COVID-19 Physician Information Update
May 7, 2020
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Updated Clinical Documents
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Order Sets, Procedures, Clinical Pathways, Guidelines and Policies
COVID Assessment and Treatment
Infection Prevention and Control
Cancer Care
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Community Cluster Update - May 7
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This morning we implemented a new strategy for identification of patients who reside in COVID-19 Community Clusters using a 6-digit postal code search tool. Today we were notified by Nova Scotia Public Health that based on available epidemiological data, all current Community Clusters (Fairview, Dartmouth North and Preston/Lake Echo/ Lawrencetown) have been resolved. Starting May 8, 2020, patients from those three Community Clusters who are asymptomatic and have no other identified
COVID risk factors will no longer require additional precautions.
The COVID Risk Assessment Form must continue to be completed with every face to face visit and admission and appropriate precautions taken for both staff and patients when COVID-19 risk factors are identified. As new community clusters are identified by Nova Scotia Public Health, we will notify staff and clinicians and the affected postal codes will be found in the
COVID community cluster postal code search.
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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
Eligible physician can apply for deferral or suspension by completing the
application form and submitting to Medical Affairs. 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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N95 Respirators and Fit Testing
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If you have been FIT tested for alternative models please use them and not the 1870+
In mid-April, NSHA introduced an expanded FIT testing model for N95 respirators to ensure that staff who are working with COVID-suspect or confirmed cases and who may need to perform aerosol-generating procedures are FIT tested to a variety of N95 respirators.
We made this change to ensure that those staff and physicians who need N95s will be able to receive and start using their supply without delay.
Many respirators are manufactured overseas. We’re well aware that global markets could shift and change; many countries are limiting exports. As a result, we launched an expanded FIT testing model to ensure staff are FIT tested to all procured models. In addition, we are adding to our stockpile of N95s to ensure we have the supply we need to enable our frontline workers to safely care for patients.
With ongoing consumption, our supply of 1870+ models has been reduced. These models will now only be provided to areas that have not undergone FIT testing on alternative models.
Knowing that a significant number of health care workers have been FIT tested to this model, we expanded FIT testing to include 3M 1870 and 1860, 1860s and 8210 models, as well as Pleats Plus. If you have been FIT tested to an alternative N95 model, you must select and don an alternative N95.
Many high-consumption areas such as COVID units, Critical Care, Respiratory Therapy, Anesthesia, Emergency, Perioperative and Airway teams have completed alternative FIT testing. Occupational Health, Safety and Wellness will be working with leadership in other units/areas to coordinate alternative FIT testing. It is important that staff participate in these FIT testing sessions to ensure they are properly FIT tested to a variety of models as noted above.
We want to assure you that our supply of all PPE, including N95s, can meet our current needs and we are working to ensure our supply meets future demand. Your safety and protection are our priority.
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New Vice President Corporate Services and Chief Financial Officer
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After a national search, Derek Spinney has accepted the role of Vice President Corporate Services and Chief Financial Officer. Derek joined Nova Scotia Health in October 2018 as the Senior Director of Finance and brings more than 20 years’ experience to our organization.
Prior to joining Nova Scotia Health, Derek worked at Bell Aliant as the Director, Finance Analytics. He has a Bachelor of Commerce from Saint Mary’s University and is a Chartered Professional Accountant. In the role of Vice President Corporate Services and Chief Financial Officer, Derek is responsible for planning and system performance, delivering high quality corporate services including finance, information technology, nutrition and food services, facilities and supply chain to name a few.
Please join us in welcoming Derek for taking on this vitally important role for the organization.
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Northern Zone Influenza Like Illness
Access Clinics
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In Northern Zone, the several assessment clinics have been stood up to assess and treat patients with influenza-like illness (ILI).
For Family Practices:
Locations and Hours
Amherst
11:00 am to 7:00 pm, 7 days a week
Hours that Physician or Nurse Practitioner Are On Site: 12:00 pm to 6:00 pm
New Glasgow
9:00 am to 7:00 pm, 7 days a week
Hours that Physician or Nurse Practitioner Are On Site: 12:00 pm to 5:00 pm
Truro
11:00 am to 7:00 pm 7 days a week
Hours that Physician or Nurse Practitioner Are On Site: 11:00 am to 5:00 pm Monday to Friday
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Priority COVID-19 Testing Update
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Priority COVID 19 testing on the GeneXpert platform is now available but with very limited availability. Instruments are in place in Aberdeen, CBRH, IWK, QEII, VRH, YRH and now at Colchester East Hants Health Centre. Although the assay can provide testing results within 1 hour, total turnaround time involves collection, transport and reporting of results which is closer to 2-4 hours.
NP swabs must be used however, the number of swabs are very limited and the decision to order priority testing must be carefully considered using the criteria below. The alternate throat/nares swab (Aptima) is 100 times less sensitive. GeneXpert is not validated for sputum testing.
Due to the limited availability of tests, the decision to use these tests will be managed locally and should only be used when results are required within a 6 hour time frame and cannot wait for the results from the QEII (whose TAT is < 24 hours once it arrives in the laboratory). The guidelines for test usage below will be updated when greater numbers of tests are available. There is no backlog for the routine COVID test.
GeneXpert testing should focus on:
- Intensive care settings – discuss with IPAC before removing patients from precautions. Patients with lower respiratory tract COVID 19 infection can have negative NP results. Lower respiratory tract specimens (ET secretions, BAL) are more sensitive in this setting.
- Residents in LTC (maximum of 3) – the remainder can be tested using the routine process
- Results required by Occ. Health to make decisions regarding management of HCW (requests must be requested directly to the laboratory by the Occ. Health physician)
- Pre-transplant donor or recipient screening
Decisions will be made on a case by case basis. Once our supply chain has improved we can revisit this guidance.
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Throughout COVID-19, we’ve seen many examples of people coming together and supporting each other and their communities. At Cape Breton Regional Hospital, Meaghan Grant-Bennett and Michelle Wheelhouse, medical social workers, looked for a way to acknowledge the fear and anxiety yet bring hope and optimism to co-workers, family, friends and neighbours. They reached out to various departments, units and services at the hospital to take part in the We Rise Again video project. The video features staff and physicians (and a special guest) singing
Rise Again composed by Leon Dubinsky and recorded most famously by the Rankin Family.
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Provincial COVID-19 Status Update
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Today, May 7, Nova Scotia is reporting three additional deaths related to COVID-19, bringing the total to 44. The deaths occurred at the Northwood long-term care home in Halifax Regional Municipality.
"Losing a loved one is never easy and the restrictions around COVID-19 make it difficult for families to come together to grieve," said Premier Stephen McNeil. "My heart goes out to the families who are mourning the loss of their loved one today."
As of today, Nova Scotia has 1,007 confirmed cases of COVID-19. Nine new cases were identified Wednesday, May 6.
"We're doing everything we can to bring the situation at Northwood under control," said Dr. Robert Strang, Nova Scotia's chief medical officer of health. "Our number one concern in responding to this unprecedented public health emergency has always been, and continues to be, the safety and well-being of everyone."
The QEII Health Sciences Centre's microbiology lab completed 875 Nova Scotia tests on May 6 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 44 staff with active cases. Two other facilities each have one staff member with an active case of COVID-19.
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 32,289 negative test results, 1,007 positive COVID-19 test results and 44 deaths. Confirmed cases range in age from under 10 to over 90. Five individuals are currently in hospital, two of those in ICU. Seven-hundred and 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 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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Leadership and Wellness Poster
Updated for Week of May 4 - May 10
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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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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
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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
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!
A Short Survival Guide to COVID-19
Click here for
a link to an article written by local family doctor, Dr. Maria Patriquin for the Journal of the College of Family Physicians (
cfp.ca).
Mindfulness for Physicians: Incorporating Self-Compassion
With Dr. Nicole Herschenhous, Friday, May 8, 4-5 p.m.
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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