NSHA is committed to keeping all physicians up to date with information from the provincial incident management team and all clinical information required to assist in our provincial response.
We would like to stress at this time to physicians to lead the way in modeling social distancing efforts. Please cease all in person group meetings, dinners, and any other group in-person contact.
We ask that if you need support for virtual meetings that you let us know. We must make every effort now to keep our physicians well.
Sharing Information within Your Community
We have received regular feedback from local community physicians who want to help promote social distancing and keep their local communities safe. There is an agreed upon provincial centralized communication process for official updates, which is advised as a part of Public Health crisis communication. We understand the intention of our physicians in wanting to help get messages out there to help keep people safe. We ask that physicians work to help boost messages from the Office of the Medical Officer of Health and share important information from Public Health Nova Scotia. There are important messages around social distancing that you can re-enforce with your patients on social media, message boards, or however you prefer to share. We ask at this time that you refrain from contacting local media outlets. All community media outlets now have access to the 3pm daily media availability with Dr. Strang’s office. Their messages and efforts can be found here:
https://novascotia.ca/coronavirus
Our Process for Fielding Your Questions
We have channeled a large number of questions through the Medical Affairs team and, when answers are known, we will now keep a running list under this mail out. If you don’t see your answer there, please know we are working on obtaining the information and it is likely that it involves work that is underway by a working group but not close enough for definitive answer. We will continue to provide updates on all items raised in this way.
All Physician Webinar Tomorrow
You are invited to attend a Webinar on Tuesday, March 17 at 5:00 pm to update physicians on COVID-19 with an opportunity for questions and answers. Moderator will be Dr. Nicole Boutilier (NSHA VP Medicine), Dr. Gaynor Watson-Creed (Deputy Medical Officer of Health), Dr. Ian Davis (Infection Prevention and Control) and a representative from the EOC Clinical and Medical Advisory Panel.
Thanks to Doctors Nova Scotia for providing the technology solution to be able to reach the most clinicians. The session will be recorded for sharing tomorrow evening.
A Message from Brendan Carr, President and CEO to NSHA Leaders
The NSHA senior leadership team is extremely grateful for the work that you are doing to navigate these uncertain times, working together, to support both each other and the system.
In the coming days and weeks, there will be challenges. You will be working to support patients and teams, but it is also imperative to take care of you. The health of both yourself and your family is incredibly important and we recognize what is unfolding has a profound effect on healthcare workers and their loved ones. The cancellation of vacations and trips, schools and childcare has great impact and we appreciate everything you are doing to work through these times.
As we move forward, the organization is here to support you. As you know Nova Scotia Health Authority’s Employee Family Assistance Program (EFAP) can be of great assistance in a time of uncertainty. Morneau Shepell provides immediate and confidential assistance for any work, health or life concern for both employees and their families who reside together. Your EFAP can be reached by calling 1-800-461-5558 or visiting
https://www.workhealthlife.com
. Internally, for support you can contact your zone Talent and Organization Consultant, as well as your zone Occupational Health Safety and Wellness department.
Over the next few days, there will be communication regarding ongoing virtual debriefings available to all staff, twice per day. These debriefs will provide staff strategies and techniques to deal with these rapidly changing times. In addition to this, leaders will have the opportunity to debrief together several times per week separately. Details for these sessions to follow.
Your teams will be coming to you as this situation unfolds, looking for guidance and direction related to both physical and psychological safety. NSHA has safeguards in place to support and protect the safety of all staff, but must consider the emotional impact this will have on our teams.
The Canadian Mental Health Association
has tips listed on their website, providing guidance on enhancing psychological safety.
Thank for your continued contributions and commitment to the health of Nova Scotians, your team and colleagues. We are healthier together and extremely proud of the great work you continue to do.
NSHA Health Services Update
To support efforts to contain the spread of COVID-19 and the conservation and redeployment of resources many non-urgent procedures, clinics, surgeries and appointments are being cancelled or suspended. Virtual care options are being explored, including the potential for telephone follow-up as appropriate for some patients. Emergency Services will continue to be provided.
Beginning Wednesday, March 18:
- All elective outpatient visits in NSHA clinics are cancelled. Individual services will contact patients whose appointments are proceeding. Dialysis, chemotherapy and radiation treatments, and mental health and addictions appointments will continue.
- All non-urgent diagnostic imaging appointments will be rescheduled and walk-in x-ray services will be closed.
- All same-day admission and elective surgical procedures are postponed. Cancer and urgent/emergency procedures will continue.
- As currently-occupied inpatient beds become available, they will be held open to create capacity to establish COVID-19 units in designated hospitals.
Nova Scotia Department of Health and Wellness News Release
The Nova Scotia Government announced today that Nova Scotia has two additional COVID-19 Presumptive Positive cases in Halifax. A husband and wife couple who had not traveled out of country but who had regular contact with others who have. Public Health is currently working with them on contract tracing and they are self-isolating.
NS DHW and Office of the Chief Medical Officer of Health will provide a daily media availability at 3pm. Read today’s release
here
The federal government provided an update today that imparted further travel restrictions for Canadians. They will be closing the borders to those who are not citizens or permanent residents of Canada, family and close relatives of Canadians, and American citizens. They will be routing all international flights into four major airports; Toronto, Montreal, Vancouver and Calgary and stepping up screening measures at these airports. No symptomatic person is allowed to board a flight into Canada and all Canadians abroad are asked to return home immediately. The Prime Minister’s office will daily updates to media at 12 noon ET going forward.
Supplies and Personal Protection Equipment
Our supply departments have assured us that supplies are adequate within the facilities. Current in-hospital scarcity is related to bringing supplies back to inventory to ensure supply chain has a good view of availability of PPE. Additional reserve is available to access and orders are in the queue. Please do not remove supplies from our facilities. Please see this
video from Dr. Brendan Carr
, President and CEO on the issue
A process is currently underway to explore our ability to purchase and distribute supplies to family physician offices across the province. More updates will follow. For those who do not have access to appropriate PPE or swabs, please use the physician referral pathway for Coronavirus Assessment Centres listed on the
Physician Site
.
Family physicians’ offices are asked to come together, as they typically do, to share PPE supplies with others who are impacted by global purchasing shortages. While we are asking primary care providers to begin pre-screening patients and reducing risk to their clinics, staff and patients, they may require PPE for occasional cases.
Virtual Care (Update From Doctors Nova Scotia)
NSHA is working with DNS, DHW, and IMIT to explore solutions to this issue in a time effective way.
Doctors Nova Scotia is meeting with the Department of Health and Wellness (DHW) tomorrow afternoon. We hope to have more clarity at that time, and will update members as we have more information. We see the value in physicians being able to care for their patients remotely using virtual care tools, such as the telephone and other functionalities provided through electronic medical records (EMR).
New Video to Demonstrate Appropriate Application and Removal of PPE
Please view the video
here
.
*Updated*
Physician Referrals to Coronavirus Assessment Centres
Our incident management team has created Pre-Screening Guidelines for patients presenting in your offices. This provides a clear direction to physicians on referral to Coronavirus Assessment Centres using the fax form linked below.
Today, Family Practice issued a specific screening guide for Family Practitioners and it is available with the resources below.
Please note that in the effort to get these crucial pieces of documentation and information out to you as quickly as possible, there is a likelihood of regular ongoing updates and new versions- for the most recent version, please check the
website
. We are carefully dating communications to keep you up to date.
All of these forms are available on the physician specific information site
here
.
Interim Reproductive Care Program Guidance for Prenatal care visits in Nova Scotia for low-risk women
P
regnant women require regular antenatal visits throughout pregnancy. However, if there is a need to reduce the number of visits for office/clinic crowding reasons, or because a woman herself wishes to reduce her exposure to other people, the timing and frequency of prenatal visits can be adjusted.
Prior to attending a scheduled prenatal office or clinic visit, women should answer the screening questions and call 811 if appropriate. Some women will be directed to a screening centre before attending their prenatal appointment.
For low-risk women and those for whom there are no identified maternal obstetrical or fetal concerns, it is acceptable to adjust the prenatal visit schedule to align with the WHO Antenatal Care Model (2016). The visit schedule below includes nine prenatal visits and is a slight modification of the WHO schedule.
- First prenatal visit up to 12 weeks
- 20 weeks
- 26 weeks
- 30 weeks
- 34 weeks
- 36 weeks
- 38 weeks
- 39 weeks
- 40 weeks
Please note:
- A responsible care provider must assess each woman to determine whether she is a candidate for an adjusted prenatal visit schedule.
- Prenatal blood work and prenatal ultrasounds are important aspects of prenatal care. These investigations should be offered as usual, and should be scheduled in conjunction with prenatal visits as much as possible.
- The SOGC has recommended on-going fetal surveillance in confirmed cases of COVID-19. Operational details to enact this recommendation have not yet been determined.
For women who have known or suspected maternal obstetrical and/or fetal health concerns, the schedule for prenatal visits should be determined based on medical needs.
For questions about precautions for women who are known to be COVID-19 positive, or are being investigated for COVID-19, and for questions about accompanying support people, please refer to guidance from the Nova Scotia Department of Health & Wellness, the NSHA and the IWK Health Centre.
Message on Retired Physicians and COVID-19 from College of Physicians and Surgeons of Nova Scotia
Dr Gus Grant wrote to Dr Nicole Boutilier today to confirm the College’s approach to the reactivation of medical licensure of retired physicians.
Physicians who have retired in the last 2 ½ years can reactivate their licence without fee. College staff will obtain the necessary information directly from the physician. Upon approval of licensure, the College will direct physicians to contact you for direction as to where they are needed.
These physicians will be licensed until June 1
st,
at which time we will reassess the need for ongoing licensure. The licence type will be a Restricted licence, restricted to “pandemic response efforts as directed by the NSHA or the IWK.”
Physicians who have been retired for longer than 2 ½ years will be considered on a case-by-case basis
As we have discussed, physicians licensed in other provinces seeking to help in the Nova Scotia pandemic response, will be licensed in a similar manner without fee.
Excerpt of Memo from the College of Physicians and Surgeons re: COVID-19
In these anxious days, I am receiving reports regarding the poor decision making of some of our physicians. Specifically, the following must stop:
- Working while sick. The direction from our leadership about self-isolation applies to us as well.
- Inappropriate prescribing. Physicians have begun prescribing an unproven combination therapy of includes lopinavir/ritonavir and hydroxychloroquine. This prescribing runs counter to the direction of the Pandemic Response Executive Management Team.
- Inappropriate social media postings. Physicians are referred to the Professional Standards and Guidelines Regarding Physician Use of Social Media. We must not add to the anxieties and misinformation of the times.
On another note, we have to be mindful of our mental wellness and that of our colleagues. We need to look out for each other. If you are struggling or see a colleague struggling the College encourages you to contact the
Professional Support Program
.
All stakeholders are busy ironing out some logistical challenges. Specifically:
- It is likely that virtual care will become an important component of the pandemic response. The College encourages this and refers you to our Professional Standards Regarding the Provision of Telemedicine Services.
- Recently retired physicians seeking to help out can re-activate their licence without fee. If you fall into this group, please contact the College at registration@cpsns.ns.ca
- The Nova Scotia College of Pharmacists had done good work to ensure ongoing accessibility for medications. Physicians should reassure patients regarding access to medication.
- The Canadian Medical Protective Association has taken steps to ensure seamless mobility of coverage.
- The MCC, the CFPC and the RCPS (Canada) have all postponed their examinations. These decisions will not negatively affect licensure. If you are scheduled to challenge any of these exams, you will remain licensed or on the same pathway to licensure.
The College itself continues all of its essential services. Although our offices have closed, the College’s essential services continue remotely.
For updated information from the College follow us on
Twitter
or visit our
website
.
With my thanks for all the tremendous work being done by physicians,
Dr. D.A. (Gus) Grant
Registrar and CEO, College of Physicians & Surgeons of Nova Scotia
Fit Testing for Physicians
Only physicians who are providing aerosol generating procedures (positive pressure ventilation (BiPAP and CPAP), endotracheal intubation, airway suction, high frequency oscillatory ventilation, tracheostomy, chest physiotherapy, nebulizer treatment, sputum induction, and bronchoscopy) should be participating in fit testing at this time. Staff members are working to reach all physicians in each zone to determine their fit testing status.
For information about fit testing in your area, contact your zone Occupational Health and Safety Lead:
Upcoming Fit Testing Clinics for Physicians in the Northern Zone
Fit testing takes approximately 15 minutes.
You must be clean shaven or you will not be fit tested.
Beginning the morning of Tuesday, March 17
th
at 0700 hours, call to make your appointment at 752-7600 ext. 2935 (Aberdeen Regional Hospital).
If you have to leave a message, please indicate the site and the block in which you would like to have your appointment (ex. “CRHCC – morning anytime” or “ARH evening after 1900”).
You will be called back with the appointment closest to your preferred time. No need to call back and confirm unless you cannot make this appointment time.
Aberdeen Regional Hospital – Safety Office B213b (Basement)
Wednesday March 18, 0700-0900
Tuesday March 17, 1700-2100
Colchester East Hants Health Centre – Occupational Health Room A 2009 (2
nd
floor past dialysis)
Thursday March 19, 0700-0830
Wednesday March 18, 1700-2100
Cumberland Regional Health Centre, Room 1675
Wednesday March 18, 0700-0900
Thursday March 19, 1700-2100
Note:
If you have already booked an online appointment for CEHHC this Thurs/Friday, and you would prefer one of the above times, please call to make an appointment. Contact Alison Dougan (
alison.dougan@nshealth.ca
)
