare
• Communicate – over rather than under

Workplace Health and Safety

• Stress is a significant risk factor
• Workers compensation
• Leave
• Personal
• Annual
• Unpaid
• Standing Down Staff
• Fitness to work

Workplace Health and Safety

• Appropriate PPE Equipment
• Appropriate PPE Training
• Appropriate Cleaning and Disposal of PPE
• Risk Management
• Identification, Procedures, Policies and Protocols
• Communication channels
• Support Services for staff experiencing stress

Business Im Implications

• Patients cancelling appointments or avoiding attendance
• Registrars without patients – but still have to be paid
• Financial exposure of the business is huge
• Symptomatic clinical staff, but low risk must either take leave or teleconsult.
• Symptomatic non clinical staff, but low risk must take leave or work from

home.

Privacy Im Implications

• Journalists contacting clinics for confirmed COVID-19 patient

information.

• 2 factor authentication security if staff are logging in remotely to

patient management systems from home.

• Contact tracing of confirmed cases.

Communication

• Getting the whole practice on the same page.
• We agreed a policy within the practice, but some doctors want

to do something different…suggestions?

Q & A A

• People requesting screening when they don’t fit criteria.
• Asymptomatic patients being sent from work to get a medical

clearance and screening done for COVID-19 when they have not been to affected countries or in contact with anyone with coronavirus.

• Anxious patients with flu-like illness over-run the walkin acute

clinic.

• Australian Government

Department of Health here.

• World Health Organisation

(WHO) guidelines here.

• SmartTraveller, Aust Gov: here.
• Fair Work Australia: here
• AVANT Employer Advice: here
• Employsure: here

If you’ve enjoyed this webinar…

• We’d really love your feedback
• Evaluation will be sent out directly following this

webinar

• You may be interested in our next webinar on

Wednesday 18th March on Endometritis

Acknowledgements

• GPSA is supported by funding from the Australian

Government under the Australian General Practice Training Program.

• Thank you to our webinar sponsor