April 21, 2020
To view archives of all physician resources and communication visit www.cdha.nshealth.ca/coronavirus
COVID-19 Physician Information Update
April 21, 2020
Updated Clinical Documents
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Order Sets, Procedures, Clinical Pathways, Guidelines and Policies

Infection Prevention and Control

COVID Primary Assessment Centres and Secondary Assessment Centres

Mental Health and Addictions
Grief Support Resources
Grief & Leadership in the Wake of Tragedy

The Center for the Study of Traumatic Stress has released this support resource. It is to support leaders and their critical roles in the recovery of communities and individuals after disasters.
Resources for Children and Adults Coping with Grief
The following resources were provided by our colleagues in palliative care as they may prove helpful with the tragic circumstances of recent events.

Seeking Physician Feedback for
the COVID-19 Hub
In our work to bring physician content over to the Hub, we are seeking a few physicians in the early part of next week to provide feedback about their user experience with the COVID-19 Hub. We don't expect that this would take a long time and feedback will be provided to the content owners to help ensure the content is useful for physicians.

We are reminding physicians that until all content processes are complete, to still refer to www.cdha.nshealth.ca/coronavirus for a complete listing of clinical documentations (Including links to documents on the Hub) and archived updates. There may be physician facing materials there that do not yet exist on the Hub.

If you would like to volunteer a small amount of time for user experience testing, please reply to this email.
Diagnostic Imaging - Ambulatory Booking Procedure
In accordance with NSHA policy, Diagnostic Imaging Departments are currently providing imaging services ONLY for time-sensitive examinations. This includes all cancer related imaging, and imaging that supports patients seen in hospital clinics. All other examinations will be booked when we are back to normal functioning.

Such urgent imaging examinations are readily available in a timely way upon individual DIRECT VERBAL REQUEST by the referring physician or delegate to our departments. If the patient is unstable, this request would usually come from the Emergency Department.

Non-urgent requests cannot be accommodated at this time. This includes patient walk-ins and patient telephone requests.

It is essential that the COVID-19 status of each patient is communicated to our staff in advance such that appropriate procedures can be followed. All confirmed positive or screened positive COVID-19 patients should be masked upon entry to our departments. If pre-entry masks are not available, masking will occur either upon entry to our facilities or to our departments, depending on local policy.
Protection Measures for Physicians, Locums, and Residents Traveling from Outside NS
Public Health protective measures requires that all Nova Scotians, who have travelled outside of Nova Scotia to self-isolate for 14 days upon their entrance into the province. NSHA/IWK and Dalhousie University sought direction regarding physicians, locums and residents coming from outside Nova Scotia to train or practice in Nova Scotia. The following guidance was provided:

Any physician, locum or resident originating from within the Atlantic provinces is to adhere to the work isolation protocol as adopted by NSHA and IWK for their first 14 days in Nova Scotia.

Any physician, locum or resident originating from other locations within Canada is to complete screening criteria (see below) that will be shared with MOH for review and approval to begin work:
  • with work isolation protocol
OR
  • follow self-isolation for 14 days prior to starting work

The determination on which is the appropriate approach will be made on a case-by-case based on the specific location and type of clinical work that the physician has been engaged in prior to coming to Nova Scotia and the clinical work they will be doing in Nova Scotia. 

Any physician, locum or resident coming from outside of Canada is to self-isolate for 14 days prior to working within Nova Scotia.

All physicians, locums and residents that are travelling from outside of Nova Scotia as per #2 and #3 are asked to complete the screening criteria. A member of the Medical Affairs team will be in touch with you for further guidance and instruction. If you have questions, please contact physicianrecruit@nshealth.ca

Click the image for a link to the full sized document
Screening Criteria for Physicians Entering NS
-        What province is the Physician originating from?
-        What location (s) did the Physician work in?
-        What type of clinical work did the physician engage in?
-        Did the Physician have any known contact to suspect or known cases of COVID-19?
-        At what site will the physician be working and what clinical service will they be supporting in NS?

These screening questions will be presented to incoming physicians using the webform below. Click the link to view the form and questions.

Saegis Cyber Security eLearning Course
As the COVID-19 situation unfolds and the need for virtual care increases, we are seeing a surge in cyberattacks against hospitals, organizations and healthcare professionals. Healthcare professionals may inadvertently trigger breaches that lead to locked down institutions, health systems and encrypted electronic patient records.

To help support health professionals manage this increased risk, Saegis, a subsidiary of the CMPA, is offering free COVID-19 Healthcare Cybersecurity Update, a bilingual eLearning course for those working in the Canadian healthcare space. The course is comprised of two modules which will each take approximately 7 minutes to complete.

New Pallium Modules for Palliative Care
These modules are self-directed and completed at your own pace:
  • Taking Ownership
  • Advance Care Planning
  • Decision-Making
  • Managing Dyspnea
  • Palliative Sedation
  • Last Days and Hours
  • Delirium (*NEW)
  • Pain Management (*NEW)
  • Palliative Care for COVID Illness – Module A (*NEW)
  • Palliative Care for COVID Illness – Module B (*NEW) 
Work Isolation Criteria
The following guideline has been created by Occupational Health to support employees who have been identified by Public Health as being in contact with a positive COVID-19 case.

Please click here or on the image below to view source document with working hyper links.
Updated Return to Work Guidance for COVID-19 Positive Healthcare Workers
Like many communities in Nova Scotia, NSHA has seen the identification of health care workers confirmed with COVID-19. As the weeks evolve some of these employees are considered recovered and are working with Occupational Health Safety & Wellness to return to the workplace in a safe manner.

The guidelines for return to work have been developed in collaboration with the Chief Medical Officer of Health, Infectious Disease, and Medical Microbiology.Effective April 17, 2020, a health care worker will be deemed recovered and able to return to work IF they are:
  • A minimum of 10 days from symptom onset
  • Do not present with a fever
  • Are clinically improved
  • Are demonstrating an improvement in respiratory symptoms

If all criteria noted above have been met, the employee will be cleared to return to work through Occupational Health Safety & Wellness. If one criterion is present the employee will not be considered recovered and will not be permitted to return to work.

Complex cases will be reviewed with the Occupational Health Safety & Wellness physician and case specific return to work criteria will be provided.

Please note: The return to work guidelines noted above removes the requirement for repeat swabbing of a health care worker prior to return to work. Again, some cases will require case specific guidance and these will be identified through Occupational Health Safety & Wellness.
Information for Healthcare Providers: Delivery of Test Results and Self-Isolation Requirements
Public Health informs people who are tested for COVID-19 of their results, positive or negative, and advises of any ongoing isolation requirements. Test results are typically delivered to people within 48-72 hours of testing, with some variation due to volume. Lab results for COVID-19 are also available on Share.

All people tested for COVID-19 are required to self-isolate pending the results of the test. People who are tested because they are considered ‘exposed’ (either through recent travel or as a close contact with a person who is COVID-19 positive) need to continue to isolate for the entire 14- day incubation period, even if results are negative.

The chart below outlines self-isolation advice being given based on various scenarios.

Please refer to the LTCF directive for additional isolation requirements in these facilities.

Information on self-isolation is available:
*Updated* COVID-19 PPE Recommendations
Infection Prevention and Control has provided a quick reference document for PPE Recommendations that can be used by different departments. Note that some departments may have their own guidelines for PPE that exist separate to this abridged version.

Reminder: Seeking Physician Volunteers
for Redeployment
We continue to seek volunteers for redeployment. Family doctors are needed to support this site as we expand testing for all influenza like illness and provide first line treatment or referrals.

Please complete the following  short survey , so that we may collect your information and match your skills with areas of need.

Physicians can redeploy to services within their own town, zone, or other areas of the province.

All physicians will be supported to provide the level of service that they are comfortable with. All physicians are supported to do redeployment by CMPA and the College of Physicians and Surgeons (see above). NSHA Medical Affairs will support the administrative functions required for redeployment.

Medical Affairs team members are collecting this information to assist the redeployment opportunities.
If you have questions, please contact:  physicianrecruit@nshealth.ca
Moments of Gratitude
Healthcare workers at Cumberland Regional Health Centre in Amherst found a new lawn sign in front of their facility today.
Provincial COVID-19 Status Update
Today, April 21, Nova Scotia is reporting another death related to COVID-19, bringing the total to 10. The death occurred at the Northwood long-term care home in Halifax Regional Municipality.

"This is a deeply sad day for the family and loved ones of this individual, as well as everyone at Northwood. Nova Scotians offer their heartfelt condolences to them," said Premier Stephen McNeil. "We will all get through this extraordinarily difficult time by pulling together and supporting each other."

As of today, Nova Scotia has confirmed 737 confirmed cases of COVID-19. Sixteen new cases were identified Monday, April 20.

The QEII Health Sciences Centre's microbiology lab completed 516 Nova Scotia tests on Monday, April 20 and is operating 24-hours.

As of April 20, there were 10 licensed long-term care homes and unlicensed seniors' facilities in Nova Scotia with cases of COVID-19, involving 128 residents and 62 staff.

While most cases in Nova Scotia have been connected to travel or a known case, there is now community spread. That is why travel has been removed as a requirement for testing for COVID-19.

The list of symptoms being screened for has recently expanded. If you have two or more of the following symptoms, visit https://811.novascotia.ca to determine if you should call 811 for further assessment:
  • fever
  • new or worsening cough
  • sore throat 
  • runny nose 
  • headache 

To date, Nova Scotia has 22,190 negative test results, 737 positive COVID-19 test results and 10 deaths. Confirmed cases range in age from under 10 to over 90. Eleven individuals are currently in hospital, three of those in ICU. Two hundred and eighty-six individuals have now recovered and their cases of COVID-19 are considered resolved. Cases have been identified in all parts of the province. A map and graphic presentation of the case data is available at https://novascotia.ca/coronavirus/data.

Public health is working to identify and test people who may have come in close contact with the confirmed cases. Those individuals who have been confirmed are being directed to self-isolate at home, away from the public, for 14 days.

Anyone who has travelled outside Nova Scotia must self-isolate for 14 days. As always, any Nova Scotian who develops symptoms of acute respiratory illness should limit their contact with others until they feel better.

It is now more important than ever for Nova Scotians to strictly adhere to the public health orders and directives - practise good hygiene, maintain a physical distance of two metres or six feet from others, limit essential gatherings to no more than five people and stay at home as much as possible.

Nova Scotians can find accurate, up-to-date information, handwashing posters and fact sheets at https://novascotia.ca/coronavirus.

Quick Facts:
  • testing numbers are updated daily at https://novascotia.ca/coronavirus
  • a state of emergency was declared under the Emergency Management Act on March 22 and extended to May 3

Additional Resources:
Government of Canada: https://canada.ca/coronavirus
Leadership and Wellness Poster
Updated for Week of April 20-27
This document is a list of helpful resources curated weekly for physicians by Medical Affairs’ Physician Leadership Development. Please reach out to Shawn Jolemore with your comments, questions, or suggestions for additional content.

View this week's edition here.
NSHA Physician Leadership Supports
Individual Executive Coaching for Physician Leaders with Executive Coach Lorie Campbell
Are you struggling to lead yourself or your team(s) well during this pandemic?

Take advantage of 30 or 60-minute focused, one-to-one virtual executive coaching sessions for formal physician leaders only. Email Lorie Campbell to book a time for this free service, provided by NSHA Medical Affairs Leadership Development.

*New Dates Added*
Group Coaching Call for all Physicians
Open to all NSHA Physicians, this virtual group coaching call is an opportunity to connect with your colleagues to support one another and share your experiences and challenges during this unprecedented time.

Join Medical Affairs’ Leadership Development experts, Shawn Jolemore and Lorie Campbell for this 60-minute online check in.

Next available dates for this Zoom call:

Physician Wellness Supports
Checking Your Stress Level - How do you know and what to do?
Wednesday, April 22 at 4–5 p.m.
Dr. Joseph Sadek

Join Zoom Meeting Link Password is 050891
Addressing Grief within our Healthcare Community: Mine, Yours & Ours
Join Serena Lewis and Roy Ellis (NSHA Bereavement & Grief Coordinators) from 9:30 to 10:30 am April 23 as we begin the conversation of grief in our current and future workplace. This discussion will provide information on recognizing and understanding how loss is intertwined in our lives, as well as the current landscape of our community of care providing. Roy and Serena want to hear what topics will benefit you in the upcoming weeks that will support you - as you care for yourselves, your own families and within patient care.

Daily Physician Wellness Check In - COVID-19 What's Normal?
Join Drs. Jaqueline Kinley and John Chiasson for daily online meetings to chat about coping strategies and mental health concerns. Meetings are daily M-F at 12 NOON. and are open to all physicians. Click here for the *updated* Zoom

DNS Professional Support Program
Feeling overwhelmed or need to talk to someone? 
Contact the Doctors Nova Scotia (DNS) Professional Support Program at 902-468-8215 or 1-855-275-8215 (toll-free) or via email.
Physician Screening for COVID-19
Call 1-833-750-0632 to speak to Occupational Health and Safety for your screening options.