To: Family physicians and nurse practitioners
04-23-2020
Video Message from Dr. Brendan Carr, President and CEO, NSHA

We would like to share a video message from Dr. Brendan Carr, President and CEO of NSHA, which was recorded last week for primary care providers.

This thank you message for family physicians, nurse practitioners, and teams in Primary Health Care recognizes the pace of change and your adaptability in practice to respond to COVID-19.

Thank you for everything you do to provide care and support for Nova Scotians.  
Supply of Masks for Primary Care Providers

Last week we shared information regarding NSHA’s decision to supply all health care providers with a mask for in-person patient encounters.

For community-based providers in family practice, two masks per family physician / nurse practitioner per week will be supplied from a centralized location in your area.

Based on this, we are expecting that you limit in-person appointments to one day per week in your practice. You will have one mask to wear for that day and a second as a backup. Wearing the same mask throughout the day during in-person office appointments will help to protect your patients, and by pre-screening all patients by phone in order to refer patients with respiratory symptoms to your local primary assessment centre, this will limit exposure to the virus for yourself, your staff, and your other patients.

When you require a supply of masks, please send an email to the below address for your respective area. A Primary Health Care manager or lead will contact you to arrange distribution of masks for your practice. It is important that we responsibly manage our supply; we will share with you the anticipated length of time the supplied masks should last based on the recommended usage.

Direction on Comfort Enhancements for Masks

A message from the NSHA Personal Protective Equipment (PPE) Working Group

It can be very difficult to wear a mask all day, especially if this has never been part of your practice. We understand that some staff and physicians are using other tools and enhancements to make mask-wearing more comfortable, such as headbands and plastic clips.
 
Infection Prevention and Control and Occupational Health, Safety and Wellness want to support staff and physicians to wear the masks safely and effectively, and do not endorse the use of any additions. The mask you are wearing is not intended to be worn with additional clasps or holders. Donning and doffing masks is to be done by the ear loops only. Adding enhancements of any kind increases the likelihood of staff/physician contamination when doffing, and presents another element that could fail while the mask is worn. 
COVID Community and Facility Clusters

Public Health has identified that there are areas and facilities within the province that are experiencing higher rates of COVID-19. There is a risk in these areas of asymptomatic transmission, and people may not know if they have been exposed to COVID-19. The areas are being called COVID community and facility clusters. These clusters are identified in the daily NS Public Health Epidemiology Report. NSHA has created a summary of the clusters with postal codes:
Virtual Care: Telehealth Zoom Privacy and Security Response

Nova Scotia Health Authority, the IWK Health Centre and our government partners are working together to provide a secure on-line environment for those who are using Zoom for Healthcare.

There are enhanced security features already activated in the Zoom for Healthcare application. For example, a meeting ID and password is automatically generated for every scheduled virtual meeting that only allows the health care provider and designated patient to join the meeting. Training and resources for health care providers are also available to support you in using Zoom for Healthcare securely.

We are continuing to monitor information about Zoom for Healthcare as it becomes available.


If you have any questions, visit www.cdha.nshealth.ca/telehealth-zoom or email VirtualCare@nshealth.ca. 
Virtual Care: Including Interpreters in Patient Appointments

Instructions have been created for health care providers who require an interpreter to support a patient appointment when using Zoom for Healthcare.


For phone appointments that require interpretation services, contact NSHA's Language Line:
• Northern Zone: 1-866-874-3972, Client ID: 262662
• Eastern Zone: 1-866-874-3972, Client ID: 262658
• Western Zone: 1-866-874-3972, Client ID: 562009
• Central Zone: 1-888-898-4524, Client ID: 562004

If you have questions about interpretation, please call NSHA’s Interpretation and Language Services coordinator at 902-473-1909 or 902-219-2551.
Nurse Practitioner Embraces Virtual Care for Patients
 
At the end of March, Susan Savage, NP, began providing virtual appointments for patients using Zoom for Healthcare, like many others, once it became available for health care providers in Nova Scotia.
 
“When it was indicated that we should limit in-person appointments due to the spread of COVID-19, our practice adopted virtual care overnight,” she said. “We talked about using Zoom one day, and the next day we were doing it. I’ve been providing many of my appointments with patients over the past three weeks online.”
 
Savage found it easy to adapt to virtual appointments, as she routinely provides appointments for her patients by phone. 

Read more . 
Prescribing Discharge Medications during COVID-19

To mitigate the risk of drug shortages, the Nova Scotia College of Pharmacists has directed pharmacists to only dispense a 30-day supply of medication unless a longer day supply is appropriate.

NSHA Pharmacy recommends the following process to ensure successful discharge:
  • Plan ahead for discharges as much as possible. Community Pharmacy turnaround time may be up to 48 hours.
  • Fax all discharge prescriptions to community pharmacies.
  • Confirm required medications are in stock; especially high cost or specialty items (e.g. dalteparin prefilled syringes).
  • Instruct the patient NOT to go directly to their pharmacy. They must contact their pharmacy to determine the pick-up time.
  • Complete all NS Pharmacare requests and confirm approval for any Exception Status drugs prior to discharge.
  • Plan ahead if compliance packaging (e.g., blister packs) is required.
  • Please take care to correctly indicate medications that have been started, stopped, OR changed during admission.
  • Many requirements for narcotics and controlled drugs are currently suspended.
  • Consider e-prescribing using the NS DIS.