April 22, 2020
To view archives of all physician resources and communication visit www.cdha.nshealth.ca/coronavirus
COVID-19 Physician Information Update
April 22, 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
COVID-19 Risk Factors and Risk Assessments
We are currently taking enhanced precautions across NSHA during the COVID-19 pandemic. We are aware there are several COVID-19 risk factors that patients receiving services at NSHA may have and these identified COVID-19 risks require our healthcare teams to take additional precautions to keep patients and healthcare providers safe during this time.  

We have recently developed two ways of identifying COVID-19 risk factors and communicate these risks amongst the healthcare team.

  1. The COVID-19 Risk Assessment, to be completed at the initial point of contact and then verified by the most responsible provider. If when assessed the patient has a COVID-19 risk identified, the precautions to take are outlined on the second page of the assessment form. 
  2. Droplet and contact flag at registration (Go live April 23, 2020): We know from Public Health there are areas and facilities within the province that are experiencing higher rates of COVID-19. There is a risk that in these areas that there is asymptomatic transmission and people may not know if they have been exposed to COVID-19. The areas are being called COVID community and facility clusters. These clusters are identified in the daily NS Public Health Epidemiology Report and then we are linking these cluster with postal code. When the patient present to register for an appointment, IM/IT have developed a process for clerks to place a droplet and contact precaution flag on the patient’s chart.
  3. The COVID-19 Document Hub has a link with resources:
Direction on Comfort Enhancements for Masks
A message from the Personal Protective Equipment (PPE) Working Group

Last week, NSHA, in alignment with the IWK and many health centres across North America, introduced universal masking for all staff and physicians working in patient care areas. This direction means staff and physicians should wear masks for the duration of their shift. However, we appreciate that it can be very difficult to wear a mask for 12 hours, especially if this has never been part of your practice. We empathize with all health care workers who are now wearing masks throughout their shifts and appreciate your participation in this important safety measure.

We understand that some staff and physicians are using other tools and enhancements to make mask-wearing more comfortable, such as headbands and plastic clips.
Infection Prevention & Control and Occupational Health, Safety & Wellness want to support staff and physicians to wear the masks safely and effectively, and so do not endorse the use of any additions to personal protective equipment (PPE). The PPE you are wearing is not intended to be worn with additional clasps or holders. Donning and doffing masks is to be done by the ear loops only. Adding enhancements of any kind to PPE increases the likelihood of staff/physician contamination when doffing, and presents another element that could fail while the mask is worn. Please know that discouraging the use of mask enhancements is for the protection and safety of staff and physicians, which is our primary goal with this measure.

If you are experiencing issues due to prolonged mask use, please log a report in SIMS (Western, Eastern and Northern Zones) or call 902-473-SAFE (Central Zone).

Thank you for your understanding.
Women & Children's Health Program
Patient Flow Resources
The Women and Children's Health Program has created a new Critical Pathway for Suspected/Confirmed COVID-19 and Intrapartum (Maternity) Care.

Click the image or here to view the full document.

You can also view the program's Clinical Pathway for COVID-19 Positive Maternity Patients here.
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.

Choosing Wisely Canada Webinar
Join the next virtual gathering on safety considerations with
Chloroquine, Hydroxychloroquine and Azithromycin in the Management of COVID-19.

Dr. Juurlink, internist and head of the Division of Clinical Pharmacology and Toxicology at Sunnybrook Health Sciences Centre, will be discussing his recent article published in CMAJ.

When: April 29 at noon to 1:00 p.m. (EST). Register today
New Library Services COVID-19
Research Subject Guide
As trusted publishers and research groups share findings and publications for free online, it can be challenging to stay current with the latest COVID-19 evidence.

Use Library Services’ COVID-19 Research subject guide as your starting point for emerging research. This subject guide will be updated frequently as new resources become available. Remember that you can access our online resources 24/7 from anywhere.

Questions about the COVID-19 Research subject guide? Contact Library Services at AskLibrary@nshealth.ca.
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.

*Updated* COVID-19 PPE Recommendations
Infection Prevention and Control has developed a synopsis of recommendations for personal protective equipment (PPE) to be used by health workers providing clinical care for patients with COVID-19.

COVID-19: Personal Protective Equipment (PPE) Recommendations at a Glance was developed to help determine the right PPE at the right time while providing care to patients. 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
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.
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.
Moments of Gratitude
The local Pictou County physician recruitment group purchased signs of gratitude for all essential workers and put them up all over the county. 
Local Bridgewater business Curry Express graciously provided tasty trays of samosas and pakoras today. The treats were distributed to pharmacy, nutritional services, facilities management, porters, environmental services, lab & DI. Here are a few photos of some of the appreciative team members!
Provincial COVID-19 Status Update
Today, April 22, Nova Scotia is reporting two additional deaths related to COVID-19, bringing the total to 12. The deaths occurred at the Northwood long-term care home in Halifax Regional Municipality.

"I extend my condolences to the families and loved one of these individuals - you are in the thoughts of all Nova Scotians. My heart goes out to everyone at Northwood at this time and we are working very closely with our partners to continue to implement an emergency plan to help bring this virus under control at the facility," said Premier Stephen McNeil.

As of today, Nova Scotia has confirmed 772 confirmed cases of COVID-19. Thirty-five new cases were identified Tuesday, April 21.

The QEII Health Sciences Centre's microbiology lab completed 849 Nova Scotia tests on Tuesday, April 21 and is operating 24-hours. Nova Scotia has conducted more COVID-19 tests per capita than any other province.

As of April 21, there were 10 licensed long-term care homes and unlicensed seniors' facilities in Nova Scotia with cases of COVID-19, involving 148 residents and 65 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 22,993 negative test results, 772 positive COVID-19 test results and 12 deaths. Confirmed cases range in age from under 10 to over 90. Ten individuals are currently in hospital, three of those in ICU. Three hundred and thirty 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.
COVID-19 Bulletin #6 - Canadian Society
of Physician Leaders
Issue # 6 of the Canadian Association of Physician Leaders COVID-19 Bulletin is now available.

The author says COVID-19 is as much about the narrative as it is about the facts.

"The way the pandemic evolves is mostly determined by human behaviour. Facts alone don’t motivate humans into action, particularly in the face of limited data and uncertainty. That’s why some provincial and federal public health medical officers (PHMOs) are connecting, not only with people’s brains, but also with their hearts and emotions. Aimed at physician leaders who need to motivate the public atother levels of the Canadian health system, this short paper explains the importance of the narrative and how it can motivate Canadians to take action and change their behaviour."

You can view the full bulletin 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
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.
Support Sessions - Colchester East Hants Health Centre
As things continue to unfold with the horrific situation that has occurred in Northern Zone, we recognize that staff and managers are feeling many emotions. As details about tragedies unfold, it is normal to have a wide range of thoughts, feelings and reactions. If you have experienced past traumas, including deaths, losses, violence or other assaults, you may be experiencing memories and feelings from those events and have increased symptoms now. For very public traumas, such as the one that occurred here, even those who have not directly experienced the crisis may be affected. We know in the days, weeks, and months ahead the ripple effects of this will be felt deeply by many members of our NSHA community. You may experience periods of anxiety, fatigue, nausea, headaches, irritability, feeling helplessness and more. These are normal reactions as we process what has happened; you shouldn’t feel that something is wrong with you if see these happening to you.

You can take steps to help yourselves, family members and each other cope with stress reactions. Some of the things that you can do include:

  • Experience your thoughts and feelings
  • Talk about your thoughts and feelings
  • Take care of yourself
  • Have empathy
  • Moderate your news intake
  • Know when and how to seek help

NSHA leaders within the Northern Zone have reached out to our EAP/EFAP provider to arrange additional supports onsite at CEHHC. Robert Ziegler MEd, RCT-C, is a psychotherapist provided by Morneau Shepell Global Critical Incident Team. He will be available for in-person, confidential support for hospital staff on April 23 and 24, 2020 from 2 pm until 9 pm for either booked appointments or walk in appointments (subject to availability). This service will be located in the Hawthorn Room between E2 and D2.

Individuals are able to confidentially sign up for appointments by taking an appointment card from the sign-up sheet beside the door of the Hawthorn Room. This will reserve an appointment for them to attend at the set time and date they chose. If the door is open and appointment times are not booked, staff can drop in.

Morneau Shepell has also opened its 24/7 bilingual crisis support line to help anyone in need of emotional support as a result of these tragic events. The number is : 1-844-751-2133.

Physician Screening for COVID-19
Call 1-833-750-0632 to speak to Occupational Health and Safety for your screening options.