Standard Operating Procedure (SOP) for Face to Face (F2F) Sessions - in response to Covid-19 Outbreak. Updated: 2.9.22
Covid-19 is a highly transmissible, novel virus and so additional care must be taken to limit the risk of its transmission. Predominantly the disease is passed from person to person through small droplets from the nose or mouth which are produced when a person coughs, sneezes or speaks. These droplets can land on objects and surfaces around the person. People can become infected by breathing in these droplets or by touching surfaces on which droplets have landed, then touching their eyes, nose, or mouth (1).
The objectives of this SOP are:
- To outline how Jenny Drysdale Physiotherapy will deliver physiotherapy assessments and treatment during the ongoing Covid-19 outbreak in the UK.
- To provide a plan to reduce the risk of transmission of Covid-19 The following is based on having reviewed the latest advice and guidelines from both the UK and Scottish Governments as well as the Health Care Professions Council (HCPC), Chartered Society for Physiotherapy (CSP) and Physio First.
Jenny Drysdale Physiotherapy provides physiotherapy services to patients in their own homes as well as remote consultations via Telehealth video calls or telephone.
Contents -As per CSP 7 key factors (2):
1) Legal, regulatory, and professional responsibilities
2) Risk Assessment of the working environment for which you are responsible
3) Infection Prevention and Control Measures
4) Access to Personal Protective Equipment (PPE)
5) “Virtual first” Approach
6) Patient risk assessment and clinical reasoning
7) Patient Consent for treatment
1) Legal, regulatory, and professional responsibilities
- It must be acknowledged that the risk of transmitting coronavirus cannot be completely eliminated. The aim of this SOP is to reduce the risk to the lowest practical level by implementing preventative measures.
- Risk assessment must be carried out in each individual case and this will include following the CSP guidance on face to face decision making (3)
- Risk assessment must be documented in each individual patient’s case notes as this will be patient specific. With that in mind, the therapist’s duty of care (4) must be prioritised and this will outweigh a patient’s desire for F2F treatment if it is believed that that patient’s level of risk outweighs the potential benefits of a F2F session.
- All decisions with regards to face to face consultations will be discussed in full with the patient.
- Jenny Drysdale Physiotherapy will continue to monitor changes to advice and guidance from both the UK and Scottish Governments and the HCPC and CSP.
- Track and trace:
- the therapist will report any symptoms appropriately and report for testing within 3 days as per Scottish Government testing guidelines if symptoms appear. (9)
- If symptoms appear, all face to face sessions will cease and therapist will self-isolate as per Government guidelines.
- Patients must be made aware that if contacted by track and trace teams and asked for information of those they have been in contact with, the therapist is obliged to pass on details of those patients who have been seen face to face – patients must consent to this before face to face treatment can be carried out.
2) Risk assessment of the working environment for which you are responsible
Face to face consultations with Jenny Drysdale Physiotherapy are carried out in patient’s homes and so control of the area is limited, however, the following requests will be made of clients:
- Face coverings to be worn by patient throughout session were possible, if a patient is unable or unwilling to wear a face covering, further protection in the form of a visor or goggles should be considered by the therapist
- The room for treatment should be selected for its ease of access from entry into the house and should have ample space to allow good ventilation and for 2m physical distancing to be observed as much as possible during the session. Where possible, and privacy can be maintained, an open window will be encouraged.
- Except in cases of children under the age of 18 and vulnerable groups where chaperones are required, no other people should be present in the room chosen for treatment. Chaperones will be asked to comply to 2m physical distancing as far as possible and will also be asked to wear a face covering.
- Patients are to observe hand hygiene before sessions based on the advice on the NHS website on hand washing technique: https://www.nhs.uk/live-well/healthy-body/best-way-to-wash-your-hands/. They will also be advised to observe this post session.
- Cleaning of touched surfaces will be encouraged following the appointment.
3) Infection Prevention and Control Measures
- Measures as above for patient and patient setting.
- 2m physical distancing should be maintained at all times in which direct contact is not required.
- PPE will be worn by the therapist for all face to face sessions as per UK wide advice (6). This will consist, at least, of: Face mask (fluid resistant, type IIR), Gloves.
- Use of aprons will be risk assessed on an individual patient basis depending on their level of risk.
- All PPE will be patient specific.
- Face shields will be available if risk of AGP is considered, but not used routinely.
- PPE will be donned and doffed in order advised by Health Protection Scotland (HPS) (5).
- PPE will be donned outside of the patient’s home directly before entering, after use of alcohol-based hand rub (ABHR) (7).
- PPE will be doffed, with the exception of face mask, just before leaving the patient’s home – the patient and all other household members will be asked to maintain a 2m distance from this point onwards. ABHR will be used immediately after removal and again once therapist has returned to car (7).
- PPE will be double bagged, dated and patient will be advised to set aside for 72 hours before disposal in their municipal waste (8). •
- Face mask will be removed after leaving patient’s home, double bagged, set aside for 72hrs before disposal.
- Hand Hygiene:
- Whilst away from site (therapist’s own home) ABHR will be used as above pre and post PPE.
- Therapist will carry out hand hygiene thoroughly with soap and water prior to leaving own home and on return, which will be between each client as far as possible.
- Hand hygiene will include bare arms from elbows down and inclusion of forearms and elbows in washing.
- Patient’s will be asked to carry out their own hand hygiene pre and post session. •
- No wrist jewellery or watches are to be worn by therapist.
- Hair must be tied up away from face and off clothes
- Equipment:
- Equipment, aside from plinth, will be carried in a wipeable, hard shell case.
- Patient contact with equipment will be minimised, any equipment that comes into contact with patient will be disinfected before being placed back into hard shell case.
- Plinth will not be stored in usual fabric case
- Plinth will be wiped fully with combined detergent and disinfectant wipes at the beginning and end of each session.
- All patients must complete a Covid-19 Screen before F2F consultation is confirmed and again immediately before their session – this may be online, or carried out verbally in cases where online forms are not appropriate – the screening type will be documented.
- Physiotherapy sessions may involve periods of contact closer than 2 metres – if this close contact is agreed by therapist and patient. PPE must be worn by therapist throughout.
- Uniform will only be worn during sessions and travelling between therapist’s own home and sessions. Uniform will not be worn in other areas between sessions such as shops.
- Therapists will carry out twice weekly lateral flow testing.
4. Access to PPE
- Jenny Drysdale Physiotherapy will provide all their own PPE.
- We ask that patients provide their own face covering.
5. “Virtual First” Approach
- As per current guidelines, a virtual triage will be carried out with all patients prior to their first face to face session – for new patients this should be a telephone or video call and for patients that are representing having been treated previously during the pandemic, this can be carried out with confirmation of no change via screening forms.
6. Patient Risk Assessment and Clinical Reasoning
- The CSP flow chart will be utilised in deciding if someone should be offered a F2F session (3), alongside clinical judgement, taking into account age, underlying conditions, severity of condition, etc., but always erring on the side of caution.
- The aim of risk assessment will be to establish if risk outweighs potential benefits of a F2F session, in which case management should be remote.
- Risk assessment will be individual to each patient and their circumstances and must be documented.
- Jenny Drysdale Physiotherapy will involve patients in discussions over the rationale behind face to face treatments and patients must be made aware of risks associated with this approach to allow them to provide informed consent.
7. Patient Consent for Treatment
- All patients will be individually screened and risk assessed prior to carrying out face to face treatments.
- If face to face treatment is indicated, patients will be asked to complete a screening procedure which will be either an email form or a verbal discussion prior to treatment. This must be completed satisfactorily before a face to face session can be carried out.
- The patient will then be asked to complete a further screening on the day of their face to face session, again either via online form or verbally.
- All patients who are being offered face to face sessions will be asked to read a copy of this SOP – this, alongside detailed discussion with the therapist, will be used to ensure patient provides informed consent.
- The NHS guidance on high risk and moderate risk will be acknowledged and covered with each patient to ensure risk can be managed as appropriate (11).
- Delivery of screening and patient consent to treatment specifically regarding coronavirus will be documented.
REFERENCES
1. World Health Organisation Q&A on Coronavirus: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-coronaviruses <Accessed: 11/06/2020>
2. CSP Guidance on Face to Face or Remote Consultations https://www.csp.org.uk/news/coronavirus/clinical-guidance/remote-or-face-face-consultations/implementing-guidance <Accessed: 11/06/2020>
3. CSP Guidance on deciding if face to face consultations are appropriate https://www.csp.org.uk/news/coronavirus/clinical-guidance/remote-or-face-face-consultations/flowchart <Accessed: 11/06/2020>
4. CSP Guidance on Duty of Care https://www.csp.org.uk/publications/duty-care <Accessed: 11/06/2020>
5. Health Protection Scotland Guidelines for donning/doffing PPE https://www.hps.scot.nhs.uk/web-resources-container/covid-19-the-correct-order-for-donning-doffing-and-disposal-of-personal-protective-equipment-ppe-for-healthcare-workers-hcws-in-a-primary-care-setting/ <Accessed: 11/06/2020>
6. UK wide PPE Advice https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/879111/T4_poster_Recommended_PPE_additional_considerations_of_COVID-19.pdf <Accessed: 11/06/2020>
7. HPE Advice re PPE in home care settings https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/888998/Domiciliary_guidance_01_06_2020.pdf <Accessed via UK Gov website: 11/06/2020>
8. Physio First and CSP guidance on PPE disposal in community setting https://www.physiofirst.org.uk/resources/coronavirus-covid-19.html <Accessed: 11/06/2020>
9. Guidelines on getting tested in Scotland https://www.gov.scot/publications/coronavirus-covid-19-getting-tested/pages/test-results/ <Accessed 11/06/2020>
10. CSP Remote delivery service options https://www.csp.org.uk/news/coronavirus/remote-service-delivery-options <Accessed: 11/06/2020>
11. NHS – Who’s at Risk Guidance https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk/whos-at-higher-risk-from-coronavirus/ <Accessed 12/06/2020>