Island Health LTC Physician COVID-19 Outbreak Response | Communication Bulletin

TO:

LTC Physicians and Nurse Practitioners

DATE:

December 19,  2020

FROM:

Dr. Margaret Manville, Medical Director Long-term Care

RE:

Island Health LTC Physician COVID-19 Outbreak Response

Principles and Guidelines

Purpose:

This guideline articulates and promotes physician/NP best practices in LTC during a COVID-19 outbreak at a nursing home in which you have patients.

Principles:

  • Support residents and their families.
  • Ensure continuity of care for residents
  • Ensure resident’s urgent/acute medical needs are met.
  • Reduce potential for physician/NP COVID-19 transmission within the facility.
  • Reduce risk to physician/NP and community of external COVID-19 transmission.
  • Support and share the increased burden of work with our nursing colleagues.

GUIDELINES DURING OUTBREAK:

  1. Site Medical Coordinator to act as primary liaison to physicians/NPs practising at the site and will participate in the outbreak management team. Ensure physicians/NPs kept informed of changes in outbreak activity/response (WhatsApp, group email, etc.)
  1. All non-essential meetings will be suspended for the duration of the outbreak, including resident care conferences and medication reviews.
  1. If a resident is COVID +, ideally the physician/NP should contact families at the time of COVID-19 diagnosis, and at times of significant change in resident status, rather than delegating to colleagues. Review and update your resident’s MOST to reflect their current goals of care. Please refer to COVID-19 specific goals of care conversation guideline: Serious Illness Conversation
  1. Physicians/NPs to provide patient care remotely/virtually as much as possible once there is a declared outbreak.  LTC sites and physician groups could revert back to their initial pandemic physician response in LTC, which may include delegating to an on-site physician of the day/week. Physicians/NPs to contact the delegated provider directly.
  1. The designated on-site physician/NP will coordinate on-site visits with nursing staff to efficiently assess residents. Ensure COVID-19 negative residents seen first, followed by COVID-19 affected residents. Physicians/NPs working in multiple care homes will ideally not visit other homes on the same day as the outbreak site or schedule the outbreak site visit for the last visit of the day.
  1.  Physicians/NPs must be familiar with and meticulously adherent to appropriate use of PPE in outbreak and non-outbreak settings. Having another health-care worker observe the donning and doffing of PPE can guard against errors. Links to COVID-specific resources for LTC and PPE can be found here.
     
  2. Work with nursing colleagues and pharmacists to reduce non-essential resident assessments (routine BP/weights), reduce medications, and limit medication administration times (ie: reduce TID to BID/daily, administer medications at the same time whenever possible).
     
  3. Once an outbreak of COVID-19 is declared at a LTC facility, any AGMP (CPAP, Bipap, nebulizers) should be stopped. Physicians/NPs can consult respirologist/internist if needed to assist with care planning for affected residents.
  1. Document visits/orders remotely when possible to reduce the time spent on-site. If a hospital transfer is necessary, ensure the ED/local COVID Unit is informed and ready to receive the resident from the outbreak facility. The MHO on-call should also be informed and can be contacted through your  local hospital switchboard or the medical staff intranet on-call site
  1. A COVID-19 LTC clinical order set is being developed and will be ready for use shortly based on the most recent BCCDC COVID-19 Therapeutics Committee guidelines.
  1. Re: essential health-care workers in a LTC outbreak setting: essential workers who not have symptoms of COVID-19 are able to return to work in LTC pending their NP swab results. They do not have to be absent from work while waiting for the results of testing.