north coast area health service facility pandemic …...2020/03/11 · hastings macleay network...

Hastings Macleay Network COVID-19 Pandemic Plan

Created August 2012, Revised March 16 2020 of 16

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

2020

Port Macquarie Base 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 before they enter the waiting room and before triage

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) meter 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 triage kit; ED NUM



UNIT ITEM DETAILS RESPONSIBILITY

The Kit at Triage contains; Surgical masks x 25

P2/N95 (duck bill) x 50 (check expiry

date)

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)

Screening questions as per MOH

(Current Pandemic Influenza)

viral swabs;

biohazard specimen bags;

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

relevant pandemic information and standing orders (in folder)

Hospital Wide Stores All stores orders for PPE must go through the stores

Staff are to complete the ordering excel spreadsheet and sent through to the Stores manager Wayne pope and cc: Antony Altea

Monitoring of PPE stock levels to be undertaken as directed by Ministry of Health

ED Pre-triage Screening Station

A pre-screening station will be established at the front entrance of the Emergency Department prior to triage to screen patients before entering the ED.

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 manning this station are to wear a surgical mask and protective eye wear

The Pre- Triage Screening Station will operate from Monday to Friday days a week, between the hours of 0830 to 1700hrs

It will be staffed by 1 clinical staff

Those accompanying patients with a high index

DON, ED NUM




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 to the Clinical Initiative Nurse (CIN) to be triaged.

o If the patient is deemed to be well, they will be asked to waiting outside for triage

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

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 asked to wait outside the ED waiting room for medical assessment

Those patient who are assessed as being unwell and require likely admission will be transferred to negative pressure (if possible)/single room within the ED (see appendix 3)

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

A staff log must be commenced and follow the patient into the ED (see appendix 4)

o Staff are expected to self-report on this log

ED Clerical All patient details must be updated including their contact details, NOK and 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 negative pressure room (ED Acute 1 & 10 or ESSU 5) preferably, or a single room if a negative pressure room is not available (Acute 9, Acute 8, Acute 7, Consult Exam,

DON, AHNMs, NUM




Peads room 1 & 2)

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

ED Notify PHU

Notify Public Health Unit if patient meets current case definition/suspect case

Team leader on Duty of presentation

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 the Port Macquarie Hospital Laverty Health Pathology

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

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

COVID-19 samples are not to be sent via the Pathology shute

AHNMs to organise both in and after HRS

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

Supportive measures

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

Nebulized medications

NIV/CPAP

HFNP

MOH, DMS infection control

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

PHU




been collected

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

ED Admission to Hospital

As per flow chart 1

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

The ED is to follow the direct admission policy (Admission, Consultation and Escalation Process at PMBH Emergency Department)

The patient is to be admitted under the physician of the day

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 consultant to handover care

The accepting consult must notify their team

The ED CNUM/TL must notify the Patient Flow Manager/After Hours 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]

Infection control

Hospital Wide Transfer from ED to ward

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

HSA’s

Hospital wide Cleaning of room/cubicle

Cleaning of Room / Cubicle: o Notify Hotel Service Manager /

Team Leader of cleaning required as soon as practical;

o Cleaning staff to clean area as per the Infection Control Guidelines.

Hospital wide Linen Treat all linen as per normal

Hospital wide Waste Waste as per normal waste streams

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

-Referring MO -Receiving Hospital

mailto:[email protected]




level of care offered at PMBH

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

Patients are to be prepared as per usual transfer procedure

Patient transferred by Medical Retrieval Unit (MRU) as per their developed transfer plan

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

-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, please reach out to your finance lead.

In addition to the project code please 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 recoveries including disasters

All expenditure is to be recorded on the attached “HMCN COVID -19 expense tracking schedules” (the same as forwarded yesterday). 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).

Managers, Finance, all managers

Hospital wide/ Outpatient Clinics All outpatient clinics on site at PMBH will







Community & Allied Health

commence the COVID-19 screening questions. If the patients answers yes to the screening questions and are symptomatic then that patient will be asked to defer their appointment

These clinics include o Anti-natal o Fracture clinic o Pre-admission Clinic o ? o ?

Theatres Pre-admission clinic

All patients must be screened for COVID-19

Patients who answer yes to the questions they must be deferred or their clinical criteria is determined in consultation with their

Surgery Patients are being contacted the day prior

If they answer yes to the COVID-19

Do they need surgery, can it be re-scheduled

In consultation with bookings and surgeon

LEVEL 2 UNIT ITEM DETAILS RESPONSIBILITY

ED COVID-19 Testing clinic

A COVID-19 testing center will be set up utilizing the old Renal Unit space

Purpose: The purpose of the center is to redirect the COVID-19 testing from the ED

and perform the diagnostic testing for COVID-19

Flow is as per Flow Chart 2

The Governance of the COVID-19 Testing clinic will sit with ??

Appropriate and approved way finding signage will be displayed for patients

If patients present to the ED and they answer yes to the pre-screening questions, they will be sent immediately to the COVID-19 testing Clinic if well

Patients in the COVID-19 testing center 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

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

Community and Allied Health




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 o Dedicated Cleaning Housekeeping o Shared Security

Environmental requirements o Dedicated handwashing facilities o Dedicated toilet

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 Volunteers Consider rolling back services and utilizing in non-clinical areas

Manager Patient services

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.



LEVEL 4 - Mass Admission of Pandemic Patients


Hospital wide Disaster Control Centre

PMBH activates the disaster control center

Hospital wide PMBH commences Hospital Lock Down

Police presence established around Highfields Circuit / Wrights Road / screening station, and perimeter when 30 – 50 patients present

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

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

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

Ward 3D 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

The Elevator to be isolated near ED for infectious patients only

Private Hospital to be contacted to determine number of beds available

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

Staff not going home to be accommodated at rotary lodge

Hospital wide Additional Staff

Mental health to be contacted 0412792974

Social worker to be contacted #59 (pager)

Notify PHU If suspect case meets the current definitions phone PHU:

o 1300 066 055 (Mon – Friday 08:30hrs – 17:00hrs);

o Notify ED NUM, Director Nursing, CNC Infection Control

o 00439 273 5728 after hours.

Also Notify AHNM if A/H, who will notify Executive On Call, DMS, ED NUM

Network wide Establish a fever wards

Identify a Fever Hospital/ward within the HMCN to allow for ‘core’ hospital functions to continue

Activation of fever Hospitals/wards will occur when xx admissions (to be determined) has occurred within the network

Activation of Fever hospitals/wards allows for best clinical practise and will minimise health-care associated transmission

Fever hospitals/wards will require: o Dedicated staffing – trained and




competent Infection Control Practices (e.g.: PPE hand washing)

o Ability to cohort patients o Staff areas away from patients and staff

not involved in direct patient care of infectious patients

o Transportation plans for patients being discharged

o Pathology – courier service to labs if required

o Storage areas for consumables o Mortuary availability o Reliable electricity, water, sewerage, IT

services, communications o Ability to restrict visitors o Communication strategies in place for

staff and community

Consideration will need to identify appropriate isolation rooms for ICU, maternity and paediatric patients

These specialty units will need to have in place contingencies for management of an infectious patient within their unit, to allow for the care of a patient requiring their specialty which may not be available at the Fever Hospital/Ward

Planning should include the route patients and staff will take to admit the patients

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: PORT MACQUARIE BASE HOSPITAL COVID-19 PATIENT FLOW PROCESS



APPENDIX 2

Flow Chart 2: PORT MACQUARIE BASE HOSPITAL COVID-19 PATIENT FLOW PROCESS with COVID-19 TESTING CENTER



APPENDIX 3 Port Macquarie Base Hospital Accommodation: Single Rooms / Negative Pressure Rooms

Ward Location AFM Space Name Room Type Ante Room Ensuite

3D

Room 9 IP018 Negative Pressure Yes Yes

Room 10 IP020

ICU

Room 13 IC028 Negative Pressure

Yes

Yes Room 14 IC031

Room 15 IC050

Room 16 IC053

ED Acute 1 ED011 Negative Pressure

Yes Yes

Acute 10 ED031

CCU Room 3 CA019 Negative Pressure

1C Room 1 MD Negative Pressure No Yes

ESSU Room 5 ES020 Negative Pressure No No

ICU Room 1 IC001 Single Room No

No Room 2 IC003

Room 4 IC008

Room 5 IC009

Room 7 IC017

Room 8 IC019

Room 9 IC020

Room 10 IC022

Room 11 IC023

Room 12 IC025

CCU Room 1 CA013 Single Room No No

Room 2 CA014

Room 4 CA021

Room 5 CA022

Room 6 CA023

Room 7 CA026

Room 8 CA027

ESSU Room 4 ES019 Single Room No No

Room 6 ES021

Room 7 ES023

Room 8 ES024

Emergency Dept

Acute 9 ED050 Single Room No No

Acute 8 ED049

Acute 7 ED048

Consult Exam ED037

Paeds Area ED020

Paeds Area ED019

1C Room 2 Room 3 Room 4 Room 7 Room 8 Room 9 Room 13

MD007 MD010 MD013 MD020 MD022 MD024 MD034

Single Room No Yes



Room 14 MD037

Ward Location AFM Space Name Room Type Ante Room Ensuite

Childrens’ Ward

Room 5 Room 6 Room 7 Room 8 Room 9

PD023 PD025 PD027 PD029 PD031

Single Room No Yes

Ward 2A Room 1 Room 2 Room 5 Room 6 Room 7 Room 8 Room 10

OI.007 OI.009 OI.014 OI.016 OI.018 OI.020 OI.024

Single Room No Yes

2B Room 2 Room 3 Room 6 Room 7 Room 8 Room 9 Room 10

SR010 SR012 PD014 PD018 PD020 PD022 PD024

Single Room No Yes

Ward 2C Room 2 Room 3 Room 6 Room 7 Room 8

SM010 SM012 SM019 SM021 SM023

Single Room No Yes

Ward 3D Room 1 Room 2 Room 3 Room 4 Room 5 Room 6 Room 7 Room 8

IP001 IP003 IP005 IP007 IP009 IP011 IP013 IP015

Single Room No Yes

ICU Room 3 Room 6

IC005 IC011

Single Room No Yes

CCU Room 6 CA023



Appendix 4

north coast area health service facility pandemic …...2020/03/11 · hastings macleay network...

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