North Coast Area Health Service Facility Pandemic …...2020/03/17 · Hastings Macleay Network...
Transcript of North Coast Area Health Service Facility Pandemic …...2020/03/17 · Hastings Macleay Network...
Hastings Macleay Network COVID-19 Pandemic Plan
Created March 17 2020 Page 1 of 16
Mid North Coast Local Health District Hastings Macleay Network COVID-19 Pandemic Plan
2020
Kempsey District Hospital
Purpose To provide a process to contain the disease by decreasing the rate of transmission though;
Rapid identification and isolation
Testing
Diagnosis
Contact tracing
Data collection and analysis
Core Actions
Patient screening
PPE
Isolation
Assessment of patient
Specimen collection and rapid transport to reference laboratory
Notification to Public Health Unit
Treatment
Education
Hospital Response Level 1
Establishment of screening station at the entrance to the ED to identify patients and accompanying persons that meet the case definition
Identification of a specific ward/s for suspected COVID-19
Education and training of staff regarding PPE
Level 2
Establishment of a COVID-19 screening clinic
Level 3
Quarantining and staffing escalation beds in identified ward
Level 4
Mass Admission of Pandemic Patients
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LEVEL 1 UNIT ITEM DETAILS RESPONSIBILITY
Hospital wide Education of Staff regarding Personal Protective Equipment (PPE)
All front line staff are to attend training on the correct use of (PPE) and undertake a competency assessment
A register of staff who have attended the training is to be recorded in HETI
Aim of at least 90% of front line staff trained and deemed competent in the correct use of PPE
Identification of train the trainers to roll out PPE education
Clinical Nurse Educators main focus be on training staff correct competency of PPE
ED NUM, CNUM Ward NUMs, ED Director ED CNE Ward CNE’s Nurse Educators CNC Infection Control
Hospital wide Routine Staff Flu immunization clinics
Staff immunization clinics will commence in mid-April 2020
Staff Health
Hospital wide Non-essential Meetings
Every attempt should be made to conduct all meeting by skype/teleconference only in order to contain the spread of COVID-19
Hospital wide Communications All communication regarding COVID-19 must be sent to the General Managers office prior to being used within the network.
Signage must be approved by the District Media Unit
General Manager, District Media Unit
Hospital wide PPE All staff conducting regular care for a patient must wear contact and droplet precaution PPE
This PPE consists of; Gloves Protective eye wear Surgical mask Gowns Alcohol hand rub
PPE is to be worn during assessing or providing direct clinical care patient when within one (1) metre of patient
All staff conducting aerosol generating procedures are to use airborne PPE
This PPE consists of; Gloves Protective eye wear P2 mask Gowns Alcohol hand rub
Aerosol generating procedures include, NIV/CPAP, HFNP, Nebulizers, Swabbing, Intubation, air bag mouth ventilation, bronchoscopy
All staff
ED PPE A PPE kit lives at Triage ED NUM
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UNIT ITEM DETAILS RESPONSIBILITY
The Kit at Triage contains;
Surgical masks x 25
P2/N95 (duck bill) x 25
20 x gowns impervious
1 container of cleaning wipes (alcohol based);
Gloves 1x box large/ medium/small
1 x pkt of daily wipes
3 x goggles / face shields and frames
2 x digital thermometer
2 x large plastic bags (rubbish)
2 x hand washing solution (ABHR)
viral swabs;
biohazard specimen bags;
clear plastic bag to place collected & sealed specimens into for transportation to Pathology
Temperature covers
Hospital Wide Stores A centralised ordering process has been implemented by the MoH and HealthShare to ensure continued supply during COVID-19 period.
o surgical masks (level 2, level 3, o faceshield and N95 inclusive
o eye shields
o goggles
Ordering of these items is to be coordinated through Anthony Altea. Identified individuals within your facility/service must forward orders to the Clinical Products Coordinator (CPC) for processing, as described below.
The ordering process is as follows:
1. One order per week will be placed for the entire LHD.
2. Orders will only be accepted on the template (appendix 5).
3. Orders must include the HIMF number, Cost Centre and quantity of item required. Orders will not be processed above your min-max levels.
4. The order template must be returned to the CPC, no later than 14:00hrs (2pm) each MONDAY, so as to ensure delivery to stores each Thursday.
5. Orders will be distributed by stores in the usual manner.
ED Triage Screening Station
A screening station will be established at the front entrance of the Emergency Department,
DON, ED NUM
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UNIT ITEM DETAILS RESPONSIBILITY
All patients presenting to Emergency are to be asked “screening” questions.
All patients who meet case definition will be asked to don a surgical mask and wash hands prior to entry
Staff working at this station are to wear a surgical mask and protective eye wear
Those accompanying patients with a high index of suspicion are to be given a mask e.g. parent accompanying a child
As per Flow Chart 1 o if the patient is identified as being
unwell at the pre-screening station, then they will be escorted by the triage nurse in full PPE to the designated isolation room
o If the patient is deemed to be well, they will be escorted to the safe assessment room/ interview / asked to wait outside
ED Triage As per Flow Chart 1
All patient presenting to triage will be asked COVID-19 Influenza screening questions which have been built into the Triage form
All patients being seen for suspected COVID-19 will need to select COVID-19 as their ‘presenting problem’ in FirstNet
Those patients who meet the current case definition and are assessed by the triage nurse as well, not likely to require an admission will be escorted to the Safe Assessment Room (SAR) for medical assessment
Those patient who are assessed as being unwell and require likely admission will be transferred to the designated Isolation room as per Flow Chart 1
Communication between triage and the TL and Senior Medical officer must occur immediately once a suspected COVID-19 case is identified
ED NUM/ TL/ ED Director
FW COVID19
added to presenting problems list today.msg
ED Clerical All patient details must be updated including;
Demographics o Medicare Card Details o Care Details o Contact 1 & 2
Financial Classification
Clerical /ED NUM
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UNIT ITEM DETAILS RESPONSIBILITY
o Health Fund o General practitioner
Clerical staff to have limited access to patient/s. FIRSTNET entries to be attended
Medical records to be kept outside the patients room until advised otherwise
ED Isolation Patients not to be cohorted until confirmed diagnosis
If the patient presents with a positive COVID-19 diagnosis or meets the case definition for COVID-19 they are to be moved ASAP into a designated isolation room (ED MH ISO/ Paeds area (x4 rooms))
If a child requires isolation, (one) 1 family member may be nominated to stay with the child to minimize the exposure to other family members. The family member should be in droplet level PPE
DON, AHNMs, NUM
ED Diagnostic testing
If a patient meets the current case definition as her the MOH, then a sample must be collected ASAP.
Viral swabs are to be taken from the right and left nostril as well as throat swab
Swabs are to be sent to directly to the hospital pathology department
Swabs are to be undertaken by a person assessed as competent with airborne PPE and perform the swabs
Request forms and swabs are to be labelled prior to sample being taken;
Information on the request form should include;
Test requested – COVID -19
Specimens collected – throat & nose swabs
Clinical history including; clinical signs & symptoms; travel history that meets the current case definition
If a healthcare worker – identify this on form so the tests will be prioritized
Once the sample is collected the swabs are to be placed into a biohazard bag and sealed
The sealed biohazard bag is to be placed into a clear plastic bag for transporting to Pathology
AHNMs to organise both in and after hours
Hospital wide Treatment There is no identified treatment for COVID-19 at present
Supportive measures
Aerosol generating treatment must be avoided to reduce the risk of spreading the disease. These include;
MOH, DMS infection control
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UNIT ITEM DETAILS RESPONSIBILITY
Nebulized medications
NIV/CPAP
HFNP
ED Discharge from the ED
If a patient meets the criteria for COVID-19 testing, however is clinically stable and doesn’t require admission, they may be discharged home to self-isolate once their swabs have been collected
Pathology lab staff keeping spreadsheet of all tests performed
If the diagnostic testing produces a positive result for COVID-19, the patient will receive notification from the Public Health Unit
If the patient is COVID-19 negative, they will receive notification from the ED Medical staff
PHU – postitive ED NUM – negative
ED Admission to Hospital
As per Flow Chart 1
If the patients require admission to hospital as they are unwell and meet the current case definition
The patient is to be admitted under the physician of the day / transferred to PMBH when required
As per the policy the patient does not require a medical register review in the ED, and the ED FACEM is to contact the admitting team to inform them of admission
The ED TL must notify the Nurse Manager immediately and the patient must be prioritized for transfer to the ward
The staff tracking log must follow the patient to the ward
To be developed by MOH and Public Health and distributed to ED via Public Health.
Hospital wide Staff tracking Log The staff tracking log (appendix 5) must include;
Patient identification
All columns completed
Once the patient is discharge from hospital the staff tracking Log must be scanned and emailed to the Infection Control CNC [email protected]
All staff in contact Infection control
Hospital Wide Transfer from ED to ward
When a patient is being transferred to an inpatient ward the HSA’s must DON Droplet and contact precaution PPE
HSA’s
Hospital wide Cleaning of room/cubicle
Cleaning of Room / Bay: In Hours
o Notify Cleaning staff member of suspected and / or COVID-19
o Undertake droplet and airborne precautions
Environmental services
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UNIT ITEM DETAILS RESPONSIBILITY
o Two Step Clean require with Chlor Clean tablets.
o Escalate any cleaning delays to Environmental Cleaning Services Manager on 23699
After Hours o Notify Team Leader of cleaning
required as soon as practical; o Undertake droplet and airborne
precautions o Two Step Clean require with Cholr
Clean tablets.
Hospital wide Linen Treat all linen as per normal
Hospital wide Waste Waste as per normal waste streams
All Sharps Containers removed from rooms and bays transported to disposal room in a sealed and lock state, these receptacles must be wiped down with Clinell Wipes
Hospital Wide Patient Transfer to a higher level facility
Patient transfer to a higher level facility that are COVID-19 positive is to occur only:
If clinical condition deteriorates beyond the level of care offered at KDH
This will usually be PMBH
In the instance were transfer occurs, the PHU is to be advised
Patients are to be prepared as per usual transfer procedure
Staff will follow the current process for transfer/retrieval
Once patient is transferred, the results of Pathology specimens/request, are to be sent to the receiving hospital/GP
-Referring MO -Receiving Hospital -Medical physician in charge of case
Hospital Wide Capturing financial cost
All expenditure will be tracked through the submission of the HMCN COVID -19 expense tracking schedules, project code and facility cost centers. Supporting documentation will need to be supplied.
MOH will only recognise expenditure against this project code: P10246. If you are unclear on how to use this code when raising orders, reach out to your finance lead.
In addition to the project code use the cost centres below to record expenditure where possible:
o Cc 711332 Kempsey Funding recoveries including disasters
o Cc 711342 Wauchope Funding recoveries including disasters
o Cc 711492 Port Macquarie Funding
Managers, Finance, all managers
RE HMCN COVID
19 Expense Tracking.msg
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UNIT ITEM DETAILS RESPONSIBILITY
recoveries including disasters
All expenditure is to be recorded on the “HMCN COVID -19 expense tracking schedules”. This will be used to reconcile expenditure to the cost centre and project codes.
Completed “HMCN COVID -19 expense tracking schedules” are to be emailed to [email protected] at the end of each working week (Sunday). Please note the date period on the document.
MOH require supporting documentation as evidence. This evidence could be made up of quotes, invoices, staffing sign off sheets for training etc. These are to be forwarded to [email protected] in conjunction with the “HMCN COVID -19 expense tracking schedules” at the end of each working week (Sunday).
Hospital wide/ Community & Allied Health/physical resources
Outpatient Clinics All outpatient clinics on site at KDH will commence the COVID-19 screening questions. If the patients answer ‘yes’ to the screening questions and are symptomatic then that patient will be asked to defer their appointment o Ante-natal Clinic o Ante-natal classes o Pre-admission Clinic o Allied Health o Wound Clinic o Paediatric clinics o Out-patient clinics o Any Other clinics
Theatres Pre-admission clinic
All patients must be screened for COVID-19
If the patient answers ‘yes’ to the COVID-19 screening questions a discussion must occur regarding the urgency of the surgery and the possibility for re-scheduling in consultation with bookings and the surgeon
Theatres Theatres Patients are contacted the day prior to surgery
If the patient answers ‘yes’ to the COVID-19 screening questions a discussion must occur regarding the urgency of the surgery and the possibility for re-scheduling in consultation with bookings and the surgeon
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LEVEL 2 UNIT ITEM DETAILS RESPONSIBILITY
ED COVID-19 Screening clinic
A COVID-19 Screening clinic a.k.a. ‘Fever Clinic’ will be set up utilizing the ICCC
Purpose: The purpose of the COVID-19 screening clinic is to redirect patients from the ED and perform the diagnostic testing for COVID-19
Flow is as per Flow Chart 2
The Governance of the Screening clinic will sit with Community Health
Communication to the community will be coordinated through the Media Unit and PHN
Appropriate and approved way finding signage will be put up for patients to ensure clear directions
If patients present to the ED and they answer ‘yes’ to the pre-screening questions, they will be sent immediately to the COVID-19 Screening clinic during opening hours if appearing well
Patients in the COVID-19 Screening clinic must remain within this dedicated space or outside and not be allowed to wander within the hospital
If patients are deemed to be unwell and require admission to hospital, they are to be sent back to the main ED after a phone call liaison with the ED admitting officer or Team Leader
If a patient’s condition deteriorates whist in the COVID-19 Screening clinic and requires immediate medical attention the Registered Nurse must call a MERT as per the CERS policy
Equipment requirements;
o O2 o Suction o Access to a resuscitation Trolley o Phone o Duress buttons o Workstation on Wheels o Desk o Portable vital signs monitor o Temperature monitor
Staffing requirements; o Dedicated Nursing staff (1
Registered Nurse proficient in collecting nasal and throat swabs)
o Dedicated Medical Officer o Dedicated Administration officer
Community Health /DDON
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UNIT ITEM DETAILS RESPONSIBILITY
o Dedicated Cleaning Housekeeping o Shared Security
Environmental requirements o Dedicated handwashing facilities o Dedicated toilet o Dedicated clean utility and
separate doffing space
Consumables o Viral swabs o Droplet, Contact and Airborne PPE o Tissues o Hand gel
Patient discharge pack o Information handout o 1 x surgical mask
Hospital wide Outpatient clinics Consider type of clinic and alternate methods of delivery
Community and Allied Health manager
LEVEL 3 – UNIT ITEM DETAILS RESPONSIBILITY
Operating Theatres
Reduce the number of elective Operative Theatre cases.
Theatre management
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LEVEL 4 - Mass Admission of Pandemic Patients
UNIT ITEM DETAILS RESPONSIBILITY
Hospital wide Disaster Control Centre
KDH activates the disaster control center KDH Disaster Control Team
Hospital wide KDH commences Hospital Lock Down
Police presence established as required
Patients arriving by Ambulance are to be assessed in the Ambulance prior to being offloaded;
Ambulance to advise KDH ED in advance if patient ill to allow set-up to receive patient.
All elective Operating Theatre cases to be cancelled only Emergency cases performed
Close Observation Unit (COU) to be evacuated as demand warrants (patients to be discharged and/or redirected to available other ward beds. Beds not to be filled by noninfectious patients
Consider surge capacity identified onsite as required
Staff providing direct clinical care to infectious patients to have meal breaks in designated meal areas, away from general public
Hospital wide Additional Staff
Mental health to be contacted >18 years of age 0447437073 < 18 years of age 0407261516
Security HSA to be at screening station as required
Need to increase clerical support by 1 staff member 7/7 for night duty
Hospital Wide Consider contacting Public Health Unit / HSFAC PHU 0439 882 752 HSFAC 0467 793 013
Network wide Defer to HMCN Pandemic Plan / PMBH
References
Admission, Consultation and Escalation Process at PMBH Emergency Department HMCN Clinical Emergency Response System (CERS) HMN-GH-CP-028 http://mnclhd/pd/Lists/Clinical Emergency Response System (CERS)
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Appendix 1 - FLOW CHART 1: PMBH COVID-19 PATIENT FLOW PROCESS
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APPENDIX 2 - Flow Chart 2: KDH COVID-19 PATIENT FLOW PROCESS with COVID-19 SCREENING CLINIC
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APPENDIX 3 – Kempsey District Hospital: Single Rooms / Negative Pressure Rooms
Katie to add
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Appendix 4 – Staff tracking log
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Appendix 5- Stock ordering Template