Kimberley Aboriginal Medical Services...

1 COVID-19 Toolkit Version 7 22/5/20

Kimberley Aboriginal Medical Services (KAMS)

Version 7: 22/5/20


COVID-19 Toolkit Revision History

Revision History

Version Date Revised by Changes

7.0 22/5/20 KAMS COVID-19 Clinical

Response Group

NEW:

• COVID-19 Care of COVID-19 Cases & Close Contacts • Appendix E: Mmex Template “COVID-19 POC Testing”

• Appendix F: Kams Prioritisation Criteria for COVID-19 POC Testing

UPDATED:

• Triage matrix for walk in and KRS patients

• Clinic manager checklist and guide

• COVID-19 isolation room procedures

• COVID-19 point of care testing

• COVID-19 testing at sites without POC testing

• COVID-19 Use and provision of transport

• Appendix C: MBS vulnerable patients bulk billing incentive number added

REMOVED:

• Appendix D Procedure for transport and exchange of stores and pathology


Response Group

NEW:

• Enhanced cleaning within the clinic

• COVID-19 Point of Care Testing • Positive COVID-19 Checklist

• COVID-19 Testing for Clinic Locations Without POC Testing

• Appendix E: PSLO position

• Appendix F: Taking a Nasopharyngeal Swab UPDATED:

• DAHS contact details corrected

• Clinic Manager Checklist

• Telehealth consultations


Response Group

NEW:

• Contact details for Broome COVID clinic UPDATED:

• Process for evacuation for patients for testing

• After testing for COVID-19


Response Group

NEW:

• Process for Evacuation of Patients for Testing for COVID 19 – for KAMS remote communities

• After Testing for COVID-19 UPDATED:

• Scheduled driver pick-ups: triage questions and temperature assessment


Response Group

UPDATED:

• Phone triage questions for reception staff

• Nurse/RAN Phone triage matrix

• Walk-in triage matrix updated

• Definition of who needs to be evaluated in the isolation room (expanded)

• WA Health self-isolation definitions (Appendix A) NEW:

• Principles of transport for all patients • Renal contact list added


Response Group

• Updated useful contact details

• Updated COVID-19 triage/workflow general principles & risk assessment

• Updated clinic manager checklist & guide (new items highlighted yellow) • New: COVID-19 Care of Patients with Confirmed/Suspected COVID-19 in an

Emergency Setting

• Updated COVID-19 Use and Provision of Transport

• Updated self-quarantine criteria

• New: Appendix D – procedure for transport and exchange of stores & pathology (Bidyadanga & Beagle Bay)


Table of Contents

COVID-19 Toolkit Executive Summary ........................................................................................................... 4

COVID-19 Toolkit Useful Contact Details ....................................................................................................... 5

COVID-19 Triage Guidelines and Clinical Workflow for Remote Clinics ........................................................ 7

A. General Principles............................................................................................................ 7

B. COVID-19 Risk Assessment .............................................................................................. 7

C. Phone triage for Reception Staff ..................................................................................... 8

D. Phone Triage for Clinic Nurse/RAN ................................................................................. 9

E. Walk in Triage ................................................................................................................ 10

F. COVID-19 Triage Guidelines for Kimberley Renal Service (KRS) ................................... 12

COVID-19 Clinic Manager Checklist & Guide ............................................................................................... 13

COVID-19 Isolation Room Procedures ......................................................................................................... 16

COVID-19 Emergency Care of Patients with Confirmed/Suspected COVID-19 ........................................... 18

COVID-19 Point of Care Testing ................................................................................................................... 19

COVID-19 Positive Result Checklist .............................................................................................................. 22

COVID-19 Testing for Clinic Locations Without Point of Care Testing ......................................................... 26

COVID-19 Care of COVID-19 Cases & Close Contacts .................................................................................. 28

COVID-19 Clinical Coding.............................................................................................................................. 32

COVID-19 Home Visits .................................................................................................................................. 33

COVID-19 Use and Provision of Transport ................................................................................................... 34

COVID-19 Telehealth Consultations ............................................................................................................. 36

Appendix A – Self-isolation definitions relating to COVID-19 ...................................................................... 37

Appendix B – Personal Protective Equipment (PPE) .................................................................................... 38

Appendix C – Telehealth MBS Item Numbers .............................................................................................. 42

Appendix D – Patient Liaison Support Officer (PSLO) Role .......................................................................... 43

Appendix E– Taking a Nasopharyngeal Swab............................................................................................... 44

Appendix F KAMS Priotitisation Criteria for POC Testing in KAMS Remote Clinics…………………………………..46

Appendix G – Mmex Template “COVID-19 POC Testing” ............................................................................ 45


COVID-19 Toolkit Executive Summary

The Kimberley Aboriginal Medical Services (KAMS) COVID-19 Toolkit has been developed to assist KAMS

remote clinics, Kimberley Renal Services and Headspace Broome in planning and responding to the current

Coronavirus (COVID-19) outbreak. It will also be available for use by KAMS member services.

The toolkit should be used in conjunction with:

• Advice from the WA Health Department

• Public Health Emergency Operations Centre (PHEOC)

• Commonwealth Communicable Disease Network Australia guidelines

• Kimberley Population Health Unit

• KAMS IP&C Guidelines

This toolkit will be updated as the COVID-19 pandemic continues to evolve.

Please check the KAMS website for the latest version.

For definitions relating to COVID- 19 self-isolation, consistent with the WA Health Department, please refer

to Appendix A.

https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm


COVID-19 Toolkit Useful Contact Details

• Kimberley Population Health Unit (KPHU)(office hours): (08) 9194 1630

• Metropolitan Communicable Disease Control (after hours public health enquiries): (08) 9328 0553

• Disaster Hotline (isolation/quarantine via The Department of Communities): 1800 032 965

• National Coronavirus Hotline: 1800 020 080

• WA Coronavirus Hotline: 13 COVID (13 26843)

• Broome Hospital COVID Clinic (8.30-4pm 7 days) o Clinical nurse: 9195 2568/0477 333 040 o Reception: 9195 2561 o Fax: 9194 2240 o Liaison DMO: 0474474074 o Email (COVID nurses and DMO): [email protected]

• KAMS Patient Support Liaison Officer (PLSO) 9194 0334 (see Appendix E)

• WACHS Outpatient Co-ordination/PATS 0427 796 388 (7 days/week)

KAMS Phone Fax Mobile/Satellite Email Address

Reception 9194 3200 [email protected]

MMEx Help Desk 9194 3296 [email protected]

IT Support 9194 3224 [email protected]

Deputy Medical Director (Casey Barnes)

9194 3212 0431 917 577

Medical Director (Lorraine Anderson)

9194 3284 9194 0349 0407 974 951

Beagle Bay Health Centre Phone Fax Mobile/Satellite Email Address

Clinic 9192 4914 9192 4440 0147 156 197 [email protected]

Clinic Manager 9192 4914 9192 4440 [email protected]

On-Call Phone 9192 4914 (divert)

Driver on-call Phone 0488 012 478

Doctors On-Call Phone 9194 0388

Bidyadanga Health Centre Phone Fax Mobile/Satellite Email Address

Clinic 9192 4952 9192 4827 [email protected]


1st On-Call Phone 9192 4952 (Divert)

9192 4827

Driver On-Call Phone 0448 843 771

Doctors On-Call Phone 9194 0388

Balgo Health Centre Phone Fax Mobile/Satellite Email Address



KAMS Doctor On-Call Phone 9194 0382 0429 677 323

Billiluna Health Centre Phone Fax Mobile/Satellite Email Address

Clinic 9168 8144 9168 8936 0147 180 894

BRAMS Phone Fax Mobile/Satellite Email Address

Reception 9192 1338 9192 1606 [email protected]

BRAMS Doctor On-Call Phone 0407 029 602

Derby Aboriginal Health Service Phone Fax Mobile/Satellite Email Address

Clinic 9158 4200 9158 4227 [email protected]

DAHS Doctor On-Call Phone 0428 911 884

Mulan Health Centre Phone Fax Mobile/Satellite Email Address



Ord Valley Aboriginal Health Service

Phone Fax Mobile/Satellite Email Address

Clinic 9166 2200 [email protected]

Yura Yungi Medical Sevices Phone Fax Mobile/Satellite Email Address

Clinic 9168 6266 [email protected]

Other Clinic’s Phone Fax Mobile/Satellite Email Address

Danila Dilba (NT) 8942 5444 8941 3542

mailto:[email protected]
















Lajamanu (NT) 8975 0870 8975 0903

Lombadina Clinic 9192 4935 9192 4979

Looma Clinic 9194 4767 9191 7074

One Arm Point 9192 4929 9192 4819

Wankatjunka 9191 4755

Wirrika Maya (Port Hedland) 9172 0400

Wurli-Wurlingjang (NT) 8972 9100 8971 0962

Kimberley Renal Service Phone Mobile/Satellite

Broome Renal Health Centre 9191 8600

Kununurra Renal Health Centre 9166 4400

Fitzroy Crossing Renal Health Centre 9166 1400 0447 278 414

Derby Renal Health Centre 9193 3500

On- Call Renal GP (available 7 DAYS) 0427 808 873

KRS Executive Manager (Jenny Cutter) 0411 759 921

Hospitals Phone Fax Emergency Services Phone Fax

BROOME HOSPITAL 9194 2222 9192 2322 Emergency Telehealth Service |Bidyadanga Only|

1800 422 190 1300 711 506

Allied Health 9194 2258 9194 2257 Royal Flying Doctors Services (RFDS) 1800 625 800

Day Surgery 9194 2291 9194 2292 St John Ambulance Call Centre Bookings 08 9334 1234

Theatre Co-ord 9194 2371 9194 2637 St John Ambulance Broome Office Hours ONLY

9192 0710

Emergency Dept 9194 2625 9194 2608

Medical Records 9194 2211 9194 2208 Miscellaneous Phone Fax

PATS 9194 2207 9194 2234 Aviair 9194 4300

Pathwest 9194 2286 9192 1048 ACIR 1800 653 809

Radiology 9194 2274 9194 2267 Broome Aviation 9192 1369

Specialist Centre 9194 2223 9194 2205 Central Referral Service 1300 551 142 1300 365 056

DERBY HOSPITAL 9193 3333 9193 3398 Global Direct Radiology Report Line 1300 668 957

Allied Health 9193 3217 9193 3376 PBS Authority 1800 888 333

FIONA STANLEY HOSPITAL 6152 2222 Poison Info 13 11 36

HALLS CREEK HOSPITAL 9168 9222 9168 9200 SARC 6458 1828

KUNUNURRA HOSPITAL 9166 4222 9166 4250 Pharmacies Phone Fax

Allied Health 9166 4330 9166 4383 Kimberley Pharmacy Services 9192 3611 9192 3699

Dentist (public) 9168 2055 Chinatown Pharmacy 9192 1399

PATS 9166 4237 9166 4260 Boulevard Pharmacy 9192 1866 9193 5132

Specialist Clerk 9166 4231 9166 4249 Broome Contact number

Fax

ROYAL DARWIN HOSPITAL (NT) 8922 8888 Department of Child Protection (Dept.CPFS)

9193 8400

ROYAL PERTH HOSPITAL 9224 2244 Dentist (Hospital/Public) 9192 1300

PERTH CHILDREN'S HOSPITAL 6456 2222 Headspace Broome (KAMS) 9194 4500 9193 6122

KING EDWARD MEMORIAL HOSPITAL 6458 2222 Kimberley Aged Care 9192 0333

SIR CHARLES GARDINER HOSPITAL 6457 3333 Kimberley Interpreting 9192 3981 9192 3982

Child Protection Unit 6456 4300 KRS (Dialysis reception) 9191 8600

Renal GP On-Call 0427 808 873

Perth Phone Fax Kimberley Eye Care 9192 7877 9193 7077

Pathwest Perth 13 72 84 9381 7594 Kimberley Population Health Unit (KPHU) Reception

9194 1630 9194 1633

Perth Cardiovascular Institute (PCI) 6314 6833 6314 6888 Kimberley Mental Health & Drug Service (KMHDS)

9194 2640 9192 3489

Lion's Outback Vision 0409 691 457

Milliya Rumarra 9192 1699

Sexual Assault Resource Centre (SARC) 6458 1828 Cyrenian House 9192 6400

WA Police Services Phone Fax Midwifery Group Practice 9194 4127 9194 2205 (Specialist centre)

Bidyadanga Multi-Function Police Facility

9192 4091 9192 4779

Broome Police Station (24 hours) 9194 0200 9194 0280

Dampier Peninsula Multi-Function Police Facility

9192 4590 9192 4568


COVID-19 Triage Guidelines and Clinical Workflow for Remote Clinics

A. General Principles

To reduce the risk of transmission of COVID-19 for patients and staff it is imperative that there is a

reduction in patient traffic throughout the clinic, facilitating social distancing. This is all while continuing to

provide good primary care for our patients.

It is also very important that our clinics provide triage at the first point of contact for patients who call and

attend the clinic so that their risk of COVID-19 can be assessed. This is to ensure that PPE is used

appropriately so our staff and patients are kept safe.

The general principles include:

• Triage of patients immediately when they call and attend the clinic/service

• Providing telephone support to patients to prevent them from needing to attend the clinic

• Providing home visits where possible

• Using a “fast track” for patients where contact is necessary with patients eg dressings, injections,

procedures

• Providing remote GP Videoconference support for nursing staff and patients

• Continuing to provide face to face care in emergency situations

• No visitors being permitted to the clinic (with the exception of children having one caregiver

attending with them)

B. COVID-19 Risk Assessment

• The risk assessment for when to suspect COVID-19 will depend on your location, the symptoms the

patient is presenting with, and will change over time as the situation evolves

• Refer to WA Health COVID-19 Clinical Alerts for the most up-to-date testing criteria, and advice

from Public Health (KPHU) specific to your area.

• If you have a patient who you feel may be at risk of COVID-19 but doesn’t fit testing criteria – use

appropriate PPE for your assessment and call Public Health to discuss whether this person should

be tested (KPHU 9194 1630, or MCDC if after hours 9328 0553)


C. Phone triage for Reception Staff

Is this an Emergency?

NO

Confirm registered phone Number - update on Mmex

Yes

Direct the call to the first on call staff member

immediately

NO: Ask COVID 19 Triage questions:

• have you had contact with a confirmed or suspected case

of COVID-19?

• do you have cough/ cold/ runny nose/ fevers/ sore throat

or coldsick symptoms?

• would anyone who may be attending with you answer YES

to these questions?

YES

Transfer call to nominated

staff member

NO

Transfer call to

nominated staff

member

YES

BOOK TELEHEALTH apt - mmex calendar

Confirm registered phone number

Ask patient whether they have data on their phone and would like a video call?

NO

“To make things safer for you and the community,

we are offering appointments over the phone or

internet. Would you like to book an appointment

this way?”


D. Phone Triage for Clinic Nurse/RAN

Use your clinical judgement in regards to patient calls.

Screen ALL patients assess their risk of COVID-19.

Consider the latest testing guidelines available.

Triage Matrix

Clinical staff should be allocated to answering calls where there is:

1. An emergency situation, whether this is COVID-19 or non-COVID-19 related

2. Patients who have positive screening questions at reception

3. Patients who decline a telehealth review

SYMPTOMS

RISK OF COVID-19

LOW RISK

Has not travelled outside of the community

in the past 14 days AND no (known) close

contact with a person who has COVID-19

HIGHER RISK / SUSPECTED CASE

• Has travelled outside of the community

in the past 14 days OR contact with a

known case of COVID-19

• Health Care worker/Aged Care

Worker/Police

MILD cough, sore throat, runny

nose, possible low grade fever

Telephone Triage + if meeting criteria

advise patient to attend clinic for

assessment (if any doubt for clinical

review).

Telephone Triage + Advise the patient to

attend clinic for assessment.

Tell pt what to expect and what to do on

arrival (Alert Staff, Put on mask, social

distancing, isolation room)

MODERATE persistent / more

pronounced cough, fever,

shortness of breath, reduced

intake

Telephone Triage + Advise the patient to

attend clinic for assessment

Tell pt what to expect and what to do on

arrival (Alert Staff, Put on mask, social

distancing, isolation room)

Telephone Triage + Attend clinic Advise to isolate Consider using Ambulance to transport patient. Prepare clinic team for emergency and early involvement of GP/on-call GP/ETS

SEVERE High fever, severe

shortness of breath, minimal

fluid intake, symptoms and signs

of dehydration, hypoxia or

delirium

Telephone Triage + Attend clinic by Ambulance Advise to isolate Prepare clinic team for emergency and early involvement of GP/on-call GP/ETS

Telephone Triage + Attend clinic by Ambulance Advise to isolate Prepare clinic team for emergency and early involvement of GP/on-call GP/ETS


E. Walk in Triage

Patients should be triaged immediately on presenting to the clinic. This may done by:

• Using the clinic phone outside (consider infection control and regular cleaning of the phone)

• Having a staff member to triage from behind the desk in the waiting room

• Having a clinical staff member greet patients outside the entry to the clinic

Consideration should be made in regards to PPE for each option and should be discussed with the Infection

Prevention and Control Officer.

No visitors are permitted entry to the clinic. Only one adult may attend with a child

Step 1. Assess COVID-19 Risk

SYMPTOMS

RISK OF COVID-19

LOW RISK

Has NOT travelled outside of the

community in the last 14 days AND no

(known) close contact with a person who

has COVID-19


• Travelled outside the community in the

last 14 days OR close contact with a

known case of COVID-19


Worker/Police

MILD cough, sore throat, runny

nose, possible low grade fever

Patient to apply surgical mask MOVE TO ISOLATION ROOM

Staff to wear PPE (surgical mask included)

>>GP input required <<




MODERATE persistent / more

pronounced cough, fever,

shortness of breath, reduced

intake




MOVE TO EMERGENCY ISOLATION ROOM Patient to apply surgical mask Staff to wear P2 Mask, Gown, Gloves and Eye Protection Provide Emergency care & prepare for patient evacuation Call on-call GP/ETS As soon as possible


shortness of breath, minimal

fluid intake, symptoms and signs

of dehydration, hypoxia or

delirium

MOVE TO EMERGENCY ISOLATION ROOM Patient to apply surgical mask Staff to wear P2 Mask, Gown, Gloves and Eye Protection Provide Emergency care & prepare for patient evacuation Call on-call GP/ETS As soon as possible *do not use nebuliser*


Personal Protective Equipment

See Appendix B for further details

Patient is suspected to have COVID-19

Patient: surgical mask. Avoid use of nebuliser. Staff: standard, contact and droplet precautions (gown, surgical mask, gloves, face shield or goggles).

Patient is suspected to have COVID-19 and is critically unwell or undergoing an

aerosol generating procedure

Patient: surgical mask (as much as practical given patient condition). Avoid use of nebuliser.

Staff: additional airborne precautions as well as standard, contact and droplet precautions

(P2 mask, gown, gloves, face shield or goggles).

Resource: Interim advice on non-inpatient care of persons with suspected or confirmed

COVID-19 including use of PPE

Step 2. Assess All Other Non-COVID-19 Presentations

• ATS 1 & 2

o Invite into the clinic

o Treat as a usual emergency in the emergency room of the clinic

o Early involvement of GP (if available), on-call GP or ETS (Bidyadanga) as per usual processes

• ATS 3

o Consider options for review. Discuss with GP as necessary:

Review in clinic

PRIORITY home review within 30min

PRIORITY telehealth review – within 15 min

• ATS 4 & 5

o Telehealth

Phone call while patient remains at home (preferred)

Videoconference at the clinic

o Home visit, non-urgent

o “Fast track”* for patients who require contact eg injections, dressings, procedures.

*Fast track

Consideration must be made in regards to:

• Social distancing and having clearly spaced waiting chairs (>2m apart), preferably outside the clinic

• Hand washing with soap and water or alcohol based hand gel on entry and exit to the clinic

• Seeing only one patient at a time

• Avoiding the patient entering the clinic where possible A doctor could also be available by telehealth to support the fast track eg to review wounds and update medications.

https://www.health.gov.au/sites/default/files/documents/2020/03/interim-advice-on-non-inpatient-care-of-persons-with-suspected-or-confirmed-coronavirus-disease-2019-covid-19-including-use-of-personal-protective-equipment-ppe.pdf



F. COVID-19 Triage Guidelines for Kimberley Renal Service (KRS)

All patients entering KRS should be screened for COVID-19 at entry to the dialysis centre and prior to dialysis. Patients should also be asked if they have been told to “self-isolate” or “self-quarantine”. This should be done if a patient has come into contact with a person with COVID-19 (and they themselves are not unwell) OR they have returned from outside of the region. Patients under self-isolation/quarantine should dialyse in the isolation room/mobile dialysis unit and appropriate PPE should be used by staff (gown, surgical mask, gloves, face shield or goggles as per Appendix B). Should a patient meet the current guidelines for testing the patient should be isolated and testing arranged via the closest facility, whether this be a hospital based COVID-19 clinic or the local ACCHS. Please confirm with your local organisations. For patients who have confirmed COVID-19 infection and are requiring dialysis this should occur in the dedicated isolation room/mobile dialysis unit with use of appropriate PPE (as per Appendix B). The room/unit should be cleaned as per the isolation room procedures in-between each patient.

SYMPTOMS

RISK OF COVID-19

LOW RISK

Has NOT travelled to a high risk area in the

past 14 days AND no (known) close contact

with a person who has COVID-19


• Travelled to a high risk area in the past

14 days OR close contact with a known

case of COVID-19


Worker/Police

MILD cough, sore throat,

runny nose, possible low

grade fever

Patient to apply a surgical mask. Move to the isolation room

Staff to wear PPE (surgical mask included) Seek Advice from Renal GP re:

• Proceeding with dialysis

• Need for testing/transfer of care





MODERATE persistent /

more pronounced cough,

fever, shortness of breath,

reduced intake






Staff to wear PPE (surgical mask included) Seek URGENT Advice from Renal GP re:


• Transfer of care If deterioration telephone 000


shortness of breath,

minimal fluid intake,

symptoms and signs of

dehydration, hypoxia or

delirium

Telephone 000. Patient to apply a surgical mask as practical.

Move to isolation room while waiting for ambulance

ASSUME POTENTIAL AIRBORNE SPREAD DURING CARE AND APPLY P2 MASK, GOWN,

GLOVES AND GOGGLES / EYE SHIELD FOR STAFF

Provide emergency care in isolation room while awaiting ambulance


COVID-19 Clinic Manager Checklist & Guide

SITE/FACILITY RESOURCES YES/NO/NA COMMENTS

Do you have appropriate signage advising patients on the front door?

KAMS COVID-19 information WA Department of Health

Do you have handwashing facilities or alcohol based hand gel at entry and exit points of clinic?

Do you have surgical masks available at reception/entry triage point?

Do you have PPE available in the patient transport vehicles?

Have you set up an isolation room?

Is your emergency room set up to be an isolation room if a patient is critically unwell?

Are you set up for telehealth (Microsoft TEAMS)? Is everyone aware of their responsibilities?

Have you de-cluttered the entire clinic and removed any unnecessary items eg toys, books, old equipment?

Is the ambulance free from clutter and easy to clean? Is there PPE in the ambulance?

Is enhanced cleaning being performed within the clinic?

EQUIPMENT RESOURCES YES/NO/NA COMMENTS

Resources & Communication Do you know how to access specific COVID-19 information resources (ie signage, posters, videos)?

KAMS COVID-19 information WA Department of Health

Are specific COVID-19 posters displayed in the clinic, and have old posters been removed?

KAMS COVID-19 information

Are staff aware of the KAMS staff return to work and travel guidelines?


Have you distributed the latest communication(s) to your staff?


Do your staff have access to this COVID-19 Clinical Toolkit – is it the latest version?


Stock

Do you have PPE (masks, gowns, gloves, eye protection) stocked on your shelves?

Do you have dedicated cleaning equipment that can be used for cleaning areas when managing suspected or confirmed cases? (including health centres / vehicles etc.)

Do you have adequate supplies of patient medication including Dose Administration Aids (DAA)?

Do you have an adequate supply of flocked flexible PCR swabs? (POC test sites only)

Have you made orders and sufficient stock of the 2020 influenza and/or pneumococcal vaccine?

https://kams.org.au/

https://ww2.health.wa.gov.au/Articles/A_E/Coronavirus/COVID-19-clinical-alerts








Check supplies of oxygen, tubing, face masks and nasal prongs. Order 3-4 times usual stock

Staff & Training

Check-in with staff daily to ensure they are well. Encourage staff to stay home if unwell.

Are all staff aware of the COVID-19 triaging that should occur in their clinical areas? Reception/drivers/nursing staff

Are ALL staff aware of where PPE is kept and do staff know how to safely put on and take off PPE?

WA Health PPE Donning & Doffing video Appendix B - PPE KAMS Transmission Based Precautions Guidelines

Are staff aware of appropriate cleaning procedures for the isolation room and transport?

Environmental cleaning and disinfection principles for COVID-19

Have you identified staff with any underlying illnesses that might prevent them from working with suspected or confirmed cases of COVID-19?

Do you have the resources to implement home delivery of DAAs if this is required in the future?

Do staff know how to take appropriate nasopharyngeal for COVID-19 testing? (POC test sites only)

COVID-19 clinical alerts Appendix F

YouTube -nasopharyngeal swab

Are staff sufficiently trained on the use of T-Tango Machine to undertake Point-Of-Care Testing (POC test sites only)?

Do staff have access to a hardcopy and electronic copies of the Kirby Institute SOP’s? (Electronic available on Logi QC)

• Point of Care Testing Recommendations SOP 1

• Nasopharyngeal Swab Collection SOP2

• Point of Care Testing Process SOP 3

• Infection Control Procedures SOP 4

• Quality Control and External Quality Assurance SOP 5

• Testing Data, Recording, Reporting and Notifications SOP 6

• Hub and Spoke Covid-19 Testing Model SOP 9

Are staff aware and using the template in mmex “COVID-19 POC Testing”? To be used when a POC test is completed

Do you have a plan for administration of 2020 influenza and pneumococcal vaccines to the community?

https://www.youtube.com/watch?time_continue=2&v=qENV2ly-ndk&feature=emb_title

https://www.youtube.com/watch?time_continue=2&v=qENV2ly-ndk&feature=emb_title

https://kamsc.logiqc.com.au/document/item/report/0a0973ea-ed34-4e11-8953-66216b14ee0f


https://www.health.gov.au/sites/default/files/documents/2020/03/environmental-cleaning-and-disinfection-principles-for-covid-19.pdf



https://www.youtube.com/watch?v=DVJNWefmHjE&feature=youtu.be

https://kamsc.logiqc.com.au/document/item/report/ccf17c5f-5e69-4ec1-aecc-6697a1a6a5db


https://kamsc.logiqc.com.au/document/item/report/8bb598d9-73f3-4c42-a705-938b761366b7


https://kamsc.logiqc.com.au/document/item/report/f2c50620-b0d0-4bba-a67c-0341fd213d83


https://kamsc.logiqc.com.au/document/item/report/4b98ca02-18c9-4610-9519-2075c1c20c5c

https://kamsc.logiqc.com.au/document/item/report/6b6933a6-56b4-44e8-8f5a-72b44ee23398


https://kamsc.logiqc.com.au/document/item/report/f03a466b-8e3a-442a-a9d9-eaf611f83001


https://kamsc.logiqc.com.au/document/item/report/a9e33ab5-8aaf-4a51-90bd-aa847038bfb9



PPE and other supplies

• The KAMS stores department orders and manages supplies of PPE, hand sanitiser, disinfectant, disinfectant wipes and other supplies. Supply may be severely restricted and many items will be on back order.

• In an attempt to maintain service delivery it is recommended that you order 3 – 4 weeks of additional supplies.

• Ensure a supply of PPE is kept on your clinic shelves, and is made available in the isolation room and in the case of masks, in clinic rooms, at reception and for clients requiring triage at the clinic entrance.

• Ensure orders of PPE are placed with the KAMS store in a timely manner (before supplies have been depleted).

• Please notify the KAMS infection Prevention and Control Coordinator if you are experiencing difficulties obtaining supplies of PPE and cleaning products [email protected]

• Conserve your supply of PPE. do not use PPE (particularly masks) when it is not indicated. Refer to triage, transport and isolation room guidelines.

Regular stock takes of PPE will be overseen by the Infection Prevention and Control Coordinator and monitored by the KAMS COVID-19 Logistics Team.

Enhanced Routine Cleaning

During an outbreak of infection or an unusual increase in the incidence of a particular organism such as

during the COVID-19 pandemic, enhanced routine cleaning (minimum twice daily) is recommended. This

will entail cleaning/disinfecting the environment including frequently touched surfaces such as bed tables,

sinks, call bells, door handles and push plates, and any area/piece of equipment that may potentially be

contaminated.

Refer to:

• Environmental cleaning and disinfection principles for COVID-19

• KAMS IP&C Cleaning Guidelines



https://kamsc.logiqc.com.au/document/item/report/8726e4bd-2483-473c-ba87-d939d5365e82


COVID-19 Isolation Room Procedures

Who needs to be isolated?

• Any person with respiratory symptoms with or without fever OR

• Any person who has had close contact with a confirmed case of COVID-19

Isolation room set up

• Identify a room in the clinic for use as an isolation room, preferably a smaller room, with 1) a separate entrance or near a separate entrance to the clinic, away from the waiting room;

and 2) With the least air movement and clinic traffic in the vicinity of the room

• Remove all unnecessary objects, furniture and equipment from the room, other than equipment which may be required for the assessment and management of an unwell client

• Set up a trolley in the room with:

1) Thermometer & disposable tips

2) Disinfectant & detergent wipes

3) Locate a supply of PPE at or near the entrance to the isolation room, including:

Standard PPE for droplet spread (masks, gloves, goggles / face shields, aprons)

Additional PPE for airborne precautions – any client with more severe symptoms / requiring aerosolising procedures (P2 masks, gowns)

4) Clinical waste bins (yellow bags) must be available inside the isolation room. • For locations where POC testing is available additional equipment will be required. The equipment

list is outlined in The Kirby Insitute’s SOP (SOP 2 – Nasopharyngeal swab collection

https://kamsc.logiqc.com.au/document/item/report/8bb598d9-73f3-4c42-a705-938b761366b7).

Isolation Procedures

• Refer to KAMS Transmission Based Precautions Guidelines

• Apply a surgical mask for the patient as soon as it becomes known that they may be suspected of having COVID-19, prior to entering the isolation room and for the duration of their care as is reasonable in the context of their care requirements

• Limit movement of the patient outside of the isolation room. When movement is necessary, ensure that the client’s mask is in place and that their destination is prepared

• Always apply personal protective equipment (PPE) prior to entering the isolation room, including surgical mask, gloves, goggles and gown

• Wear PPE whilst in the isolation room at all times

• Place any contaminated linen into an alginate bag at the point of removal. DO NOT carry linen out of the room, place alginate bag in appropriate colour coded bag

• All waste should be disposed of into yellow clinical waste bags within the isolation room. DO NOT carry waste out of the room




• When treatment of the client in the isolation room is completed, discard PPE into the clinical waste bin and perform hand hygiene prior to exiting the isolation room - following the safe removal of PPE guidelines

• Ensure cleaning and disinfecting of the room is performed after each client has left the isolation room and prior to any other staff or clients entering the isolation room

Cleaning procedures following attendance by person with suspected COVID-19

• Ensure you are wearing PPE – gloves, gown, goggles & mask

• The products to clean with are either:

2-step clean Physical cleaning with detergent followed by disinfection with a TGA-listed hospital-grade disinfectant with activity against viruses (according to label/product information) or a chlorine-based product such as sodium hypochlorite.

Or 2-in-1 clean A physical clean using a combined detergent and TGA-listed hospital-grade disinfectant with activity against viruses (according to label/product information) or a chlorine-based product such as sodium hypochlorite, where indicated for use i.e. a combined detergent/disinfectant wipe or solution.

• Using either option - wipe down all surfaces and equipment in any room or other area of the clinic that may have become contaminated

• Used cleaning products are to be placed in the clinical contamination bin in the isolation room Resource: Environmental cleaning and disinfection principles for COVID-19



COVID-19 Emergency Care of Patients with Confirmed/Suspected COVID-19

There are some important considerations that should be thought about before commencing CPR on a patient with presumed or confirmed COVID-19. This includes and assessment of the risks (to staff) and the benefit to the patient (and whether this is futile). Decisions to commence and or cease CPR should be made by the lead clinician available at the time, whether this be an Aboriginal Health Professional, Nurse, Remote Area Nurse or General Practitioner. If the situation is deemed too risky then CPR should not be commenced. PPE should always be donned prior to reacting to an emergency. Below are some important factors to consider in a critically unwell patient in the clinic:

Recognition of cardiac arrest

• Look for chest rise only: DO NOT listen and feel for breath by placing your face near the patient's mouth

• Confirm absence of carotid pulse if trained to do so Basic Life Support

• PPE (including N95 mask & eye protection) MUST be donned before starting chest compressions

• Apply oxygen mask at a maximum rate of 6 - 10 L/min to minimise aerosol production

• Compression only CPR should be commenced as soon as oxygen mask has been applied

• AVOID mouth to mouth or pocket mask ventilation and AVOID suctioning Staff Safety

• All team members need PPE for aerosol generating procedures. MINIMUM: Gown, Gloves, Eye protection, N95 mask

• Isolation room door should remain closed as much as possible Defibrillation

• Remove defibrillator from resus trolley, removing any surplus cables before bringing into the isolation room (if not already there)

Airway Management

• Bag-mask ventilation should be avoided if at all possible. If bag-mask ventilation is required, a two-person technique is preferred to maintain a good seal

• Airway interventions must be performed by an experienced individual

• Intubation should not be performed in KAMS clinics On Stand Down of Resuscitation

• Safely remove PPE

• Keep room empty for 30min after cessation of CPR

• dispose of or clean contaminated equipment as per the cleaning guidelines


COVID-19 Point of Care Testing

Point of Care (POC) testing is now available in Balgo clinic. At the time of writing POC testing is pending for

both Bidyadanga clinic and Beagle Bay clinic.

Testing Criteria

Testing should be performed on patients who:

1. Meet the latest WA Health testing criteria (WA Health Clinician Alert )

AND

2. Meet the KAMS Prioritisation Criteria (See Appendix F)

AND ARE NOT

3. Clinically unwell requiring evacuation OR at high risk of testing positive (eg they have a clinically

compatible illness and have been in contact with a confirmed case).

Testing must involve the KAMS doctor on-site or on call and will be at their discretion. If there are any

queries in regards to the WA Health testing criteria advice may be sought from public health (KPHU in hours

or statewide public health after hours). If there are queries about the KAMS Prioritisation Criteria or unwell

or high risk patients, can be directed to the KAMS Medical Director.

Any patients who are clinically unwell requiring evacuation and meet testing criteria or at very high risk of

testing positive should be discussed with public health (KPHU in hours or statewide public health after

hours). Decisions can then be made around whether further action is required eg contact tracing.

Notifications

When COVID-19 testing is performed in KAMS clinics the following notifications should occur:

1. Mandatory notification to The WA Department of Health. Complete the online notification form for

any patients having a test, regardless of the result

2. MMex message notification to “Dr Casey Barnes” in mmex to advise of cartridge use

If the results are POSITIVE further notifications are required. Please refer to the Remote Community

Positive Result Checklist (page 23)

Locations Close to POC Testing – Mulan & Billiluna Clinics

In the event of a patient meeting the testing criteria in Mulan or Billiluna, clinic staff will contact the on-call

Kutjungka GP immediately. It will be at the discretion of the GP the action taken to facilitate testing. This

could include:

https://ww2.health.wa.gov.au/Articles/A_E/Coronavirus/COVID19-information-for-health-professionals

https://cdcwa.health.wa.gov.au/surveys/?s=3PANDLMR84


Swabbing the patient at the clinic location and transporting the sample to Balgo (thought to be the

best approach at the time of writing); or

Transporting the patient to Balgo and swabbing them at Balgo clinic

Consideration should be made in regards to safely isolating the patient, staffing, safe transport of the

patient/sample and the current closure of Mulan airstrip. Any concerns can be escalated to the Deputy

Medical Director and or the Medical Director.

Performing Point of Care Testing

The Kirby Institute will be providing training for staff to become accredited in the use of the GeneXpert

machines and Xpert Xpress SARS-CoV-2 cartridges. Only those who have received the accredited training

should participate in the use of the machine.

The Kirby institute has provided Standard Operating Procedure (SOP) documents which outline the process

of obtaining, processing and transporting swabs. These SOP’s should be available in each clinic in hardcopy

and electronically on LogiQC:

• Point of Care Testing Recommendations SOP 1

• Nasopharyngeal Swab Collection SOP2

• Point of Care Testing Process SOP 3

• Infection Control Procedures SOP 4

• Quality Control and External Quality Assurance SOP 5

• Testing Data, Recording, Reporting and Notifications SOP 6

• Hub and Spoke Covid-19 Testing Model SOP 9

The procedure for obtaining a nasopharyngeal swab is available in Appendix E. This information is also

outlined in the SOP’s mentioned above.

While patients are awaiting results patients must be isolated in a designated isolation room in the clinic

until they receive their result (turn-around time approximately 45 minutes)

Testing for Other Respiratory Viruses

Strong consideration should be made for testing patients who are undergoing COVID-19 POC testing for

other respiratory viruses, including influenza. This should be sent to PathWest using same swab used for

the COVID-19 POC test. Information on specimen handling and transport are outlined within the Kirby

Institute SOP documents. All requests should be accompanied by a PathWest request form requesting

“General Respiratory Panel/Influenza PCR”.

Documentation

To enable clear and consistent documentation, a template has been created in mmex to be used by any

staff who are undertaking a POC test. This is named “COVID-19 POC Testing” and is detailed in Appendix G.




https://kamsc.logiqc.com.au/document/item/report/4b98ca02-18c9-4610-9519-2075c1c20c5c





Negative Results

As per the COVID-19 CDNA Guidelines for Public Health Units, it is recognised that without any other

epidemiological risk factors, the risk of a person having COVID-19 is low. Any symptomatic person, even if

COVID-19 negative, should stay at home until their symptoms have resolved.

As per the CDNA guidelines epidemiological risk factors include;

• In the 14 days prior to illness onset has a history of close contact with a confirmed or probable

case, international or interstate travel, or travel on a cruise ship,

• Any staff with direct patient contact in the healthcare, aged or residential care setting,

• Has lived in or travelled through an area confirmed by public health as having increased risk of

community transmission, or

• Hospitalised patients where no other focus of infection is evident

A risk assessment should be undertaken for suspect cases who initially test negative for COVID-19. If the

clinician continues to have a high index of suspicion that the person has COVID-19, discuss this with public

health (KPHU in hours or statewide public health after hours) to decide whether isolation and re-testing

should be arranged.

Please also note that suspect cases who are also close contacts or are required to quarantine for other

purposes (e.g. international travel) must continue quarantine for the remainder of the 14 day period,

regardless of any negative test results.

Positive Results

Refer to the section COVID-19 Positive Result Checklist on Page 24 for guidance. Ongoing care will be

provided to patients and their close contacts who are not hospitalised. This is outlined on page 29 in the

care of COVID-19 patients and their close contacts. This care is co-ordinated by the PLSO position.



*DISCUSS:

• with KPHU/MCDC if uncertainty about the WA Health Testing Criteria

• with Medical Director if uncertainty about the KAMS Prioritisation Criteria

Process Summary –Point of Care Testing in Remote Communities

Patient COVID-19 Testing Considered 1. Meets latest WA Health testing criteria AND 2. Meets KAMS prioritisation criteria (Appendix F)*

Evacuation (+ close contacts)

See Positive Result Checklist pg 23

Broome Hospital Admission

Reassess Patient

• Clinically stable?

• Safe for discharge home?

• Discuss re-presentation if

deterioration

• Advise to isolate until well

• If, despite negative result,

there is high clinical

suspicion for COVID-19

discuss with KPHU 9194 1630

(in hours) OR MCDC 9328

0553

Isolation in Broome Ongoing KAMS and KPHU involvement in care

Patient is Clinically Stable

Evacuation

• RFDS 1800 625 800 (preferred mode of evacuation)

• Hand patient over to Broome Hospital ED DMO 9194 222

• Call KPHU 9194 1630 (in hours) OR MCDC 9328 0553 (after hours) for advice and consideration for contact tracing. Refer to Positive Result Checklist pg 23 if treating patient as a positive case

Patient is Clinically Unwell

Do not swab in clinic due to aerosolising risk

Negative Result

COVID-19 Point of Care Testing • Keep sample to send for general respiratory viral panel/influenza (PCR)

• Use Mmex template “COVID-19 POC testing” for documentation

• Complete WA Health notification online notification form

• Notify cartridge use: mmex message “Dr Casey Barnes”

Positive Result

https://cdcwa.health.wa.gov.au/surveys/?s=3PANDLMR84


COVID-19 Positive Result Checklist

TASKS TICK GUIDANCE

1 Patient Clinical Care • Attend to any immediate clinical needs with the appropriate PPE

• Inform patient of positive result and need for evacuation, contact tracing & need for isolation

2 Inform KAMS Medical

Director

• Advise KAMS Medical Director of result (Lorraine Anderson 0407 974 951)

3 Arrange urgent evacuation to

Broome

• Call the RFDS on 1800 625 800 to arrange urgent evacuation of COVID-19 positive patient to Broome

• If delay or logistical concerns consider road transfer from Beagle Bay and Bidyadanga on discussion with Deputy Medical Director (Casey Barnes 0431 917 577)

• If patient is unwell requiring admission, call Broome Hospital ED DMO to accept patient on 9194 2222 (Broome Hospital Switch)

• If patient does not require admission, call on-call Regional Physician or Paediatrician to inform of case and discuss appropriate care setting (Hospital or DoCs accommodation) on 9194 2222 (Broome Hospital Switch)

4 Notify Public Health & Begin

Contact Tracing Process

• Call KPHU 8am-4.30pm (9194 1630) or state-wide public health (9328 0553) after hours to inform them of result & receive support to begin case interview and contact tracing

• Refer to Contact Tracing Pack for case assessment form and close contact line list

5 Conduct the case interview

with assistance from Public

Health

With the assistance of KPHU/State-Wide Public Health Officer begin the

case interview with the COVID-19 positive patient:

• This can be done either over speaker phone or Microsoft Teams video conference – please help to facilitate this

• Please note important contact tracing information: o Infectious period: begins 48 hours prior to symptom onset. Any

person who has close contact with the case during this period needs follow-up and to be quarantined for 14 days.

o Close contacts: all household contacts; any person that has had >15min face-to-face contact during the infectious period (cumulative over 1 week); any person that has spent >2 hours in a closed space (e.g. car, waiting room, other).

Ensure COVID-19 positive patient remains in isolation room and is wearing a surgical mask

Ensure the health care worker caring for patient is wearing appropriate PPE & minimise the need

for other staff to enter isolation room.

Consider utilising CLO or Police if escalation anticipated

Do not allow any visitors to enter clinic (a child may have one carer who should wear a surgical

mask, and maintain physical distance of 1.5m if able)

Maintain confidentiality


o Exposure period: exposure to COVID-19 is likely to have occurred in the 14 days before symptom onset and so is assessed in the case interview.

It will important to check for any travel outside of community, contact with a COVID-19 case or other sick person, or large gatherings attended. For more information see the CDNA COVID-19 National Guidelines for Public Health Units

6 Interview Close Contacts

Informing close contacts:

• KPHU will assist to produce a list of ‘close contacts’ of the case during their infectious period. All close contacts must be contacted either by phone or in person to: o Inform them that they have been identified as a close contact of

someone who has tested positive for COVID-19 o Verify the date, time and location of potential exposure o Assess for symptoms of COVID-19 e.g. fever, history of fever,

cough, sore throat, shortness of breath, lethargy, other respiratory symptoms

o If symptomatic, COVID-19 testing must be arranged o Inform them of the requirement to quarantine for 14 days from

last exposure and that this will be via evacuation o If close contact interviews are done in person, make sure to stay

1.5m away and consider doing the interview outside

7 Management of Close

Contacts (evacuation)

• Appropriate quarantine of close contacts will be via evacuation from community, unless a community’s pandemic plan dictates otherwise (ensure you are aware of the local community’s specific plan)

• Call RFDS (1800 625 800) to arrange transport from the Kutjungka to Broome; discuss appropriate evacuation options for close contacts from Bidyadanga and Beagle Bay with Public Health and KAMS Deputy Medical Director (0431 917 577)

o Asymptomatic close contacts: should wear a surgical mask for transport

o Symptomatic close contacts: discuss with Public Health and arrange testing if necessary prior to evacuation; will require separate transport to asymptomatic contacts

8 Arrange isolation

accommodation in Broome

for non-hospitalised case, and

close contacts

*Please note KAMS staff and

government employees (e.g.

police, teachers) should have

isolation accommodation

arranged through their employer

• Call KAMS Patient Support Liaison Officer (PSLO) (including after hours) on 9194 0334

o Provide details: name, DOB, employment/Centrelink status, if COVID-19 case or a close contact (symptomatic or asymptomatic), mode of transport to Broome and ETA.

o Please note: case needs to be isolated separately from any close contacts; discuss any questions about who can isolate or travel together with Public Health

• The PSLO will contact the Disaster Response Hotline (1800 032 965) to request isolation assistance for close contacts (and case if isolating out of hospital) *

• KAMS PSLO will liaise with clinical staff to arrange ongoing clinical monitoring of case and close contacts in Broome




8 Ensure all information is up-

to-date

• Make sure you have up to date contact details for the case and all of their close contacts

• Make sure Public Health & KAMS PSLO is aware of these details

9 Environmental Cleaning • Follow KAMS IP&C guidelines available in the KAMS toolkit to clean all spaces where the confirmed case/contacts have been in the clinic and any vehicles

10 Support the Community • Provide information as needed to community council, family members and community members while maintaining confidentiality


COVID-19 Testing for Clinic Locations Without Point of Care Testing

Beagle Bay & Bidyadanga (prior to testing being available in Bidyadanga)

In the event of a suspected case of COVID-19 the on-call GP or clinic GP should be involved.

Once it is decided that a patient requires COVID-19 testing:

• Seek approval for rapid COVID-19 testing for a patient from a remote community in Broome by;

o Office hours (8.00am-4.30pm Monday to Friday): call KPHU on 9194 1630 for approval from

Public Health Physician.

o After hours: call the on-call regional Physician or on-call regional Paediatrician for approval

(Broome Hospital Switch 9194 2222).

• Inform the Broome COVID clinic (open 8.30-4pm, 7 days/week) on 9194 2229 that patient is

attending for a test.

If rapid testing is planned (preferred):

• Arrange transport to the Broome Hospital COVID-19 clinic (open 8.30am to 4pm, 7 days/week)

• SEND a letter with the patient to explain presentation, PMHx, who has been contacted and that

rapid testing is required

• If the test is negative they may return to community that same day under the direction of the

medical officers at the COVID-19 clinic

• Notify the KAMS Patient Support Liaison Officer (PSLO) by mmex message “Helen Harrision” or call

9194 0334 to advise he patient is being transported for testing. Also advise of the result (this result

will be phoned through to the requesting doctor) by mmex message.

If conventional testing (sample sent to Perth) is planned:

• Discuss isolation requirements with the patient and that they should remain isolated until their

return to community

• Notify the KAMS Patient Support Liaison Officer (PSLO) on 9194 0334

• Call the Disaster Response Hotline on 1800 032 965 to arrange isolation accommodation for the

patient. School teachers, police, KAMS staff and other similar staff who work in community do not

qualify for Department of Communities accommodation. Often their workplace will allow funding

for this isolation accommodation and KAMS staff. Direction can be provided by the PLSO.

• SEND a letter with the patient to explain presentation, PMHx, who has been contacted and

arranged (eg accommodation/transport) and that conventional testing is required

• Arrange transport to the Broome Hospital COVID-19 clinic and then to their accommodation (the

PSLO will be able to assist)

• The results will be followed up by the PSLO and their supporting GP who will co-ordinate transport

as required.


Process Summary – COVID-19 Testing in locations without POC Testing

Refer to current testing criteria: WA Health Testing Criteria

Patient meets WA Health Testing Criteria

STANDARD TEST Clinic Car transfer

Hospital > Accommodation

Broome Hospital

Admission

Determine if patient will qualify for Rapid or Standard Testing In Hours: KPHU 9194 1630 After Hours: Discuss with on-call physician OR on-call paediatrician 9194 2222

Patient is Clinically Stable with No Deterioration

Expected- SEND WITH LETTER

IF RAPID TESTING – PREFERRED 1. Arrange transfer by clinic car to Broome (Beagle Bay & Bidyadanga) 2. Consider return arrangements (if tests negative) 3. Mmex message “Helen Harison” to advise

IF STANDARD TESTING

1. Arrange transfer (clinic car for Beagle Bay & Bidyadanga) 2. Contact Disaster Hotline to arrange accommodation 1800 032 965

(give below PLSO number to contact) UNLESS a Teacher/KAMS staff/Police etc

3. Advise KAMS PLSO of transfer, ETA and accommodation location (08) 91940334 (8am-4.30pm 7 days). Non urgent after hours mmex message “Helen Harrison”

Patient to be Evacuated from Community

RAPID TEST Negative Result Same day return to

community

Clinic Car transfer Clinic > Broome Hospital

Patient is Clinically Unstable OR

Expected Deterioration

1. Arrange transfer (RFDS: preferred)

2. Hand patient over to Broome Hospital DMO

3. Advise KAMS patient support officer by mmex message “Helen Harrison”

RFDS transfer

(preferred)

Clinic Ambulance

transfer

Testing in Broome COVID Clinic 8.30am – 4pm

After Hours: Testing in ED



COVID-19 Care of COVID-19 Cases & Close Contacts

KAMS aims to provide ongoing care of patients who test positive and their close contacts who do not

require hospitalisation.

Background

Around 80% of COVID-19 infections present as a mild respiratory illness in a patient who is ambulatory and

can generally be managed outside of hospital. Around 15% typically need hospital care (usually for

moderate to severe pneumonia), and another 5% have critical illness requiring more intensive supports.

For those who require hospitalisation, the median time from first symptom to dyspnoea is 5 days, the

median time to hospital admission is 7 days and the median time to Acute Respiratory Distress Syndrome

(ARDS) is 8 days.

Patients with suspected or confirmed COVID-19 should be assessed for features of severe disease, and risk

factors for progression to severe disease. This will assist with determination of whether a patient can be

managed in the community or requires referral and admission to a facility able to provide acute inpatient

and/or critical care.

Pre-Hospital Management

Management of COVID-19 is supportive. There are currently no specific agents demonstrated to be

clinically effective in the management of COVID-19.

Pre-hospital supportive management should include:

• Maintaining oxygen saturations at 92-96% with supplemental oxygen (in those known to retain

CO2, aim for saturations 88-92%)

• Consider empiric antibiotic therapy for bacterial pneumonia in those with severe illness or clinical

deterioration

• Consider alternate or dual pathologies, and recognise sepsis/shock promptly

Determining Setting of Care

Discuss all positive COVID-19 cases diagnosed in a remote community with the on-call physician or

paediatrician to help determine setting of care for patients diagnosed with COVID-19. The table below can

be used for some guidance when making these decisions, but it does not replace good clinical judgement.


Table 1. Assessing disease severity and consideration for setting of care for patients diagnosed with COVID-

19 (Adapted from Clinical Presentation and Management of COVID-19, Theverajan et al, MJA).

Disease Severity Clinical Features Setting of Care

Mild illness/lower risk of progression to severe disease

Mild upper respiratory symptoms (eg cough, sore throat, myalgia, fatigue)

AND Age <60 years

AND No major comorbidities

Consider managing out of hospital

unless symptoms progress to

develop lower tract symptoms eg

shortness of breath

Moderate illness/intermediate risk of progression to severe disease

Stable patient presenting with respiratory and systemic symptoms or signs Characteristics:

• Severe lack of energy, prostration, fever >38◦C or productive cough

• Clinical or radiological signs of lung involvement but:

o No signs of severe pneumonia AND

o No clinical or lab indicators of clinical severity or respiratory impairment AND

o No major comorbidities

Discuss with on-call physician or

paediatrician to determine if

hospitalisation recommended.

If patient agreeable and able to

monitor their own condition can

consider managing out of hospital

with careful monitoring into

second week of illness

AND

Early referral to hospital if any

evidence of clinical deterioration

Severe illness Any of the following characteristics: • Dyspnoea

• Saturations <92% on RA

• RR >22

• Haemodynamic instability SBP <100

• Extensive CXR infiltrate (if available) or rapid worsening from baseline

Refer to hospital for assessment

and admission

At risk of severe illness Regardless of clinical characteristics; If ANY of:

• Age >60y

• Cardiovascular disease

• Chronic respiratory disease

• Diabetes

• Chronic kidney disease

• Hypertension

• Immunocompromising conditions

Refer to hospital for assessment

and admission

https://www.mja.com.au/system/files/2020-04/Preprint%20Thevarajan%20%28Cowie%29%208%20April%202020.pdf


COVID-19 Cases Evacuated to Broome

Patients will either be admitted to hospital, or accommodated in isolation facilities by the Department of

Communities.

Hospitalised Patients

Patients deemed appropriate will be admitted to hospital for all or part of their disease duration. On

discharge the patient is to be handed over to the allocated KAMS GP (as communicated with the Broome

Hospital) or the KAMS on-call GP. Follow up and monitoring of the patient can then be arranged, with co-

ordination from the PLSO.

Isolation

Out of Hospital Management Checklist:

Mild disease AND no comorbidities

Provided education regarding illness and what symptoms to watch out for (especially difficulty

breathing)

Ensure patient able to monitor their condition

Access to working phone (ideally with video call capabilities for telehealth)

Knows who to contact if becoming more unwell (office hours KPHU case manager; after hours

hospital / 000)

Consider discussing Advanced Care Directive if not in place & appropriate

Monitoring:

• KPHU case manager daily phone call

• KAMS clinical COVID monitoring (co-ordinated through PLSO)

o RAN telehealth / telephone assessment twice daily with escalation to GP as required

o GP telehealth review on day of arrival to Broome, Day 5 from symptom onset, Day 7 since

symptom onset & after release from isolation from public health

• If KPHU and KAMS are unable to contact a patient, Department of Communities or local police may

need to conduct a welfare check on the patient

• KPHU may request clinical information from KAMS if unable to contact a patient. This information is

uploaded to the state-wide public health database for COVID-19

Management:

• Manage mild COVID-19 in a similar way to seasonal flu – advise rest & drink fluids

• Paracetamol can be considered for symptomatic relief

• Daily KAMS monitoring: ask about / assess for

o New or worsening symptoms

o Any shortness of breath or difficulty breathing

o Chest pain or pressure

o Dizziness

o Confusion

o Reduced urine output

o Cough/haemoptysis

o Social/emotional wellbeing


o Other concerns

• Initial GP review with the patient will include:

o Assessment for deterioration

o Education about the illness and what to do should they deteriorate

o Medication review including cessation of medications as required eg SGLT2’s. Arrangement

for medications to be delivered to their accommodation in Broome via Kimberley Pharmacy

Services and the PLSO

o GPMP and/or review and addition of COVID-19 care plan to patient mmex file

o Discussion with the on-call Paediatrician or Physician as required

• If any of the above or other clinician concerns, transfer to hospital is recommended

• Ensure patients continue to receive their usual care for pre-existing conditions

• Pre-existing conditions management:

o Asthma/COPD: consider managing in hospital. Inhaled or oral steroids can be used as you

normally would for viral exacerbation of asthma or COPD. Do not use a nebuliser.

o Diabetes/Cardiovascular disease: manage in hospital. Do not cease or change the dose of

treatments such as insulin or other diabetes medications, statins, ACE inhibitors,

angiotensin receptor blockers.

o Immunosuppressants: manage in hospital. Consider cessation/dose change of long-term

immunosuppressants on discussion with treating specialist only.

More information: https://covid19evidence.net.au/wp-content/uploads/COVID-19-FLOW-CHART-4-

MANAGEMENT-OF-SUSPECTED-MILD_V2.0.pdf

Release from Isolation

• Public health will advise when a patient meets criteria to be released from isolation according to

the COVID-19 CDNA National Guidelines for Public Health Units

• KPHU will advise patients from remote communities to remain in their accommodation until

transport is arranged for them back to their community to ensure community requirements are

maintained before their return

• Patients will receive a letter from KPHU confirming the date of their release from isolation

Close Contact Management

• Close contacts of COVID-19 cases will be evacuated to Broome for isolation in DoCs

accommodation (OR other accommodation should the patient not qualify for supported

accommodation)

• KPHU will send a daily SMS asking about the development of symptoms to all close contacts

• KAMS RANs will contact close contacts every second day to ask about the development of

symptoms, care for other health conditions and assess other welfare needs

• Please let KPHU know if any close contact reports new symptoms to facilitate testing

References

• MJA. Clinical presentation and management of COVID-19

• WHO. Clinical care for severe acute respiratory infection COVID-19 Adaptation

• National COVID-19 Clinical Evidence Taskforce. Australian guidelines for the clinical care of people

with COVID-19

https://covid19evidence.net.au/wp-content/uploads/COVID-19-FLOW-CHART-4-MANAGEMENT-OF-SUSPECTED-MILD_V2.0.pdf

https://covid19evidence.net.au/wp-content/uploads/COVID-19-FLOW-CHART-4-MANAGEMENT-OF-SUSPECTED-MILD_V2.0.pdf


https://www.mja.com.au/system/files/2020-04/Preprint%20Thevarajan%20%28Cowie%29%208%20April%202020.pdf

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/patient-management

https://app.magicapp.org/#/guideline/L4Q5An

https://app.magicapp.org/#/guideline/L4Q5An


COVID-19 Clinical Coding

Please note two new tabs relevant to COVID-19 appearing on the progress notes tab:

1. COVID-19 Complete this for any patient who is suspected to have, has confirmed or contact related to COVID-19. This is our best way of tracking patients with suspected/confirmed/contact with COVID-19 so please complete fastidiously. Options in the drop down menu:

• COVID-19 suspected (for patients who meet testing criteria)

• COVID-19 confirmed (for patients who have tested positive)

• COVID-19 contact (close contacts of a patient who has tested positive)

• COVID-19 negative (where a patient has been tested and is negative for COVID-19)

2. Non-MBS

For GP’s only This relates to non-MBS billable consults. Given the current guidelines from MBS some telehealth consults cannot be billed through Medicare (See Appendix C for details). For these consults complete this tab and note the level of consult that was undertaken. Options in the drop down menu:

• Level A

• Level B

• Level C

• Level D


COVID-19 Home Visits

Consider Telehealth

Before deciding on a home visit, a telehealth review should be offered instead. This could be:

• At home (preferred): the patient’s phone number should be confirmed and recorded in Mmex

• At the clinic

Telehealth can also be used while visiting a patient at home with the clinical staff carrying a smart phone,

lap top or similar device to contact the GP. See the section on telehealth for further details

Checklist Before Leaving

Has the patient been screened for COVID-19 by phone or when they presented to the clinic? (if not

consider calling ahead to screen)

Do you have all the necessary equipment and is this clean?

Do you have PPE equipment (surgical masks- including one for patient, gowns and gloves) and

disinfectant wipes in your vehicle?

Do you have another staff member to travel with you? (travelling in another vehicle for social

distancing measures) – always travel with more than one person

Perform a risk assessment before leaving the clinic and before getting out of the car: is it safe for

me to attend the house?

o Previous history of aggression/violence?

o Who else will be at the house?

Review patients:

o Outside where possible

o At a social distance

During the Visit

• Park your vehicle on the road rather than on the client’s driveway. This will avoid both

inconvenience for clients and other visitors to the home, as well as to enable an unobstructed

departure (if and when required).

• Make sure you practice strict hand hygiene and adhere to the practices of social distancing during

your time in the home wherever feasible.

Relevant KAMS Policies

• Headspace Broome Working Offsite Policy

• KAMS Risk Assessment Tool

https://kamsc.logiqc.com.au/document/item/report/7e6218b1-f835-47f8-98f6-2f3138fcc6af

https://kamsc.logiqc.com.au/document/item/report/4e434c8b-e88e-064f-9a2b-96f750f0b134


COVID-19 Use and Provision of Transport

Principles for Transport for All Patients

• One person at a time is preferable. Where this is not possible (eg children, escort required) it is also

preferable they are from the same household. Where the aforementioned is not possible then

social distancing should be maintained (4m2 for each person)

• A window should be open in the vehicle to allow ventilation

• Hand hygiene should be undertaken by the driver and passengers on entry and exit of the vehicle

Scheduled Driver Pick-Ups

Before patients are transported within clinic vehicles, the clinic driver should screen for COVID-19.

Ask COVID-19 Triage Questions:

• Have you had contact with a confirmed or suspected case of COVID-19?

• Do you have cough/cold/runny nose/fevers/sore throat or coldsick symptoms?

• Would anyone who may be attending with you answer YES to any of these questions?

If anyone answers “Yes” or “Unsure” to these questions contact the nominated nurse or clinical staff member at the clinic. Do not interact with the patient. Temperatures can also be taken prior to travel, which is best performed with a no-contact thermometer. Where this is performed a temperature above 37.5 degrees should trigger the nominated nurse or clinical staff member to be contacted.

Scheduled Transport Out of Community (for Bidyadanga and Beagle Bay communities)

Transport of patients out of community to access medical services should be conducted where required. Consideration should be ongoing to offer telehealth services where possible so the patients can remain in the community and/or the local region.

Emergency Transfer of Patients (Remote Clinics Only)

All patients who have suspected COVID-19 should be evacuated from community. The mode of evacuation will be at the discretion of the GP/on-call GP and in discussion with the on-site clinical staff. This will take into account:

• Clinical state of the patient; and

• Availability of RFDS. Should the patient be evacuated by road, there is option to transport the patient in:

• Clinic car, with or without clinical staff on-board; OR

• Ambulance. This decision will be made based on the clinical state of the patient.


Transporting a Patient with Suspected or Confirmed COVID-19

The following principals should be followed:

• Staff must wash or sanitise hands and put on PPE, including googles, surgical mask, gown and gloves.

• The patient should be asked to undertake hand hygiene (hand washing or alcohol based hand gel) and to wear a surgical mask.

• Maximum distance between the patient and staff should be facilitated, where possible eg patient sits in the back, driver in the front.

• Open the windows for ventilation.

After transportation and before removing PPE, the inside of the vehicle and external door handles must be cleaned using the procedure outlined below.

Vehicle Cleaning Procedures

• Ensure the staff member undertaking the cleaning has been trained and is wearing PPE including gloves, gown, goggles or face shield and surgical mask

• Using one of the options below wipe down all surfaces in the vehicle that may have become contaminated, including wiping down external surfaces that may have been touched or contaminated (door handles, boot handle, other) then place directly into a clinical waste bin bag.

2-step clean Physical cleaning with detergent followed by disinfection with a TGA-listed hospital-grade disinfectant with activity against viruses (according to label/product information) or a chlorine-based product such as sodium hypochlorite OR 2-in-1 clean A physical clean using a combined detergent and TGA-listed hospital-grade disinfectant with activity against viruses (according to label/product information) or a chlorine-based product such as sodium hypochlorite, where indicated for use i.e. a combined detergent/disinfectant wipe or solution.

• Follow strict hand hygiene procedures

• Leave vehicle for 30 minutes after cleaning and before further use Resource: Environmental cleaning and disinfection principles for COVID-19



COVID-19 Telehealth Consultations Telehealth consultations can be used to replace face-to-face consultations by:

• Specialists (whether the specialist be in Broome or Perth)

• Allied Health Professionals; and

• General Practitioners.

Specialist Visits

Significant effort should be made to arrange all future specialist appointments by telehealth. WACHS and WA Health use a program named Scopia, which can be used from every computer with video and sound capability. Each clinic will be contacted individually to arrange these. Note: MBS items can be billed by a nurse or AHW sitting in on this consultation. Specifically, the item number 10983 could be utilised.

Allied Health Consultations

Diabetes WA has capability to provide diabetes education to patients via telehealth. Boab health and the Broome hospital allied health department have capability to provide telehealth services. They will be in contact with the individual clinic managers to arrange these clinics.

General Practice Consultations

This is one of the safest ways for our clinics to provide ongoing primary care for our patients. There are new MBS items associated with Telehealth consultations, see Appendix C for details.

A. From the Clinic

Can now be arranged by the use of Microsoft Teams. This program has now been downloaded to each

computer at KAMS remote sites. Search for this program on the computer. If you are unable to find

Microsoft Teams, try to:

1. Restart the computer and search again

2. Log in to Outlook 365 and download from the icon “Teams”

3. Failing this: call KAMS IT Services for assistance

Login details and passwords are the same as those used for outlook 365 and or Microsoft outlook with your

KAMS email/password.

B. From the Patient’s Home –

The patient can be called on their phone by the GP from the comfort of their own home.This service should

be offered to all ATS 4 & 5 patient presentations where possible.

Bookings can be made using an agreed calendar in Mmex. Please check with your clinic manager on the

current clinic process.

https://www.diabeteswa.com.au/manage-your-diabetes/programs-and-resources/diabetes-telehealth-for-country-wa/


Appendix A – Self-isolation definitions relating to COVID-19

There are a number of situations in which people may be required to self-isolate. People who do not comply face a fine of up to $50,000 for individuals and $250,000 for body corporates. This is essential for the health and wellbeing of the community. More information is available at WA.gov.au. You must self-isolate:

• If you have tested positive for COVID-19: you must self-isolate until you have been told you can be

released from isolation

• If you have been tested for COVID-19 and are waiting for your result

• If you have been in close contact with a confirmed case of COVID-19: you must isolate yourself for

14 days after the date of last contact with the confirmed case

• If you arrived into Western Australia by air, sea, rail or road from 1.30pm Tuesday 24 March 2020:

you must self-isolate for 14 days from the date of arrival (some exemptions may apply).

• If you have returned from overseas: you must self-isolate for 14 days after the date of return to

Australia

• If you arrived from mainland China, Iran, South Korea and Italy prior to 16 March 2020: you must

self-isolate for 14 days after the date of leaving that country.

Self-isolation

Self-isolation means you must stay in your home, hotel room, or other accommodation even if you are perfectly well with no symptoms. If you live in a unit or apartment block you must stay in your unit or apartment. You cannot attend public places such as work, school, shopping centres or go on a holiday. Only people who usually live with you should be in the home. Do not see visitors.

• Maintain social distancing if you live with other people (e.g. staying in an isolated room preferably

with a separate bathroom – if available)

• Cover your cough and sneeze with a tissue or flexed elbow, dispose of tissues, and wash your hands

• Wash your hands often, including before and after eating and after going to the toilet, with soap

and water for at least 20 seconds

• Ensure that you do not share household items with other people in your home such as dishes,

towels and pillows.

• Monitor yourself for symptoms including fever, cough, sore throat, or shortness of breath.

• You must stay in your place of isolation and NOT GO OUT, except to seek medical care. You should

call ahead for advice.

If you require urgent medical assistance call 000 and let them know that you are in self-isolation

due to COVID-19.

What does this mean for your family or other people you live with?

Other people who live in your home do not need to self-isolate and can go about their usual activities provided the above precautions are followed. Self-isolation is important for protecting your family, friends and the Western Australian community. Medical certificates are not required for people who need to self-isolate.

https://www.wa.gov.au/government/document-collections/covid-19-coronavirus-state-of-emergency-declarations


Appendix B – Personal Protective Equipment (PPE)

Patient is suspected to have COVID-19

Patient: Surgical mask. Avoid use of nebuliser. Staff: standard, contact and droplet precautions (gown, surgical mask, gloves, face shield or goggles).

Patient is suspected to have COVID-19 and is critically unwell or undergoing an aerosol generating procedure

Patient: Surgical mask (as much as practical given patient condition). Avoid use of nebuliser. Staff: additional airborne precautions as well as standard, contact and droplet precautions (P2 mask, gown, gloves, face shield or goggles).

Resources

The below posters should be displayed in appropriate areas within the clinic. These are available for

download on the KAMS website.

More detailed advice on PPE is available at: Interim advice on non-inpatient care of persons with suspected

or confirmed COVID-19 including use of PPE





Appendix C – Telehealth MBS Item Numbers

GP Telehealth Item Numbers Service Existing item

(Face to Face) COVID-19 Telehealth item videoconference

COVID-19 Telephone items (when

videoconference is unavailable)

MBS Fee

Standard Consultation Items

GP attendance for obvious problem 3 91790 91795 $17.50

GP attendance less than 20 min 23 91800 91809 $38.20

GP attendance at least 20 min 36 91801 91810 $73.95

GP attendance at least 40 min 44 91802 91811 $108.85

Health Assessment

GP ATSI health assessment 715 92004 92016 $215.65

Chronic Disease Management

GP management plan, prepare 721 92024 92068 $146.55

GP team care arrangement, co-ordinate development 723 92025 92069 $116.15

GP contribution to prepare or review a multidisciplinary plan, prepared by another provider

729 92026 92070 $71.55

GP attendance to coordinate a GP management plan or team care arrangements (GPMP review)

732 92028 92072 $73.20

Mental Health

GP mental health consult, more than 20 mins 2713 92115 92127 $72.85

GP (without mental health training) prepare mental health plan, 20-40mins 2700 92112 92124 $72.85

GP (without mental health training) prepare mental health plan, >40mins 2701 92113 92125 $107.25

GP (with mental health training) prepare mental health plan, 20-40mins 2715 92116 92128 $92.50

GP (with mental health training)prepare mental health plan, >40mins 2717 92117 92129 $136.25

GP to review mental health plan 2712 92114 92126 $72.85

Urgent after hours

GP urgent after hours, unsociable (11pm-7am) 599 92210 92216 $155.45

Bulk Billing incentive - <16yrs or Health Care Card 10991 10991 10991 $19.30

Bulk Billing incentive (venerable patients not covered by 10991) NEW 10982 10982 $19.30

Existing Items

Service MBS item number MBS Fee

ATSIHP

Immunisation 10988 $12.20

Wound Care (review with GP first) 10989 $12.20

ATSIHP/Nurse/RAN

Health Check f/up (10 x /year) 10987 $24.40

Chronic Disease f/up (5 x /year) 10997 $12.20

Telehealth Support (specialist/physician/psychiatrist) 10983 $32.90

Midwife/ ATSIHP/Nurse/RAN

Antenatal check 16400 $23.55

Bedside Investigations

ECG (and report) 11700 $27.00

VA &Retinal Photography (diabetic) 12325 $43.20

Point of Care Pathology

HbA1C (screening) (1 x /12 months) 73839 $14.30

HbA1C (diabetic) (4 x/12 months) 73840 $14.45

Urine ACR (diabetic) 73844 $17.30

Hb (Haemocue OR istat) 73802 $3.90

Pregnancy test 73806 $8.65

Pathology bulk billing incentive 74991 $12.00


Appendix D – Patient Liaison Support Officer (PSLO) Role

Contact Details:

Phone 9194 0334

MMex message “Helen Harrison”

This a position that has been created during the COVID-19 pandemic to help with patient co-ordination in

relation to COVID-19 testing. Having patients evacuated from community to Broome for testing has created

additional logistical challenges, creating a need for this role.

This PLSO helps in the co-ordination of:

• Transport (mainly pertaining to transport within Broome and to-from the airport). This is in

combination with clinic based and Broome based drivers.

• Accommodation (by liaising with department of communities after the clinic has placed an initial

request to the Disaster Hotline. This may also involvement of KAMS HR or other agencies where

patients do not qualify for accommodation assistance)

• GP and Nurse Telehealth visits for patients in Broome relating to COVID-19 (this includes an initial

GP telehealth and an ongoing plan for intensive review should patients be positive for COVID-19 or

a close contact and not require admission)

• Medication delivery to patients–on request of the GP, with delivery arranged by Kimberley

Pharmacy Services.


Appendix E– Taking a Nasopharyngeal Swab

Process adapted from PathWest Collection of specimens from suspected cases of COVID-19 in community

settings. Please note: advice and training will be provided by the Kirby Institute for the provision of point of

care testing in our clinics. Where advice differs please follow the Kirby Institutes advice with priority.

1. Perform hand hygiene before donning PPE.

2. Remove the flexible shaft swab from its packaging.

3. Stand slightly to the side of the patient to avoid exposure to respiratory secretions, should the patient

cough or sneeze.

4. Nasopharyngeal samples: Tilt the patient’s head back. Gently insert the flexible shaft nasopharyngeal

swab into one nostril, then gently insert it along the floor of the nasal cavity parallel to the palate until

resistance is encountered. This is approximately half to two-thirds of the distance between the anterior

nares and the ear. Rotate gently for 10-15 seconds, then withdraw, and repeat the process in the other

nostril with the same swab, to absorb secretions.

5. Place the swab into the UTM container, flocked end first, and snap the shaft at the indicated snapping

point, using the rim of the UTM tube for leverage if required.

6. Close the UTM container with the flocked end of the swab inside, discarding the remainder of the shaft.

7. Ensure that the UTM container is closed correctly and is not leaking – the swab is usually slightly bent

within the tube.

Refer to the YouTube video below:


Collection from patients with severe symptoms is not to be undertaken in KAMS clinics.



Appendix F – KAMS Prioritisation Criteria for Point of Care Testing in Remote Clinics

Please also note that any person in Kimberley region who meets criteria for COVID-19 testing will receive

the test either as conventional PCR testing, rapid testing or POC testing. Despite this, not all persons will

qualify for the POC testing available in KAMS clinics.

The following criteria applies to POC testing occurring in KAMS Clinics. If there are any situations where

there is uncertainty about whether a patient meets the criteria, please contact the KAMS Medical Director

for advice. Please note that further sub- prioritisation may be required and clinicians will be updated

appropriately.

• Aboriginal clients of the ACCHO presenting for COVID-19 testing who meet the testing criteria and for whom self-isolation while waiting more than 24 hours for a conventional test result places others at risk of transmission (for example due to social housing which is overcrowded or health hardware inadequate (plumbing, washing machine etc); personal impoverishment means it is not possible to separate individual sets of cutlery/crockery/ towels/sheets; there are major physical or cultural barriers to social distancing effectively within the home). Within this category, the following are to be prioritized:

o Anyone with a concurrent mental health condition that will complicate clinical management

o Any mother with young children o Anyone with a concurrent chronic conditions especially COPD, renal disease or

cardiovascular disease o Anyone over the age of 50 years

• Healthcare workers or staff from a RACF, residential facility, correctional facility or other group setting who are symptomatic, especially when the risk of self-isolation while waiting for conventional PCR test could lead to significant risk of service failure and/or the scope of their likely close contacts could have resulted in transmission to Aboriginal people at risk

• Symptomatic Aboriginal people who are known (or revealed to be) close contacts of a confirmed case

• Requests by the respective local hospital (where relevant) for individual inpatients or patients in ED for whom a rapid POCT PCR result would change management (eg use NIV). This request will be considered by the ACCHO for individuals only and only if also endorsed by the Consultant Public Health Medicine, Regional Physician Lead or Regional Paediatrics Lead. Verbal confirmation by the hospital staff member of this endorsement is sufficient for proceeding but must be followed by an email confirmation. Responsibility for communicating the subsequent result to the patient is to be clarified before proceeding.

• Requests by the respective local hospital (where relevant) for individual inpatients or patients currently in ED for whom the diagnosis of COVID is highly suspected and where the respective local hospital has critically limited inpatient single room capacity and rapid POCT PCR result critically informs evacuation. This request will be considered by the ACCHO for individuals only and only if also


endorsed by the Consultant Public Health Medicine, Regional Physician Lead or Regional Paediatrics Lead. Verbal confirmation by the hospital staff member of this endorsement is sufficient for proceeding but must be followed by an email confirmation. Responsibility for communicating the subsequent result to the patient is to be clarified before proceeding.

• Requests from nearby WACHS-managed primary care clinics for Aboriginal clients of the WACHS-managed clinic presenting for COVID-19 testing who meet the testing criteria and for whom self-isolation while waiting more than 24 hours for a conventional test result places others at risk of transmission. This request will be considered by the ACCHO for individuals only and only if also endorsed by the Consultant Public Health Medicine, Regional Physician Lead or Regional Paediatrics Lead. Verbal confirmation by the hospital staff member of this endorsement is sufficient for proceeding but must be followed by an email confirmation. Responsibility for communicating the subsequent result to the patient is to be clarified before proceeding.


Appendix G – Mmex Template “COVID-19 POC Testing”

To help facilitate good documentation when performing POC testing a template has been created for staff.

This should be used by any staff who are undertaking POC testing. The purpose of this template is to

ensure:

• accurate, consistent and thorough documentation

• accurate clinical coding

• processes are utilised that are consistent with the COVID-19 toolkit.

It is available by clicking “Insert Template” in the progress notes tab and selecting “Covid 19 POC Testing”

and then clicking “Insert”

The template includes the below information. The highlighted red text is to prompt staff and can be

deleted from the notes as appropriate.

Assessment undertaken in isolation room

PRESENTATION

Presenting complaint *record in designated field*:

International travel in 14 days prior to symptom onset?

Travel outside of the Kimberley 14 days prior to symptom onset?

Travel outside of the community 14 days prior to symptom onset?

Contact with confirmed/known case? If so who and when?

Contact with any unwell person with fever or respiratory symptoms?

ASSESSMENT

Signs/Symptoms:

*update smoking history in designated module*

*ensure Indigenous status is recorded in designated field*

Other relevant history:

Examination

*record ATS in designated field*


General Impression:

Temperature:

Respiratory Rate:

Heart Rate:

Blood Pressure:

SAO2 Room Air:

Weight:

Chest auscultation:

Work of breathing:

Other Examination:

Diagnosis/Impression:

INVESTIGATION

-COVID-19 testing approved by Dr (enter Dr Name)

*mmex message to be sent to Dr Casey Barnes to advise of cartridge use*

*record result “COVID-19 – negative” OR “COVID-19- confirmed” in designated field*

*follow KAMS COVID-19 toolkit*

Result: positive/negative/indeterminate. Dr (enter Dr Name) advised of result

Actions:

PLAN

Follow up:

Patient advice provided:

*record diagnosis and outcome in designated field*

Assessment undertaken in isolation room

PRESENTATION

Presenting complaint *record in designated field*:

International travel in 14 days prior to symptom onset?

Travel outside of the Kimberley 14 days prior to symptom onset?

Travel outside of the community 14 days prior to symptom onset?

Contact with confirmed/known case? If so who and when?

Contact with any unwell person with fever or respiratory symptoms?

ASSESSMENT

Signs/Symptoms:

*update smoking history in designated module*

*ensure Indigenous status is recorded in designated field*

Other relevant history:

Examination

*record ATS in designated field*

General Impression:

Temperature:

Respiratory Rate:

Heart Rate:

Blood Pressure:

SAO2 Room Air:

Weight:

Chest auscultation:

Work of breathing:

Other Examination:

Diagnosis/Impression:


INVESTIGATION

-COVID-19 testing approved by Dr (enter Dr Name)

*mmex message to be sent to Dr Casey Barnes to advise of cartridge use*

*record result “COVID-19 – negative” OR “COVID-19- confirmed” in designated field*

*follow KAMS COVID-19 toolkit*

Result: positive/negative/indeterminate. Dr (enter Dr Name) advised of result

Actions:

PLAN

Follow up:

Patient advice provided:

*record diagnosis and outcome in designated field*

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