Our COVID-19 Safety Plan
Risk Assessment
❏ We have involved frontline workers (MOAs) and physicians.
❏ We have identified areas where people gather, such as the lunch room, office spaces, and waiting rooms.
❏ We have identified job tasks and processes where individuals are close to one another and/or members of the public.
❏ We have identified the office, medical and other equipment that staff and team members share while working.
❏ We have identified surfaces that people touch often, such as doorknobs, elevator buttons, and light switches.
Risk Reduction Protocols
First level protection (elimination)
❏ We have established and posted an occupancy limit for our premises. Maximum 7 staff and 6 patients (not more than 4 “groups” of patients).
❏ In order to reduce the number of people at the office, we have arranged work-from-home arrangements, virtual care, rescheduled work tasks, and limited the number of staff and patients in the workplace.
❏ We have established and posted occupancy limits:
· Waiting Room: 4 patient groups (max 6 people total)
· Washroom max 1 person
· Back break room max 1 person
· Common elevator max 2 people if from same family, otherwise 1 person
❏ We have implemented measures to keep staff and others at least 2 metres apart, wherever possible.
❏ We have a sign on the door indicating patients should wait in their cars/outside when they first arrive and call us to check-in. This is reinforced by a message on our website and telephone system.
❏ We will call patients or send them an SMS message when we are ready for them to come in.
❏ We have allocated a limited number of appointments per day to allow for physical distancing in common areas.
❏ We have placed occupancy limits on our waiting room and ensured chairs are at least 2 meters apart and we will minimize patients waiting in our waiting room—they will be taken back to an examination room as soon as possible.
❏ We do not accept “walk-in” appointments.
❏ We will only allow patients with scheduled appointments themselves to enter the office. We will make exceptions for care-givers, only if necessary.
❏ Scheduled appointments for those at higher risk (e.g. immunocompromised, multiple comorbidities or the elderly) will be done in the morning.
❏ We have limited surfaces that allow for physical contact, including removing magazines, toys and clipboards from waiting rooms and exam rooms; and removing extra chairs.
❏ We have reduced the materials available for pick-up and drop-off to minimize non-vital in-person contacts.
Second level protection (engineering)
❏ We have installed a sneeze-guard barrier at the reception desk.
❏ We have included barrier cleaning in our cleaning protocols.
❏We have indicated a distance of 2 metres in front of the front desk.
❏ We have implemented a telephone check-in system – no additional information will need to be obtained, and no paper forms exchanged when the patient arrives.
❏ We have set up a one-way directional flow through the office marked with arrows.
❏ We have inspected and verified all infrastructure systems
❏ We have increased the rate of air exchange/ventilation by running the AC in circulation mode and having windows open when possible.
Third level protection (administrative)
❏ We have identified rules and guidelines for how staff and team members should conduct themselves.
❏ We have clearly communicated these rules and guidelines to staff and team members through a combination of training and signage.
❏ If sick, physicians and team members must remain at home. They may continue to provide patient care via telephone or video.
❏ All staff will perform hand hygiene and don appropriate PPE (i.e. a surgical mask) immediately upon entering the office. The BCCDC Hand Hygiene poster is being used to educate staff and team members.
❏ All staff will clean their hands frequently—as this is the best thing anyone can do to decrease the transmission of COVID.
❏ We will conduct temperature checks of patients upon arrival and ensure all staff and team members continuously self-monitor for symptoms.
❏ We are prepared to cross-cover staff or team members who are ill or quarantined:
❏ We have put up laminated signage in the areas frequented by patients (e.g. washrooms and above examination room sinks) outlining the appropriate hand washing protocols, alerting high-risk patients (i.e. respiratory symptoms, recent travellers) to notify staff immediately, cough etiquette, etc.
❏ We will wipe down laminated signage regularly.
Fourth level protection (PPE)
❏ We have reviewed the information on selecting and using PPE and instructions on how to use appropriate PPE.
❏ We understand the limitations of masks and other PPE. We understand that PPE should only be used in combination with other control measures.
❏ We understand that if PPE is not available, staff and physicians are not expected to risk their own health by providing in-person care.
❏ We have trained staff and team members to use PPE properly, following manufacturers’ instructions for use and disposal.
❏ We are following the PPE guidelines for asymptomatic patients in community, as recommended by the BCCDC and/or Island Health Community PPE Guidelines.
❏ We will encourage patients to wear their own masks, or else we will provide masks for patients and instructions on how to wear them.
❏ We will keep our mask on at all times while seeing patients, and keep our hands away from our face. If we touch it or remove it, or it becomes soiled or wet, we will change it.
Reduce the risk of surface transmission through effective cleaning and hygiene practices
❏ We have reviewed the information on cleaning and disinfecting surfaces.
❏ Our office has enough handwashing facilities on site for all our staff and patients.
❏ Handwashing locations are visible and easily accessed.
❏ We have a policy that specifies that staff and team members must wash their hands before and after patient contact, on arrival at work, before leaving a work and frequently throughout the day. We have communicated good hygiene practices to staff and team members. Frequent handwashing and good hygiene practices are essential to reduce the spread of the virus.
❏ We have implemented cleaning protocols for all common areas and surfaces
Washrooms, door knobs, reception desk, waiting room chairs, light switches, workstations: at least 2 times a day and at the start and end of the day
❏ Staff and team members who are cleaning have adequate training and materials.
❏ We have removed unnecessary tools and equipment to simplify the cleaning process – e.g., coffee makers and shared utensils and plates.
❏ We have placed the patient chair as far away as possible from the physician chair/stool in the exam room.
❏ In order to minimize exposure to patients, if an accurate weight is needed, staff will instruct patients on how to weigh themselves on the office scale without touching the controls.
❏ We will accept blood pressure and heart-rate results brought in from home by patients, and only measure vital signs ourselves in extenuating circumstances.
❏ We have assigned each staff member to a dedicated work area as much as possible and discouraged the sharing of phones, desks, offices, exam rooms and other medical and writing equipment.
❏ We have made hand hygiene supplies readily available for both patients, staff and team members. Our hand sanitizers are approved by Health Canada.
❏ Between patients, we will disinfect everything that comes into contact with the patient (i.e. chairs, medical instruments, stethoscopes).
❏ Team members will use the same stethoscope provided it is wiped with alcohol pads or a disinfectant wipe between patients.
❏ We have put up signage encouraging patients to only use the office washroom if there is an urgent need.
❏ We have set up a sanitizing station near the entrance for all patients entering the office.
❏As we are not seeing symptomatic patients, we are using local testing and assessment centers to minimize patient exposure.
Our policies ensure that staff, team members and others showing symptoms of COVID-19 are prohibited from the office.
· Anyone who has had symptoms of COVID-19 in the last 10 days. Symptoms include fever, chills, new or worsening cough, shortness of breath, sore throat, and new muscle aches or headache.
· Anyone directed by Public Health to self-isolate.
· Anyone who has arrived from outside of Canada or who has had contact with a confirmed COVID-19 case must self-isolate for 14 days and monitor for symptoms.
· Visitors are prohibited or limited in the office.
· We have a work from home policy in place (if needed).
· Staff and team members have the training and strategies required to address the risk of violence that may arise as patients and members of the public adapt to restrictions or modifications to the office.
Our policy addresses staff and team members who may start to feel ill at work. It includes the following:
· Sick staff or team members should be asked to wash or sanitize their hands, and go straight home.
· If the staff or team member is severely ill (e.g., difficulty breathing, chest pain), call 911.
· Clean and disinfect any surfaces that the ill staff or team member has come into contact with.
Daily precautions taken by all staff:
Staff tasks prior to opening of the office:
● All staff use hand hygiene immediately upon entering the clinic.
● Place a sign on the front door and barrier in the waiting room to ensure only scheduled patients are entering the clinic and patients remain the required physical distance to personnel at all times.
● Ask patients to arrive no more than 5 minutes before their appointment. If patients arrive earlier than 5 mins, they need to wait elsewhere (e.g. in their vehicle) until appointment time.
● Ensure that all necessary PPE is easily accessible.
● Ensure that a hand sanitizer is set up in the waiting room and in each exam room for easy access.
● Staff will work where they are able to see patients enter the clinic.
Safety measures to take prior to all appointments:
● Call patients before their appointment to:
1. screen them for risks—rescheduling if they are sick, are placed on self-isolation or have travelled out of the country within the last 14 days,
2. educate them of changes to office protocols,
3. indicate that they should attend appointments alone when possible and not bring friends or children, and
4. request that they not enter the office earlier than 5 min before their appointment.
● Signage is posted at the clinic entrance to assist with communicating expectations (i.e. hand hygiene, physical distancing, respiratory etiquette, reporting illness or travel history, occupancy limits and no entry if unwell or in self isolation).
● All patients will be screened for COVID symptoms prior to and upon arrival.
● The patient's temperature will be checked on arrival with a contactless thermometer.
● Patients screening positive or having a fever will be redirected home for a virtual appointment or referred to a Health Authority assessment clinic or the Emergency Department (depending on severity of symptoms) if necessary.
● Patients screening positive will be advised to self-refer to a testing facility.
Clinic workflows for Physicians:
● All individuals seeing patients are to perform hand hygiene and put on a mask while seeing patients.
● Patient should also be wearing a mask.
Take history from at least 6 feet away, if possible.
● Add gloves while examining the patient. Try to spend as little time as possible in close contact.
● For higher risk patients, or clinical suspicion, option to add gown and eye protection.
● After examination is complete:
1. Remove exam table paper.
2. Wipe down exam table with antiseptic wipe or spray.
3. Wipe down stethoscope or any equipment that touched the patient.
4. Remove gloves (and other PPE if used).
5. Perform hand hygiene.
6. Ask patient to use hand sanitizer as they leave.
7. Open the door for the patient and stand aside as they leave.
8. Leave your mask on if you are seeing another patient
9. Otherwise, perform hand hygiene before and after taking off your mask.
● Consider faxing prescriptions, requisitions for investigations, and labs requisitions, rather than giving paper copies to the patient.