Covid-19 is a new and novel virus, for which there is currently no vaccine 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 Marchmont Physiotherapy Clinic 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 for everyone attending the clinic

 

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.

 

Marchmont Physiotherapy Clinic provides physiotherapy services to clients in our clinic, people’s homes if urgently needed for those isolating as well as remote consultations via Telehealth video calls or telephone.

 

Contents -As per our professional 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) Our 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 professional guidance on face to face (F2F) 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 F2F consultations will be discussed in full with the patient.
  • Marchmont Physiotherapy Clinic 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 F2F sessions will cease and therapist will self-isolate as per Government guidelines.
    • Clients are 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 their details– clients should consent to this before F2F treatment is carried out as this pandemic overrides our clients rights to confidentiality.

 

2) Risk assessment of the working environment for which you are responsible

 

  • F2F consultations carried out by Marchmont Physiotherapy Clinic in client’s homes are out with our control. However, the following requests will be made of our 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 will be discussed by your therapist
    • The room for treatment should be selected for its ease of access from entry into the house. It should have ample space for movement and as much 2m physical distancing as possible during the session. Good ventilation, such as an open window. Where possible, privacy between the client and therapist can be maintained.
    • 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.
    • Our clients 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 after their therapy session.
    • Cleaning of touched surfaces will be encouraged following the appointment with hot soapy water and,/or antibacterial or 70% alcohol solution. Washing fabrics touched should be at 60 degrees or as per washing instructions allow.

 

3) Infection Prevention and Control Measures

 

  • Measures as above for clinic and patient setting.
  • 2m physical distancing will be maintained unless direct contact is required.
  • All clients will have their forehead temperature checked using a non-contact thermometer.  F2F treatment will not proceed if temperature is greater than 37.5.
  • Protective garments will be worn by the therapist for all F2F sessions as per UK wide advice (6). This will consist of:
    • Face mask (fluid resistant)
    • Gloves
    • Apron
    • (Face shields in some circumstances)

All protective garments will be client specific

  • Face shields will be available but not used routinely.
  • Protective garments will be donned and doffed in order advised by Health Protection Scotland (HPS) (5).
  • Protective garments will be on before contact and after use of alcohol-based hand rub or appropriate hand washing (ABHR) (7).
  • Protective garments will be removed, with the exception of face mask and/or shield, just before leaving the clinic or client’s home – the patient and all other household members will be asked to maintain a 2m distance from this point onwards. Appropriate sanitizer will be used immediately after your session (7).
  • Protective garments must be double bagged, dated; and clients will be advised to set aside for 72 hours before disposal in their municipal waste when seen at home(8).
  • Face masks and shields will also be removed after leaving the patient’s home and be double bagged, dated and disposed of after 72 hours.
  • Hand Hygiene:
    • Sanitizer will be used between each client, hand washing with soap and hot water prior to leaving and on return to the clinic 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 before and after consultation.
  • 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 examination couch, 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 separated before being cleaned with combined detergent and disinfectant wipes and placed back into hard shell case. The tray will then be wiped and stored in the case between sessions, the case will be wiped at the end of each client.
    • Examiniation couches will not be stored in the fabric case
    • Examination couches will be wiped fully with hot soapy water and appropriate antibacterial wipes before each client.
  • All patients must complete a Covid-19 Screening Form before F2F consultation is confirmed and contacted before their consultation (upto 48hrs prior).
  • Physiotherapy sessions may involve periods of contact closer than 2 metres – if this close contact is agreed by therapist and patient, it will not exceed 15 minutes continuously.
  • Uniform will only be worn during consultations. Uniform will not be worn in other areas between sessions, such as shops.

 

  1. Access to PPE

 

  • Marchmont Physiotherapy Clinic will provide protective garments where necessary.
  • We ask that clients bring their own face covering and gloves were possible.

 

  1. “Virtual First” Approach

 

  • Virtual consultations must remain first line practice at this time (2). These should ideally be video consultations, via Telehealth, WhatsApp, Zoom or telephone consultations. Our professional  body’s advice on digital solutions will be observed during these sessions (10).
  • All patients will be contacted if consent is granted, and will continue to be managed remotely unless F2F is deemed more beneficial and safe to do.
  • In cases that are deemed non-urgent, would not be expected to worsen and continue to improve without F2F input, a virtual approach should be tried before considering F2F.

 

  1. Client Risk Assessment and Clinical Reasoning

 

  • The professional 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 in full.
  • A risk assessment tool will be completed for each patient being considered for F2F treatment – this will be used to assist in clinical judgement.
  • Marchmont Physiotherapy Clinic will discuss any risks or concerns our patients have, the reasons behind virtual or face to face treatments, and made aware of risks associated with this approach in order to allow you to provide informed consent based on a full understanding of said risks.
  1. Your Consent for Treatment

 

  • All patients will be individually screened and risk assessed prior to carrying out F2F treatments.
  • If F2F treatment is indicated, you will be asked to complete a screening form which will be emailed or posted. This must be completed satisfactorily before your session can be confirmed.
  • We will fill out a further screening form including your temperature  and your therapist’s on the day of your F2F session.
  • All patients who are being offered face to face sessions will be contacted by the clinic to ensure patient provides an informed consent and is provided with the most up-to-date information.
  • 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).
  • Patients will be asked to sign a consent form confirming they have been made aware of risks of face to face as well as completing screening forms. Failure to do this will result in F2F sessions being unable to proceed.

 

 

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>

  1. CSP Guidance on Face to Face or Remote Consultationshttps://www.csp.org.uk/news/coronavirus/clinical-guidance/remote-or-face-face-consultations/implementing-guidance<Accessed: 11/06/2020>
  2. 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>
  3. CSP Guidance on Duty of Carehttps://www.csp.org.uk/publications/duty-care<Accessed: 11/06/2020>
  4. Health Protection Scotland Guidelines for donning/doffing PPEhttps://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>
  5. UK wide PPE Advicehttps://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>
  6. 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>
  7. 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>
  8. Guidelines on getting tested in Scotlandhttps://www.gov.scot/publications/coronavirus-covid-19-getting-tested/pages/test-results/<Accessed 11/06/2020>
  9. CSP Remote delivery service optionshttps://www.csp.org.uk/news/coronavirus/remote-service-delivery-options<Accessed: 11/06/2020>
  10. NHS – Who’s at Risk Guidancehttps://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk/whos-at-higher-risk-from-coronavirus/<Accessed 12/06/2020>

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