OPERATIONAL

How do I refer a patient to a CBAC Facility?

For patients who meet the case definition and who are unable to be swabbed in your practice, please visit HealthPathways and use the ERMS referral form and send to ‘CBAC’. This will activate the triage centre to triage your referral and contact the patient. The triage team will contact your patient with an appointment. (Walk-ins are not allowed access at this time at most CBACs.) The triage team will also notify your patient if their swab is negative.

If your patient’s condition is worsening consider referral to 24 Hour Surgery or other urgent care clinic.

Where are the CBACs?

Community-based Assessment Centres, or CBACs, have been set up to support general practice teams swabbing in the community. They were established in key areas across the region to enable people to get tested close to their homes and have tested over 12,000 people since 18 March. The first CBAC was set up on Hagley Ave, in the old Eye Outpatients portacom.

Novel CBAC facilities have gradually been closing as demand has eased for wide testing. Patients can still be tested at most general practices and some CBAC facilities are still operational.

CBACs are currently located at:

  • Ashburton Hospital
  • Riccarton Clinic
  • 24 Hour Surgery
  • Moorhouse Medical
  • Aranui – Nga Hau e Wha marae
  • Rangiora – Durham Health

A mobile unit can be deployed to test people who can’t make it into their general practice or a CBAC.

This unit also supported asymptomatic sentinel testing that was requested by the Ministry of Health or by Community & Public Health, e.g., at a rest home to test staff. They have tested CDHB staff, rest home staff, FENZ, Police and Corrections staff. They have operated a pop-up testing centre at Pak ‘n Save on Moorhouse Ave. They have been to marae and rugby fields. (Asymptomatic testing has currently ended.)

I have a friend who isn't enrolled in a general practice, can they be tested?

Anyone can be tested for COVID-19 at a testing general practice or CBAC. They can ring Healthline and get an appointment, or they can visit the Whanau Ora CBAC at Nga Hau e Wha in Aranui and walk in to be tested there during opening hours.

How much PPE can we order?

PPE supplies are distributed to allow for on-going testing of COVID-19 suspect patients in general practice. Limited PPE may be available for public-facing healthcare roles, following Ministry guidelines.

Supplies are limited so for practices assessing and testing patients, order only when your supplies drop to 10 sets, as needed to replenish your stock to 25 sets of PPE by clicking on the ‘Order PPE’ button to the left and completing the form.

Should I still be wearing full PPE in my practice?

As you know, the risk of community transmission of COVID-19 is extremely low. We haven’t had a positive case in the whole country for some time. We are still testing people with symptoms, so it is unlikely we are missing people with the disease in the community. Influenza and influenza-like illness is also very low.

The Ministry of Health has guidelines on the use of PPE at Alert Level 1. But practices must act as they see fit to protect their staff and patients, keeping in mind that PPE is a finite resource. We need to make sure we have sufficient PPE if there is a second wave of COVID-19. Perspex barriers for receptionists or pharmacy staff, for instance, are a resource that is easy to clean and doesn’t need to be replenished. Streaming patients in practice may continue to be appropriate and help reduce PPE wastage by seeing suspect patients in specific sessions.

Who gets CPRG Updates?

CPRG updates are sent to GPs, pharmacists, general practice and community pharmacy teams or partnering organisations or health agencies in Canterbury’s primary care emergency response. They are intended to be concise notices of urgent or important matters.

Our updates contain clinical information for primary care and community health providers and are not intended for public distribution.

If you meet either one of the above description and would like to receive our updates please email us at eoc@cprg.org.nz

Do we still need to notify the Medical Officer if we are swabbing patients?

With the current emphasis on widespread testing, medical officers of health in our region no longer require clinicians to notify on suspicion for every patient currently being tested for COVID-19. Please continue to notify on suspicion any patients being tested for COVID-19 where there is high risk of ongoing spread of infection. These include patients who have had recent overseas travel or known contact with COVID-19, and situations where the patient or their household members reside or work in healthcare or aged residential care facilities.

What is the subsidy for assessing and testing COVID-19 patients?

Visit Community HealthPathways and click on the funding section for current advice.

CLINICAL

How should our Practice be handling presenting, suspected Covid-19 patients?

Guidelines for managing an influx of affected patients in your practice have been developed. You can find more information on setting up your practice, briefing and preparing your staff, and protecting your patients on HealthPathways.

PPE guidelines and clinical guidelines for assessment and management of patients are available on Community HealthPathways.

If a staff member presents with symptoms, what should I do?

The staff member should not be coming to work in your pharmacy or practice with symptoms, but if they do, they should go home. They need to get tested and stay off work until the swab results guide next steps. They should not be returning to work until they are symptom free for 48 hours.

See Guidelines here.

If their swab result is negative (according to the Ministry of Health):

  • The employee still needs to complete the full 14-day quarantine period if they have returned from overseas or have had close contact with someone with the virus.
  • If they have not recently returned from overseas or have had close contact with a positive case then they should stay home for 48 hours after their symptoms subside.
  • If they are still sick with the same illness at the end of the 14-day isolation period, they will need to stay in isolation until they have been symptom free for 48 hours.
  • If they are well, and have been for 48 hours, they can return to normal daily activity.

Always check the Ministry of Health or Community HealthPathways websites for current information.

My wife is a doctor and has symptoms, should I stand down from my job at the pharmacy?

Your wife should get tested. The swab result will guide the decision on whether she is a confirmed case, a probable case, or not a case. You should stand down until that decision is made by the Medical Officer of Health.

A suspect case who, following investigation and testing, returns a negative test is considered ‘not a case.’ They should be advised to remain in isolation until 48 hours after their symptoms resolve. If your partner is not a case and you are symptom free, you can return to work.

The lab won't give us any swabs!

In early April every general practice was contacted by their respective PHO to get an understanding of their interest in swabbing patients. From that exercise a list was created and sent to the lab. Only practices on this list were given testing kits. Over the last few weeks more practices have said they are interested in swabbing patients so they have been added to the list.

If your practice is interested in assessing and testing COVID-19 suspect patients, email us on eoc@cprg.org.nz and we’ll add you to the list. After you are added to the list you will need to contact the lab to obtain swabs. Contact them via the usual methods: labinfo@cdhb.health.nz or (03) 364 0484.

Do household members need to stay home if someone is sick?

If someone is sick they should not go to work or school.

People living with someone who has respiratory symptoms do not need to self-isolate, unless the sick person in their household is tested for COVID and their test comes back positive. In this situation Community & Public Health will be in contact with all close contacts.

The person who is sick and has tested for COVID-19 is considered a ‘suspect’ case until they receive a negative result. They should self-isolate until they get their result.

Can I refer my patient for specialist services now?

You are now asked to refer patients to specialist services as usual. If you have any requests parked in ERMS, you can ‘unpark’ them and send them through.

CDHB are going to progressively put routine elective (planned care) requests into a new patient management system for review. Routine requests will remain in the PMS until, or if, specialist services have the capacity to see them. New letters to patients may not provide certainty of date or service as DHB capacity may vary greatly over the next year or two.

My patient is asking to be tested for COVID-19 before they return to work, what do I do?

If your patient is displaying COVID-19 symptoms then they can be tested. Asymptomatic testing is not currently funded. There is no remit for occupational asymptomatic testing.

The alcohol-based hand rub (ABHR) that has been potentially used by a suspected case could now be used by another patient, is this ok?

Any ABHR dispenser should be routinely cleaned and disinfected as part of environment cleaning.

It is more important that alcohol hand rub is used correctly, don’t forget between fingers, nails, etc. rub until the hands are dry, typically for a minimum of 20-30 seconds.

Also remember that dispensers of hand care products must not be refilled.  They should be used until empty and discarded.

We are seeing a number of suspect COVID patients in a row, do we change all our PPE gear completely between each patient?

If you are running a COVID-19 clinic use full PPE.  Between each patient change gloves only, do not use alcohol hand rub on gloves. Wash hands and put on new gloves.  If a patient has coughed/sneezed over you then after completion of assessment remove all PPE and apply new PPE as per instructions.

Self-care is important so if running COVID-19 clinics ensure you take regular breaks, drink lots of fluids.  If taking fluids whilst in PPE, remove mask, wash hands, take drink, wash hands and put on a new mask. Remove all PPE as per in instructions when taking a break – approximately every 2 hours.

We dispose our PPE equipment in waste bags, does this include disposal of the goggles?

Most plastic safety goggles can be reused.  They should be cleaned and disinfected with a 2-step process. Firstly, wash googles in warm water with a detergent and dry with suitable cloth e.g. Chux. Secondly disinfect using a chlorine- based product.

Check the quality of goggles regularly e.g. for scratches, cracks and visibility and throw out when damaged.

Please remember that if you wear personal glasses to use safety goggles on top.

Why are my hand gel and masks out of date?

Pegasus PHO previously purchased with available funds a bulk supply of PPE for the pandemic in 2007-8. Leftover stock that wasn’t sent to practices at the time has since been held in reserve at the CDHB Stores. We have been drawing down from this supply for COVID-19 PPE requirements. Some items are now past their manufacturer’s ‘best by’ date. We have had the antiseptic hand gel tested and its efficacy has been confirmed by the lab and IPC consultant. Masks have been randomly tested and assessed as showing no degradation in the physical nature of the masks, so should still be suitable for patient contact for non-aerosol generating procedures.