North Coast Area Health Service Facility Pandemic …...2020/03/17 · Hastings Macleay Network...

Hastings Macleay Network COVID-19 Pandemic Plan

Created March 17 2020 of 16

Mid North Coast Local Health District Hastings Macleay Network COVID-19 Pandemic Plan

2020

Kempsey District Hospital

Purpose To provide a process to contain the disease by decreasing the rate of transmission though;

Rapid identification and isolation

Testing

Diagnosis

Contact tracing

Data collection and analysis

Core Actions

Patient screening

PPE

Isolation

Assessment of patient

Specimen collection and rapid transport to reference laboratory

Notification to Public Health Unit

Treatment

Education

Hospital Response Level 1

Establishment of screening station at the entrance to the ED to identify patients and accompanying persons that meet the case definition

Identification of a specific ward/s for suspected COVID-19

Education and training of staff regarding PPE

Level 2

Establishment of a COVID-19 screening clinic

Level 3

Quarantining and staffing escalation beds in identified ward

Level 4

Mass Admission of Pandemic Patients



LEVEL 1 UNIT ITEM DETAILS RESPONSIBILITY

Hospital wide Education of Staff regarding Personal Protective Equipment (PPE)

All front line staff are to attend training on the correct use of (PPE) and undertake a competency assessment

A register of staff who have attended the training is to be recorded in HETI

Aim of at least 90% of front line staff trained and deemed competent in the correct use of PPE

Identification of train the trainers to roll out PPE education

Clinical Nurse Educators main focus be on training staff correct competency of PPE

ED NUM, CNUM Ward NUMs, ED Director ED CNE Ward CNE’s Nurse Educators CNC Infection Control

Hospital wide Routine Staff Flu immunization clinics

Staff immunization clinics will commence in mid-April 2020

Staff Health

Hospital wide Non-essential Meetings

Every attempt should be made to conduct all meeting by skype/teleconference only in order to contain the spread of COVID-19

Hospital wide Communications All communication regarding COVID-19 must be sent to the General Managers office prior to being used within the network.

Signage must be approved by the District Media Unit

General Manager, District Media Unit

Hospital wide PPE All staff conducting regular care for a patient must wear contact and droplet precaution PPE

This PPE consists of; Gloves Protective eye wear Surgical mask Gowns Alcohol hand rub

PPE is to be worn during assessing or providing direct clinical care patient when within one (1) metre of patient

All staff conducting aerosol generating procedures are to use airborne PPE

This PPE consists of; Gloves Protective eye wear P2 mask Gowns Alcohol hand rub

Aerosol generating procedures include, NIV/CPAP, HFNP, Nebulizers, Swabbing, Intubation, air bag mouth ventilation, bronchoscopy

All staff

ED PPE A PPE kit lives at Triage ED NUM



UNIT ITEM DETAILS RESPONSIBILITY

The Kit at Triage contains;

Surgical masks x 25

P2/N95 (duck bill) x 25

20 x gowns impervious

1 container of cleaning wipes (alcohol based);

Gloves 1x box large/ medium/small

1 x pkt of daily wipes

3 x goggles / face shields and frames

2 x digital thermometer

2 x large plastic bags (rubbish)

2 x hand washing solution (ABHR)

viral swabs;

biohazard specimen bags;

clear plastic bag to place collected & sealed specimens into for transportation to Pathology

Temperature covers

Hospital Wide Stores A centralised ordering process has been implemented by the MoH and HealthShare to ensure continued supply during COVID-19 period.

o surgical masks (level 2, level 3, o faceshield and N95 inclusive

o eye shields

o goggles

Ordering of these items is to be coordinated through Anthony Altea. Identified individuals within your facility/service must forward orders to the Clinical Products Coordinator (CPC) for processing, as described below.

The ordering process is as follows:

1. One order per week will be placed for the entire LHD.

2. Orders will only be accepted on the template (appendix 5).

3. Orders must include the HIMF number, Cost Centre and quantity of item required. Orders will not be processed above your min-max levels.

4. The order template must be returned to the CPC, no later than 14:00hrs (2pm) each MONDAY, so as to ensure delivery to stores each Thursday.

5. Orders will be distributed by stores in the usual manner.

ED Triage Screening Station

A screening station will be established at the front entrance of the Emergency Department,

DON, ED NUM




All patients presenting to Emergency are to be asked “screening” questions.

All patients who meet case definition will be asked to don a surgical mask and wash hands prior to entry

Staff working at this station are to wear a surgical mask and protective eye wear

Those accompanying patients with a high index of suspicion are to be given a mask e.g. parent accompanying a child

As per Flow Chart 1 o if the patient is identified as being

unwell at the pre-screening station, then they will be escorted by the triage nurse in full PPE to the designated isolation room

o If the patient is deemed to be well, they will be escorted to the safe assessment room/ interview / asked to wait outside

ED Triage As per Flow Chart 1

All patient presenting to triage will be asked COVID-19 Influenza screening questions which have been built into the Triage form

All patients being seen for suspected COVID-19 will need to select COVID-19 as their ‘presenting problem’ in FirstNet

Those patients who meet the current case definition and are assessed by the triage nurse as well, not likely to require an admission will be escorted to the Safe Assessment Room (SAR) for medical assessment

Those patient who are assessed as being unwell and require likely admission will be transferred to the designated Isolation room as per Flow Chart 1

Communication between triage and the TL and Senior Medical officer must occur immediately once a suspected COVID-19 case is identified

ED NUM/ TL/ ED Director

FW COVID19

added to presenting problems list today.msg

ED Clerical All patient details must be updated including;

Demographics o Medicare Card Details o Care Details o Contact 1 & 2

Financial Classification

Clerical /ED NUM




o Health Fund o General practitioner

Clerical staff to have limited access to patient/s. FIRSTNET entries to be attended

Medical records to be kept outside the patients room until advised otherwise

ED Isolation Patients not to be cohorted until confirmed diagnosis

If the patient presents with a positive COVID-19 diagnosis or meets the case definition for COVID-19 they are to be moved ASAP into a designated isolation room (ED MH ISO/ Paeds area (x4 rooms))

If a child requires isolation, (one) 1 family member may be nominated to stay with the child to minimize the exposure to other family members. The family member should be in droplet level PPE

DON, AHNMs, NUM

ED Diagnostic testing

If a patient meets the current case definition as her the MOH, then a sample must be collected ASAP.

Viral swabs are to be taken from the right and left nostril as well as throat swab

Swabs are to be sent to directly to the hospital pathology department

Swabs are to be undertaken by a person assessed as competent with airborne PPE and perform the swabs

Request forms and swabs are to be labelled prior to sample being taken;

Information on the request form should include;

Test requested – COVID -19

Specimens collected – throat & nose swabs

Clinical history including; clinical signs & symptoms; travel history that meets the current case definition

If a healthcare worker – identify this on form so the tests will be prioritized

Once the sample is collected the swabs are to be placed into a biohazard bag and sealed

The sealed biohazard bag is to be placed into a clear plastic bag for transporting to Pathology

AHNMs to organise both in and after hours

Hospital wide Treatment There is no identified treatment for COVID-19 at present

Supportive measures

Aerosol generating treatment must be avoided to reduce the risk of spreading the disease. These include;

MOH, DMS infection control




Nebulized medications

NIV/CPAP

HFNP

ED Discharge from the ED

If a patient meets the criteria for COVID-19 testing, however is clinically stable and doesn’t require admission, they may be discharged home to self-isolate once their swabs have been collected

Pathology lab staff keeping spreadsheet of all tests performed

If the diagnostic testing produces a positive result for COVID-19, the patient will receive notification from the Public Health Unit

If the patient is COVID-19 negative, they will receive notification from the ED Medical staff

PHU – postitive ED NUM – negative

ED Admission to Hospital

As per Flow Chart 1

If the patients require admission to hospital as they are unwell and meet the current case definition

The patient is to be admitted under the physician of the day / transferred to PMBH when required

As per the policy the patient does not require a medical register review in the ED, and the ED FACEM is to contact the admitting team to inform them of admission

The ED TL must notify the Nurse Manager immediately and the patient must be prioritized for transfer to the ward

The staff tracking log must follow the patient to the ward

To be developed by MOH and Public Health and distributed to ED via Public Health.

Hospital wide Staff tracking Log The staff tracking log (appendix 5) must include;

Patient identification

All columns completed

Once the patient is discharge from hospital the staff tracking Log must be scanned and emailed to the Infection Control CNC [email protected]

All staff in contact Infection control

Hospital Wide Transfer from ED to ward

When a patient is being transferred to an inpatient ward the HSA’s must DON Droplet and contact precaution PPE

HSA’s

Hospital wide Cleaning of room/cubicle

Cleaning of Room / Bay: In Hours

o Notify Cleaning staff member of suspected and / or COVID-19

o Undertake droplet and airborne precautions

Environmental services

mailto:[email protected]




o Two Step Clean require with Chlor Clean tablets.

o Escalate any cleaning delays to Environmental Cleaning Services Manager on 23699

After Hours o Notify Team Leader of cleaning

required as soon as practical; o Undertake droplet and airborne

precautions o Two Step Clean require with Cholr

Clean tablets.

Hospital wide Linen Treat all linen as per normal

Hospital wide Waste Waste as per normal waste streams

All Sharps Containers removed from rooms and bays transported to disposal room in a sealed and lock state, these receptacles must be wiped down with Clinell Wipes

Hospital Wide Patient Transfer to a higher level facility

Patient transfer to a higher level facility that are COVID-19 positive is to occur only:

If clinical condition deteriorates beyond the level of care offered at KDH

This will usually be PMBH

In the instance were transfer occurs, the PHU is to be advised

Patients are to be prepared as per usual transfer procedure

Staff will follow the current process for transfer/retrieval

Once patient is transferred, the results of Pathology specimens/request, are to be sent to the receiving hospital/GP

-Referring MO -Receiving Hospital -Medical physician in charge of case

Hospital Wide Capturing financial cost

All expenditure will be tracked through the submission of the HMCN COVID -19 expense tracking schedules, project code and facility cost centers. Supporting documentation will need to be supplied.

MOH will only recognise expenditure against this project code: P10246. If you are unclear on how to use this code when raising orders, reach out to your finance lead.

In addition to the project code use the cost centres below to record expenditure where possible:

o Cc 711332 Kempsey Funding recoveries including disasters

o Cc 711342 Wauchope Funding recoveries including disasters

o Cc 711492 Port Macquarie Funding

Managers, Finance, all managers

RE HMCN COVID

19 Expense Tracking.msg




recoveries including disasters

All expenditure is to be recorded on the “HMCN COVID -19 expense tracking schedules”. This will be used to reconcile expenditure to the cost centre and project codes.

Completed “HMCN COVID -19 expense tracking schedules” are to be emailed to [email protected] at the end of each working week (Sunday). Please note the date period on the document.

MOH require supporting documentation as evidence. This evidence could be made up of quotes, invoices, staffing sign off sheets for training etc. These are to be forwarded to [email protected] in conjunction with the “HMCN COVID -19 expense tracking schedules” at the end of each working week (Sunday).

Hospital wide/ Community & Allied Health/physical resources

Outpatient Clinics All outpatient clinics on site at KDH will commence the COVID-19 screening questions. If the patients answer ‘yes’ to the screening questions and are symptomatic then that patient will be asked to defer their appointment o Ante-natal Clinic o Ante-natal classes o Pre-admission Clinic o Allied Health o Wound Clinic o Paediatric clinics o Out-patient clinics o Any Other clinics

Theatres Pre-admission clinic

All patients must be screened for COVID-19

If the patient answers ‘yes’ to the COVID-19 screening questions a discussion must occur regarding the urgency of the surgery and the possibility for re-scheduling in consultation with bookings and the surgeon

Theatres Theatres Patients are contacted the day prior to surgery

If the patient answers ‘yes’ to the COVID-19 screening questions a discussion must occur regarding the urgency of the surgery and the possibility for re-scheduling in consultation with bookings and the surgeon






LEVEL 2 UNIT ITEM DETAILS RESPONSIBILITY

ED COVID-19 Screening clinic

A COVID-19 Screening clinic a.k.a. ‘Fever Clinic’ will be set up utilizing the ICCC

Purpose: The purpose of the COVID-19 screening clinic is to redirect patients from the ED and perform the diagnostic testing for COVID-19

Flow is as per Flow Chart 2

The Governance of the Screening clinic will sit with Community Health

Communication to the community will be coordinated through the Media Unit and PHN

Appropriate and approved way finding signage will be put up for patients to ensure clear directions

If patients present to the ED and they answer ‘yes’ to the pre-screening questions, they will be sent immediately to the COVID-19 Screening clinic during opening hours if appearing well

Patients in the COVID-19 Screening clinic must remain within this dedicated space or outside and not be allowed to wander within the hospital

If patients are deemed to be unwell and require admission to hospital, they are to be sent back to the main ED after a phone call liaison with the ED admitting officer or Team Leader

If a patient’s condition deteriorates whist in the COVID-19 Screening clinic and requires immediate medical attention the Registered Nurse must call a MERT as per the CERS policy

Equipment requirements;

o O2 o Suction o Access to a resuscitation Trolley o Phone o Duress buttons o Workstation on Wheels o Desk o Portable vital signs monitor o Temperature monitor

Staffing requirements; o Dedicated Nursing staff (1

Registered Nurse proficient in collecting nasal and throat swabs)

o Dedicated Medical Officer o Dedicated Administration officer

Community Health /DDON




o Dedicated Cleaning Housekeeping o Shared Security

Environmental requirements o Dedicated handwashing facilities o Dedicated toilet o Dedicated clean utility and

separate doffing space

Consumables o Viral swabs o Droplet, Contact and Airborne PPE o Tissues o Hand gel

Patient discharge pack o Information handout o 1 x surgical mask

Hospital wide Outpatient clinics Consider type of clinic and alternate methods of delivery

Community and Allied Health manager

LEVEL 3 – UNIT ITEM DETAILS RESPONSIBILITY

Operating Theatres

Reduce the number of elective Operative Theatre cases.

Theatre management



LEVEL 4 - Mass Admission of Pandemic Patients


Hospital wide Disaster Control Centre

KDH activates the disaster control center KDH Disaster Control Team

Hospital wide KDH commences Hospital Lock Down

Police presence established as required

Patients arriving by Ambulance are to be assessed in the Ambulance prior to being offloaded;

Ambulance to advise KDH ED in advance if patient ill to allow set-up to receive patient.

All elective Operating Theatre cases to be cancelled only Emergency cases performed

Close Observation Unit (COU) to be evacuated as demand warrants (patients to be discharged and/or redirected to available other ward beds. Beds not to be filled by noninfectious patients

Consider surge capacity identified onsite as required

Staff providing direct clinical care to infectious patients to have meal breaks in designated meal areas, away from general public

Hospital wide Additional Staff

Mental health to be contacted >18 years of age 0447437073 < 18 years of age 0407261516

Security HSA to be at screening station as required

Need to increase clerical support by 1 staff member 7/7 for night duty

Hospital Wide Consider contacting Public Health Unit / HSFAC PHU 0439 882 752 HSFAC 0467 793 013

Network wide Defer to HMCN Pandemic Plan / PMBH

References

Admission, Consultation and Escalation Process at PMBH Emergency Department HMCN Clinical Emergency Response System (CERS) HMN-GH-CP-028 http://mnclhd/pd/Lists/Clinical Emergency Response System (CERS)

http://sp.int.ncahs.net/sites/mnclhd/pd/Lists/FullIndex/DispForm.aspx?ID=5464&Source=http%3A%2F%2Fsp%2Eint%2Encahs%2Enet%2Fsites%2Fmnclhd%2Fpd%2FPDPages%2FGlobalView%2Easpx%3FFilterName%3DKeywords%26FilterMultiValue%3D%2Acer%2A%26View%3D%7B3506AC0F%2DFC44%2D4519%2DACE4%2D3956612E31EB%7D%26FilterField1%3DDocType%26FilterValue1%3DPRO%26FilterField2%3DScope%26FilterValue2%3DHMN



Appendix 1 - FLOW CHART 1: PMBH COVID-19 PATIENT FLOW PROCESS



APPENDIX 2 - Flow Chart 2: KDH COVID-19 PATIENT FLOW PROCESS with COVID-19 SCREENING CLINIC



APPENDIX 3 – Kempsey District Hospital: Single Rooms / Negative Pressure Rooms

Katie to add



Appendix 4 – Staff tracking log



Appendix 5- Stock ordering Template

North Coast Area Health Service Facility Pandemic …...2020/03/17 · Hastings Macleay Network...

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