COVID-19 Physician Information Update
May 4, 2020
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Updated Clinical Documents
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Order Sets, Procedures, Clinical Pathways, Guidelines and Policies
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COVID Community Virtual Care Team Referral Process
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The COVID Community Virtual Care Team (CCVCT) provides 24/7 virtual care availability for patients with a
known COVID-19 diagnosis who do not have a current indication for hospital admission but who are at risk of clinical deterioration in the community. The intention is to facilitate home-based care whenever possible and to provide safe and rapid access to acute care facilities when transfer is clinically indicated. This team is a provincial service available to patients from any zone who meet all of the eligibility criteria.
Eligibility criteria (must meet ALL of the following criteria):
- Known diagnosis of COVID-19 (positive swab results only, those with pending tests are not eligible to be followed by this team)
- Day 2-14 after symptom onset
- Deemed to be at high risk of clinical deterioration given risk factors AND symptom severity*
- Does not meet criteria for hospital admission
- Does not meet criteria for COVID-19 recovery (at least 10 days after symptom onset and afebrile with improving symptoms)
*risk factors: age>65, BMI>30, one or more chronic conditions (eg. heart failure, chronic lung disease, hypertension); severe symptoms: shortness of breath, clinical features of pneumonia
Referral sources:
- Public health (will require notification to team to ensure pulse oximeter is distributed)
- Secondary assessment centres
- Emergency departments
- Inpatient COVID wards
- Primary Care offices
Referral process:
- Ensure patient meets ALL eligibility criteria
- Provide patient with a pulse oximeter with batteries (contains the phone number to access
- the team), patient information sheet, and return envelope
- Fax letter informing primary care provider that patient has been referred to the CCVCT
- Fax referral form to 902-405-4373
Discharge criteria:
- >14 days since symptom onset OR
- Meets definition for recovery: at least 10 days after symptom onset AND afebrile with improving symptoms
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NSHA COVID-19 Medication Supply Update
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Pharmacy continues to receive questions about the availability of drugs surrounding COVID‐19. It is understandable staff are concerned about our supply, especially with the various news headlines. 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 will be posted by
Health Canada. List of Drugs for Exceptional Importation and Sale ‐ Canada.ca
To communicate current supply of COVID‐related medications to NSHA a graded list will be communicated regularly. As signals of shortages or potential shortages arise this communication will be updated Supply should be managed judiciously and waste reduction is important.
CRITICALLY LOW
None identified currently
LOW
Salbutamol Inhalers
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. For example:
Cisatracurium
- signals that higher doses are required in COVID patients
- Sole source manufacturer
Ketamine
- An increase in use of infusions at high doses could strain supply
The NS DSTT continues to monitor drug supply and signals of shortages for all medications. Questions regarding drug shortages can be directed to the Drug Information Center via
lisa.grandyallen@nshealth.ca.
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Congratulations to Research Funding Recipients
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In this unprecedented time of local and global uncertainty, there has never been a greater need to conduct medical and health related research to collect real-time evidence to inform practice, policy and decision making in this new pandemic environment. The Nova Scotia research community has come together to respond to the COVID-19 global pandemic with a collective investment of just over $1.5 million in COVID-19 focused research.
“Nova Scotians are known for their resilience, optimism and generosity. That spirit has come through in the response to the need for COVID-19 research support. This collective commitment of $1.5 million will allow us to tap into health researchers from across the province who will provide real-time results that will inform how we respond to this pandemic”
- Dr. Gail Tomblin Murphy, Vice President and CNE, Research, Innovation & Discovery, NSHA
This Coalition’s funding announcement will support COVID-19 research that will inform health system decisions, facilitate vaccine development, identify novel treatments, develop devices, and influence social response to the pandemic. Funding will also leverage existing research capabilities to help rapidly respond to the urgent need to support further COVID-19 focused research right here in Nova Scotia.
The COVID-19 Health Research Coalition is dedicated to fostering a research environment that engages our academic partnerships and responds to the current needs of Nova Scotians and our health system, in addition to maintaining the expertise in innovative research, discovery science, population/social sciences, and health system improvement.
The Nova Scotia COVID-19 Health Research Coalition encourages others to join our collective efforts to support this urgent research and fund more grants. For more information about donating to these efforts please contact one of our Foundation partners.
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Emergency Preparedness Week
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Emergency Preparedness Week (EP Week) is an annual event that takes place during the first full week of May. EP Week is promoted as a time to encourage Canadians to take action to be better prepared to protect themselves and their families during emergencies. Together with community leaders, first responders, all levels of government and non-government organizations, we can build a more resilient and safer Canada.
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Choosing Wisely Canada Updates
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Choosing Wisely Weekly Webinar
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Patient and Provider Recommendations Updated
Recruiting Lead Author for Choosing Wisely Section in
Canadian Family Physician Journal
There is an opportunity for a family physician in their first five years of practice to lead the CW series in the Canadian Family Physician Journal. In this role, the applicant will be the lead author on a quarterly series (co-authoring 8-12 articles) of profiles of family physician leading CW in family practice.
Specifically, in collaboration with the CWC primary care lead, family physicians will be interviewed and an article drafted and published by the applicant. It is a 2-year commitment and is a paid position. To apply a CV with a brief statement of interest (400 words or less) to
info@choosingwiselycanada.org is required. Deadline to apply is June 1, 2020.
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Income Stabilization Program
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Physician Reassignment Opportunities
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In response to the unique demands of providing care during COVID-19, NSHA is organizing opportunities for physician redeployment or reassignment. These opportunities are shared to physicians by your local leadership (ZMED, Department/Division Heads, Chiefs, Network Leads, and Site Leads).
The intent in all reassignment is to match physicians to the areas and needs that best match their skills, interests, and abilities. Physicians will be matched as needs arise across the province.
To date, the following areas have provided opportunity for physician reassignment:
- Long term care
- Inpatient care
- Secondary assessment centers
- Access Clinics – Primary Care
- Emergency Medicine
- ICU/Critical Care
- Primary Assessment Center
- Virtual Care
Current needs are met but we expect these needs to fluctuate in the future. It is important to build a robust roster of available resources in the event that care needs change quickly. However, in some cases, physicians who volunteer for redeployment may not be matched as there is no current need identified.
The following guiding principles are to be considered:
- All programs will endeavour to continue current service delivery (reduced/unchanged/increased) and assist with COVID-19 care.
- Each physician has the ability to contribute to our combined effort to support pandemic response.
- Clinical work for COVID-19 patients will be performed by physicians who best meet the required skillsets and who would typically provide this level of care.
- Physicians reassignment is a voluntary program.
- Department Head (s), Site Lead(s), Zone Medical Executive Director will make every effort to fairly and equitably reassign work between departments when required.
- Reassignment request (s) may exist to provide support in another zone and will only occur if there is a critical need. Participation in these opportunities is voluntary.
- Physicians who are quarantined or ill, they may be requested to support virtual care assignments or COVID-19 planning if they are well enough to contribute.
- Please see Occupational Health guidelines for staff with chronic conditions as well as pregnant staff. These will be considered in reassignment opportunities.
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Canada's Snowbirds flew over the QEII on Sunday, May 3 as part of
#
operationinspiration
.
Karen David, Technical Specialist at the QEII microbiology lab caught them going over the Mackenzie Building.
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Provincial COVID-19 Status Update
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Today, May 2, Nova Scotia is reporting two additional deaths related to COVID-19, bringing the total to 31. The deaths occurred at the Northwood long-term care home in Halifax Regional Municipality.
"On behalf of all Nova Scotians, I want to offer my condolences to the families of the residents of Northwood who have died due to COVID-19. I am very sorry for your loss," said Premier Stephen McNeil. "I ask Nova Scotians to continue to fight this virus through diligent social distancing, hand washing and common sense. When you are outside this weekend, taking care of your physical and mental health, please keep these things top of mind."
As of today, Nova Scotia has 963 confirmed cases of COVID-19. Four new cases were identified Friday, May 1.
"We are working very hard with the Northwood team and the health authority to isolate the virus to protect the residents and staff at Northwood," said Dr. Robert Strang, Nova Scotia's chief medical officer of health. "Please continue to follow public health directives and advice. We must all keep working as one to fight COVID-19."
The QEII Health Sciences Centre's microbiology lab completed 866 Nova Scotia tests on May 1 and is operating 24-hours.
As of May 1, there were 10 licensed long-term care homes and unlicensed seniors' facilities in Nova Scotia with cases of COVID-19, involving 239 residents and 109 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 29,406 negative test results, 963 positive COVID-19 test results and 31 deaths. Confirmed cases range in age from under 10 to over 90. Nine individuals are currently in hospital, three of those in ICU. Six-hundred and nine 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:
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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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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SAVE the DATE: Special Webinar for Physician Leaders
May 6 from 7-8 p.m.
“COVID – What’s normal? Leading through crisis and change” with Dr. Jackie Kinley and Tony Case. Presented by Physician Leadership Development for formal physician leaders. For more information, contact
shawn.jolemore@nshealth.ca.
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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
New Local Website offering Support and Resources for NS Physicians
Please visit a new
website full of helpful resources and important contact information for NS physicians and their families, brought to you by volunteer members of the Dalhousie University Department of Psychiatry and Doctors Nova Scotia’s Professional Support Program.
Communication about Substance Use
With Dr. David Saunders, Wednesday, May 6, 4-5 p.m.
Mindfulness for Physicians: Incorporating Self-Compassion
With Dr. Nicole Herschenhous, Friday, May 8, 4-5 p.m.
Addressing Grief within our Healthcare Community: Mine, Yours & Ours
Weekly on Thursdays from 9:30 a.m. to 10:30 a.m.
Join Serena Lewis and Roy Ellis (NSHA Bereavement & Grief Coordinators) as we begin the conversation of grief in our current and future workplace. This discussion will provide information on recognizing and understanding how loss is intertwined in our lives, as well as the current landscape of our community of care providing. Roy and Serena want to hear what topics will benefit you in the upcoming weeks that will support you - as you care for yourselves, your own families and within patient care.
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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