Amersham Physios Covid-19 Risk Assessment across all Clinic sites

What are the hazards?

Who might be harmed 

Controls Required

Mitigating Actions

Action by who?

Action by When?

 Done

Spread of Covid-19 Coronavirus

Staff

Patient Prioritisation

Virtual First approach with remote consultations remaining standard practice during phase 2. The physiotherapist must undertake a risk assessment and make a clinically reasoned decision for offering face to face contact which must be documented for each session. The patient should be made aware of all current risks and must give their consent and it be documented.

The physiotherapist is accountable for prioritising access to in person services based on their clinical judgement.  When determining priority physiotherapists are encouraged to reflect upon: Acuity of patients condition (such as recent surgery, removal of cast or immobiliser, or recent RTA), Functional impairment on quality of life including ability or work or carry out ADL’s, Likelihood that in the absence of services patient will require services in an emergency care setting and necessity of services which can only be provided in person eg Diagnostic Ultrasound or Shockwave Therapy.

Screening

Screen patients prior to attendance at the practice environment for signs, symptoms or risks of Covid-19 including asking about current symptoms, international travel and contact with individuals who have a confirmed or presumptive diagnosis of Covid-19

If Patient screening reveals risk factors services must be deferred until signs and symptoms have resolved and a minimum of 7 days of self isolation after last day of symptoms.

Screen patients for signs and symptoms upon arrival.  In the event that a patient attends the practice environment whilst exhibiting signs and symptoms consistent with respiratory illness whether Covid-19 is suspected or not the physiotherapist must: Provide and have the patient don PPE (surgical masks) and complete hand hygiene, isolate the patient, explain the concern, discontinue and reschedule the appointment and disinfect the practice area immediately. 

Hand Washing

Physiotherapists are expected to practice routine hand hygiene consistent with WHO’s ‘5 moments for hand hygiene’: Before touching a patient, before clean/aspetic procedures, After body fluid/exposure risk, After touching a patient, After touching patient surroundings.  Physiotherapists much also avoid touching their face and practice respiratory etiquette. 

Staff encouraged to protect skin by applying hand emollient cream regularly.  https://www.nhs.uk/conditions/emollients/

PPE

Uniforms and work clothing to be washed at the hottest temperature suitable for the fabric. Check the care label, which is usually near a seam in the garment. A 10-minute wash at 60ºC removes almost all micro-organisms. Washing with detergent at a range of temperatures between 30ºC-60ºC removes most micro-organisms.

The Government advice on cleaning uniforms includes the following:

The appropriate use of personal protective equipment (PPE) will protect staff uniform from contamination in most circumstances. Healthcare facilities should provide changing rooms/areas where staff can change into uniforms on arrival at work. Uniforms should be not worn in the commute to work and washed after every shift.

PPE worn in MSK Clinic required: Gloves and Apron for every patient.  https://www.csp.org.uk/news/coronavirus/clinical-guidance/ppe-faqs

The topic of mask use is an ongoing source of debate and confusion and therefore will be continually reviewed. We should not be seeing any patients who have suspected Covid-19/ are symptomatic or had any contact with a confirmed case as this will have been successfully screened for prior to clinic visit. Therefore a surgical mask or fluid-resistant surgical mask (Type IIR) use is not currently required in the aforementioned CSP guidelines.  Continuous Masking for duration of face to face consultations for the therapist and if requested for the patient with single use surgical mask will be worn however until further clarification.

Social Distancing 

Redesigned processes to ensure social distancing in place. The subjective assessment is done at a 2m distance and contact time kept to a minimum.  Work in prone wherever possible or in non forward facing positions. 

Ensure booking practices comply with ongoing directives on group gatherings - Patients to wait in their vehicles to be called in, adequate time between patients to clean and disinfect clinic equipment and touch points, posting signage reminding patients to perform hand hygiene, limiting exchange of paper - online notes and exercise prescription, contactless payment options https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people 

Taking steps to review work schedules including start & finish times/shift patterns, working from home etc. to reduce number of workers on site at any one time.  Making sure only one Physiotherapist is in each of the clinics every day and encouraging patients to attend the clinic alone.

Clinic and equipment Cleaning

Frequently cleaning and disinfecting objects and surfaces that are touched regularly particularly in areas of high use such as door handles, light switches, reception area. Using appropriate cleaning products and methods in the clinics. Cleaning plinths after each patient with disinfectant wipes.

Spread of Covid-19 Coronavirus

Visitors to clinic (Patients, Cleaning staff other MDT members)

Screening

Screening policy as previously stated will reduce the potential to exposure to an environment where Covid-19 was present and thereby reduce the infection risk for a Visitor to the clinic.

Hand Washing

Patients should be asked to complete hand hygiene using alcohol based hand rub or soap and water upon arrival at the practice setting, before and after use of weights or exercise equipment, Prior to processing payment, prior to departure from the practice. 

Cancellation Policy

Temporary changes to cancellation policies to patients, avoiding unintentionally incentivising patients to attend clinic. 

Informed consent form

Patient to consent to face to face appointments and be made fully aware of the risks and measures put in place to mitigated these risks.

Social Distancing

Ensure booking practices comply with ongoing directives on group gatherings - Patients to wait in their vehicles to be called in, adequate time between patients to clean and disinfect clinic equipment and touch points, posting signage reminding patients to perform hand hygiene, limiting exchange of paper - online notes and exercise prescription, contactless payment options eg To use contactless payment https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people 

Encouraging patients to attend the clinic alone.

PPE

PPE use by Physiotherapists as previously started available on request for patient use.

Vulnerable Groups - Elderly, Pregnancy and those with existing underlying health conditions

Triage of Vulnerable groups 

Offer Domiciliary appointments or see these at risk groups at the start of clinics if face to face required and virtual appointments not appropriate. Only Audley residents seen within clinics held at Audley. Above mitigation actions also followed in these cases regarding Patient Prioritisation, Screening, Hand washing, PPE and social distancing.

Anyone else who comes into contact with staff in relation to Excel Physio and Sports Injury Clinic

Reinforcing Public Health Advice

To help reduce the spread of coronavirus (COVID-19) reminding everyone of the public health advice - https://www.publichealth.hscni.net/news/covid-19-coronavirus 

Posters, leaflets and other materials are available for display.

Staff and all visitors to the clinic 

Cleaning

Complying fully with all directives from DOH including cleaning and disinfection requirements, lawful release of patient information to enable contact tracing, and staff quarantine orders in the event that a patient treated in the practice later tests positive for Covid-19.

Frequently cleaning and disinfecting objects and surfaces that are touched regularly particularly in areas of high use such as door handles, light switches, reception area. Using appropriate cleaning products and methods in the clinics. Cleaning plinths after each patient with disinfectant wipes.

Ensuring sufficient rest breaks for staff and breaks to ensure cleaning regime is kept up with in-between patients. Management checks to ensure this is adhered to.

Covid-19 confirmed case in patient or staff.

Staff and all visitors to the clinic 

Covid-19 confirmed case in patient or staff guidance.

If advised that a member of staff or public has developed Covid-19 and were recently on our premises (including where a member of staff has visited other work place premises such as domestic premises), the management team of the workplace will contact the Practice Manger and if advised Public Health Authority to discuss the case, identify people who have been in contact with them and will take advice on any actions or precautions that should be taken. https://www.publichealth.hscni.net/

Lawful release of patient information to enable contact tracing, and staff quarantine orders in the event that a patient treated in the practice later tests positive for Covid-19

First signs of sickness in staff

Staff and all visitors to the clinic 

Covid-19 Staff sickness guidance 

If anyone becomes unwell with a new continuous cough or a high temperature in the workplace they will be sent home and advised to follow the stay at home guidance. The management team of the workplace will contact the Practice Manger and if advised Public Health Authority to discuss the case and start following above Covid-19 confirmed case guidelines if appropriate.

Line managers will maintain regular contact with staff members during this time. Line managers will offer support to staff who are affected by Coronavirus or has a family member affected.

Mental Health 

Staff

Promote mental health and wellbeing awareness to staff.

Regular communication of mental health information and open door policy for those who need additional support. https://www.mind.org.uk/information-support/coronavirus-and-your-wellbeing/ , www.hseni.gov.uk/stress 

Promote mental health and wellbeing 

If concerns arise regarding mental health and wellbeing of patients or members of staff, discus with line manager.