COVID-19 Physician Information Update
April 28, 2020
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Updated Clinical Documents
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Order Sets, Procedures, Clinical Pathways, Guidelines and Policies
COVID Primary Assessment Centres and Secondary Assessment Centres
Cancer Care Updates
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Today, we join employers and labour organizations throughout Canada and around the world to observe a
Day of Mourning. This is a day to pause and pay tribute to those who have lost their lives, suffered an injury or became ill at work. Today, we renew our commitment of improving health and safety in our workplace.
I would like to say thank you to all those staff and physicians working hard during this pandemic. Safe behaviors and routine practices have been critical in ensuring the safety of ourselves, our colleagues at work, our patients, as well as our family and loved ones at home.
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N95 Collection in Targeted Areas Only
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NSHA Supply Chain is closely monitoring supplies to ensure they are available when they’re needed. This includes the supplies needed to collect, store and reprocess N95s if needed in the future. At this time, NSHA is focusing N95 collection efforts in targeted areas only:
• Designated COVID-19 inpatient units
• ICUs
• Regional emergency departments
• Operating rooms
A small working group is working through plans for collection, pick-up and storage of used N95 respirators.
Used N95s in these areas can be stored in ventilated boxes until retrieved by MDR staff or designates.
Targeted units should order storage boxes through their regular stock ordering processes. Leaders of targeted areas have been provided the SAP number for these boxes.
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Guidelines for Glaucoma Treatment for
Patients in Long Term Care Facilities
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An issue has arisen with some facilities directing care teams to temporarily discontinue glaucoma treatment for their patients during COVID-19 pandemic.
In some cases, a temporary pause in treatment is safe. In other cases, it could create irreversible deleterious outcomes to the patient’s vision.
There is some concern that assessment of these patients, and triage for those who would require treatment, might not be within the scope of practice for the staff members involved in patient care.
The following direction should be followed:
- Allow all patients who are capable to self-administer drops
- Those patients who can’t self-administer drops, the attending ophthalmologist should be consulted to advise if the patient can safely discontinue drops on a temporary basis.
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COVID Risk Assessment and Expanded Community/Facility Clusters
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The COVID-19 Risk Assessment tool was created to ensure uniform, mandatory assessment of all patients presenting for care. The Risk Assessment tool also outlines recommended PPE to be used in each clinical setting in order to ensure safety of staff and patients. It has been recently updated as the community and facility cluster areas have expanded.
- The PAC Referral Fax Form should be used to expedite testing in a PAC without requiring the patient to call 811.
The Clinical Medical Advisory Committee (CMAC) will work with Zone Medical Directors and Primary Care leads to ensure that the Community/Facility Cluster information is disseminated to physicians to ensure that this information is readily available to those who do not have access to the information on the NSHA COVID-19 Hub.
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Preview: Guidelines for
First Trimester Ultrasound During COVID-19
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For clinicians at NSHA and IWK Health Centre
These guidelines have been developed through consultation with Diagnostic Imaging (DI) and the Fetal Assessment and Treatment Centre (FATC) at the IWK Health Centre.
The goal is to provide optimal prenatal care while balancing the impact of hospital visits on the health of the public and our staff.
First Trimester Ultrasound
- For any patient who qualifies for Early Pregnancy Review (EPR) in FATC and LMP certain/reliable, this visit will serve as the dating ultrasound. Requests can be sent directly to FATC; no need to request a dating US from DI.
- Any early pregnancy complications such as bleeding, possible ectopic pregnancy, abnormal pattern of beta hCG, etc. will continue to be seen in DI. Please send the US request with pertinent history and current beta hCG level directly to DI.
- Any patient with uncertain dating by LMP will continue to be seen in DI, including those who quality for EPR. Please send the US request with pertinent history and current beta hCG level directly to DI.
Due to the pandemic, a first trimester dating ultrasound is not required in the following
scenarios:
- LMP certain/reliable and no identified risk factors or complications.
- If conception date is known and no identified risk factors or complications.
- If IVF pregnancy, then the EPR will serve as the dating US.
- Clinicians with additional questions or concerns are welcome to contact the DI
Department or FATC.
Due to the nature of the pandemic response, these guidelines may change to reflect department capacity and staff availability. Updates will be provided as necessary.
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N95 Fit Testing for Potential Code Blue First Responders
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Principles for N95 fit testing for team member who could be first responders in the event of a Code Blue:
- In the event of a cardiac or respiratory arrest, healthcare team members need to be able to respond in safe and timely manner
- The Code Blue Guiding Principles during the COVID pandemic, provide guidance to providers in the event of a cardiac or respiratory arrest is a suspect or known COVID-19 patient. In suspected and known COVID-19 patient the guidelines indicate that there is a the risk that chest compression could be aerosol generating and the other elements of CPR are considered AGMP and as such airborne precautions including N95 are indicated before starting CPR
- To facilitate the timely resuscitation efforts in the event of a cardiac or respiratory arrest, first responders should be N95 fit tested and have access to N95 masks in their local units
- PPE is not an unlimited resource and as such needs to be conserved; our current process of quantitative N95 fit testing requires the use of N95 masks to fit test the person
- Consideration of staff and patients safety through the entirety of the pandemic is needed, which includes being thoughtful in who is N95 fit tested. The COVID Code Blue working group discussed and has developed principles for consideration related to N95 fit testing:
- The most responsible person to take the lead in the event of a cardiac or respiratory arrest on each shift on a unit, outside of the Code Blue team or EHS should be part of the priority group for N95 fit testing.
- The designation of healthcare provider that must be present on every shift should be part of the priority group of N95 fit testing.
- For example, if there is a Team Lead or Charge Nurse on every shift, the priority group of staff to be fit tested should be that group. To ensure there is consistent coverage 24/7 that a healthcare provider on a unit is N95 fit tested and can start CPR in the event of a cardiac arrest.
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DNS Webinar on Income Stabilization
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To ensure you have an opportunity to ask your questions before signing onto the income stabilization program, DNS is hosting a physician webinar on
Thursday, April 30 at 7:00 p.m.
Register for the webinar and join us to learn more about the details and implementation plan for the province's physician income stabilization program. Doctors Nova Scotia staff will present the details of the program, outline the enrollment process and take your questions.
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Join Dr. Gord Gubitz for a Virtual Information Session on Medical Assistance in Dying (MAiD).
Friday May 1, 9:00 a.m. to 10:00 a.m.
Dr. Gubitz will review federal legislation, the referral / intake process, assignment of assessments, patient eligibility criteria, MAiD procedure, clinical documentation, as well as Federal reporting requirements.
We are working toward building additional clinical capacity within the MAiD team, and this session is therefore directed at Physicians and Nurse Practitioners. However, anyone who wishes to learn more about MAiD may take part.
Please register with
John McCarthy, Medical Affairs Advisor by 12:00 noon, Thursday, April 30th. Those who register will receive a link and login credentials for the Zoom meeting. If you have any questions, please call John McCarthy at 902-220-2968.
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NSHA received a generous donation today from Ms. Abi Conrod. She purchased beautiful flowers and gift bags (picture attached) and donated them to NSHA staff. The executive office decided to give them to the Environmental Services & Food and Nutrition Services staff. Both department directors in Central Zone were contacted and parcels were picked up earlier this morning.
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Last week, Cumberland North MLA Elizabeth Smith-McCrossin and her husband, Dr. Murray McCrossin, family physician, arranged to deliver a pizza lunch to staff at Cumberland Regional Health Care Centre in Amherst.
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Provincial COVID-19 Status Update
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Today, April 28, Nova Scotia is reporting three additional deaths related to COVID-19, bringing the total to 27. The deaths occurred at the Northwood long-term care home in Halifax Regional Municipality.
"Three more families are grieving losses in our province today and my heart goes out to them at this incredibly difficult time," said Premier Stephen McNeil. "We are working with our partners to ensure Northwood has the support they need to try to stop this virus."
As of today, Nova Scotia has 915 confirmed cases of COVID-19. Fifteen new cases were identified Monday, April 27.
The QEII Health Sciences Centre's microbiology lab completed 483 Nova Scotia tests on April 27 and is operating 24-hours.
As of April 27, there were 10 licensed long-term care homes and unlicensed seniors' facilities in Nova Scotia with cases of COVID-19, involving 218 residents and 95 staff.
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 26,902 negative test results, 915 positive COVID-19 test results and 27 deaths. Confirmed cases range in age from under 10 to over 90. Twelve individuals are currently in hospital, three of those in ICU. Five-hundred and twenty-two 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)
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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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A message from Medical Affairs’ Physician Leadership Development
It’s week six and the COVID-19 pandemic is feeling like a new normal in Nova Scotia. Many of us continue to work remotely and in relative isolation and the concept of “time” is becoming blurry. A theme that is emerging throughout our virtual check-in calls with our physician clients and staff colleagues alike is the importance of maintaining morale. Confounding things is the heavy grief that hangs over our province, following the Portapique tragedy. It’s safe to say that most leaders have never been trained to manage through situations like these.
In a Conference Board of Canada insights
article, the Niagara Institute’s Leanne Picot says that helping your people maintain their morale is key to keeping your organization going. She suggests that those of us in formal leadership roles must also be ready to take on the role of “chief morale officer.” Here’s a summary of a few key tenets that will help build and sustain morale within teams.
- Show trust. Checking in regularly and having virtual one-to-ones is good, but too many meetings and calls can undermine morale as it suggests you need to “see” what people are doing. Dial back on the command-and-control and step up on the trust. Shift your mindset to the idea that people want to contribute good work.
- Create connection. The author notes that people are missing connections that the physical workplace provides so it’s important to be intentional about creating ways for people to stay connected to each other, to you (the team leader), and to the work. Include stories of success, humour, and empathy in your internal communications now too.
- Give direction. Many of us may be struggling to stay focused so it’s important to help people get clear on priorities with a specific time frame attached. Attending to the first point above about showing trust, provide some boundaries yet allow for flexibility. Set people up for “wins” because it boosts morale.
- Share appreciation. This may seem obvious, writes Picot, and we’ve written about this leadership skill in previous updates because, unfortunately, appreciation can still be lacking within our work circles. Continue to share genuine, heartfelt appreciation for the work that is getting done and the contributions people are making. When people feel appreciated they are more engaged and tend to step up and help out.
Like most leadership skills, increasing and sustaining morale in your teams and work groups requires a people-focused approach. You don’t really need to take on the role of “chief morale officer”—just try out the four points above to ensure that morale stays steady.
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Leadership and Wellness Poster
Updated for Week of April 27- May 3
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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.
Talking About Trust: An Exploration of BRAVING, Brene Brown’s Tool for Having More Effective Conversations About Trust.
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Canadian Society of Physician Leaders
Bulletin 7
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Self-compassion: cultivating physician resilience during the pandemic
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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
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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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