COVID-19 Physician Information Update
April 23, 2020
|
|
Updated Clinical Documents
|
|
Note: Some users have reported issues accessing links in Google Chrome. IT is seeking a solution to this issue but until then, if your link doesn't work please try another browser alternative.
Order Sets, Procedures, Clinical Pathways, Guidelines and Policies
Occupational Health
Infection Prevention and Control
COVID Primary Assessment Centres and Secondary Assessment Centres
Mental Health and Addictions
|
|
The National Police Federation, working with the RCMP, are organizing events for a day of mourning in the wake of the tragic loss of Constable Heidi Stevenson and the many other innocent victims killed in Nova Scotia on April 19.
Canadians from coast to coast are being asked to wear something red and share pictures, videos, and messages of support online using the hashtag #WearRedFriday this Friday, April 24.
“This was an unimaginably tragic event that underscores the very real risk that our RCMP Members face when they go to work everyday to protect our communities,” said Brian Sauvé, President of the National Police Federation. “Our hope is that this small gesture will help unite Canadians in a show of support for the RCMP and the families of all the victims of this tragic event.”
“These are unusual times, as physical distancing and restrictions on gatherings make it harder to gather together and mourn as a nation,” added Sauvé. “In better times, we would be able to come together in great numbers to show our appreciation, and so we hope by wearing red together on Friday we can mourn these senseless losses and show all the families that we care.”
|
|
**REVISED** Diagnostic Imaging
Ambulatory Booking Procedure
|
|
In accordance with NSHA policy, Diagnostic Imaging Departments are currently providing imaging services ONLY for time sensitive examinations.
Normal walk-in procedure for Plain film (xray) is suspended. If outpatients require urgent or emergent xray imaging, this can be arranged upon DIRECT VERBAL REQUEST by the referring physician or delegate to our departments. As always, unstable patients would usually be seen in the Emergency department. Patients being seen in hospital clinics, patients undergoing cancer treatment, patients in the emergency department and inpatients, do not require direct verbal request for xray.
New requisitions for advanced imaging (eg, CT, MRI, US, PETCT) will only be booked if the request is considered urgent or emergent. For such exams, referring physicians are asked to include whenever possible a completed Covid Risk Assessment form as provided by NSHA. All other examinations will be booked when restrictions are lifted. Please contact our department directly if you disagree with a triage or booking decision.
It is essential that the COVID status of each patient be known and communicated to our staff such that appropriate procedures can be followed. All confirmed positive or screened positive COVID patients should be masked upon entry to our departments. If pre-hospital masks are not available, masking will occur either upon entry to our facilities or to our departments, depending on local policy.
|
|
Memo: New NSHA In-Home Blood Collection Service for Eligible Patients
|
|
Due to impacts on public and private blood collection services in N.S. related to the COVID-19 pandemic, NSHA is implementing an in-home blood collection service. Referrals will be accepted beginning Monday, April 27th with appointment bookings starting Wednesday, April 29th. This service is specifically for patients requiring urgent/time-sensitive testing for immediate diagnosis and management of chronic illness (e.g. renal disease, cancer, etc.).
Routine blood work that does not fit in the criteria above should not be ordered at this time. Patients who are eligible to be referred for this service are as follows:
- patient is housebound and unable to go out of the home; or
- not providing blood collection in the home would cause undue hardship to the patient. The hardship could be physical, medical, financial or other.
All requests must be directed to Continuing Care following the existing Continuing Care referral process. Please fax a completed
Continuing Care Referral Form along with a completed laboratory requisition to:
- CZ: 902-455-3809
- EZ: 902-563-3433
- NZ: 1-866-682-8170
- WZ: 1-866-246-4554
Your partnership in selecting the right patients is key to our success with this service. Please ensure only patients meeting the above criteria are referred to avoid overwhelming this new service and maintaining access for those who require it most. Your local NSHA laboratory will connect with the client to make arrangements for an in-home blood collection appointment.
Ambulatory patients requiring urgent blood work can still access NSHA outpatient blood collection clinics by booking an appointment with their local NSHA Blood Collection Service. Please be assured that pre-screening, social distancing, and additional infection prevention and control measures are in place to ensure their safety. Information about NSHA Blood Collection Service including appointment booking, can be found on the NSHA website:
http://www.nshealth.ca/blood-collection .
NSHA is also offering support to Long-Term Care facilities to ensure blood collection services can be provided safely to their residents. Long term care facilities needing assistance are asked to contact
josh.macdonald@nshealth.ca for more information.
We appreciate your cooperation and patience at this difficult time.
- If you have any questions, please contact your local laboratory directly.
|
|
Spectrum App - Your Infectious Diseases
and COVID-19 Assistant
|
|
The Spectrum App is your infectious diseases and COVID-19 assistant. A quick, easy way to access:
- Antimicrobial stewardship guidelines for COVID-19 and other infectious diseases
- Pathogen summaries
- Formulary entries
|
|
DMF Policy - Injection and Preparation
of Ultrasound Enhancing Agents
|
|
In order to increase the efficiency and thus improve patient care in Echocardiography Lab, the cardiologist a new policy has been finalized that delegates the duty of preparing and injecting Ultrasound Enhancing Agents (UEA) to cardiac sonographers.
|
|
COVID-19 Risk Factors and Risk Assessments
|
|
We are currently taking enhanced precautions across NSHA during the COVID-19 pandemic. We are aware there are several COVID-19 risk factors that patients receiving services at NSHA may have and these identified COVID-19 risks require our healthcare teams to take additional precautions to keep patients and healthcare providers safe during this time.
We have recently developed two ways of identifying COVID-19 risk factors and communicate these risks amongst the healthcare team.
- The COVID-19 Risk Assessment, to be completed at the initial point of contact and then verified by the most responsible provider. If when assessed the patient has a COVID-19 risk identified, the precautions to take are outlined on the second page of the assessment form.
- Droplet and contact flag at registration (Go live April 23, 2020): We know from Public Health there are areas and facilities within the province that are experiencing higher rates of COVID-19. There is a risk that in these areas that there is 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 and then we are linking these cluster with postal code. When the patient present to register for an appointment, IM/IT have developed a process for clerks to place a droplet and contact precaution flag on the patient’s chart.
- The COVID-19 Document Hub has a link with resources:
|
|
Direction on Comfort Enhancements for Masks
|
|
A message from the Personal Protective Equipment (PPE) Working Group
Last week, NSHA, in alignment with the IWK and many health centres across North America, introduced universal masking for all staff and physicians working in patient care areas. This direction means staff and physicians should wear masks for the duration of their shift. However, we appreciate that it can be very difficult to wear a mask for 12 hours, especially if this has never been part of your practice. We empathize with all health care workers who are now wearing masks throughout their shifts and appreciate your participation in this important safety measure.
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 & Control and Occupational Health, Safety & Wellness want to support staff and physicians to wear the masks safely and effectively, and so do not endorse the use of any additions to personal protective equipment (PPE). The PPE 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 to PPE increases the likelihood of staff/physician contamination when doffing, and presents another element that could fail while the mask is worn. Please know that discouraging the use of mask enhancements is for the protection and safety of staff and physicians, which is our primary goal with this measure.
If you are experiencing issues due to prolonged mask use, please log a report in SIMS (Western, Eastern and Northern Zones) or call 902-473-SAFE (Central Zone).
Thank you for your understanding.
|
|
Grief & Leadership in the Wake of Tragedy
|
|
Resources for Children and Adults Coping with Grief
The following resources were provided by our colleagues in palliative care as they may prove helpful with the tragic circumstances of recent events.
|
|
Choosing Wisely Canada Webinar
|
|
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.
|
|
New Library Services COVID-19
Research Subject Guide
|
|
As trusted publishers and research groups share findings and publications for free online, it can be challenging to stay current with the latest COVID-19 evidence.
|
|
*Updated* COVID-19 PPE Recommendations
|
|
Infection Prevention and Control has developed a synopsis of recommendations for personal protective equipment (PPE) to be used by health workers providing clinical care for patients with COVID-19.
|
|
Reminder: Seeking Physician
Volunteers for Redeployment
|
|
We continue to seek volunteers for redeployment. Family doctors are needed to support this site as we expand testing for all influenza like illness and provide first line treatment or referrals.
Please complete the following
short survey
, so that we may collect your information and match your skills with areas of need.
Physicians can redeploy to services within their own town, zone, or other areas of the province.
All physicians will be supported to provide the level of service that they are comfortable with. All physicians are supported to do redeployment by CMPA and the College of Physicians and Surgeons (see above). NSHA Medical Affairs will support the administrative functions required for redeployment.
Medical Affairs team members are collecting this information to assist the redeployment opportunities.
|
|
Updated Return to Work Guidance for
COVID-19 Positive Healthcare Workers
|
|
Like many communities in Nova Scotia, NSHA has seen the identification of health care workers confirmed with COVID-19. As the weeks evolve some of these employees are considered recovered and are working with Occupational Health Safety & Wellness to return to the workplace in a safe manner.
The guidelines for return to work have been developed in collaboration with the Chief Medical Officer of Health, Infectious Disease, and Medical Microbiology.Effective April 17, 2020, a health care worker will be deemed recovered and able to return to work IF they are:
- A minimum of 10 days from symptom onset
- Do not present with a fever
- Are clinically improved
- Are demonstrating an improvement in respiratory symptoms
If all criteria noted above have been met, the employee will be cleared to return to work through Occupational Health Safety & Wellness. If one criterion is present the employee will not be considered recovered and will not be permitted to return to work.
Complex cases will be reviewed with the Occupational Health Safety & Wellness physician and case specific return to work criteria will be provided.
Please note: The return to work guidelines noted above removes the requirement for repeat swabbing of a health care worker prior to return to work. Again, some cases will require case specific guidance and these will be identified through Occupational Health Safety & Wellness.
|
|
We wanted to share this heartwarming video of a performance by Victoria Straub, an employee at High- Crest Place in New Glasgow. She played and sang today during their residents ‘canteen hour’. High-Crest was mindful of having only five residents in the room at once and said the performance was an instant mood booster for their residents.
Victoria is a first year university student and the daughter of Dr. Deborah Straub, an ER doctor at Aberdeen Hospital. Thank for for sharing the joy of music Victoria!
|
|
Valley Regional Hospital received a special gift yesterday, when a group of local teachers and community members delivered coffee break treats. As the treats were delivered throughout the facility, the responses ranged from surprise to tears of joy for being thought of.
“On behalf of over 500 staff members, we are humbled by this groups’ thoughts and generosity,” said Karen MacDonald, perioperative leader at Valley Regional.
Pictured are: Therese Forsythe, a local teacher, donor and Vice President of NSTU, Holly Moore, an LPN from the OR and member of CUPE and Dianna Hutt, Cancer Care Navigator and President of the local NSNU.
|
|
Provincial COVID-19 Status Update
|
|
Today, April 23, Nova Scotia is reporting four additional deaths related to COVID-19, bringing the total to 16. Three occurred at the Northwood long-term care home in Halifax Regional Municipality and the other occurred at Harbourstone Enhanced Care in Sydney.
"Our hearts ache for those who have lost a loved one to COVID-19. All Nova Scotians send their support and condolences to the families and friends of those who have passed," said Premier Stephen McNeil. "The entire health-care system has rallied around Northwood and we continue to provide support and guidance to all long-term care homes to address this virus."
As of today, Nova Scotia has confirmed 827 confirmed cases of COVID-19. Fifty-five new cases were identified Wednesday, April 22.
The QEII Health Sciences Centre's microbiology lab completed 921 Nova Scotia tests on Wednesday, April 22 and is operating 24-hours. Nova Scotia has conducted more COVID-19 tests per capita than any other province.
As of April 22, there were 10 licensed long-term care homes and unlicensed seniors' facilities in Nova Scotia with cases of COVID-19, involving 158 residents and 79 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 23,731 negative test results, 827 positive COVID-19 test results and 16 deaths. Confirmed cases range in age from under 10 to over 90. Ten individuals are currently in hospital, four of those in ICU. Three hundred and fifty-eight 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 3
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).
|
|
This section of our update is a list of helpful resources curated weekly for physicians by Medical Affairs’ Physician Leadership Development.
Please reach out to
Shawn Jolemore with your comments, questions, or suggestions for additional content.
|
|
Leadership and Wellness Poster
Updated for Week of April 20-27
|
|
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.
New Strategies for Time Management During Stressful Times
April 24 from 4-5 p.m. with Dr. J. Sadek.
Join Zoom Meeting. Password if prompted: 050891
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
|
|
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
|
|
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.
|
|
Physician Screening for COVID-19
|
|
Call 1-833-750-0632 to speak to Occupational Health and Safety for your screening options.
|
|
|
|
|
|
|
