COVID-19 Physician Information Update
May 1, 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
Cancer Care Updates
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Dr. Nicole Boutilier, Vice President Medicine shared the video below earlier today to mark Doctor's Day.
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For those without access to sound, the full transcript is written below.
Good morning,
It's May 1 and it's Doctor's Day!
I want to take a few moments to celebrate and acknowledge the caring and dedicated physicians who serve Nova Scotians every day across this province.
This month is the 25th anniversary of my graduation from Dalhousie University Medical School and I cannot remember a time in my career where there were so many challenges and changes as in the past few months.
In the midst of the COVID-19 global pandemic, Nova Scotians and our communities suffered one of the worse tragedies in Canadian history.
Physicians everywhere have come to work and tirelessly implemented changes into their practice with new guidelines, policies and standards of practice.
We have embraced social distancing to continue to care for our patients including a widespread adaptation of virtual care into our practices.
Our physician leaders have worked with physicians and their inter-professional colleagues across departments, zones programs, and facilities to create and implement a variety of new patient care settings.
Our Public Health colleagues, Infection Prevention and Control practitioners, Infectious Disease specialists, Laboratory specialists and Emergency Preparedness experts have come together to guide us with their expert knowledge and coordinate our response.
Physician educators have worked with countless physicians and other staff to teach new skills that are necessary through simulated learning experiences and online webinars.
Our researchers and innovators have created new studies and come up with solutions to front line issues.
Our mental health, palliative care and leadership experts have created a variety of opportunities to bring people together, both physicians leaders in our communities and our peers to ensure we have resources available to deal with the emotional impact of the pandemic and the recent tragedy.
By our sides--collaborating every step of the way -- has been the Nova Scotia College of Physicians and Surgeons, Doctors Nova Scotia, and the Department of Health and Wellness, MARDOCs, and the IWK. We are truly in this together.
You have come to work every day with tremendous courage and compassion. I want to express my gratitude for your professionalism and your resiliency. As you have faced your own issues with social distancing from family and friends as well as the emotional impact of being on the front lines at this time. You have continued to support the people who need you.
I feel an immense pride for each of you. And I hope you will take time to reflect today on the work that you do and the difference that you make. From all Nova Scotians, your patients and colleagues, thank you.
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Message from NSHA President and CEO
Dr. Brendan Carr
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Dear colleagues,
Now that we have officially reached the peak of the pandemic I wanted to acknowledge the tremendous toll this situation is taking on our communities and our organization. In the midst of that, many are also deeply affected by recent tragic events in our province.
It is an incredibly difficult and challenging time. There are many supports available and I encourage you to access them. Visit the
COVID-19 Hub for information about the wide range of supports available to staff and physicians.
In the face of this, our staff, physicians and partners have demonstrated amazing resiliency, agility and ingenuity, as well as compassion and care. We should be proud of the work we have done.
Regards,
Brendan
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Memo - Community/Facility Clusters
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CMAC introduced a
COVID-19 risk assessment tool early last week to ensure that there is uniform, mandatory assessment of all patients presenting for care. The COVID-19 risk assessment tool also outlines recommended PPE to be used in each clinical setting to ensure safety of staff and patients.
In addition to COVID-19 risk factors associated with symptoms, travel and contact with known or suspected COVID cases, Nova Scotia Public Health characterizes provincial clusters of higher rates of COVID-19 (community clusters) being observed. With the potential for presymptomatic/asymptomatic transmission, it is important that patients presenting from these community or facility clusters be similarly managed to protect staff and patients.
At present there are four active community clusters that have been identified by Public Health. In addition, there are ten long term care facilities designated as facility clusters. Please see the
NSHA COVID-19 document Hub (COVID-19 community/facility cluster information under “I am looking for…”) for a
list of postal codes that can be used to identify patients who reside within an identified community clusters, as well as a list of affected facilities.
The revised COVID-19 risk assessment tool outlines the recommended Infection Prevention and Control (IPAC) guidance for caring for patients with identified risk for COVID-19, including those who reside in a community or facility cluster. Given the expansion of the community clusters, IPAC and CMAC have reviewed current recommendations in an effort to balance the safety of our staff and patients while mitigating some of the operational challenges of managing patients presenting from these clusters.
In the ambulatory setting (other than the Emergency Department), interactions with patients tends to be of shorter duration, patients are typically in contact with fewer healthcare providers, and appointments can be scheduled to allow appropriate social distancing. In this setting, IPAC and CMAC have modified the recommendations for PPE. For patients with an identified COVID-19 risk factor who are asymptomatic, the patient should be provided with a surgical mask to be worn throughout the visit. Healthcare providers do not need to don droplet and contact PPE but should carefully adhere to the universal masking policy and be diligent with hand hygiene. Given the potential for asymptomatic infection, the provider should ensure that all equipment and surfaces in contact with the patient and high-touch surfaces are wiped with disinfectant at the end of the visit.
It is important that ambulatory providers ensure they have appropriate PPE and cleaning supplies available. To facilitate this, whenever possible the COVID-19 risk assessment should be performed a day or two prior to the visit to allow the site to prepare. Remember to screen the patient for symptoms when they arrive for the visit that day.
No changes in the management of patients identified with COVID-19 risks factors in the Emergency Department or Inpatient setting are recommended at this time. Given the nature and intensity of the interaction between patients and staff in these settings, IPAC and CMAC continue to recommend that patients who reside in a community or facility cluster be managed on contact and droplet precautions and that room cleaning per droplet and contact cleaning protocols be followed.
Postal Code cluster information is changing regularly, and only currently accessible on the NSHA Intranet (as per links above). We are aware that it is not easily accessible to all family practices in NS as not every physician has an NSHA account.
CMAC will work with Zone Medical Directors and Primary Care leads to ensure that the community/facility cluster information is disseminated to physicians to ensure that this information is readily available to those who do not have access to the information on the NSHA COVID-19 Hub. If you would like a copy of the cluster report each time it is updated, sign up
here.
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Collection Strategy for Possible N95 Reprocessing in Future - FAQs
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As you are aware, NSHA has developed a strategy to balance supply and demand of our PPE. We have discussed the needs to manage our supply between shipments and
NSHA has N95 supply to meet current needs.
As we move forward with our planning, we are preparing for all scenarios, including the potential of reprocessing. This is a back-up measure to prepare for any possible N95 shortage in the future. We are collecting N95s for
possible reprocessing and reuse and will be launching further N95 conservation measures.
We will begin rolling out our collection strategy in targeted, high-use areas, such as ICUs, emergency departments, perioperative (surgical) and COVID units. We are doing this to make sure that those staff and physicians who need an N95 to provide care safely could continue to access them even if we reached a point in the future where there was a shortage of supply.
We are NOT asking staff to wear reprocessed N95 respirators at this time.
Teams from Research, Medical Device Reprocessing, Infection Prevention and Control, Infectious Diseases, Occupational Health & Safety, and Industrial Engineering have been working to identify safe, evidence-based reprocessing methods that could be put in place quickly to allow safe re-use of N95 respirators.
NSHA will follow Health Canada, CDC and FDA guidelines for approved and validated reprocessing methods.
Leaders of areas that use N95s daily but are not reflected in the list of targeted units above should contact their Zone IMT.
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Guidance for Removal of Droplet and Contact Precautions for COVID-19 Patients in Hospital
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Droplet and contact precautions can be discontinued for inpatients with COVID-19 a minimum of 10 days from the date of first symptom onset, provided they are clinically improved and have two consecutive negative COVID-19 swabs no less than 24 hours apart.
Patients with COVID-19 requiring ICU/IMCU care may experience complications resulting in ongoing respiratory symptoms and/or fever (e.g. ventilator associated pneumonia, line infection). These patients will be reviewed by IPAC and Infectious Diseases on a case by case basis and will require two negative COVID tests (at least one from a lower respiratory tract specimen in patients who are still intubated or have a tracheostomy) before discontinuation of precautions. Click
here to view document.
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Income Stabilization Program
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Physician Reassignment Opportunities
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In response to the unique demands of providing care during COVID-19, NSHA is organizing opportunities for physician redeployment or reassignment. These opportunities are shared to physicians by your local leadership (ZMED, Department/Division Heads, Chiefs, Network Leads, and Site Leads).
The intent in all reassignment is to match physicians to the areas and needs that best match their skills, interests, and abilities. Physicians will be matched as needs arise across the province.
To date, the following areas have provided opportunity for physician reassignment:
- Long term care
- Inpatient care
- Secondary assessment centers
- Access Clinics – Primary Care
- Emergency Medicine
- ICU/Critical Care
- Primary Assessment Center
- Virtual Care
Current needs are met but we expect these needs to fluctuate in the future. It is important to build a robust roster of available resources in the event that care needs change quickly. However, in some cases, physicians who volunteer for redeployment may not be matched as there is no current need identified.
The following guiding principles are to be considered:
- All programs will endeavour to continue current service delivery (reduced/unchanged/increased) and assist with COVID-19 care.
- Each physician has the ability to contribute to our combined effort to support pandemic response.
- Clinical work for COVID-19 patients will be performed by physicians who best meet the required skillsets and who would typically provide this level of care.
- Physicians reassignment is a voluntary program.
- Department Head (s), Site Lead(s), Zone Medical Executive Director will make every effort to fairly and equitably reassign work between departments when required.
- Reassignment request (s) may exist to provide support in another zone and will only occur if there is a critical need. Participation in these opportunities is voluntary.
- Physicians who are quarantined or ill, they may be requested to support virtual care assignments or COVID-19 planning if they are well enough to contribute.
- Please see Occupational Health guidelines for staff with chronic conditions as well as pregnant staff. These will be considered in reassignment opportunities.
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Zoom Healthcare Website and Resources Update
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To support patient care and health care providers (HCPs) in Nova Scotia during the current COVID-19 pandemic, Zoom for Healthcare has been approved as a virtual care platform for use on an interim basis for all health care providers (physicians, nurse practitioners and allied health professionals). There are a number of important updates related to Zoom for Healthcare including:
- Website Reorganization and Rebranding
- Software Privacy and Security
- Resources (including Frequently Asked Questions)
- Training
For the detailed update, please visit:
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Team members at Aberdeen Hospital in New Glasgow showed their support for our communities and one another, while encouraging everyone to do their part through social distancing. The top photo includes emergency department staff, nurses and physicians, clerks and environmental services staff. The bottom photo includes emergency department and ICU nurses, respiratory therapists, x-ray team members and EHS paramedics.
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Archie MacKinnon, Director of Health Services/Site Lead at Colchester East Hants Health Centre (CEHHC), and Dr. Tanya Munroe, Interim Medical Site Lead, CEHHC shared a letter of support and photo received from St. Joseph's Hospital in Saskatchewan, along with treats for team members.
"It has certainly been a tragic few weeks for our beloved province of Nova Scotia. While we are experiencing heightened degrees of emotion these days, may we be reminded of the beauty of humanity.
Yesterday our site was provided with refreshments made available to us from St. Joseph’s Hospital, Saskatchewan. These gestures remind us of the unity we have as healthcare providers and as a nation...
They want us to know- that despite the distance, we are sending our thoughts, prayers and love to all of the people of your province." - Archie and Tanya
The photos below show team members from St. Joseph's holding NS flags and messages of support and CEHHC team members expressing their thanks for this very kind gesture.
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Provincial COVID-19 Status Update
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Today, May 1, Nova Scotia is reporting one additional death related to COVID-19, bringing the total to 29. The death occurred at the Northwood long-term care home in Halifax Regional Municipality.
"The thoughts and best wishes of all Nova Scotians are with everyone at Northwood. To the family and loved ones of this individual, please accept our deepest condolences," said Premier Stephen McNeil. "Many people, representing many organizations, are working hard to help Northwood address this virus. This support will continue as long as it is needed."
As of today, Nova Scotia has 959 confirmed cases of COVID-19. Twelve new cases were identified Thursday, April 30.
The QEII Health Sciences Centre's microbiology lab completed 812 Nova Scotia tests on April 30 and is operating 24-hours.
As of April 30, there were 10 licensed long-term care homes and unlicensed seniors' facilities in Nova Scotia with cases of COVID-19, involving 237 residents and 105 staff.
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 28,883 negative test results, 959 positive COVID-19 test results and 29 deaths. Confirmed cases range in age from under 10 to over 90. Ten individuals are currently in hospital, three of those in ICU. Five-hundred and ninety-two 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.
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 17
Additional Resources:
Government of Canada toll-free information line 1-833-784-4397
The Mental Health Provincial Crisis Line is available 24/7 to anyone experiencing a mental health or addictions crisis, or someone concerned about them, by calling 1-888-429-8167 (toll free)
Kids Help Phone is available 24/7, by calling 1-800-668-6868 (toll-free)
For help or information about domestic violence 24/7, call 1-855-225-0220 (toll-free)
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Some Easing of Public Health Restrictions
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Premier Stephen McNeil and Dr. Robert Strang, chief medical officer of health, announced today, May 1, the easing of some public health restrictions around COVID-19.
"We know that getting outdoors for recreation is important for people's physical and mental health," said Premier McNeil." That's why we are easing some restrictions, while still keeping the majority of our public health directives in place to continue fighting the virus. But I need to be clear: if we see an increase in positive cases or people not continuing to adhere to all the public health measures, the restrictions will return."
Existing public health directives around social distancing and social gatherings remain in place. People must keep two metres apart and not gather in groups of more than five.
The initial steps are:
- provincial and municipal parks can reopen, but playground equipment will continue to be off limits
- trails are allowed to open
- people are allowed to use and visit community gardens
- garden centres, nurseries and similar businesses can open
- sportfishing is permitted from shore or boat, but fishing derbies are not allowed
- people can attend boating, yacht or sailing clubs for the purpose of preparing boats for use
- golf driving ranges can open, including those at golf clubs, but the course must remain closed; golf clubs can perform necessary maintenance and preparations for openin
- people can use their cottages. Use is restricted to one household unit at a time, travel must be directly to the cottage and back, and travelling back and forth frequently from cottage and primary residence is discouraged
- provincial and private campgrounds remain closed, but they can perform necessary maintenance and preparations for opening. An exception is recreational vehicles parked year-round at private campgrounds, which can be used but must follow the same rules as cottages
- drive-in religious services will be allowed, as long as people stay in their cars, they are parked two metres apart and there are no interactions between people in cars or between people in cars and others
These measures take effect immediately.
"Our ability to open things up further - for example, beaches, golf courses and campgrounds -- depends on how each of us does with these adjustments, how well Nova Scotians comply and how the pandemic continues to impact people's health," Dr. Strang said. "We can't let our guards down. We need to continue to flatten the curve."
A phased plan to further lift public health restrictions is under development. It is based on science and the timing of each phase will be determined by the result to the easing of restrictions.
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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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A Growth Mindset in the Time of COVID-19
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A
thought-provoking diagram made its way to us recently via a collaborative physician colleague in the Saskatchewan Health Authority. It is a version of what’s known as the “growth mindset” or “learning zone” model, but adapted for our COVID-19 reality.
It starts with an introspective question that we’ve asked in some previous posts, “Who do I want (or need) to be during COVID-19?” Notice how the question is not about what are we going to do but, rather about who we want to be. The aim here is to be moving toward the right side of the diagram, away from fear toward learning and, hopefully growth.
- Fear zone- there are a lot of things triggering a fear response within us throughout the day or week. It’s very easy to fall into the fear zone and it’s completely justifiable to be there temporarily. The issue becomes when we allow ourselves to be triggered, reactive, and fearful a lot of the time.
- Learning zone- shifting away from a reactive place of fear, the learning zone offers a more proactive position and is a more active space with more choices available to us.
- Growth zone- the choices available in the growth zone can make us feel better, lower our stress responses, and help us to feel more purposeful.
The learning and growth zones are best for your emotional and psychological wellbeing as well as your work performance. As we shift into a growth mindset we are creating rather than reacting. These are trying times, but by being in the growth zone we can improve our ability to be resilient and flexible which will help through the months ahead.
Thanks to Dr. Steven Soroka who received permission to share this resource from his Saskatchewan colleague.
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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.
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SAVE the DATE: Special Webinar for NSHA Physician Leaders
May 6 from 7-8 p.m.
“COVID – What’s normal? Leading through crisis and change” with Dr. Jackie Kinley and Tony Case. Presented by Medical Affair’s Physician Leadership Development
Invitation and Zoom link to be sent out to formal physician leaders via NSHA email, by Monday.
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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
New Local Website offering Support and Resources for NS Physicians
Please visit a new
website full of helpful resources and important contact information for NS physicians and their families, brought to you by volunteer members of the Dalhousie University Department of Psychiatry and Doctors Nova Scotia’s Professional Support Program.
Charge Your Battery: Introduction to Self-Care Skills Training for Healthcare Providers
With Dr. Dayna Lee-Baggley, Monday May 4, 4-5 p.m.
Communication about Substance Use
With Dr. David Saunders, Wednesday, May 6, 4-5 p.m.
Mindfulness for Physicians: Incorporating Self-Compassion
With Dr. Nicole Herschenhous, Friday, May 8, 4-5 p.m.
Addressing Grief within our Healthcare Community: Mine, Yours & Ours
Weekly on Thursdays from 9:30 a.m. to 10:30 a.m.
Join Serena Lewis and Roy Ellis (NSHA Bereavement & Grief Coordinators) as we begin the conversation of grief in our current and future workplace. This discussion will provide information on recognizing and understanding how loss is intertwined in our lives, as well as the current landscape of our community of care providing. Roy and Serena want to hear what topics will benefit you in the upcoming weeks that will support you - as you care for yourselves, your own families and within patient care.
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.
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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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