North Yorkshire Physiotherapy Covid 19 Policy
This policy has been produced following the guidelines produced by the CSP in collaboration with Physio First, which followed the Government’s announcement of the next stage of the Covid 19 Pandemic Response on Sunday May 10th 2020.
In summary, there is a continued prevalence of COVID-19 and risks associated with transmission and exposure, and we have a continued duty of care to manage the safety of our patients and staff as best as possible and mitigate, as far as possible, the risk of harm and to continue to abide by the HCPC and CSP Professional Standards and work within our legal, regulatory and professional frameworks.
Our duty is to comply with Government social distancing and shielding directives and mitigate as far as reasonably practicable the risk of transmitting the disease to patients and the wider general public, particularly to those in the vulnerable and extremely vulnerable categories.
We also have a responsibility to protect our business and itsreputation as well as that of the profession.
The CSP predict an increasing demand for the need for physiotherapy from the general public as time goes on and there may be a belief that we will re-open as “normal”. However, we must consider all aspects of risk and maintain safety as much as possible – to ourselves, to our staff, to our clients and to the general public – including those who also work in the building.
Procedure for Face To Face Appointments
All new requests for appointments must be met with a video consultation, or telephone triage, in the first instance. The key factors as described by the CSP (file:///C:/Users/Kate%20T/Downloads/CLEANF2Fdoc.pdf) must be considered. These factors are:
• Legal, regulatory and professional responsibilities
• Risk assessment of the working environment for which you are responsible
• Infection prevention and control measures
• Access to personal protective equipment
• ‘Virtual first’ approaches
• Patient risk assessment and clinical reasoning
• Patient consent for treatment
If red flags are identified, local procedures and best practice must be adopted
If clinician deems benefits of a face to face appointment outweigh the risks of Covid 19 transmission and the condition cannot be managed virtually, a face to face appointment can be offered, having followed the CSP’s flowchart (https://www.csp.org.uk/system/files/documents/2020-08/001750_COVID-19_Opening%20up%20healthcare%20flowchart_V8.pdf). This is based on the clinician’s autonomous clinical reasoning and taking account client preference.
The reasoning for a F2F (face to face) appointment must then be thoroughly explained to the client, alongside the risks of the contact to enable the client to make an informed decision as to whether to attend the clinic. All measures that are to be put in place must be explained to the client, as per below.
While public information on COVID-19 is extensive a clinician should not assume that a patient understands:
• the mechanisms and risks of transmission and exposure
• the nature of close patient contact during a physiotherapy consultation
• the level of PPE (personal protective equipment) that a clinician will be required to wear
• the infection prevention and control measures that must be taken
PPE that must be worn is set by Public Health England guidelines (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/fil
e/910885/COVID-19_Infection_prevention_and_control_guidance_FINAL_PDF_20082020.pdf) but should at the very least consist of a plastic gown, gloves and a fluid repellent surgical mask. Further PPE is dependent upon the nature of the treatment to take place and the likelihood of production of aerosols. The vast majority of our clients will fall into the Medium Risk pathway. The CSP has confirmed that the use of eye protection as required in the PHE guidelines can be risk assessed on an individual basis (https://www.csp.org.uk/news/coronavirus/clinical-guidance/ppe-faqs).
Infection control measures consist of:
• client to stay in their car until called into the clinic by the treating clinician
• clinician to open all doors for the client whilst wearing PPE or reception staff whilst wearing a face mask
• clients use hand sanitiser or wash their hands on entering the clinic and on leaving
• all equipment that has come into contact with the client to be cleaned with Cliniwipes once they have left
• the avoidance of use of pillows as much as possible – if they are used the pillow case is to be immediately replaced and any towels used to be disposed of in the laundry basket
• the correct disposal of PPE – bagged in a clinical waste bag and collected by Business Waste/double bagged for 72 hours before disposing of as municipal waste
• Contactless payments as preferred method of payment
• All surfaces that a client or chaperone has contacted to be cleaned using clinic wipes
• Clients to wear face covering in the reception area and on entering and leaving the building
• Clients to remain at 2m apart when in the reception area
Prior to all F2F appointments the client must be screened for any symptoms of Covid 19 (temperature, persistent dry cough, change in taste or smell) they are displaying or have been in contact with anyone displaying symptoms in the last 10 days. If so, the client must NOT attend the appointment.
A risk assessment of the clinic environment has been completed and must be adhered to.
For domiciliary visits, the risk assessment for this scenario should be adhered to.
Documentation must include:
• clinical reasoning for F2F appointment
• that all risks of attending have been explained to client and discussions taken place
• shared decision making
• screening of the client re Covid symptoms has taken place
• all precautions taken to mitigate risk eg what PPE was worn
• informed client consent has been gained with reference to Covid 19 transmission
• informed consent for Contact and Trace
An electronic registration form is emailed to all clients, if possible, prior to an initial appointment and completed prior to attendance. This form will include consent to contact and trace and understanding of the risks of exposure to Covid with a F2F appointment. If a client has been unable to complete this form, a paper copy will be requested to be completed prior to their appointment commencing.
Appointment confirmations and reminders are emailed to every client with a registered email address to remind them not to attend if they have any symptoms of Covid or have been in close contact with anyone with symptoms of Covid in the previous 10 days. It will also remind them to wear a face covering.
Assistance from Reception and Administration Staff
All reception staff are required to have understood the Cleaning Protocol and signed it to assist clinical staff in cleaning the clinic room and reception area following any contact from clients.
NHS Contact and Trace
All clients are requested consent to pass details to NHS Contact and Trace as required.
There is a QR Code available for use by visiting members of the public and clients to use if they wish to check in for NHS Contact and Trace.
It is recommended that clinical staff turn off Blue Tooth if they have the NHS Contact and Trace App on their phone to decrease the likelihood of being contacted by NHS Contact and Trace for contact with a client who later tests positive. There are some scenarios being reported of inconsistent advice for clinical staff who have treated a person who has later developed symptoms and the advice they have been given regarding isolating. If a clinician is contacted by NHS Contact and Trace via the app it can be confirmed that the contact is due to a social setting and not a work one.
If a clinician is contacted by NHS Contact and Trace and advised to isolate due to close contact with a client, it is advised to ensure it is understood that the clinician was treating as a regulated health professional and was wearing the full PPE as described by PHE for the management of that client. This should avoid the need to isolate.
Updated 6th June 2020; Updated 29th September 2020