COVID-19 INFORMATION

West Coast Family Medical Clinic COVID-19 Safety Plan

June 3, 2020

This document is for the purposes of communicating with our patients and staff the policies and procedures that West Coast Family Medical Clinic (WCFMC) has in place to minimize risk of transmission of COVID-19 while continuing to provide care in a manner that will not reasonably compromise patient health outcomes.

This document and our procedures will be updated as guidelines change.

All staff members, associated health professionals, and physicians working at WCFMC will read this document and indicate in writing that they have read and understand the safety plan.

FIRST LEVEL PROTECTION – ELIMINATION
Limit the number of people in the workplace at any one time.

  • We have established and posted an occupancy limit for our premises, which is 37, with a maximum of four persons in the staff room at any one time.
  • In order to reduce the number of people at the office, we have considered work-from-home arrangements, virtual care, rescheduling work tasks, and limiting the number of staff and patients in the workplace.
  • We have established and posted occupancy limits for common areas such as lunch rooms, examination rooms, waiting rooms, washrooms, and elevators.
  • We have implemented measures to keep staff and others at least 2 metres apart, wherever possible
  • Where possible, staff will maintain physical distancing (e.g. avoid eating meals together, will increase the space between desks/workstations or alternate which desks/workstations are used).
  • We have a sign on the door indicating that patient are required to wear a mask while in the office. This is reinforced by a message on our website and telephone system and at the time of booking. There will always be someone present at the reception desk to receive patients from a distance and ensure that they have an appointment and that they are wearing a mask.
  • We have allocated a limited number of appointments per day, and we have staggered appointments to allow for physical distancing in common areas.
  • We have Eliminated patients waiting in our waiting room entirely—they will immediately be taken back to an examination room or be asked to wait in their car for a phone call to return to the office.
  • We no-longer accept “walk-in” appointments. There is a sign on the door informing patients that no walk-ins are being accepted and redirecting them to our website or to a phone number. This message is also on our website and phone system. Patients can book a same day virtual appointment.
  • All initial patient appointments will take place via phone or video. If required and appropriate, a scheduled in-person appointment will be offered. If an in-person exam is required, patients will be screened by the physician for COVID-19 symptoms. If the patient has symptoms, they will be deemed “high risk” and will be seen via a separate entrance, in our “high risk exam room”.
  • We will only allow patients with scheduled appointments themselves to enter the office. We will make exceptions for pediatric patients or caregivers/interpreters or emergencies if necessary.
  • In case of emergency (chest pain, shortness of breath, major injury), patients will be quickly be given a mask, ushered to a treatment room and a physician will be located who can see the patient urgently – this would be a physician already in PPE seeing patients, or any other physician present who will quickly don PPE and attend to the patient.
  • Scheduled appointments for prenatal patients and babies occur during a specific time frame, during which time, no other patients will be in the office. Normal risk patients are seen throughout the day, depending on their physician’s allocated time slot for in-person visits. Any higher risk patients (if those are seen in the clinic) will be seen at the end of the day. All in person visits are booked directly by the physician or by staff with explicit instruction by the physician as to when the patient is to be booked. This has been communicated to all staff.
  • We have limited surfaces that allow for physical contact:
    • Removed magazines, toys and clipboards from waiting rooms and exam rooms;
    • Foot-operated garbage bins or removed lids;
    • Removed extra chairs from examination rooms.
    • We have developed pick-up and drop-off protocols that eliminate people coming into the office:
    • We have reduced the materials available for pick-up and drop-off to minimize non-vital in-person contacts.  If at all possible, papers, forms, requisitions and prescriptions are faxed or emailed to the appropriate party, with very few exceptions
    • Payment for private services (insurance forms, non-MSP patient visits) can be done by phone prior to the forms being emailed/faxed, or prior to the appointment. All such services are to be pre-paid.

SECOND LEVEL PROTECTION – ENGINEERING
If we can’t maintain distance, find ways to be physically separate

  • We have installed barriers where workers can’t keep physically distant from co-workers, customers, or others.
  • We have included barrier cleaning in our cleaning protocols.
  • We have indicated increments of 2 meters in front of the front desk.
  • We have set up a single dedicated “high risk” examination room with nearby PPE for patients with respiratory symptoms.
  • We have set up a second entrance immediately adjacent to the “high risk” examination room for patients with respiratory symptoms. This entrance is only used by the patient and the physician and is not used as a general entrance for staff/other workers.
  • We have prohibited our staff from direct patient contact such as doing BP readings, Holter monitor application, measuring height, weight, etc. They will continue to process urine samples with appropriate protection and hand hygiene.

THIRD LEVEL PROTECTION – ADMINISTRATIVE
Establish rules and guidelines to keep people physically separated

  •  We have identified rules and guidelines for how staff and team members should conduct themselves.
  • We have clearly communicated these rules and guidelines to staff and team members through a combination of training and signage.
  • If sick, physicians and team members must remain at home. They may continue to provide patient care via telephone or video. They will be tested for COVID-19.
  • All staff will perform hand hygiene and don appropriate PPE (i.e. a surgical mask) immediately upon entering the office if physical distancing measures are not possible (working near another worker without a barrier, or moving through the office frequently). We encourage our staff to wear masks while at work. The BCCDC Hand Hygiene poster is being used to educate staff and team members.
  • All staff will clean their hands frequently—as this is the best thing anyone can do to decrease the transmission of COVID.
  • We will use the Alberta Health Services Daily Fit for Work Screening tool and accompanying instructions. https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-daily-fitness-for-work-screening-questionnaire.pdf
  • We have prepared to cross-cover staff or team members who are ill or quarantined
  • We have put up laminated signage in the areas frequented by patients (e.g. washrooms and above examination room sinks) outlining the appropriate hand washing protocols.
  • If paper signage is used, we will date when it should be discarded (monthly).
  • If laminated signage is used we will wipe it down regularly.

FOURTH LEVEL PROTECTION – PERSONAL PROTECTIVE EQUIPMENT (PPE)

  • We have reviewed the information on selecting and using PPE and instructions on how to use appropriate PPE.
  • We understand the limitations of masks and other PPE. We understand that PPE should only be used in combination with other control measures.
  • We understand that if PPE is not available, staff and physicians are not expected to risk their own health by providing in-person care.
  • We have trained staff and team members to use PPE properly, following manufacturers’ instructions for use and disposal.
  • We are following the PPE guidelines for (asymptomatic OR both asymptomatic and symptomatic) patients in community, as recommended by the BCCDC and/or our Regional Health Authority (e.g. Island Health Community PPE Guidelines).
  • We will NOT be performing any aerosol generating medical procedures in our office.
  • We will provide masks for all patients (if seen in-office) and instructions on how to wear them, given upon arrival. Low risk patients may wear cloth masks with nose and mouth coverage, provided they are not soiled or wet.
  • Physicians seeing patients in person will keep our mask on at all times, and keep our hands away from our face. If we touch it or remove it, or it becomes soiled or wet, we will change it.
  • We have reviewed the information on cleaning and disinfecting surfaces and will post this information in all exam rooms. http://www.bccdc.ca/Health-Professionals-Site/Documents/COVID-19_MOH_BCCDC_EnvironmentalCleaning.pdf
  • Our office has enough handwashing facilities on site for all our staff and patients.
  • Handwashing locations are visible and easily accessed.
  • We have policies that specify when staff and team members must wash their hands and we have communicated good hygiene practices to staff and team members. Frequent handwashing and good hygiene practices are essential to reduce the spread of the virus.
  • We have implemented cleaning protocols for all common areas and surfaces — e.g., washrooms, tools, equipment, vehicle interiors, shared tables, desks, light switches, and door handles. Shared equipment such as headsets, keyboards, workspaces are to be sanitized prior to and at the end of the staff person’s use of that station for their shift. Common areas such as lunch room tables are to be sanitized after each use, by the individual who used them. Light switches and door handles are to be sanitized upon arrival in the morning, and after lunch, by a staff member assigned to answering phones for that portion of their shift.
  • Staff and team members who are cleaning have adequate training and materials.
  • The following shall apply to our shared staff room:
    • All dishes must go directly into the dishwasher, or be immediately washed, dried, AND put away (ie not sitting in drying rack)
    • The first MOA of day shall empty/put away clean dishes from dishwasher.
    • No food items or food storage items shall be kept on the shared table in the staff room.
    • We have a disinfectant spray bottle in the staff room to clean/wipe surfaces after each use (kettle, espresso machine).
    • We will wipe coffee pot handle each time it is used, and will wipe machine down at start and end of each day as  well as after lunch.
    • External fridge door, microwave door/buttons, handles for all drawers and cupboards in lunch room will be sanitzed twice daily (start of day, after lunch
    • There will be no shared food set out.
  • We have removed unnecessary items or items that are hard to disinfect from exam rooms and will only bring them into the room as necessary (e.g. tissue boxes, soft office furniture, any equipment not regularly used).
  • We have placed the patient chair as far away as possible from the physician chair/stool in the exam room.
  • In order to minimize exposure to patients, staff will provide verbal instructions—such as instructing patients in how to use a scale, baby weigh-station or wall-mounted measuring tape—instead of doing it for them.
  • We have established a cleaning and disinfection schedule and clean all exam rooms after each use.
  • We have assigned each staff member to a dedicated work area as much as possible and discouraged the sharing of phones, desks, offices, exam rooms and other medical and writing equipment.
  • We have made hand hygiene supplies readily available for both patients, staff and team members. Our hand sanitizers are approved by Health Canada.
  • We have increased disinfection of frequently touched surfaces in common areas (i.e. computer keyboards, door handles, phones, armrests, elevator buttons, banisters, washrooms, etc.), even if not visibly soiled.
  • Between patients, we will disinfect everything that comes into contact with the patient (i.e. pens, clipboards, medical instruments, stethoscopes).
  • Team members will use the same stethoscope provided it is wiped with alcohol pads or a disinfectant wipe between patients.
  • We have put up signage encouraging patients to only use the office washroom if there is an urgent need.
  • We have set up a sanitizing station near the entrance for all patients entering the office.
  • We have adequate, easily accessible garbage bins throughout the premises.
  • As we are seeing symptomatic patients, we have dedicated a room(s) for symptomatic patients with nearby PPE and minimal surfaces and we are seeing them at the end of the day.

CLINIC POLICIES TO REDUCE THE RISK OF COVID-19 SPREAD

  • Staff, team members, and others showing symptoms of COVID-19 are prohibited from the office:
    • Anyone who has had symptoms of COVID-19 in the last 10 days. Symptoms include fever, chills, new or worsening cough, shortness of breath, sore throat, and new muscle aches or headache.
    • Anyone directed by Public Health to self-isolate.Anyone who has arrived from outside of Canada or who has had contact with a confirmed COVID-19 case must self-isolate for 14 days and monitor for symptoms.
  • Visitors are prohibited or limited in the office.
  • Staff or physicians with COVID-19 or symptoms of COVID-19, will work from home in a way that ensures that we do not compromise patient care or confidentiality in any way, and is accordance with Worksafe BC guidelines, found at https://www.worksafebc.com/en/resources/health-safety/information-sheets/working-from-home-guide-keeping-workers-healthy-safe?lang=en. If working from home is not possible, we will work with staff to ensure they access their sick leave pay, or medical EI, as appropriate.
  • We will ensure that our staff and team members have the training and strategies required to address the risk of violence that may arise as patients and members of the public adapt to restrictions or modifications to the office.
  • Staff or team members who start to feel ill at work. Must  report to a WCFMC physician, even with mild symptoms. Sick staff or team members will be asked to wash or sanitize their hands, provided with a mask, isolated, and sent straight home. They will be offered COVID-19 swab on-site.
  • Severely ill (e.g., difficulty breathing, chest pain) staff or team members will be transferred to hospital by ambulance.  Any surfaces that the ill staff or team member has come into contact with will be cleaned and sterilized.
  • Daily precautions taken by all staff:
  • Staff tasks prior to opening of the office
    • All staff use hand hygiene and don a mask immediately upon entering the clinic, if distancing measures are not possible. This mask stays on until lunchtime, after which a new mark is donned, again, if distancing measures are not possible.
    • Open disinfected rooms and:
    • Make sure exam room is set up properly
    • Place a sign on the front door and barrier in the waiting room to ensure only scheduled patients are entering the clinic and patients remain the required physical distance to personnel at all times.
    • Ask patients to arrive no more than 5 minutes before their appointment. If patients arrive earlier than 5 mins, they need to wait elsewhere (e.g. in their vehicle) until appointment time.
    • Limit the number of exam rooms used as much as possible.
    • Ensure that all necessary PPE is easily accessible.
    • Staff should work where they are able to see patients enter the clinic.
    • Glass shielding has been added at our front desk for staff and we have markings on the floor to ensure the required minimum 2 m distance between patients and staff.
    • Review daily in-person appointments and put in “prep” notes so that onsite staff can prepare the necessary equipment for the physician when they prep the patient.
  • Safety measures to take prior to all appointments
    • Call patients before their appointment to:
      • screen them for risks—rescheduling if they become sick, are placed on self-isolation or have travelled out of the country within the last 14 days,
      • educate them of changes to office protocols, and
      • inform them that they should attend appointments alone when possible and not bring friends or children.
    • Email patients any forms that need to be filled out so clients can complete them before arriving at the clinic. This cuts down on needing pens, etc.
  • Office Preparation
    • Post signage at the clinic entrance to assist with communicating expectations (i.e. hand hygiene, physical distancing, respiratory etiquette, reporting illness or travel history, occupancy limits and no entry if unwell or in self isolation)
    • Limit exchange of papers during transactions (i.e. receipts), we have moved to contactless payments
    • Use single use items where necessary (i.e. disposable cups)
    • Keep records of all staff training (i.e. training for donning/doffing/use of PPE, training on work safe procedures)
    • All patients should be screened for COVID symptoms prior to and upon arrival (patients should be notified of this upon booking their appointment)
    • Patients screening positive should be redirected home for a virtual appointment in order to be assessed again and to book an in-person high-risk visit or COVID-19 swab
  • Clinic workflows for Physicians
    • All individuals seeing patients are to perform hand hygiene and put on a mask directly prior to any in-person visits. This mask stays on until it is removed after patient visits are complete, or if it becomes soiled or wet.
    • Prior to opening of the clinic, physicians will review booked patients to see if they need any equipment for prep (baby scale, Chemstrip urine dipstick, etc.) and ask staff to have these items either in the room before the patient arrives or close to the room.
    • When we are ready to see our first patient:
      • Don PPE (mask should already be on)—gloves and eye protection +/- gown.
      • Assess our patient: take history from as far away as possible and then move to examination (try to spend as little time as possible in close contact).
      • When assessment completed, the patient will leave right away, and be instructed to use hand sanitizer as they leave. Physicians will remain in the exam room with gloves on to complete charting in the room. Physician will remove exam table paper and leave table exposed and indicated that the table is “dirty” by flipping the “clean/dirty” placard over. Still in the room: discard gloves, leave stethoscope and other equipment used OR take to wipe down. Keep eye protection and mask on unless soiled .Perform Hand Hygiene
        If patient must remain in room, leave stethoscope and other equipment used in room OR take to wipe down, clear exam table paper . Physician will open door for themselves and before leaving room, discard gloves then perform hand hygiene. Then either chart at a dedicated workstation (if available) or leave charting until the end of day.
      • Between patients, physician will wipe down stethoscope and other equipment that touched patient, then perform hand hygiene, and put on gloves before next patient and repeat process above until all patients seen.
      • Once last patient seen (at end of day or at lunch), physician will complete all steps: clear exam table paper leaving table exposed. Discard gloves in room. Remove stethoscope and eye protection and leave in room. Perform hand hygiene. Leave exam room. Perform hand hygiene. Remove mask and discard. Perform hand hygiene. Let staff know the last patient has left.
  • Staff tasks upon closing
    • Discard exam table paper, wipe exam table with a disinfectant wipe, Hydrogen peroxide or bleach solution, remove gloves and discard in room
    • Leave room
    • Perform hand hygiene
    • Remove goggles and stethoscope and bring to Utility room (‘dirty side’) for sanitization. Perform Hand hygiene
    • Remove mask and discard, place in plastic bag to take home (if cloth), or in washing machine (if cloth)
    • Perform Hand hygiene
    • Let staff know last patient has left, so that:
    • Staff can lock doors and put up signage notifying of next opening time
    • Staff perform hand hygiene after locking door and placing sign

Human coronaviruses are common and are typically associated with mild illnesses, similar to the common cold. The new coronavirus disease (COVID-19) is caused by the SARS-CoV-2 virus. It has the possibility to cause severe respiratory infections in some people.

Most people with COVID-19 have mild symptoms. Symptoms may take up to 14 days to appear after exposure. Many people are presenting with cold or flu-like symptoms such as fever or cough. Severe cases may have difficulty breathing. Risk of severe disease may be higher for older adults, people with chronic disease (for example: diabetes, cancer, heart, renal, or chronic lung disease), and those with weakened immune systems.

If you are experiencing symptoms such as fever, cough, or shortness of breath, isolate yourself from others and book a virtual appointment or phone appointment with your health care provider. Let them know if you have travelled in the last 14 days or been exposed to someone that has travelled during that time. If your symptoms become severe, call 9-1-1.

Please visit https://covid19.thrive.health/ for up-to-date recommendations for who should be tested and how to arrange for testing if needed.

Right now, there is no specific treatment for most people with COVID-19. Your health care provider may recommend steps you can take to relieve symptoms and prevent the spread to others.

In response to the COVID-19 outbreak , all physicians at WCFMC are now offering virtual appointments. You can book either a virtual (video) appointment or a phone appointment with your regular physician. If your doctor feels that you need to be assessed in person, an in-person follow-up appointment will be arranged. Prescriptions, lab work, and other investigations will be arranged as appropriate.

Yes. In response to the COVID-19 outbreak, we are temporarily offering virtual appointments in our Urgent Care Clinic. You will need Internet access and a device with a camera and microphone (smartphone/tablet/ computer) to participate.

If you feel that you need to be seen in-person (for example: acute injury requiring treatment), please CALL our office to book. 250-642-4233.
DO NO SHOW UP UNANNOUNCED.