April 25 - COVID-19 Physician Specific Information

April 25, 2020

To view archives of all physician resources and communication visit www.cdha.nshealth.ca/coronavirus

COVID-19 Physician Information Update

April 25, 2020

Updated Clinical Documents

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Order Sets, Procedures, Clinical Pathways, Guidelines and Policies

April 25 - Alternate Gestational Diabetes Mellitus Screening & FAQ
April 25 - COVID-19 Primary Assessment Chart - In Home Assessment
April 25 - Code Blue Response Rural Sites - CZ - Eastern Memorial Hospital
April 25 - Code Blue Response Rural Sites - EZ - Guysborough Memorial Hospital
April 25 - Code Blue Response Rural Sites - EZ - St Marys Memorial Hospital
April 24 - Periop: Decision Management Protocol for Surgical Procedures Requiring General Anesthesia
April 24 - Information about Self-Isolation following COVID-19 Testing
April 24 - COVID Risk Assessment - Community / Facility Cluster Info for Healthcare Providers
April 24- COVID Risk Assessment - Staff Alert Form CZ
April 24- COVID Risk Assessment - Patient Alert Form NZ EZ WZ
April 24- COVID Risk Assessment - Postal Code Flag Droplet Precautions
April 24 - Code Blue - SOP - DGH/QEII Response
April 24 - Continuing Care Home Care Fact Sheet
April 24 - COVID Community Virtual Team (CCVCT) Eligibility/Referral Process -HCP
April 24 - COVID Community Virtual Team (CCVCT) – Patient Information

COVID Primary Assessment Centres and Secondary Assessment Centres

April 25 - Updated Referral Guideline - Secondary Assessment Centre
April 24 - Clinical Pathway - Adult - Primary Assessment to Secondary Assessment - EZ
April 24 - Clinical Pathway - Pediatric - Primary Assessment to Secondary Assessment - EZ
April 24 - Primary Assessment Centres Contact/Location Information
April 24 - Secondary Assessment Centres Contact/Location Information

Alternative Gestational Diabetes Mellitus Screening

NSHA/IWK Pathology and Lab IWK Pathology and Laboratory Medicine Program

To manage COVID-19 related issues with GDM screening, the PLM Program, in collaboration with

NSHA Women and Children’s Program, IWK Pregnancy and Diabetes Clinic, and the Reproductive and

Diabetes Care Programs of Nova Scotia, have jointly approved temporary implementation of an

alternative GDM screening strategy recently recommended by SOGC and Diabetes Canada. Rather

than the 50g-GCT (Trutol), low risk pregnant women between 24 to 28 weeks’ gestation will

be screened with a random (non-fasting) glucose and HbA1c.

No changes to screening for overt diabetes early in pregnancy are recommended.
To override utilization rules, please indicate on the lab requisition that the patient is pregnant.
Caregivers are requested to order HbA1c and a Random (non-fasting) glucose instead of the 50g-GCT. The patient will not have to wait 1-hour for the timed collection.
If a 50g-GCT is ordered, it will be corrected at the time of collection to the alternative screen.
If a fasting glucose, HbA1c, and/or 75g-OGTT are ordered (i.e. given clinical context), it will be carried out as requested by the physician.
These measures are temporary and their continuance will be reviewed by the COVID-19 GDM working group every two weeks. Post-pandemic, we will return to the original recommendation of the 2018 Diabetes Canada Clinical Practice Guidelines.
FAQs are located on the NSHA COVID-19 Hub here
The full statement from SOGC and Diabetes Canada can be found here

Grief Support Video

Dr. David Henderson, Sr. Medical Director for NSHA Palliative Care talks about moving towards resilience & safety in grieving and what has history taught us.

The Provincial Mental Health Crisis Line is available for you or someone you are concerned about 24/7, by calling toll-free 1-888-429-8167.

A message from Dr. Henderson, Sr. Medical Director for NSHA Palliative Care

Drug Supply Update

Pharmacy continues to receive questions about the availability of drugs surrounding COVID-19. It is understandable staff are concerned about our supply, especially with the various news headlines. The Nova Scotia Drug Shortage Task Team (NS DSTT) in conjunction with the Provincial Drug Distribution Program (PDDP) continue to monitor supply. Most manufacturers continue to fulfill orders however; have implemented monthly allocations based on historical usage patterns.

Health Canada has identified the highest risk medications. Rather than wait for a shortage to occur, they have classified key medications (sedatives, NMBAs, opioids etc) at the highest acuity of shortage in anticipation. This initiates processes to solicit manufacturers for mitigation proposals immediately. As proposals are approved they will be posted by Health Canada.

To communicate current supply of COVID-related medications to NSHA a graded list will be communicated regularly. As signals of shortages or potential shortages arise this communication will be updated Supply should managed judiciously and waste reduction is important.

CRITICALLY LOW

None identified currently

LOW

Salbutamol Inhalers

Shift from salbutamol nebules along with high demand has strained supply
Shipments of small quantities are still being received
Current mitigation strategy: Optimizing Utilization of Metered Dose Inhalers (MDI) and Spacers/Aerochambers upon Patient Transfer of Care from EHS to ED

Epinephrine pre-filled syringes

Pre-existing shortage situation with 50-75% monthly allocations. Ampoules are available.

STABLE

Frequent inquiries are received regarding supply of neuromuscular blocking agents, sedatives and vasopressors. Current NSHA levels are at or above historical volumes. Agents of concern include those needing higher doses in COVID patients, those that may have a surge in usage or drugs with sole source manufacturers.

Cisatracurium

signals that higher doses are required in COVID patients
Sole source manufacturer

Ketamine

An increase in use of infusions at high doses could strain supply

It important to note that the NS DSTT continues to monitor drug supply and signals of shortages for all medications. Questions regarding drug shortages can be directed to the Drug Information Center via lisa.grandyallen@nshealth.ca.

New Mental Health and Wellness

Resource Sheets

MAiD Information Session

Join Dr. Gord Gubitz for a Virtual Information Session on Medical Assistance in Dying (MAiD).

Friday May 1, 9:00 a.m. to 10:00 a.m.

Dr. Gubitz will review federal legislation, the referral / intake process, assignment of assessments, patient eligibility criteria, MAiD procedure, clinical documentation, as well as Federal reporting requirements.

We are working toward building additional clinical capacity within the MAiD team, and this session is therefore directed at Physicians and Nurse Practitioners. However, anyone who wishes to learn more about MAiD may take part.

Please register with John McCarthy, Medical Affairs Advisor by 12:00 noon, Thursday, April 30th. Those who register will receive a link and login credentials for the Zoom meeting. If you have any questions, please call John McCarthy at 902-220-2968.

Choosing Wisely Canada Webinar

Join the next virtual gathering on safety considerations with

Chloroquine, Hydroxychloroquine and Azithromycin in the Management of COVID-19.

Dr. Juurlink, internist and head of the Division of Clinical Pharmacology and Toxicology at Sunnybrook Health Sciences Centre, will be discussing his recent article published in CMAJ.

When: April 29 at noon to 1:00 p.m. (EST). Register today

Moments of Gratitude

Chessie Yorke is a Microbiology Technologist in the lab at Colchester East Hants Health Centre in Truro and created this "specimen" to let families know we are thinking of them #novascotiastrong

Provincial COVID-19 Status Update

Today, April 25, Nova Scotia is reporting six additional deaths related to COVID-19, bringing the total to 22. Five occurred at the Northwood long-term care home in Halifax Regional Municipality. As well, a man in his 80s with underlying medical conditions died in the Western Zone; he was not a resident of a long-term care home.

"Our province is experiencing a tremendous amount of pain right now. Our thoughts are with everyone who has lost a loved one from this virus," said Premier Stephen McNeil. "We stand together to grieve those who have died and to support those who are in mourning."

As of today, Nova Scotia has 865 confirmed cases of COVID-19. Fifteen new cases were identified Friday, April 24.

"With the weekend upon us, I ask everyone to remain vigilant. Please stay home as much as possible, wash your hands and maintain physical distance," said Dr. Robert Strang, Nova Scotia's chief medical officer of health. "Let's be able to look back and know we did everything we could to stop this virus from hurting any more of our fellow Nova Scotians."

The QEII Health Sciences Centre's microbiology lab completed 965 Nova Scotia tests on April 24 and is operating 24-hours. Nova Scotia has conducted more COVID-19 tests per capita than any other province.

As of April 24, there were 10 licensed long-term care homes and unlicensed seniors' facilities in Nova Scotia with cases of COVID-19, involving 191 residents and 90 staff.

While most cases in Nova Scotia have been connected to travel or a known case, there is now community spread. That is why travel has been removed as a requirement for testing for COVID-19.

The list of symptoms being screened for has recently expanded. If you have two or more of the following symptoms, visit https://811.novascotia.ca to determine if you should call 811 for further assessment:

fever
new or worsening cough
sore throat
runny nose
headache

To date, Nova Scotia has 25,119 negative test results, 865 positive COVID-19 test results and 22 deaths. Confirmed cases range in age from under 10 to over 90. Eleven individuals are currently in hospital, three of those in ICU. Four hundred and twelve individuals have now recovered and their cases of COVID-19 are considered resolved. Cases have been identified in all parts of the province. A map and graphic presentation of the case data is available at https://novascotia.ca/coronavirus/data .

Public health is working to identify and test people who may have come in close contact with the confirmed cases. Those individuals who have been confirmed are being directed to self-isolate at home, away from the public, for 14 days.

Anyone who has travelled outside Nova Scotia must self-isolate for 14 days. As always, any Nova Scotian who develops symptoms of acute respiratory illness should limit their contact with others until they feel better.

It is now more important than ever for Nova Scotians to strictly adhere to the public health orders and directives - practise good hygiene, maintain a physical distance of two metres or six feet from others, limit essential gatherings to no more than five people and stay at home as much as possible.

Nova Scotians can find accurate, up-to-date information, handwashing posters and fact sheets at https://novascotia.ca/coronavirus .

Quick Facts:

testing numbers are updated daily at https://novascotia.ca/coronavirus
a state of emergency was declared under the Emergency Management Act on March 22 and extended to May 3

This section of our update is a list of helpful resources updated daily for physicians.

Please reach out to Shawn Jolemore with your suggestions for additional content.

Leadership and Wellness Poster

Updated for Week of April 20-27

Leadership Supports

Individual Executive Coaching for Physician Leaders with Executive Coach Lorie Campbell

Are you struggling to lead yourself or your team(s) well during this pandemic?

Take advantage of 30 or 60-minute focused, one-to-one virtual executive coaching sessions for formal physician leaders only. Email Lorie Campbell to book a time for this free service, provided by NSHA Medical Affairs Leadership Development.

Setting Personal and Professional Priorities in the Midst of Pandemic

April 27 from 4-5 p.m. with Dr. Lara Hazelton. Join Zoom Meeting. Password if prompted: 050891

Talking About Trust: An Exploration of BRAVING, Brene Brown’s Tool for Having More Effective Conversations About Trust.

Wednesday, April 29 12:00-1:00 pm with Basia Solarz. Email Dana2.Jakeman@nshealth.ca to request your Zoom link..

Wellness Supports

Daily Physician Wellness Check In - COVID-19 What's Normal?

Join Drs. Jaqueline Kinley and John Chiasson for daily online meetings to chat about coping strategies and mental health concerns. Meetings are daily M-F at 12 NOON. and are open to all physicians. Click here for the *updated* Zoom - Join Zoom Meeting Link

DNS Professional Support Program

Feeling overwhelmed or need to talk to someone?

As we try to wrap our heads around the weekend’s tragic events and the senseless loss of so many innocent lives, I want to remind you that help is available. Whether you were directly connected to it or not, the tragedy intensifies the stress of the pandemic and the pressure on our lives due to the measures we are all following.

Contact the Doctors Nova Scotia (DNS) Professional Support Program at 902-468-8215 or 1-855-275-8215 (toll-free) mail or via email. LifeWorks by Morneau Shepell is also available to members and their families affected by the events in Portapique and surrounding communities. The crisis support line is open 24-7. Call 1-844-751-2133.

Preparing for Crisis: A Healthcare Professional's Guide to Emotional Health

April 29 from 4-5 p.m. with Dr. Angela Cooper. Join Zoom Meeting. Password if prompted: 050891

View the session handout

Support Sessions - Colchester East Hants Health Centre

As things continue to unfold with the horrific situation that has occurred in Northern Zone, we recognize that staff and managers are feeling many emotions. NSHA leaders within the Northern Zone have reached out to our EAP/EFAP provider to arrange additional supports on site at CEHHC. Robert Ziegler MEd, RCT-C, is a psychotherapist provided by Morneau Shepell Global Critical Incident Team. He will be available for in-person, confidential support for hospital staff on April 24, 2020 from 2 pm until 9 pm for either booked appointments or walk in appointments (subject to availability). This service will be located in the Hawthorn Room between E2 and D2.

Individuals are able to confidentially sign up for appointments by taking an appointment card from the sign-up sheet beside the door of the Hawthorn Room. This will reserve an appointment for them to attend at the set time and date they chose. If the door is open and appointment times are not booked, staff can drop in.

Morneau Shepell has also opened its 24/7 bilingual crisis support line to help anyone in need of emotional support as a result of these tragic events. The number is: 1-844-751-2133.

Physician Screening for COVID-19

Call 1-833-750-0632 to speak to Occupational Health and Safety for your screening options.