Cardinal Point Health Plan for Return to Clinical Practice in Respect of Covid-19

Posted by on Monday, May 18th, 2020 in General

 

This plan was developed with guidelines from the Provincial Health Officer. The goal is reducing the risk of exposure to the virus that causes Covid-19 for both patients and the practitioner within our clinical setting.  Here, we identify the actions that each therapist at Cardinal Point Health commits to, and that all visiting patients must commit to, in order to resume paramedical services.

The overall aim of these protocols is to reduce potential coronavirus transmission by:

  • Required ongoing self-assessment for signs of Covid-19 related illness in both the patient and the therapist
  • Reducing all physical, non-treatment related interactions amongst all people within the practice environment
  • Hand hygiene requirements
  • Avoiding face touching
  • Enhanced cleaning protocols
  • Appropriate use of personal protective equipment (PPE)
  • Meeting professional obligations, particularly related to informed consent

Self-Assessment Tool for Symptoms of Covid-19: For Patients & Therapists

Pre-Screening / Prior to Arrival

  • Patients will be informed about their responsibilities at the time of booking. A notice will be placed on the website.
  • Reception will phone the patient one day before their booked appointment to discuss using the online BC COVID-19 Symptom Self-Assessment tool (5 questions takes ~ 1-2 minutes). The patient will be required to complete the assessment and to stay home if they experience any symptoms of Covid-19.
  • Each therapist and staff member will use the BC COVID-19 Self-Assessment tool daily and commits to cancelling all appointments if symptoms appear.
  • Symptoms of Covid-19 are similar to other respiratory illnesses and seasonal allergies. An appointment must be cancelled immediately if either the patient or the therapist presents with even mild symptoms that may be signs of Covid-19 including:
    • Fever
    • Cough
    • Chills
    • Shortness of breath
    • Sore throat or pain with swallowing
    • Stuffy or runny nose
    • Loss of sense of smell
    • Headache
    • Muscle aches
    • Fatigue
    • Loss of appetite
  • As a part of this consent form, patients commit to understanding that while we’ve taken all possible measures to minimize risk of viral transmission, the nature of massage therapy, acupuncture and naturopathic medicine means that physical distancing is not possible in the treatment room.
  • In order for treatment to commence the therapist and patient agree that the therapeutic benefit outweighs any potential consequence of treatment, including the possibility of viral transmission.
  • Patients confirm that they have not been in contact with anyone displaying illness, or signs and symptoms of Covid-19 within 14 days prior to their treatment.
  • Patients with higher risk profiles and/or weakened immune systems should consider alternatives for care and postpone treatment.
    • The patient and the therapist should both agree that the benefits of therapy outweigh the potential risks involved.
  • Patients who develop even mild illness or symptoms should cancel booked appointments, even without notice.
    • They will not be charged a late cancellation fee if they cancel due to illness.

Upon Arrival

  • Patient must confirm that they have not traveled outside British Columbia within 14 days prior to their appointment.
  • The treatment will be cancelled immediately if the patient does not meet the pre-screening criteria upon physical presentation at the clinic.
  • There will be a hand sanitizing station at the entrance to the clinic and all patients are asked to please make use of this.
  • If the patient has a mask, they are asked to bring it with them and wear it when they arrive. If the patient does not have a mask, a single-use mask will be provided upon request.

Physical Distancing

Reception Area / Entry into Clinic Space

  • A self check in may be available when you arrive at the clinic, please check your confirmation email for more detailed instructions.
  • Only 1 patient/person is permitted in the clinic lobby at any given time. Patients will arrive unaccompanied.
    • Unless patient is a minor who requires parent/guardian, or infirm and needs assistance.
  • Coffee, tea, cups have all been removed from the clinic reception area. Water cooler is available but patients will need to use their own bottles.
  • Nothing remains in the clinic space that cannot be disinfected after each touch.
  • Patients are asked to arrive on time and not early or late for appointments.
  • Patients are required to wait in their vehicles or outside the clinic, until the therapists comes to the clinic door to call them in.
  • The clinic door will be locked if reception is not available to prevent anyone else from entering the space during the course of   The clinic door will be re-opened by the therapist at the end of the appointment for the patient to leave.
  • Patients are not permitted to lounge in the clinic reception area before or after the treatment.
  • We are not currently accepting cash payments.

Within the Treatment Room

  • It is not possible to maintain physical distancing while in the treatment room.
  • The fabric chairs have been removed from the therapist rooms, and have been replaced by vinyl-covered chairs.
  • All sheets and blankets are laundered after every patient.

Restroom for Patient Use

  • The restroom has been equipped with paper towels and proper hand washing guidelines.
  • Soap and fresh paper towels for drying will be available at all times.

Hand Hygiene

Reception Area / Entry into Clinic Space

  • If hands are visibly soiled, the patient should opt to wash hands at the bathroom sink.
  • The therapist will wash hands thoroughly for at least 20 seconds between patients, before and after disinfecting spaces, before donning gloves and after taking gloves off, and before donning or doffing other PPE such as facemasks or shields.
  • Payment occurs in the reception area. A Point of Sale system with Tap is available for card use. Receipts will be emailed unless specifically requested otherwise. Invoices may also be emailed to the patient and paid online through Jane app. The POS machine will be sanitized between each patient. Cash is currently not being accepted.

In the Treatment Room

  • The door and doorknobs will be disinfected between each patient.
  • Tissue is available at reception and inside the treatment room that the patient may use as a barrier when opening doors.
  • Hand sanitizer is available within the treatment room; patients will be asked to wash or sanitize their hands after the treatment.
  • Patients are not to leave the clinic on their own. They will be escorted out by their therapist to avoid interactions with other people within the clinic.
  • Clean linen will be stored in a sealed plastic bin that will be cleaned and sanitized at the end of every shift.

Avoid Face Touching

  • Tissue will be available throughout the clinic: in the reception area, treatment room and washroom in order that patients and the therapist may use tissue to address an itch and/or touch the face for any other reason.

Enhanced Cleaning

  • Additional time has been scheduled between patients to allow for thorough cleaning of the treatment room.
  • Visibly soiled surfaces will be cleaned followed and disinfected with a Canada Health Approved for use against Covid-19 disinfectant as listed here: https://www.canada.ca/en/health-canada/services/drugs-health-products/disinfectants/covid-19/list.html
  • Common areas will be cleaned and disinfected at least twice a day, including the restroom.
  • All high touch surfaces will be cleaned and disinfected between patients, regardless of appearances. High touch surfaces include (but are not limited to):
    • Light switches, door knobs, POS machine, electronic devices, table surfaces, chairs, stools, faucets, etc.
    • The treatment table, table levers, face cradle, lotion bottles will be immediately cleaned after each treatment.
    • No hydrotherapy supplies, thermophores, table warmers or covers will be used.
  • All linens, including blankets and pillow cases are single use only and will be laundered using high heat and detergent between each use.

Personal Protective Equipment

  • The therapist will wear non-latex gloves if/when appropriate or if requested by the patient.
    • Gloves may be appropriate when over-use of cleaning and/or chemicals causes skin irritation, or when the therapist’s hands or skin of the hands are otherwise injured.
    • Hands will be washed prior to putting the gloves on and immediately after removing them.
    • Paper or fabric facemasks and/or glasses will be worn by the therapist at the patient’s request.

Professional Obligations

In the Event That a Patient Alleges they Caught COVID-19 from the Therapist

  • The therapist will immediately call public health at 8-1-1 to report the alleged transmission, providing both the name of the therapist and the name and contact details of the patient.
    • The patient must agree to the release of this information.
  • All appointments will be cancelled and the therapist will cease to provide services until Public Health has investigated and provided direction.
  • The therapist will immediately self-isolate until Public Health has investigated and provided direction.

Asymptomatic Spreaders

  • Asymptomatic transmission of the coronavirus is an unavoidable risk of practice until we’ve acquired herd immunity and/or there is an effective treatment or vaccine against Covid-19.
  • We have put into place protocols to help mitigate that risk as outlined in the preceding documentation.

Informed Consent

In the current environment of Covid-19 risk, informed consent requires that the patient be informed and understands that:

  • Any in-person treatment involves some risk of Covid-19 transmission.
  • The therapist is following protocol to help reduce or mitigate risk where possible, but that risk cannot be reduced to zero.
  • The patient consents to the treatment despite some risk.
  • And the practitioner will document the patient’s consent in advance and at every treatment.

2 Responses to “Cardinal Point Health Plan for Return to Clinical Practice in Respect of Covid-19”

  1. Balbir Vaid says:

    I am glad to see the protocols in place and happy to know the clinic will be open soon.

    Will there be any paper towels outside the bathroom door to use to open the door?

    • Dr Kellie Ferguson says:

      Hi Balbir. Thank you! We look forward to seeing everyone soon. And that’s a great suggestion and we are looking into getting a bunch of paper towel dispensers. Meanwhile, our protocol is to sanitize all high touch areas (including the washroom and all door handles) after every client.

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