Covid

Clinic Risk Assessment

Primary Consideration — If I or anyone in my household or any of my staff who will come into contact with patients, have any of the symptoms of coronavirus (COVID-19), been in contact with someone with confirmed COVID-19 or are self isolating, we must close your practice and isolate for the specified period.

No ‘At Risk’ Groups at home

Wifes parents over 70 – mod risk only – occasional meet up from june 15th

Rationale for care

  • No At Risk treatment unless specifically pre-approved by GP/Consultant
  • Moderate Risk groups –
    • Traige form picks up moderate risk, discuss rationale for tx over phone.
      • Treat acute cases, not resolving with conservative care after a few days
      • Treat acute when it is known that treatment will usually resolve episode quickly.
      • Treat cases affecting quality of life that would normally resolve with treatment
      • No Maintenance care until symptoms begin to show.
      • More than 1-2 risk factors to get pre-approval
      • Send Patient Info and Covid Consent Remote forms
      • Send Clinic Protocol forms out when consent receicved.

Treatment of ‘Moderate Risk’ Group –

May 29 2020 – In the face of increasing need from those in the clinically vulnerable/moderate risk group and with the R value stable and below 1, it is felt that provided we have a clinical justification to offer face-to-face-care to someone in this group we should now be able to do so.

  • An enhanced process of triage has been adopted to ascertain that need before the patient attends the practice and triage and consent forms have been adapted accordingly.
  • The threshold for making a decision to treat someone in the moderate risk group must be set higher and must take into consideration all additional risk factors, including, but not limited to,
    • the risk of leaving their house to attend the practice for chiropractic care and how that patient would travel to the practice.
    • The clinic environment must be adapted to ensure minimal contact with others.
      • Reception layout modified
      • No other practitioners or patients in building
      • No entry without appt
      • no walkins
    • You may wish to consider the use of enhanced PPE, perhaps offering the patient a mask for reassurance.
    • Appropriate intervals of time must be factored in between an appointment for a vulnerable patient and other patients attending your practice.
    • You must carefully record all procedures and decisions involved in this process.

All appointments to be remote triaged via https://www.jotform.com/build/201733508212344

Remote Point of Care Triage at clinic before treatment via

All entry to clinic via entry protocol

  • Clinic protocol file emailed to patients before treatment
  • Temperature taken and noted

Infection control

  • PPE
  • 1 practitioner: 1 patient in clinic at any 1 time
  • Cleaning start and end of day
    • cleaning log
  • 1 patient in clinic at time (plus triaged chaperone if necessary)
  • Cleaning post treatment – 15 minute gap to clean and let virus settle out of air cf. Surgical theatres
  • use 2 rooms in clinic, 1 room ‘rests’ as other in use, keep swapping
  • No receptionist in clinic

COVID-19 is a reportable disease. Reporting procedures – RIDDOR reporting of COVID-19

Public entering clinic unannounced

  • stop sign on door
  • door locked/ intercom entry only

Covid patients spreading virus

  • Triage 2 Step Screening to identify Covid and at Risk patients
  • Clinic protocol for arrivals
  • Temperature taken

At risk Patients (high) contracting Virus

  • Triage 2 Step Screening to identify Covid and at Risk patients – Refuse Treatment

Local R rate increases

  • R=1.1 on 25-6-2020 midlands
  • 68 new cases per million = 7 new cases per 1000

Asymptomatic Patients spreading virus unbeknownst

  • PPE for px and practitioners
  • wipe down post treatment
  • 15 min before next px
  • 2 clinic rooms used in relay

Patients requiring Chaperone

  • Must go thru same triage and consent process before access

Disposal of used PPE and clinic waste to bee double bagged and held secure in cellar for 72 hours

Footfall minimised –

  • no patient walkins, no face to face queries
    • all such directed via signage or over intercom to call clinic number
  • Reduced patient number
    • gaps between patients reduce total number seen in fixed working hours
    • Rationale for care – no maintenance treatments reduces patient numbers

No covid patients accepted via triage

We will not accept face-to-face care of a patient who has symptoms of coronavirus, is self-isolating or has been in contact with someone with or suspected to have COVID19 and has been asked to self-isolate for 7 or 14 days.

No high Risk patients to be accepted – unless GP / consultant has pre-approved treatment

Changes to Practice

  • Layout of Reception – open plan to allow for ease of social distancing, removal of magazines .
  • No entry to clinic unless pre-booked ie no walk-ins
    • also applies to meter readers, deliveries
  • Protocol to meet px at car
  • Cleaning pre day start
    • ~Total wipe down of clinic surfaces
      • door edges, handles, buzzer/ intercom
      • couch handles
      • tables, chairs,reception surfaces
      • toilet
      • using Viro-kill RTU
      • 70-80% alcohol Hand gel and medical face masks available
      • Single use plastic aprons and aprons changed for every client
      • no Porous couch covers to be used
      • Patient may bring own freshly laundered towels
      • Clinic areas used cleaned after px leaves
      • Bacs and contactless payment only
      • Cleaning logs in place and used