V2.1_Resources_for_setting_up_a_testing_service.amended

Setting up a testing service COVID-19

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Setting up a Testing Service - COVID-19 v2

16/07/2020

WBOP PHO

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Updates to document Version 1 Date 25/05/2020 27/05/2020 27/05/2020 27/05/2020 28/05/2020 28/05/2020 02/06/2020

02/06/2020 02/06/2020 02/06/2020 03/06/2020

Title Pathlab COVID-19 Community Testing Pathlab Testing Centres Process for Pathlab Collection and Swabbing How to swab advice from Pathlab Halcyon Manual Form Covid-19 testing in General Practice Pathlab COVID-19 testing in the community Reswabbing process Frequently asked questions about PPE PPE Document Referral process for patients who are housebound

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Title Data Entry – Halcyon Referral process for patients in aged residential care Frequently asked questions about PPE PPE Document Information for suspected case COVID-19 Testing in Practice Potential scenarios for applying new case definition Advice to patients following a surveillance COVID-19 swab – Low risk people with symptoms Notice to employers and education providers Negative swab result letter to patients Referral process for patients who are housebound Advice to patients following a COVID-19 swab – Low risk people with symptoms

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Table of Contents Getting Ready ............................................................................................................................ 4 Readiness checklist for setting up a testing and assessment service .................................................4 Suggested resources for COVID 19 testing service ..............................................................................5 Covid-19 testing in General Practice ...................................................................................................6 Potential scenarios for applying new case definition ..........................................................................7 Process for re-swabbing ......................................................................................................................8 Pathlab Testing Centre Process ...........................................................................................................9 Referral process for patients in Aged Residential Care .....................................................................11 Ordering Supplies ................................................................................................................... 14 Role descriptions for assessments ........................................................................................ 15 Clinical admin support role (Tier 2 and 3) .........................................................................................15 Clinician role (Tier 2 and 3) ................................................................................................................16 Swabbing Instructions ............................................................................................................ 17 How to swab advice from Pathlab .....................................................................................................17 PPE ........................................................................................................................................... 18 Donning PPE .......................................................................................................................................18 Removing PPE ....................................................................................................................................19 Health and Disability sector: Frequently asked questions related to PPE and COVID-19.................20 Risk Assessment .................................................................................................................................26 Cleaning ................................................................................................................................... 26 Cleaning instructions .........................................................................................................................27 Droplet cleaning instructions.............................................................................................................28 Transport for patients ............................................................................................................ 29 Guidelines for transporting a suspect case where the driver is not a household contact................29 Patient Handouts .................................................................................................................... 30 COVID-19 testing medical certificate.................................................................................................30 Self-isolation ......................................................................................................................................31 Information for ‘case under investigation’ ........................................................................................33 Advice to patients following a COVID-19 swab – Low risk people with symptoms ..........................35 Data Entry - Halcyon ............................................................................................................... 36 Manual Data Collection Form ............................................................................................................41

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Getting Ready Readiness checklist for setting up a testing and assessment service For Tier 1 assessments Have you clarified your process for referring patients to a testing centre?

For Tier 2 and 3 assessments

Yes / No

Identified where in your building/outdoor area you will undertake Tier 2 and/or Tier 3 assessments?

Identified your team who will undertake the swabbing and assessments each day?

Has the team had PPE training?

Has the team had swab taking and handling training?

Do you have: A place to store the swabs until collection by Path lab?

Necessary PPE and equipment required for Tier 2 and 3 assessments?

Process for safe disposal of used PPE and cleaning of equipment?

Equipment which can be used to undertake examinations and assessment?

COVID 19 Patient information leaflets and resources?

PPE, swab and instruction posters?

Latest guidelines and criteria from the MOH? For all assessments

Yes / No

Do you have a process for completion of the COVID19: Data entry?

Results notification?

Claiming?

Way of communicating to the team regarding changes to criteria or MOH definitions?

Have you considered: Access for vulnerable patients?

Equity issues (including patients with disabilities)?

Have you updated your website / patient information for patients explaining your new process for testing?

Have you communicated your arrangements with the wider health and community services?

What other resources/training do you require at this stage?

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Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No

Yes / No Yes / No Yes / No

Yes / No Yes / No Yes / No Yes / No

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Suggested resources for COVID 19 testing service • •

IT access Information handouts o ‘Self-isolation – Unite against COVID19’ o Toi Te Ora ‘Information for a suspected case under investigation’ o Information for employers/education providers o Negative swab result letter for patients

•

Guidance resources o Donning & doffing guideline & PPE video link o How to swab Pathlab laminate o Case definition o MoH Flow Chart

• • • • • • • • • • • • • • • • • • • • • • • • • • • •

Medical certificate Prescription pad Lab forms Tissues box Rubbish bags Masks Ear loops Full visor PPE gowns Goggles/face shields (if full visor not being used) Hand sanitizer Gloves S/M/L Thermometer plus probe covers Pulse oximeter adult & paeds Auroscope plus adult and kids covers (for examination rooms only) Sphygmomanometer (for examination rooms only) Stethoscope (for examination rooms only) Penlight Tongue depressors Swabs Scissors Alcohol Prep pads Detergent antiseptic wipes Chux cloths Paper towels Detergent spray bottle Clipboard (for assessing at carside) Pens

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Covid-19 testing in General Practice Tier

Consultation Setting Risk Level

V3 updated 09/07/2020

COVID -19 Assessment 1 2 COVID-19 Triage or Telehealth COVID-19 assessment of patient with symptoms alone symptoms of COVID-19 in community Telephone or video In-person clinic / car N/A

Low (symptoms without epidemiological criteria)

3 Higher Index of Suspicion COVID-19 symptoms plus HIS criteria

In-person clinic

• • •

• •

• Examination

Assessment by Nurse, NP or GP including risk assessment and detailed consultation

Consultation outcome

If patient is in an aged Patient sent home or to hospital residential care facility, see process for referral If patient is housebound see process for referral If swabbing For swabbing in practice, outside of follow Tier 2 practice, follow process. the process for referring to Pathlab Practice responsible for negative results. Toi Te Ora will continue to follow up positive results.

Follow up care Infection Control Claim in Halcyon Conditions of claiming:

Visual +/- basic examination and obs. with swab, according to clinical discretion* Patient sent home with recommendations

Must meet Higher Index of Suspicion criteria including: returned from overseas close contact of positive case had direct contact with a person who has travelled overseas (eg Customs and Immigration staff, staff at quarantine/isolation facilities) worked on an international aircraft or shipping vessel cleaned at an international airport or maritime port in areas/ conveniences visited by international arrivals, or any other criteria requested by the local Medical Officer of Health

Visual +/- basic examination and obs. with swab*

N/A

1 or 2 people in 1 or 2 people in PPE PPE $60.00 $60.00 no swab $250.00 $120 with swab No fee to patient (including prescriptions) No claim for Clawback, limited to one claim per day per person/practice, No simultaneous claiming against other funding stream, patient must consent to swab being taken. *If the patient is sent to hospital, then they should not be swabbed in the practice.

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Potential scenarios for applying new case definition

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Process for re-swabbing A re-swab is required if the specimen is received at the lab and has been incorrectly labelled, unlabelled, contaminated during transport, there is no swab at all or the sample has not been taken correctly.

When a re-swab is required Pathlab will ring the practice who completed the swab The practice will be given: • •

Patient Name, DOB, swab date Time swab was received at the lab

The practice will identify and contact the patient, and organise for them to be re-swabbed as soon as possible. Ideally this should occur at the location where the original swab was taken.

The practice will be able to complete a new claim form for the re-swab.

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Pathlab Testing Centre Process

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Referral process for patients in Aged Residential Care

RN to contact Facility GP/NP to screen client (use COVID-19 Community Assessment form)

Client meets clinical criteria and testing authorised by facility GP/NP

FACILITY GP / NP

FACILITY RN

Step 1: Complete Pathlab form (and email Step 1: Determine assessment level required - Tier COVID-19 Community Assessment form to GP) 1 – Virtual, Tier 2 - Simple Assessment orFacility Tier 3 - GP/NP to screen RN to contact client Full Examination Step 2: Check testing kit available Step 2: Check that facility RN is available to Step 3: Complete COVID-19 test as soon as complete test (Tier 1 or 2) and that testing kit is practically able or arrange GP/NP to complete available Step 3: Complete COVID-19 test at facility if RN not able to do so or if a Tier 3 assessment Step 4: GP/NP enter completed COVID-19 data in Halcyon (WBOPPHO) or eReferral (EBPHA) Step 5: Claim Virtual Consultation Tier 1/virtual assessment if Facility RN does the swab, Tier 2 or 3/face-to-face assessment if GP visits the facility and does the swab

Step 4: Arrange Pathlab courier collection of swab or if Pathlab courier not available arrange transport of swab to nearest Pathlab collection point when able to do so Step 5: Notify DHB ARC team of delays in testing due to issues with collection of swab

If two or more swabs completed for respiratory illness within 72 hours within same facility please notify TTO Clinical Case Advisor – 027 336 9097 Testing completed

Testing not able to be completed

Due to dementia residents BPSD, risk to staff GP/NP or Facility RN to check results on CHIP safety Resident to remain in isolation until 48 hours after (This will be at the discretion of the tester) symptoms resolve Inform GP ARC COVID-19 All positive results will be followed up by ToiTesting Te Ora. Information Clinical Advisor 027 336 9097 P a g e | 11 Setting up a Testing Service - COVID-19 v2 Liaise with TTO 16/07/2020 WBOP- PHO This document is valid on the day it is accessed. Please check the electronic version for the most up to date information

Please see the attached additional information around COVID-19 testing for BOP ARC residents.

It is important that RNs within the facility familiarise themselves with the process and testing instructions, if possible it will be a nurse at the facility who will be completing the test. If there is no RN available to complete the procedure the facility GP/NP will do so.

PROCESS for Testing STEP 1: Requirement for COVID-19 test confirmed by facility GP/NP STEP 2: Check testing kit available at facility (testing swabs and collection bags available to order from the DHB using the PPE order form – max 4 testing kits per facility) Consider transport arrangements for getting swab to Pathlab (see Step 4) STEP 3: ARC COVID-19 testing will be carried out at the ARC facility by facility RN or GP/NP Prior to undertaking the test, please ensure the following: • •

Review the COVID-19 Testing Instruction Sheet (at end of document) Review MOH Personal Protective Equipment (PPE): for staff taking nasopharyngeal/throat swabs available from https://www.health.govt.nz/system/files/documents/pages/hp7353_02__ppe_ipc_poster_nasopharyngeal_testing_v3.pdf

•

Review the BOP DHB PPE donning and removal video: https://vimeo.com/399710678 NB: Additional videos also available on MOH website.

• • •

Complete the Pathlab form and label the specimen tube before entering the room You will need a second person ready with gloves holding the bag that you can drop the completed sample into.

Please ensure you have sealable rubbish bag for disposal of PPE - this can be placed in general waste once sealed

STEP 4: Arrange transport of swab to nearest Pathlab or Pathlab collection point Using Pathlab Courier service (PATHLAB Courier: 07 5787073 ext 6712) o Weekdays – utilise usual Pathlab courier service if available in your area o Weekends - Please phone request for courier to the laboratory before 11am o If weekend test request occurs out of collection hours it is preferable to wait until the following day for test to be completed to coordinate with courier collection hours. o If it is necessary to complete a swab after hours it will need to be kept in an appropriately allocated fridge until collected as long as the swab outer bag clearly indicates it is a COVID specimen.

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•

Using own transport: o Please arrange transportation of swab to nearest Pathlab or Pathlab collection point https://www.pathlab.co.nz/locations/ o If nearest collection point closed please arrange transport to Whakatane ED or to Pathlab at Tauranga Hospital or to nearest GP practice (check this GP service is available)

STEP 5: Review and ensure isolation procedures, adequate PPE, staffing plans etc, and await swab result. Ensure resident remains in isolation until 48 hours after symptoms resolve.

APPENDIX 1 PathLab Form COVID-19 lab form ARC (2) 20 May 2020.docx

PPE order form for PPE and Covid-19 Testing kit: Nasopharyngeal swab and red top tube, x1 laboratory bag PPE Order Form (max 4 test kits per facility) PPE Order Form updated 20 May 2020.docx

COVID-19 Community Assessment Form Community COVID_19 assessment form.docx

Any queries or feedback regarding any aspect of this process please contact: Kate O’Dwyer CNS ARC team – kateo@wboppho.org.nz Rosie Winters NP Older Adult – rosie.winters@bopdhb.govt.nz

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Ordering Supplies Personal Protective Equipment (PPE) Order Form Requestor Details: Organisation Name: Contact Name: Contact Cellphone: Delivery Address:

PPE Request Details: Please allow 36 hours from order to delivery – excluding weekends and public holidays Please try to source PPE from your normal suppliers before requesting Standard Qty Required Qty Masks – surgical (patients/staff) BX 50 Masks – surgical (staff) BX 50 Masks – N95 BX 50 Goggles/Visors: Please ensure you are washing and recycling current goggles and visors Goggles EACH Visor EACH Gowns (isolation) extra large BX 10 Apron Disposable EACH Hand Gel: Please ensure that wherever possible soap and hot water is used Alcohol Hand Gel – 500ml EACH To be used to clean all clinical equipment only. Disinfectant solution should be used to clean down any other areas Disinfectant wipes Pack 50 Gloves Small BX 200

DHB Code 253766 301325 289627 261964 257739 255742 264441 262810 Wipes: 285997

267285 267286

Description

267287 301502

Gloves Medium

BX 200

Gloves Large Covid Nasal Swab Kit

BX 200 EACH

Name

Signature

Date

Please e mail this completed form to ppeordering@bopdhb.govt.nz For DHB use only: EOC Approved: Name Oracle Entry Completed by: Name P a g e | 14

Signature

Date

Req #

Date

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Role descriptions for assessments Clinical admin support role (Tier 2 and 3) Description of role: Can be HCA or trained Admin • •

Assist the clinician as a scribe Label swab tube and cut swab post use so fits into tube (if needed)

Procedure • • • • • • • • • • • • • • • • • • •

Set table up with clean/dirty side All equipment on clean side Put mask and gloves on Act as scribe for clinician – record assessor and time of assessment, take history, document recordings After use, clinician places used equipment on dirty side Label specimen tube and discard empty packet into rubbish bin.

Hand specimen tube and swab (packet opened) to clinician.

Discard empty packet into rubbish bin.

Clinician performs swab.

If required, cut swab with scissors at top of specimen tube to fit, then place scissors on dirty side of table Clinician puts lid on specimen tube – invert 2-3x to ensure good seal Hold double lab bag (COVID sticker on outside) OPEN for clinician to drop sample in and close the bag. Before closing bags, double check sample correctly labelled Clinician discards top of swab stick and PPE into hazardous waste and sanitises hands.

Place lab form into sleeve of outside bag.

Clean used equipment (including scissors) with separate small alcohol wipes and place on clean side.

Clean dirty side of table and surroundings with cleansing wipes.

Remove dirty gloves Sanitise hands Reapply gloves

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Clinician role (Tier 2 and 3) Description of role Tier 2 •

To provide simple assessment of a patient (potentially in their vehicle) and collect COVID-19 swab

Description of role Tier 3 •

To provide examination of patient outside of vehicle to enable Clinician to:

•

Determine a probable diagnosis and swab for COVID-19

•

Determine whether the patient is safe to be managed in community or if they require secondary level care

Examination Room Procedure: •

Ensure examination room is fully equipped and clean o o o o o o o o o

• • • • • • • • • •

Stethoscope Tongue depressors Sphygmomanometer Pulse oximeter Thermometer plus end pieces Auroscope plus end pieces Alcohol wipes Small scissors for cutting swab stick Rubbish bin

If not already, don PPE at doorway to room / in exam room, enter room. You are now the “germy clinician in the germy room” and you are the only team member that enters this space Ask clinical support worker to escort patient to room from car Examine patient, while clinical support stands at doorway acting as scribe, recording observations as you require Perform COVID19 swab Make management plan with patient, if providing a script establish best option for collection/delivery of this with patient Clinical Support will escort patient out to the designated area/car where they will wait to receive paperwork Remove gloves, sanitise hands, put on new gloves and clean all instruments used, wipe down surfaces. NB pulse oximeter must only be cleaned with alcohol swab not a wipe – ruins sensor Doff PPE as per protocol and exit “dirty space” Go to “Clean Area”, complete any examination notes / write script/ arrange secondary level care as you feel necessary Clinician or clinical assistant (wearing gloves and mask) take all relevant documentation to patient and confirm they understand procedure for prescription/ swab info sheet/ isolation info/ copy of notes if referring to TPH

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Swabbing Instructions How to swab advice from Pathlab

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PPE Follow the instructions below or go to https://vimeo.com/399710678 and watch the video.

Donning PPE

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Removing PPE

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Health and Disability sector: Frequently asked questions related to PPE and COVID-19 11 June 2020 The first lines of defence to reduce your risk of getting or spreading COVID-19 are: staying home when unwell, hand hygiene, respiratory hygiene, cough etiquette, regular cleaning of high-touch surfaces, and maintaining physical distancing where possible and practical.

Personal protective equipment (PPE) is not needed in all instances. PPE needs to be considered as part of a range of activities that reduce the risk of transmission of infection, when used correctly, and in the appropriate context.

Key risk assessment questions How do I find out a person’s COVID-19 status?

When you do not know someone’s COVID-19 status - before using any PPE, remember to ask the key risk assessment questions to determine what’s required for your initial interaction. Also consider the clinical situation, the risk of exposure, the type of interaction, task and any other health risks of the patient or client.

The key risk assessment questions should ideally be asked in advance of your interaction with the person (by phone or signage), otherwise remember to maintain 1 metre physical distancing while asking them. The current risk assessment questions are available at Alert Level 1: Risk assessment questions if COVID-19 status is unknown.

Standard and Transmission Based Precautions What are Standard Precautions?

Standard Precautions are a set of routine infection prevention and control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, nonintact skin and mucous membranes. Standard Precautions should be used for all patient/client care activities, regardless of their diagnosis or suspected infectious status. They help to protect from unknown and potential risks.

Key elements of Standard Precautions: Hand hygiene - perform hand hygiene before and after touching a patient/client, before and after clean or aseptic procedures, after touching patient surroundings, as well as before and after putting on and taking off PPE. PPE - assess the risk of exposure to body substances or contaminated surfaces before any health care activity. Select PPE based on an assessment of likely exposure risks. For example, gloves if your hands may be in contact with body fluids, an apron or gown to prevent soiling of clothing, a face shield/mask/goggles if droplets or splashes are likely to be generated near your face.

Respiratory hygiene and cough etiquette - sneezing or coughing into the crook of your elbow or covering coughs and sneezes with a tissue, then putting the tissue in a bin and cleaning your hands.

Safe use and disposal of needles and other sharps

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Aseptic ‘non-touch’ technique - for all invasive procedures, including appropriate use of skin disinfectants.

Patient care equipment – clean, disinfect and reprocess reusable equipment between patients.

Appropriate cleaning and disinfection - of environmental and other frequently touched surfaces.

Safe waste management Safe handling of linen Refer to the World Health Organization (WHO) poster on standard precautions for further information, available at: https://www.who.int/csr/resources/publications/standardprecautions/en/

What are Transmission Based Precautions?

Transmission Based precautions are a secondary set of infection prevention and control practices.

They are used in addition to Standard Precautions for patients who may be infected or colonised with infectious agents, specifically to prevent transmission of infections. There are three additional Transmission Based Precautions – Contact, Droplet and Airborne.

Contact Precautions Required to prevent transmission of infections that can be transmitted through either direct or indirect contact with people, or objects and items that have infectious matter on them. Examples include: diarrheal illnesses, multi drug resistant organisms, open infectious wounds.

What PPE is needed: •

Gloves, as well as an apron or gown should be worn by the health care worker on entry to the room for all interactions that may involve contact with the patient or the patient’s environment. See the Use of PPE section for additional information on whether an apron or gown should be worn.

Droplet Precautions

Required when interacting with people who have infections or diseases that can be spread by droplets. Examples include: influenza, COVID-19, pertussis, meningococcal disease.

What PPE is needed: A surgical mask should be worn by the health care worker on entry to the room when interactions mean that physical distancing of 1 metre cannot be maintained.

• A mask should be worn by the patient whilst awaiting assessment, or for any movement outside of a single room, along with strict adherence to respiratory hygiene and cough etiquette.

Airborne Precautions •

Required when interacting with people known or suspected to having diseases spread by very small particles that can suspend in the air and can be inhaled into the lungs. Examples include: pulmonary tuberculosis, measles. See the Aerosol Generating Procedures section for additional information related to COVID-19.

What PPE is needed: •

A P2/N95 respirator should be worn by the health care worker prior to entering the room.

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• •

Patients in a hospital setting should be placed in an airborne infection isolation room (negative pressure room).

A mask should be worn by the patient whilst awaiting assessment, or for any movement outside of a single room, along with strict adherence to respiratory hygiene and cough etiquette.

What is good hand hygiene practice?

Good hand hygiene means washing your hands with soap and water for at least 20 seconds and drying them for 20 seconds. You can also use hand sanitiser (containing at least 60 percent alcohol) if soap, water and paper hand towels are not available, and if your hands are not visibly dirty. If you use hand sanitiser, cover all the surfaces of your hands and rub them together until they feel dry.

Perform hand hygiene before and after touching a patient/client, before and after clean or aseptic procedures, after touching patient surroundings, as well as before and after putting on and taking off PPE. Remember to wash your hands before preparing and eating food, after using the toilet, and after sneezing and coughing.

Review the ‘5 moments for hand hygiene’ at: handhygiene.org.nz See also the hand hygiene video and posters on the MOH website: health.govt.nz/ppe-health

What is respiratory hygiene and cough etiquette?

People with respiratory symptoms should be facilitated and encouraged to: Sneeze or cough into the crook of their elbow or cover their coughs and sneezes with a tissue, then put the tissue in a bin and clean their hands.

Health care facilities should: Put signage at the entrance to health care facilities instructing people with acute respiratory symptoms to practice respiratory hygiene and cough etiquette, and alert staff to their symptoms.

Make hand hygiene information, hand sanitiser, tissues and masks available in common areas and areas used for the evaluation of patients with respiratory illnesses.

Place people with acute respiratory symptoms at least 1 metre away from others in common waiting areas or in a single room (if available). Ask the person to wear a mask until they can be moved to a single room.

What is physical distancing?

Physical distancing means maintaining at least 1 metre distance from others. This should be maintained where possible and practical, including in controlled environments such as healthcare facilities.

Can people transmit COVID-19 if they have no symptoms?

The COVID-19 virus can be detected in respiratory secretions before individuals have any symptoms or may have very mild symptoms. However, dispersal of the respiratory secretions requires coughing and sneezing and in the absence of these, the risk of transmission of infection to others will be very low.

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Aerosol generating procedures What are aerosol generating procedures?

Aerosol generating procedures (AGPs) include: intubation, extubation and related procedures, for example manual ventilation and open suctioning of the respiratory tract (including the upper respiratory tract), tracheotomy or tracheostomy procedures (insertion or open suctioning or removal), bronchoscopy and upper ENT airway procedures that involve suctioning, upper gastrointestinal endoscopy where there is open suctioning of the upper respiratory tract, surgery and post mortem procedures involving high-speed devices, some dental procedures (for example, use of any rotary handpieces, triplex syringes or ultrasonic scalers), non-invasive ventilation (NIV); Bi-level Positive Airway Pressure Ventilation (BiPAP) and Continuous Positive Airway Pressure Ventilation (CPAP), High Frequency Oscillatory Ventilation (HFOV), induction of sputum (cough), high flow nasal oxygen (HFNO), and nebulisers.

A N95 mask should be worn by the health care worker during AGPs if the person is a probable or confirmed COVID-19 case, or under investigation for COVID-19.

Visiting patients in isolation What advice should be provided to visitors for patients in isolation in a health care setting?

Follow the health care facility’s visitor policy for patients in isolation. If visitors are allowed, they need protection from infectious respiratory droplets while they are in the room and should be provided with a surgical/medical grade mask. Show visitors how to put on a mask properly, to dispose of the mask safely, and to perform hand hygiene before and after handling the mask, and when they enter and leave the room.

Visitors should be asked to leave the room if the patient needs an aerosol producing procedure.

Use of PPE Can I reuse PPE? Masks, aprons, gowns and gloves should not be reused by health and disability care workers.

How do l dispose of used PPE? In the hospital setting, used PPE should be discarded into a Biohazard waste bag as per hospital policy.

In the community, used PPE should be put into a separate bag and sealed before placing in the general waste.

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How do I put on and take off PPE? See the poster for steps to put on PPE and remove it safely on the MOH website: health.govt.nz/ppe-health You can also watch the PPE instructional video produced by Auckland DHB for primary health care on that page.

Face masks What is the difference between a surgical/medical mask and a N95/P2 Respirator?

A well-fitting surgical/medical grade mask provides protection from droplets produced by the wearer because these are contained within the mask. It also protects the wearer from infectious respiratory droplets produced when a person within 1 metre of them coughs or sneezes.

N95/P2 respirators are only required with aerosol generating procedures (AGP) for a person who is a probable or confirmed COVID-19 case, or is under investigation for COVID-19. AGPs can promote the generation of fine airborne particles (<5 microns). These fine particles remain suspended in the air for longer periods than larger particles and can be inhaled, resulting in a risk of airborne transmission. An N95/P2 respirator has a higher level of filtration to filter small particles produced during the AGP. More information about the role of face masks is on the Ministry of Health website: health.govt.nz/covid19-hp-advice

How often should I change a mask?

A surgical/medical grade mask should be changed when it is damp, soiled or damaged.

The same mask should not be worn across multiple home visits (where there are more likely to be risks of contamination between patients/clients).

Masks should not be touched or adjusted during use. Masks should be removed and discarded into the waste prior to eating and drinking. Perform hand hygiene before and after the mask is removed. More information is available at health.govt.nz/ppe-health

Should clients/patients wear a surgical/medical mask?

If your risk assessment identifies that a patient/client has a chance of having COVID-19 or another acute respiratory illness, they should be provided with a surgical/medical grade mask to wear while they wait to be assessed or are being transferred between departments or facilities.

Once they are isolated in a single room, it is not necessary for them to wear a mask.

If I have assessed the need for eye protection, what should be used?

Eye protection can be goggles or plastic glasses that have side visors and fit closely to your forehead and face. Alternatively, a long face shield that covers the eyes, nose and mouth can be used for eye protection.

Prescription glasses do not provide adequate eye protection. Reusable eye protection should be cleaned safely prior to reuse, following local Infection Prevention and Control protocols.

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In some low risk interactions, where COVID-19 is not suspected, a long face shield may provide reassurance to you and your patient/client and replace the need for eye protection and a mask.

Aprons or gowns When should l wear a plastic apron?

For Standard Precautions when contamination of clothing is anticipated during patient care, but it is unlikely to involve excessive blood or body fluid exposure.

When should l wear a fluid-resistant long sleeve gown?

For Standard Precautions to protect skin and prevent soiling of clothing during activities that are likely to generate excessive splashing of blood or other body fluids, for example when a patient is vomiting.

For Contact Precautions when the health care worker’s skin or clothing is in contact with the patient, or the immediate environment, for example of a patient who is a probable or confirmed COVID-19 case, or infected with a multi drug resistant organism.

Gloves Gloves must be worn when exposure to blood and other body fluids is anticipated. They should be: changed between each patient, with hand hygiene performed before putting on and after taking off • replaced if they become punctured or torn.

Use appropriate size and type of gloves depending on the nature of care to be provided. For example, single use non-sterile gloves for general patient care or single use sterile gloves for aseptic non-touch technique procedures.

•

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Risk Assessment

Cleaning

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Cleaning instructions

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Droplet cleaning instructions

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Transport for patients Guidelines for transporting a suspect case where the driver is not a household contact Transportation must be arranged in advance so that driver is informed and prepared for the process.

Driver The driver needs to be assessed as not being at increased risk, i.e. under 70 years of age and no health conditions that increase their risk of significant illness from COVID 19.

The driver should use hand gel and a surgical mask to protect themselves from inadvertent contact.

They must receive instructions on safe use of masks and have a safe way of disposing of masks (household rubbish acceptable). Should change mask every 4 hours or if the mask becomes damp or contaminated.

Passenger Vehicle should only transport people who are from the same ‘bubble’ i.e. family or household at any given time. Collecting people from multiple addresses to share rides increases risk of transmission between households.

Limit number of passengers to those with symptoms only, plus a support person or dependants (if no other arrangements can be made).

NO passengers in the front of the vehicle.

Passengers and Support people are provided with surgical masks and must use hand gel before entering and after leaving the vehicle.

Vehicle Vehicle must have seats and surfaces that can be wiped with detergent and water after the person has completed the assessment and returned home. For plastic and leather seats, no further cover is needed. If the vehicle has cloth seats this may be achieved by the use of impermeable seat covers (i.e. plastic or similar material). Once the transport is completed seats, door handles and surfaces that passengers touched should be wiped down with a disinfectant wipe or detergent.

During transport • • •

Maintain a negative air flow through the vehicle Turn off fans and air con Seat passenger in rear of vehicle on left side of vehicle

Drivers window down and passenger window down to create air flow from outside, past driver.

Passenger and support person enters and exits vehicle on passenger’s side

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Patient Handouts COVID-19 testing medical certificate

MEDICAL CERTIFICATE

Date

Name

The above patient attended their General Practice today.

A swab was taken for COVID-19 testing.

Until the results are known, they are now considered a suspect case and must self-isolate.

If the swab is POSITIVE, Toi Te Ora Public Health service will manage ongoing care and advice around work and testing of contacts.

If the result is NEGATIVE, your employee can return to work once they have been asymptomatic for 48 hours.

Signed

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Self-isolation

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Information for â&#x20AC;&#x2DC;case under investigationâ&#x20AC;&#x2122;

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Advice to patients following a COVID-19 swab â&#x20AC;&#x201C; Low risk people with symptoms To support the continued efforts to keep COVID-19 out of New Zealand, people with symptoms consistent with COVID-19 are being offered a test. This is voluntary. The principle is that by continuing to test people in the community, we would detect any cases early which can then be isolated and contained.

You have been swabbed as you have symptoms.

The result is available within 2-5 days; however, this time may vary as it depends on how many samples the laboratory receives each day. Tests from the hospital and from higher risk people, such as those in managed isolation, are processed first.

You will receive a phone call from Toi Te Ora Public Health if you have a positive swab, but at this stage you will not be contacted if your result is negative. If you are concerned, please call your general practice for the result.

Please ensure that the team who have seen you today have the correct phone number and contact details for you.

When can I return to work/school?

As your test is only for surveillance purposes you can return to work as soon as you feel better.

The doctor or nurse who has assessed you should be able to tell you how long this might be.

Sometimes the symptoms of a cold or flu, such as a cough or runny nose, can linger for days if not weeks, even if you are feeling better. In this instance, a swab can be helpful in reassuring you that you do not have COVID-19, while also allowing you to return to work.

It is important that you do not go to work or school if you feel unwell.

Is there any treatment I can take?

Simple pain killers like paracetamol can make you feel more comfortable while your body fights the infection. If your doctor or nurse finds a bacterial cause of your illness, such as a chest or throat infection, antibiotics may be required.

If you start to feel worse rather than better, call your General Practice or Healthline on 0800 358 5453. For more information, please refer to the NZ Government Covid-19 website: www.covid19.govt.nz

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Data Entry - Halcyon Getting Started: Select patient and open Halcyon Portal To display the COVID-19 form: Go to Other Options and click New Assessment PLEASE NOTE: Available for casual AND enrolled and funded patients

All Tabs on the form MUST be completed

Clinical Assessment tab First section relates to the service claiming Delivery mode and Assessment type MUST be completed

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Case Definition, Consent & Swab Information MUST also be completed (Added to guide on 5 June 2020) SPECIAL NOTE on Swab Taken field: All swabs done MUST be recorded in the Bay of Plenty region reporting database, and the Covid Halcyon form does this for WBOPPHO. To ensure this happens accurately please fill out the Swab Taken fields as follows Virtual Assessment with Swab Taken in a general practice: â&#x20AC;˘

Select NO to reflect assessment only

Virtual Assessment with swab referral to Pathlab: â&#x20AC;˘

Select YES to reflect assessment and swab to be taken

Pathlab are not able to update the swabbing database. To work around this all Pathlab swab referrals need to recorded as Swab Taken the Halcyon form when virtually assessed as shown below

Clinical Assessment continued: See below a screenshot of the rest of the sections and points to note All sections MUST be completed with all relevant clinical information

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Identification Details tab: PLEASE NOTE: Not Required to complete all fields under this Tab Required to Complete: 1. Address where the Patient is living today / now â&#x20AC;˘ Auto populates from the practice management system 2.

For casual patients complete the Patients Usual GP information.

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When form completed SUBMIT the form to lodge the claim and write back an invoice to the account nominated in the PMS. The following write backs occur in the PMS: • •

Copy of the form to Inbox and Clinical notes Adds Suspected COVID-19 to classifications

EXTRA INFORMATION about Virtual Assessment Claiming: For a Virtual Assessment, where the patient will be swabbed in the same practice (or a different site in their network sharing the same enrollment database) the Virtual Assessment fee CANNOT be claimed.

The assessment is funded under the Simple or Full assessment / swab claim and cannot be claimed twice.

In this instance PARK the form, so that it can be completed and submitted at the time of swabbing.

This claim will be for either: •

Simple or Full Assessment and swab

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Any PARKED COVID-19 form awaiting completion and claiming will show when Halcyon is opened for that patient. See screenshot.

Claiming Claiming Amounts and Process Simple Full Examination Assessment $60.00 $120.00 $250.00 Claim to be submitted via the Halcyon form.

Virtual Claim amount WBOPPHO

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Manual Data Collection Form BOP COVID-19 Community Assessment Form Patient Details *NHI (if known) *Date of Birth *First name

Location: Ethnicity Details*

New Zealand European

Which ethnic group(s) do you belong to?

Samoan

* Tick the space or spaces which apply to you

*Surname *Gender Patient is enrolled at this practice?

Yes / No

Maori

Cook Island Maori Tongan Niuean Chinese Indian Other (such as Dutch, Japanese, Tokelauan).

Please state:

Identification Details *Address *Suburb *City

Postcode

*Phone

*Email Address

Patient’s usual GP Occupation

*Usual Practice Name *Usual Country

Provider Details *Provider

Clinical Assessment Details *Assessment Date *Delivery Mode

*Assessment Time

 face to face, one patient to one clinician  face to face, one patient to many clinicians  face to face, one clinician to many patients

(tick all that apply)

*Assessment Type (tick all that apply)

Meets current case definition

 Simple assessment  Full assessment  Virtual assessment  No assessment completed  No  Unknown  *Do you provide consent to access your personal details so we can identify you?  Yes

 Yes *Swab taken

Date:

 No

*Recent travel overseas

 Yes

 No Days since exposure:

Time:

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 remote patient monitoring  videoconference  Non-contact (virtual)

Setting up a Testing Service - COVID-19 v2

*Exposure to confirmed or suspected case

 Yes

 No Days since exposure:

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*Medical Conditions

 Immunodeficiency including HIV  Cardiovascular disease including

(Tick all that apply)

hypertension

*Symptoms (Tick all that apply)

 Chronic lung disease  Chronic neurological disease  Chronic neurological disease

Allergies:  Diabetes  Liver disease *Pregnancy:  Kidney disease  First trimester  postpartum > 6wks  Stroke (history of)  Second trimester  Not pregnant  Current Cancer  Third trimester  Not applicable  Cancer (history of < 5 years)  Fever  Headache These symptoms are:  Chills  Irritability  Mild  General weakness  Confusion  Cough  Altered mental state  Moderate  Sore throat Clinical signs of shock  Severe  Haemoptysis Loss of sense of smell  Runny nose  Loss of taste  Head cold Muscular pain Social/ Personal Circumstance  Shortness of  Chest pain  unable to mobilise without breath assistance  Abdominal pain  Respiratory  unable to safely provide self-care  Joint pain distress  No alternate carers available  Nausea  Vomiting  Diarrhoea

*Clinical Signs Temperature Respiratory rate

Tick all clinical signs that apply

Blood Pressure

Pulse

SaO2

 Pharyngeal Exudate  Seizure  Tachypnea  Conjunctival Injection  Coma  Abnormal Lung auscultation  Other clinical signs  Dypsnea  Abnormal lung Xray

Clinical Notes

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