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Pandemic Return to Service Considerations and Risk Matrix May 10, 2020
PREAMBLE CONSIDERATIONS
This document is intended to offer health care service providers in the mental health and addictions sector helpful, but non-prescriptive guidance pertaining to pandemic risk determination and related considerations and responses. The framework is purposely nimble and adaptable for use and should be personalized accordingly. In that vein, it invites decision-makers to consider the WHAT but not necessarily the HOW of risk assessment and response in a pandemic context.
PRINCIPLE CONSIDERATIONS
1. The health and well-being of our staff teams and the individuals we serve are our utmost priority. It is understood that the interests of these two groups can sometimes be perceived to be as competing (e.g., access to service versus mitigating the risk of an internal outbreak).
2. In the context of a pandemic response, we accept the responsibility to do all we can to mitigate the risk of community spread.
3. Our decision-making and related actions for the direction forward should be evidence-informed, based on available best practices, and aligned with governmental guidance.
STRUCTURE / HOW TO USE DOCUMENT
Service Area Criteria influence the level of risk determination.
Parameters will vary by organization/program and should be adjusted as needed.
Levels of Risk are best viewed as a continuum as opposed to distinct categories. Overlap between risk levels are to be expected, and organizations may have different risk thresholds. As well, identical circumstances can result in different risk determinations by organizations as specific LIKELIHOOD and IMPACT can vary.
Personalize sections to your organizational environment, such as:
a. Inserting links to relevant legislative orders and/or legislation (i.e. Federal, Provincial, Ottawa Public Health)
b. Inserting links to sector-specific guidance documents (e.g., residential, outpatient, community-based mental health, home visits, hospital etc.)
c. Inserting links to relevant standards of practice/professional obligations (e.g., professional colleges)
d. Insert links to agency-specific policies and procedures (e.g., PPE, HR, etc.)
Scenario Planning is an important way to use these documents and walk through risks and assumptions in this very dynamic pandemic situation. Different scenarios and organization specific assumptions can be developed and considered within these tools to help organizations prepare for moving between service levels.
Tools Section: The following bullets describe three tools built for your consideration. Examples of the tools with context are within this document, and separate versions are provided as working documents for your organization to adapt, as needed.
Decision Tree below provides questions for you to consider as you move through different levels of service provision on the accompanying matrix. Government guidelines, healthcare provider colleges, and your own organizations risk management considerations are all important in determining next steps.
Levels of Service Matrix provides specific criteria and parameters per service level to help determine the new normal and three associated restricted levels of service. This is another tool to customize for your own circumstances. The decision tree and matrix can work together for each service level, as different parts of the organization move through the matrix. ie. Different services will most likely be at different levels on the matrix, depending on the circumstances.
Risk Management Framework provides a method for an organization to review and score likelihood and impact of risks, which can give focus to risk mitigation efforts. The first section is a detailed review of the type of risk, mitigation and overall residual risk. The second graphic is a scorecard or heat map to provide a view of the collective risks.
L evels of Restriction – CoVid-19 pandemic planning
N.B. - Under all closure conditions individuals with symptoms or close contact with anyone known to be infected with
Instructions This decision matrix was created in response to the Covid 19 epidemic and the need for a
successive range of measures and restrictions designed to provide optimum safety for staff and clients. Three levels of restriction (consistent with the Province of Ontario ‘Reopening framework’) are proposed. Level 1 is the most restrictive and level 3 is the least restrictive set of expectations beyond ‘new normal’ conditions.
The agency can use this format to determine criteria to be considered in decision making, identify critical categories of responses that can be adjusted, and create specific guidelines to be implemented at various levels of restrictions. Each service type (work unit, service architecture, modality) would be expected to have its own unique set of criteria, benchmarks, protocols.
Criteria would be identified and would be considered in determining how the inherent risks and current guidelines on which decisions would be made. While agencies can identify their own unique set of criteria these would likely include government policies, professional standards, local conditions, etc. Critical changes in benchmark criteria that would lead to lessening restrictions can be identified by the agency/service in advance.
Response categories are defined as the various aspects of the work and workplace that can be adapted to meet the adaptations called for by the level of restrictions and should be considered for planning purposes.
Agencies would complete the body of the table with more detailed guidelines outlining how specific protocols and measures would be established appropriate to each level of restrictions. These can be prepared in advance and confirmed as implemented. Information contained in the body of this matrix is for example only and should be amended as needed by each organization and applicable to each service area. Furthermore, the decision tree document can assist in deciding when to move between different service levels.
Levels level 1 level 2 level 3 Normal Access Heavy limits Moderate limits Light limits Ongoing limits
Criteria
Prevalence of CoVid-19 Unknown/ growing Growing known Stable, known Stable, known, lowGov’t orders Comply Comply Comply System load Full Near full Low LowTreatment/ Vaccine Not available Not available Limited
availabilityAvailable
Testing Unavailable when needed
Available on site, or accessible in community
Available on site
Widely available
Levels level 1 level 2 level 3 Normal Access Organizational rules and obligations
comply Comply Comply Comply
Professional standards comply Comply Comply Comply Service area #1: Office operationsConsiderations Building access – staff Only pre-approved Limited entry,
drop-in max=5Max = 10 with screening at door;checked in
Unlimited entry with sign-in. Self-screening for symptoms
Unlimited entry,Self-screening for symptoms
Building access – clients none Physical distancing 2m. By invitation only
Screening at door
Unlimited entry
Stair/elevator access
Elevator to basement only; stairs closed
Elevator to basement open; to 2nd and 3rd by fob.One way stairs.
Elevator to basement and second open, 3rd by fob
Elevator to basement and second open, 3rd by fob
Concierge On site – deliveries On-site deliveries and distribution;check staff in/out (end-of-day walk around)
On-site, deliveries and distribution; check people in
Not needed
Work from home Everyone, except essential/occasional on siteHome office support
All, limited scheduled access, home office support in place
Occasional work at home; no special home office supports
As required;no special home office supports
Kitchens Kitchens closed Limited access, 1 at a time
Limit 4 at a time
Unrestricted access
Meeting rooms Single occupancy, wiped down after use
Single assigned occupancy, wiped down after use
Half max capacity
Full capacity
Paper distribution Limited paper exchange
Safety protocols in place (gloves when indicated, distancing, no-touch practices)
Safety protocols in place (distancing, low-touch practices)
Increased automated systems
Coffee stations Closed Only Coffee Open access
Levels level 1 level 2 level 3 Normal Accesshandwashing available, one
person at a time
Movement in office One way only hallways
Any direction Any direction
PPE Supply Management As needed and available
Anticipated allotment for all staff as available
Required allotment for all staff as available
Regular supply available
Disinfection/cleaning weekly cleaning Extra 2 x weekly cleaning, daily hi-touch disinfection
Regular cleaning, daily hi-touch disinfection
Regular cleaning, daily hi-touch disinfection
Work Stations Not used Limited availability – every third, rotated daily. Disinfectant spray at hand.
Every second desk open, rotated daily.Disinfectant spray at hand.Splatter shields to be considered.
No restrictions, Disinfectant spray available
Cloth masks on site Worn when moving around office
Worn by clients and staff in office
Worn during close contact in office
Not needed
Mail Collected periodically – opened scanned and emailed; personal mail addressed to individual staff set aside for pickup
Collected, set aside for pickup
Collected, set aside for pickup
Collected, set aside for pickup
Education Virtual/ Online Virtual/ Online Smaller groups - ½ room capacities
Open, continue screening, don’t attend if you are sick etc.
Gym Closed Closed Limit 4 at a time, self-screening, don’t use if sick
Open, self-screening, don’t use if sick
Service area #2: Community Client Services
Levels level 1 level 2 level 3 Normal AccessConsiderations Driving clients None permitted None permitted Emergency
only, PPE and or shields
As indicated
In home visits None permitted Permitted with PPE and qualified
Permitted with PPE and qualified
In community visits Only with distancing
Only with distancing
Only with distancing
PPE Practices Full PPE for close contact (< 2m) for all
Full PPE for close contact (< 2m) for presumptive cases
Follow Ottawa Public Health Guidelines
Follow Ottawa Public Health Guidelines
Individual client sessions None on site, Remote only
Limited on-site, distanced
Limited on-site, distanced
On site
Group counselling None on site; virtual only – staff remote
None on site; virtual only
?? Open access with no close contact
Nursing access Off-site, pre-approved, full PPE. Only for injections and if client at risk of harm or illness if not seen.
As needed, pre-approved. Limited contact with full PPE on site. Off-site if presumptive case.
PPE as needed PPE as needed
Service area #3: Blank – Copy and Create Own Service Area Considerations
Considerations Driving clients
In home visits
In community visitsPPE PracticesIndividual client sessionsGroup counsellingNursing access
Service Areas to be completed – In home visits, in community visits, housing, etc. May 6, 2020© Canadian Mental Health Association – Ottawa Branch
Risk Assessment Framework Example
Risk Assessment Scorecard / Heat map –for Monitoring
Enclosures:
1. Decision Tree: Visio and PDF formats
2. Service Levels Document: Excel and Word Versions
3. Risk Assessment Framework: 8.5 x 11 and 11 x 17 Versions
4. Web Links Word Document
5. A Measured Approach to Planning for Surgeries and Procedures during the COVID-19 Pandemic
6. A Framework for Reopening our Province
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