COVID-19 Physician Information Update
April 26, 2020
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Updated Clinical Documents
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Order Sets, Procedures, Clinical Pathways, Guidelines and Policies
COVID Primary Assessment Centres and Secondary Assessment Centres
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Another week has passed . A hard difficult week. The aftermath of a mass shooting took an emotional toll on all Nova Scotians. The impact of the Covid pandemic in Nova Scotia is sobering as well with the death toll rising to 24 today.
We are here for you if you are struggling.Please note and take advantage of all the opportunities to reach out and connect if you need to or know someone who does. Our daily communication lists a variety of services available. We have expanded capacity of platforms to allow increased numbers of people to join.
With all the grief and sadness we have been faced with this week, I would like to take the opportunity to reflect on some positive things that have happened over the past six weeks. One of the first things that comes to mind is the explosion of virtual care opportunities. I am hearing from patients and providers alike the value they are receiving from these options. Convenience, accessibility and efficiency are descriptors that are evident. While not every visit can be facilitated virtually, we have seen office visits, patient monitoring, consultant referrals, physiotherapy, to name a few move successfully to different modalities. For those that have been working on virtual care strategies for a few years, this will be a gain we will not and cannot lose post pandemic.
The next thing that comes to mind is the dissolution of structural barriers that have prevented us in the past from working as cohesively together as we have been able to do so now. There has been sharing of information , problem solving, and solutions generated both within NSHA and outside NSHA with our partners. Access clinics for patients without physicians, provincially standardized policies and order sets, funds for research, multi organization strategies for PPE, and multi organization support for our long term care partners are only the tip of the iceberg in terms of all the improvements we have seen.
Innovation also comes to mind with not only new strategies to source and create needed products, but new ways of delivering services such as drive through primary assessment centres, home blood collection, and in home/in facility swabbing.
Most of all, I want to acknowledge and applaud the sense of teamwork that has emerged, not just in individual facilities but, across professions, programs, zones, communities, organizations, and province. We are truly in this together.
Send us your thoughts on positive change you’ve noticed. We will feature them as we do your moments of gratitude.
I want to take a last moment to thank you for the way you supported our first responder partners as they faced the worst days of their lives. You not only showed up for them clinically when they needed and continue to need you as professionals, you were there supporting them as people for all the community to see when they needed you the most: wearing red, holding up signs of support, holding vigil side by side. NSHA has lots to be proud of with the compassion and support displayed by staff and physicians to our partners during your own difficult time.
With my thanks to all of you,
Nicole
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Medical Support Services for Long Term Care Medical Directors / Physicians
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The following processes have been established to support a consistent approach to NSHA Medical
Support Service for LTC Medical Directors and Physicians. These are interim measures during COVID-19
and do not constitute permanent changes within NSHA.
MED-LTC SUPPORT SERVICE CATEGORIES
Three categories of support will be available to LTC Medical Directors and Physicians:
1. Prognostication of Goals of Care
- Assessment of patient’s frailty status and trajectory of health preceding illness.
- Discussion of risks associated with interventions in the setting of respiratory and/or hemodynamic decompensation (risks specific to acute illness and risks specific to the patient).
- Co-development of a care plan with input from primary care provider, and patient/family to ensure care is delivered appropriately in an optimal setting.
2. Acute Medical Management Advice
- Confirmation that the goals of care remain meaningful and attainable given the clinical situation.
- Help with assessment of hemodynamics and volume status and with management of dyspnea and hypoxia.
- Help with assessment and management of delirium and/or behavioural symptoms of dementia.
- Recommendations on, if and when further investigations are necessary.
3. Coordination of Care and Disposition Planning
- Assessment of whether care plan can be achieved utilizing services within the LTC facility.
- Assessment of whether hospital transfer is appropriate and necessary.
ACCESSING MED-LTC SUPPORT DURING COVID-19 PANDEMIC
A MED-LTC team has been established to provide these support services. A listing of the MED-LTC team
The support services outlined above can be accessed using the following
processes:
1. Immediate advice from the Internist: Call 1-833-460-0848
2. Formal Consultation Services:
- General Internal Medicine, Geriatrics, and Goals of Care Planning consults are available.
- Fax referral form to 902.473.8430 specifying request is for MED-LTC team, and identifying
- appropriate Clinical Service from list above.
- Please send appropriate supporting documents (CGAs, most recent Advanced Directives, SDMs names and contact info).
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Reminder: Gestational Diabetes Mellitus Screening
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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.
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- 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
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Reminder: Drug Supply Update
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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
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.
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New Mental Health and Wellness
Resource Sheets
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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.
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Choosing Wisely Canada Webinar
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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.
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Nova Scotia Mass Choir Tribute to Nova Scotia from April 24, 2020
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Provincial COVID-19 Status Update
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Today, April 26, Nova Scotia is reporting two additional deaths related to COVID-19, bringing the total to 24. The deaths occurred at the Northwood long-term care home in Halifax Regional Municipality.
"Every time a family loses a loved one to this virus, the pain is new. Two more families must say goodbye and not being able to gather with friends and neighbours to mourn together only makes it harder. Your entire province grieves with you," said Premier Stephen McNeil.
As of today, Nova Scotia has 873 confirmed cases of COVID-19. Eight new cases were identified Saturday, April 25.
"We continue to see the devastating impact this virus can have. Please stay strong and stay the course," said Dr. Robert Strang, Nova Scotia's chief medical officer of health. "You can and should enjoy the outdoors this weekend, but please do it safely. Stay in your yard, walk around your neighbhourhood and keep your distance from others."
The QEII Health Sciences Centre's microbiology lab completed 673 Nova Scotia tests on April 25 and is operating 24-hours. Nova Scotia has conducted more COVID-19 tests per capita than any other province.
As of April 25, there were 10 licensed long-term care homes and unlicensed seniors' facilities in Nova Scotia with cases of COVID-19, involving 197 residents and 95 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 25,615 negative test results, 873 positive COVID-19 test results and 24 deaths. Confirmed cases range in age from under 10 to over 90. Thirteen individuals are currently in hospital, three of those in ICU. Four hundred and thirty-nine 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:
-- a state of emergency was declared under the Emergency Management Act on March 22 and extended to May 3
Additional Resources:
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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.
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Leadership and Wellness Poster
Updated for Week of April 27- May 3
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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.
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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
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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.
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Physician Screening for COVID-19
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Call 1-833-750-0632 to speak to Occupational Health and Safety for your screening options.
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