COVID-19 Physician Information Update
May 11, 2020
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Updated Clinical Documents
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Order Sets, Procedures, Clinical Pathways, Guidelines and Policies
COVID Assessment and Treatment
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Witnessing Non-NSHA Documentation
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Legal Services is advising that current COVID19 measures meet the criteria of exceptional circumstances under CDHA Policy 30060. Therefore, during the COVID19 visitation restrictions,
NSHA employees may act as a witness to a patient’s non-NSHA generated documentation, including wills and power of attorneys.
This policy exception shall also apply to lawyer prepared documents. NSHA employees should not explain, interpret, or provide advice on the content of non-NSHA documents they have been requested to witness. This direction does not change on account of COVID19 measures.
If at all possible, non-clinical NSHA employees should first act as a witness. If a document must be sworn, the document may be sworn by a NSHA employee who holds a valid Commissionaires of Oath. The above advice shall apply to any documents which may be sworn by a Commissionaires of Oath.
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Continuing Care: In-Home Assessment
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Effective April 30, 2020, NSHA Continuing Care began taking referrals for in-home assessment for COVID-19. Through the home care program, VON and NSHA nurses are delivering this service across the province as needed, with the exception of Halifax (former HRM boundaries) and industrial Cape Breton where currently the EHS Field Assessment Unit is providing this service. Screening will continue through the 811 system.
Upon referral to the Primary Assessment Centre in the client’s geographical area, if it is determined that the client is housebound/unable to travel for testing, the Primary Assessment Centre will make a direct referral to Continuing Care for an in-home assessment.
With the implementation of this new service, we made a commitment to monitoring access and demand.
Since last week, VON has reported providing in-home swabbing for two individuals that they believe could have accessed the local Primary Assessment Centre.
To support appropriate referrals and quick feedback to the Primary Assessment Centres, the following process will be followed:
- VON and NSHA nurses notify the NSHA Continuing Care team member who made the referral about their concern.
- NSHA Continuing Care team member escalates the details of this concern to the local NSHA Continuing Care Zone Director.
- NSHA Continuing Care Zone Director follows up with the Primary Assessment Centre Site Lead for discussion and resolution.
The best place to access related materials, requisitions, and other tools and resources on in home COVID-19 assessment, ensuring the most recent versions are being used, is on the
NSHA
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Preview : Palliative Care Pathway
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Palliative care providers continue to deliver care during the COVID-19 pandemic. Palliative care is an essential component in pandemic planning and its guiding principles could never be more important. While the demands for critical, life-saving care increase, so does the need to ensure that high quality palliative care is accessible to all those who need it.
In the time of a pandemic, we need to plan palliative care service delivery for two populations:
1. Patients who become rapidly and terminally ill as a result of COVID-19.
2. Existing/new patients with progressive, life-limiting conditions who require complex symptom management and end-of-life care planning.
Patients who become rapidly and terminally ill as a result of COVID-19
For Physicians/NPs caring for COVID-19 patients, Palliative Care Physicians have established an on-call phone support system to ensure that Palliative Care expertise is accessible for complex symptom management in any setting of care. Several tools have also been developed to help support end-of-life care for people with COVID-19, which are available on the
COVID-19 End of Life Care section of the NSHA COVID-19 Hub.
To access a Palliative Care Physician 24/7:
- Central Zone: Team coverage as usual, contact: 902-473-2220
- Sydney and area: Team coverage as usual, contact: 902-567-8597
- For all other areas, contact your local Regional Hospital switchboard, who will connect you to an on-call physician.
Existing/new patients with progressive, life-limiting conditions who require complex symptom management and end-of-life care planning.
In response to the COVID-19 pandemic, and the requirement to take all precautions necessary to prevent the spread of the virus to patients, families and health care providers, the palliative care teams in the province have substantially reduced community-based visits. We continue to provide essential care based on need, including virtual care options and in-person support for those who require it.
All consults will be triaged in order to allocate clinical resources to those in most immediate need of our services. We do not have physical ambulatory care clinics at this time. Three priority levels have been developed to support triaging of new referrals and outlining the level of support that will be offered to new and existing palliative care patients.
(for full size document, click the image below)
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COVID Code Blue Pathway for Tri-Facilities
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Ensure Patient Care Goals are Documented and Reviewed.
If patient screens negative by an NSHA employee then can treat patient as a “regular code”
Mask/Gloves.
If the patient is identified as per the
COVID RISK Assessment to have an identified COVID risk they are considered suspected or known COVID, the team should proceed as follows:
First Responder (wearing Droplet and Contact PPE).
- Patient Found Unresponsive and not breathing normally. Shut Door.
- If Patient has a DNR proceed with End of Life Care.
If NO DNR – Call Code Blue. CALL LIFEFLIGHT – Call Early/ Call Often
- Place surgical mask on patient and put bed in CPR mode.
- Defibrillator will be passed into room by another staff member.
- Attach Pads
- Analyze rhythm and Shock if appropriate / as directed by AED.
- Initiates IV if time (Grab and Go Bag)
When second responder enters room with Airborne PPE the first responder will:
- Help second responder place patient on back board. Once completed, first responder doffs PPE and leaves room.
- This team member (first responder) should now begin to safely don airborne PPE (as required depending on number of team members available). Stop and ensure everyone in room has airborne PPE donned.
Second Responder
Ensure door is shut.
- GOAL IS TO MINIMIZE CHEST COMPRESSIONS PRIOR TO INSERTION OF KING LT.
- RN/Physician to insert a KING LT airway with HME filter firmly attached ASAP. Ensure PEEP is turned to 10. Attach to 15 L o2 dial up slowly ensuring no leak.
- If Second Responder not a RN/Physician compression only.
- Do not bag patient. Passive ventilation only.
- Start / Resume chest compressions.
- Once airway is secure, continue per ACLS guidelines.
- Follow ACLS protocol for 10 minutes – consider Hs and Ts
- If no ROSC end code.
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Storage of Personal Health Information
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Store PHI [Personal Health Information] only on NSHA network drives or in the electronic medical record (EMR); PHI is not to be stored or retained on individual computer hard-drives or in email folders (Outlook or other email system).
Some temporary exemptions have been granted to this rule for storage of PHI on SharePoint during the COVID-19 pandemic, however, this does not mean that we should store PHI on SharePoint on a regular basis. Any long-term use of SharePoint for storage of PHI requires the completion of a Privacy Impact Assessment and approval by the Privacy Office.
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NSHA enacted a process to forgive rent for physician experiencing a financial loss for the month of April.
NSHA has developed guidelines to forgive physician rents and will continue to evaluate these criteria for up to three months as we enter the height of COVID-19. Physicians who qualify for income stabilization can apply but this information will be reviewed with your application.
Eligibility
- Only physicians seeing a measurable decrease in revenue from MSI (defined as either FFS or other forms of alternative funding) are eligible to apply for this program.
- Individuals who are primarily remunerated through APP or AFPs are not eligible to participate in this program.
- Physicians who have received a portion of their income, typically less than 50%, through AFP or APP are eligible for this program.
- Eligibility is subject to NSHA verification of MSI billings.
Rent Suspension Application Process for May
We have noted that the online form previously provided, was not working as intended.
Eligible physicians can apply for deferral or suspension by downloading and completing the
application form and submitting to Medical Affairs at
PhysicianContracts@nshealth.ca. NSHA will review and communicate approval back in writing to all eligible physicians within 5 business days of the receipt of a completed application.
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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 are posted by Health Canada.
List of Drugs for Exceptional Importation and Sale ‐ Canada.ca
A graded list of COVID‐related medication supply will be communicated regularly to NSHA. As signals of shortages or anticipated shortages arise this communication will be updated. Supply should be managed judiciously and waste reduction is important.
CRITICALLY LOW
None identified currently
LOW
Epinephrine pre‐filled syringes
- Pre‐existing shortage situation with 75% monthly allocation. 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.
Salbutamol Inhalers
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The very inspiring dancing staff of Sacred Heart in Cheticamp are here to keep spirits high!
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Check out this cool t shirt design received by Dr. Cheryl Pugh of Western Zone from her colleague Dr. Robin MacQuarrie in Northern Zone.
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Provincial COVID-19 Status Update
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Today, May 11, Nova Scotia is reporting one additional death related to COVID-19, bringing the total to 48. The death occurred at the Northwood long-term care home in Halifax Regional Municipality.
"It is with heavy hearts we report the passing of another resident at Northwood. My thoughts are with the family and friends of this individual," said Premier Stephen McNeil. "All Nova Scotians are asked to do everything you can to continue to slow the spread of this virus in our province."
As of May 11, Nova Scotia has 1,019 confirmed cases of COVID-19. One new case was identified Sunday, May 10.
"COVID-19 is a terrible disease, but we all play a role in how it impacts our province," said Dr. Robert Strang, Nova Scotia's chief medical officer of health. "Maintain social distance, wash your hands, stay home as much as possible, and clean high-use surfaces."
The QEII Health Sciences Centre's microbiology lab completed 291 Nova Scotia tests on May 10 and is operating 24-hours.
There are three licensed long-term care homes and unlicensed seniors' facilities in Nova Scotia with active cases of COVID-19. Northwood in Halifax currently has 156 residents and 18 staff with active cases. One other facility has one staff member with an active case of COVID-19 and another facility has one resident with an active case.
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 33,869 negative test results, 1,019 positive COVID-19 test results and 48 deaths. Confirmed cases range in age from under 10 to over 90. Nine individuals are currently in hospital, three of those in ICU. Seven-hundred and sixty-seven 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:
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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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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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Physician Leadership and Wellness Poster for Week of May 11
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Charge your Battery Series: Self-care Skills Training for Healthcare Providers During COVID-19
These sessions review empirically based skills that healthcare providers can use to be more fulfilled at work and home, and more engaged in consistent self-care behaviours, even during these times of crisis.
- Session 1: Building and sticking to a daytime routine that includes self-care
- Session 2: Emotion-focused coping for difficult emotions
- Session 3: Present moment awareness
- Session 4: Self-compassion to respond kindly to ourselves and others
- Session 5: Building and sticking to an evening routine to promote sleep
- Session 6: Emotion-focused coping for change and loss
- Session 7: Mindfulness
- Session 8: Compassionate responding to self and others
Sessions begin the week of May 11
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Physicians
Thursdays 4-5 pm
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Residents
Tuesdays 4-5 pm
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Managers/Leaders
Thursdays 2-3 pm
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CPSL Special Session - Everyday Resiliency
Dr. Robyne Hanley-Dafoe is a multi-award-winning psychology and education instructor who specializes in resiliency, navigating stress and change, and personal wellness in the workplace.
Described as transformational, engaging, and thought-provoking, Hanley-Dafoe provides practical strategies, grounded in global research and case studies, that help foster resiliency within ourselves and others.
With over 13 years of teaching and research experience at Trent University, her work connects research-informed practices with everyday applications that are realistic, universal, and sustainable.
Individuals must join via the link to have both audio and video. Understand that this is a sharing video so please be dressed and ready to go.
May 13, 2020 / 4:00 pm
Mind Body Skills Group:Learn Three Different Practices That Calm Your Mind, Relax Your Body and Life Your Spirits
With Dr. Zenovia Ursuliak, Wednesday, May 13, 4-5 p.m.
Please sign in with your full name and write your location of work after your name.
Mindfulness for Physicians: Emotion Regulation
With Dr. Nicole Herschenhous, Friday, May 15, 4-5 p.m.
Please sign in with your full name and write your location of work after your name.
Balint Support Group
Drs. Nicole Herschenhous and Ali Manning are starting a six-week virtual Balint group for physicians. Balint groups help reduce burnout and improve communication skills and empathy. Physicians will use case-based discussion for support around emotions and ethical dilemmas. More info
here. Email
Dr. Ali Manning to register!
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.
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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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