1. How will physicians/NPs be involved with planning the initial care of their resident who tests positive for COVID-19?
Your physician/NP colleagues have participated in COVID-specific simulation exercises to help fine tune our LTC and Health Authority response to an outbreak on Vancouver Island. As a result of this excellent work, if a resident receives a positive test, NP/physicians (MRPs) will be called directly from the LTC facility during daytime hours (on-call physicians after-hours). Then, MRPs will be given instructions (verbally from the facility RN, and faxed in the nursing SBAR- example below) to join an emergency response teleconference 1-2 hours after notification of the positive test. The teleconference will be between 20-30 minutes in length.
PLEASE CONSIDER PUTTING THIS NUMBER INTO YOUR PHONE FOR EASY ACCESS 250.519.7700 ext. 26834 (COVID LTC EMERGENCY OUTBREAK TELECONFERENCE #). This teleconference number will remain the same during the course of the pandemic.
The local Medical Health Officer and the LTC Director will lead the call. Other participants include the affected LTC home leadership and nursing, LTC operations director, the LTC outbreak response team, communicable diseases reps, acute care reps, licensing reps, logistics, supply and communications leads. The MRPs role will be to provide medical input regarding the patient, discuss appropriate care and/or arrange transfers, and to then communicate with family. If the LTC site has a medical coordinator, they will also be asked to attend and could give medical input if the MRP in unavailable.
We will be working on training all of our LTC sites on this protocol so that it is a smooth process if/when it is needed.
2. How do we safely increase physician/NP presence in nursing homes?
In order to support excellence in medical care for our LTC residents, we would like to provide some guidance on how to safely resume in-person LTC visits from those which are ‘essential’ to those which could be considered proactive or routine.
Our recommendations are as follows:
- All physicians/NPs should wear a mask for any LTC visits.
- Physicians/NPs must practice meticulous hand hygiene.
- Point of care risk assessment should be done by physicians/NPs to determine if additional PPE is required.
- Decontaminate personal instruments (eg. stethoscope) in between residents.
- Practice social distancing with residents and staff as much as is possible during the visit.
- Refrain from LTC visits if you have any symptoms of illness, however mild.
- Regular clothing is adequate for LTC visits. There is no requirement to change clothing in between LTC facilities and other worksites or home. Physicians may choose to do this based on personal comfort. However point of care risk assessment (PCRA) should be performed by physicians for all patient encounters in all care settings throughout the day to determine what specific PPE is needed in each situation. For some encounters, the PCRA may indicate that gowns are required to reduce the likelihood of droplet or blood and body fluid contamination of clothing. This will be important for reducing risk for both the physician, and subsequent patients they my care for.
- If possible, try to limit the number of sites visited per day and prioritize visiting a LTC facility on days when you will not need to be in other clinical settings, such as acute care, prior to the visit. Please let the nursing staff know that you are coming to visit the facility. If sites are unable to provide you with PPE/mask during your visit, please let us know.
- We encourage the continued use of telehealth in lieu of an in-person visit IF a high standard of medical care can be obtained with this method. The LTCI island-wide has been very successful at improving and supporting physician presence in LTC. Our medical input makes a great difference to the care our patients receive. The personal relationships and trust we’ve earned with our nursing home staff is key to how we deliver good care. We don’t want to undo this excellent work. A balance should be sought between virtual and in-person visits to our LTC homes, depending on the situation and risk. Please consider virtual LTC visits as tools to enhance our continuing care, but not replace in-person evaluations as the situation demands.
- Medical residents are required to follow the same guidance that has been outlined for physicians. Medical students should not visit LTC facilities for educational purposes at this time.
As always, this guidance could change depending on how the pandemic evolves over the coming months. Thank you for your continued support of our LTC residents, staff and your colleagues during this challenging time.
Dr. Margaret Manville,
Medical Director Long Term Care
Geography 1: Dr. Kathleen McFadden, Medical Lead, LTC
Geography 2 Dr. Erfan Javaheri, Medical Lead, LTC
Geography 3 Dr. Stacey McDonald, Medical Lead LTC
Geography 3 Dr. Eric George, Medical Lead LTC
Geography 4: Dr. Ian Bekker, Medical Lead LTC