COVID-19 Physician Information Update
March 26, 2020
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A Message from Dr. Nicole Boutilier, Vice President of Medicine
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Updated Clinical Documents
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Order Sets and Clinical Guidelines
Coronavirus Care Pathways
Occupational Health and Safety
New Laboratory Requisitions
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Choosing Wisely Canada has shared an important reminder regarding the importance of blood
conservation in our COVID-19 response.
- Don’t transfuse more than one red cell unit at a time in non-bleeding patients.
- Don’t transfuse red blood cells in asymptomatic, non-bleeding patients with hemoglobin greater than 70 g/L.
- Don’t transfuse blood if other therapies (e.g. iron) would be effective.
You can download and print their poster
here
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Emotional Support Resource for Physicians
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We are pleased to share a new document that summarizes various emotional support resources, information and tools. Coping with COVID - A Resource for Physicians, can be found
here
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Updated Naming of Health Services to Support COVID-19
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The Medical and Clinical Advisory Group of the provincial Incident Management Team have refined the terms to be used in the documentation of guidelines, communications, and any NSHA related material.
Here are terms to ensure common language:
- Primary Assessment Centres (PAC): These are the centres within (or near) our facilities that receive 811-referred patients for assessment and testing for COVID-19.
- Community Primary Assessment Centres (CPAC): These are centres in the community that receive 811-referred patients for assessment and testing for COVID-19.
- Secondary Assessment Centres (SAC): These are units, centres or wards for further assessment of patients who were tested for COVID-19 and referred for further follow up and assessment before being referred to convalesce at home.
- COVID Inpatient Units: these are units to support COVID-19 patients who require admission to hospital for stabilization and treatment.
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Point of Care Testing Solicitation
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Vendors are reaching out to various stakeholders regarding the availability of new Point of Care Testing to perform COVID-19 antibody testing. At this time, we do not recommend using this technology due to the lack of information on their performance characteristics, particularly with regard to the sensitivity to detect infection compared to the robust gold standard molecular based testing being performed in the NSHA QEII Virology Laboratory. Also of concern is any deviation from the current process of seamless reporting through the Laboratory Information System to ensure health care providers and Public Health officials are able to monitor and follow up on COVID-19 suspect and positive cases. This is critical to supporting efforts to contain and control the spread of COVID-19 in Nova Scotia.
These technologies are being evaluated by provincial partners across the country and we will continue to monitor the evolution of this technology and look for future opportunities to incorporate new and innovative ways to respond to the pandemic. If you receive offers form vendors please reach out to your local laboratory for more information and advice.
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Dear Colleagues,
While most people are being told not to go to work, you – as health care providers – are coming to work to look after patients. This requires you to come into the same close contact with people that others are avoiding. It can be scary.
We’ve heard many staff and physicians express concern about a shortage of personal protective equipment (PPE). You’re seeing a lower than normal stock on your units and in your departments and you’re worried there’s not enough to go around. Please watch my video message for some important information about how we’re managing the supply of PPE in our organization.
As indicated in the video, we have enough PPE to meet current demands, and teams are working hard to procure additional items for our stockpile. In the meantime, it’s important that all of us continue to focus on meeting not only the demands of today, but the demands of a surge we know is coming.
You are the most important part of this equation. Your actions will help us ensure staff have the necessary PPE when it is needed.
There is no more important time for everyone to follow the current evidence-based recommendations for use of PPE in looking after patients with confirmed or suspected COVID-19 and other infections that are spread through droplets.
Droplet and contact precautions are NOT needed for people without a respiratory tract infection. We need to make sure that individuals involved in an aerosol-generating medical procedure have an N95 respirator when they need it. We all have the responsibility to use PPE at the right time and in the right way.
The most important and effective things for you to do to protect yourself and others are:
- Practice frequent hand hygiene.
- Make sure that you screen for those respiratory symptoms in every patient you see.
- Apply contact and droplet precautions when appropriate, and
- Don’t come to work sick.
- And yes, we do want you to wear an N95 for an aerosol generating medical procedure, but there are very few of those types of procedures.
There may be specific situations where Infection Prevention and Control recommends additional precautions. These decisions will be made case by case.
We know you want to protect yourselves and your families – we want to protect you too. It’s up to all of us – together – to help make that happen.
Thank you for all that you’re doing to keep Nova Scotians, your colleagues and yourselves safe and healthy.
Donations of PPE
Independent offers of /solicitation for donations of PPE - NSHA has been approached by a number of individuals and groups interested in donating items or equipment during the pandemic, including personal protective equipment (PPE). Although we have enough PPE to meet the current need, NSHA is following up on offers for N95 respirators to help boost our stockpile for the coming weeks and months, when we expect to see a surge in cases. The organization is also working to source additional PPE using a streamlined approach. NSHA is keeping a list of offers received for reference and possible follow-up if/as appropriate. Staff are asked NOT to solicit donations of PPE from individuals or groups – it’s important that any efforts to source additional PPE be coordinated. If you receive unsolicited offers of N95 respirators, please forward these to
wearelistening@nshealth.ca
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Patient Lists
If you are utilizing printed patient lists during this busy time please remember that that these lists, although containing limited personal health information (PHI), are still considered PHI and must be protected at all times. Please ensure these are securely shredded when no longer required. Thank you.
Sharing Personal Health Information
Anxiety about COVID-19 is high at among the public, staff, and patients; the Privacy Office has had multiple reports about inappropriate sharing and access to Personal Health Information related to the Pandemic. With heightened sensitivity around COVID-19 it is especially important to remember Patient Privacy at this time. It may be tempting to discuss difficult situations with your colleagues, however we ask that any conversation about patients be limited strictly to matters directly related to patient care as they always should be. Thank you for helping us to protect patient privacy during this challenging time.
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Introducing New Occupational Health Physician - Pandemic Support: Dr. Kevin Bourke
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Dr. Kevin E. Bourke, MD MRO CAME
Dr. Bourke is a general practitioner trained at Dalhousie Medical School. He is passionate about the relationship between patients’ medical conditions and their ability to fulfill their roles both at work and at home. Dr. Bourke’s career experience includes primary care, insurance, Worker’s Compensation, private industry, policing and military frameworks.
As an Occupational Health medical consultant, he provides advice on the active management of disability and return to work cases, determines fitness for duty, and designs workplace medical surveillance programs (MSP) for occupational diseases.
Previously an active scuba diver with extensive experience in both hyperbaric and flight medicine, Dr. Bourke’s special interest is the assessment of fitness for duty in isolated or extreme environments. He enjoys cycling in the Annapolis Valley and practicing docking his pontoon boat!
Dr. Bourke will be embedded in the Occupational Health Safety and Wellness Leadership Team to provide operational surveillance, screening and management of healthcare workers who are off work due to travel requirements or potential exposure.
Thanks to all who applied for this opportunity! We were pleased with the quality of candidates and willingness to help your fellow physicians in this time of need.
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NSHA prepares for service delivery during COVID-19 pandemic
Nova Scotia Health Authority (NSHA) continues to plan and prepare at an organizational level, across the province, for service delivery during the COVID-19 pandemic.
As an organization, NSHA must adapt and respond to changing conditions and optimize the overall system’s ability to respond to the needs of Nova Scotia patients. This includes creating processes to quickly move patients and/or staff to different surgical centres if emergency surgery cannot go ahead in one hospital due to capacity issues.
At this time it is necessary to consolidate emergency services, optimizing the number and distribution of emergency departments in Nova Scotia.
NSHA is modifying the roles of collaborative emergency centres in Cumberland County to better align available resources with care needs. This will be done in the following ways, beginning Friday, March 27 at 8 a.m.:
- All Saints Springhill Hospital’s emergency department will become an urgent care treatment centre. It will be open from 7 a.m to 7 p.m., seven days a week. Urgent treatment centres primarily treat injuries or illnesses requiring immediate care, but not serious enough to require an emergency department visit.
- North Cumberland Memorial Hospital in Pugwash will serve the community as an urgent treatment centre. It will be open from 8 a.m. to 8 p.m., seven days a week, and will continue to operate as a collaborative emergency centre overnight.
- South Cumberland Community Care Centre in Parrsboro will transition to a family medicine/general practice clinic. It will provide daytime primary care services to the residents of this community. This hospital will not provide emergency care overnight.
Regional hospitals in Amherst, Truro, and New Glasgow provide emergency care 24/7.
Emergency Health Services (EHS) will divert ambulances to these emergency departments with the new model changes in Cumberland County.
Emergency care in Nova Scotia is made up of many connected parts, including urgent and emergency departments. – They are designed to make sure Nova Scotians have access to emergency care and receive the care they need, when they need it.
Anyone unclear about the availability of services may always contact their local hospital. Nova Scotia Health Authority’s website (www.nshealth.ca) provides a complete list of service changes and temporary closures.
Those experiencing a medical emergency should always call 911. For non-emergency health advice from a registered nurse, please call 811. The provincial Mental Health Crisis Line also operates 24/7 at 1-888-429-8167.
Temporary closure of women’s and children’s unit at Cumberland Regional Health Care Centre
Amherst, N.S. – The inpatient women’s and children’s unit at Cumberland Regional Health Care Centre in Amherst is temporarily closed, including for any planned deliveries, until further notice.
Pregnancy and delivery care will be provided in Colchester East Hants Health Centre in Truro or the Moncton Hospital in Moncton, New Brunswick depending on the patients’ home location.
In the event on an emergency or unplanned delivery, there will be family physician, obstetrician and nursing staff available in Cumberland Regional Health Care Centre to support pregnancy care. Prenatal care will continue to be provided by the hospital’s team.
This closure allows for the redeployment of the staff and physician to other work.
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Online Access to Referral Forms for Primary Assessment Centres
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We received feedback from family physicians who are working in virtual care settings without access to a fax machine. As a result, the PAC Referral Forms are being updated to Electronic Medical Record systems over the next several days. EMR providers will email providers when the form is added.
- The form is now available in Accuro.
- Practimax will be releasing it to clinics one by one during downtime from now until Monday.
- MedAccess will be releasing during scheduled downtime this weekend, making it available by Monday.
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While fit testing is a required session for medical staff available year round, it has not been well attended. The Occupational Health team is seeing exceptionally high demand for fit testing due to COVID-19. Many groups are working to schedule fit testing and, with limited capacity, fit testing is currently only available to care providers who are directly involved in aerosol generating medical procedures (positive pressure ventilation,BiPAP and CPAP, endotracheal intubation, airway suction, high frequency oscillatory ventilation, tracheostomy, chest physiotherapy, nebulizer treatment, sputum induction, and bronchoscopy).
We are working to build additional capacity for fit testing, particularly in Central zone where there is no further capacity for physicians at this time. We are working to schedule an additional physician-only session and more information will be shared soon.
The following reminders apply to all who are scheduled for fit testing:
- Please bring your own mask from your unit. This is because they have to be tested against the supply that you have available in your department. We know local supplies are reduced, which is another reason participants are asked to be prioritized based on those that perform aerosol generating medical procedures first. Mask Sizes are 1870+, 1860, 1860, and 1805.
- All participants who do fit testing are required to be clean shaven.
Occupational Health staff members are working to reach physicians in each zone to determine their fit testing status.
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COVID-19 Q&A with Dr. Strang
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Click
here to view the full Children's series Q & A
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To view the full Q & A Series, click
here
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Returning to Workforce After Self Isolation
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Physicians who are completing their mandatory 14 day isolation after travel will receive a request from Medical Affairs to confirm that they are asymptomatic and to discuss their return to work plans. Please complete this information request to enable a quick return to work.
If you require support for symptoms of an influenza like illness, Medical Affairs support staff will connect you to the appropriate Occupational Health resource for further screening.
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Provincial COVID-19 Status Update
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Premier Stephen McNeil, Dr. Robert Strang, Nova Scotia's chief medical officer of health, Dr. Brendan Carr, president and CEO of Nova Scotia Health Authority (NSHA) and Dr. Krista Jangaard, president and CEO of IWK Health Centre gave an update today, March 26, on the health system and efforts to help Nova Scotians dealing with COVID-19.
"Our health-care system is being examined from top to bottom to ensure we are ready for COVID-19," said Premier McNeil. "Our hospital administrators, our doctors and nurses, cleaning staff - everyone is focused on containing the spread. But none of this matters if you don't stay at home and avoid social gatherings."
Dr. Strang said testing to confirm COVID-19 is being expanded to include:
- anyone referred by 811 to an assessment centre
- all close contacts of people who test positive
- people in hospital that meet the criteria for testing
An alternate phone line has been set up to ensure health-care workers are virus-free, able to safely provide care and not burden the 811 system. The service deals with NSHA and IWK staff, home-care and long-term care providers, pharmacists and health providers in First Nations communities.
Other measures announced today include:
- reservations for the 2020 camping season are on hold; an announcement will made when they are available
- open fires are banned for any purpose in woods or within 305 metres of woods in any part of the province and will be in effect until May 15 (the public can report wildfires by calling 911 in an emergency or by calling 1-800-565-2224)
"While most people are being told not to go to work, our staff and physicians are showing up every day to ensure Nova Scotians get the care they need. As we continue to plan, prepare and respond to COVID-19, we appreciate your patience, support and co-operation with the important public health measures that are in place. This will help reduce the impact the pandemic will have on Nova Scotians and our health system. It is a difficult time for everyone, but if we all do our part, we will reduce the spread of the virus and life will return to normal sooner."
- Dr. Brendan Carr, president and CEO, Nova Scotia Health Authority
Quick Facts:
- testing numbers are updated daily at https://novascotia.ca/coronavirus
- Nova Scotia's Health Protection Act gives the chief medical officer of health the authority to give dvice to protect public health and decrease risk to public health presented by communicable diseases such as COVID-19
- a state of emergency was declared under the Emergency Management Act on March 22 and remains in effect until noon, April 5
- under the state of emergency government can control or prohibit assembly as well as travel to and from areas. It can also coordinate commerce activity and emergency responders
- a new virus like COVID-19 can cause fear. Nova Scotians are encouraged to support each other and use technology to stay connected
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