April 24, 2020
To view archives of all physician resources and communication visit www.cdha.nshealth.ca/coronavirus
COVID-19 Physician Information Update
April 24, 2020
Updated Clinical Documents
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Order Sets, Procedures, Clinical Pathways, Guidelines and Policies

Occupational Health

Infection Prevention and Control

COVID Primary Assessment Centres and Secondary Assessment Centres

Mental Health and Addictions
Efficiencies Found in Truro with Drive Through Primary Assessment Centre
On Wednesday, April 15, Colchester East Hants Health Centre, began a Drive Through COVID-19 Testing site. The idea for the innovative approach to the Primary Assessment Centre came from Heather Wolfe and Raj Makkar. Heather had already set up a tent for pre-triage and noted the logistical opportunity of the roundabout at the entrance to the Emergency Department. The group submitted their idea to the EOC and it was approved.

As the site began operating, the team continued to seek out efficiencies and were able to streamline the Primary Assessment Centre to reduce the number of PPE and staff resources required. They are now sharing this work with teams across the province.
Please find the summary of results for the drive-thru swabbing model PDSA cycle. There have been several efficiencies realized through this PDSA cycle, especially PPE utilization which is embedded in cycle 3.

The PDSA cycle included 3 cycles of review ( #1 April 16, #2 April 17, #3 April 22) and has been focused on the following measures and produced the following outcomes: 

1. Total patients (booked, referred, drive-in)
  • Booking/performed ~ 30 patients daily with 1-2 “drive-ins”/physician referrals accommodated.  
  • Drive-thru testing continues to operate without process issues. 
  • Additional pylons added for vehicle flow.
2. PPE counts: PPE usage analysis completed: 
  • PAC RECC vs PAC Drive Thru (10 hr day)
  • Gowns: decreased 87% (75 -> 10)
  • Gloves: decreased 50% (160 -> 80)
  • Masks: decreased 67% (90 ->30)
  • Eliminated roles of Security and Environmental Services
3. Total HR resources
  • Staffing model working well. (Staffing model adjusted to 1 - TD LPN, 1 - 10hr D RN, 1 - 10hr D LPN.)
  • Pre-triage function in place 0700 to 1900, no longer supported by ED staff.

Process Improvements: 
• Referring some patients to respiratory clinic now and will continue to explore further opportunities through upcoming cycles

View the pathway below. Click the image for the link to the full sized document.
NSHA Launches In-Home Blood Collection Services for Eligible Patients
Due to impacts on public and private blood collection services in N.S. related to the COVID-19 pandemic, NSHA is implementing an in-home blood collection service. Referrals will be accepted beginning Monday, April 27th with appointment bookings starting Wednesday, April 29th. This service is specifically for patients requiring urgent/time-sensitive testing for immediate diagnosis and management of chronic illness (e.g. renal disease, cancer, etc.)

Routine blood work that does not fit in the criteria above should not be ordered at this time. Patients who are eligible to be referred for this service are as follows:
  • patient is housebound and unable to go out of the home; or
  • not providing blood collection in the home would cause undue hardship to the patient. The hardship could be physical, medical, financial or other. 

All requests must be directed to Continuing Care following the existing Continuing Care referral process. Please fax a completed  Continuing Care Referral Form along with a completed laboratory requisition to:
  • CZ: 902-455-3809
  • EZ: 902-563-3433
  • NZ: 1-866-682-8170
  • WZ: 1-866-246-4554

Your partnership in selecting the right patients is key to our success with this service. Please ensure only patients meeting the above criteria are referred to avoid overwhelming this new service and maintaining access for those who require it most.  Your local NSHA laboratory will connect with the client to make arrangements for an in-home blood collection appointment.

Ambulatory patients requiring urgent blood work can still access NSHA outpatient blood collection clinics by booking an appointment with their local NSHA Blood Collection Service. Please be assured that pre-screening, social distancing, and additional infection prevention and control measures are in place to ensure their safety. Information about NSHA Blood Collection Service including appointment booking, can be found on the NSHA website:  http://www.nshealth.ca/blood-collection .

NSHA is also offering support to Long-Term Care facilities to ensure blood collection services can be provided safely to their residents. Long term care facilities needing assistance are asked to contact  josh.macdonald@nshealth.ca for more information.

We appreciate your cooperation and patience at this difficult time.
  • If you have any questions, please contact your local laboratory directly.
Well Child and Prenatal Visits During COVID-19
Choosing Wisely Canada has a resource to support family practices care for children and pregnant women through the pandemic. See the interim schedule suggested for well-child visits including vaccines as well as low risk pre-natal visits.
Northwood Update
Despite recent claims regarding the working conditions at Northwood we want to assure you that the safety of the residents and the employees remains our top concern and primary focus. All employees working at Northwood receive the personal protective equipment recommended by both the World Health Organization and expert Infection Prevention and Control Clinicians in Nova Scotia. Northwood has a solid supply of personal protective equipment to keep both employees and residents safe.

Safe work environments and strong infection prevention and control practices are important in every health care setting, and especially those with a COVID-19 outbreak. Safety and infection control are so important that two infection prevention and control practitioners are on site daily to support Northwood’s efforts. There are appropriate and safe spaces for staff to don and doff their PPE without risk of contamination. 

As always, we encourage employees to raise any concerns they have with their onsite manager immediately so they can be addressed in a timely manner.

We sincerely thank you for the work you are doing to support the Northwood family. Our residents are benefiting from the care and support you are providing and your continued efforts to work together to provide quality care in a safe environment.

Sincerely,
Janet Simm and Vickie Sullivan on behalf of Northwood and NSHA Leadership Teams
Atlantic Canada COVID-19 Study
Today, Narrative Research has released the second of four press releases with results from an extensive study of Atlantic Canadians regarding COVID-19. More than 3,200 residents were surveyed as part of Narrative Research’s East Coast Voice online panel.

The third and fourth releases will be shared early next week.

Click the image to the left for today's release.

The first release, and other Narrative Research press releases, can be found on our website: https://narrativeresearch.ca/news/
MAiD Information Session
Join Dr. Gord Gubitz for a Virtual Information Session on Medical Assistance in Dying (MAiD).

Friday May 1, 9:00 a.m. to 10:00 a.m.

Dr. Gubitz will review federal legislation, the referral / intake process, assignment of assessments, patient eligibility criteria, MAiD procedure, clinical documentation, as well as Federal reporting requirements.

We are working toward building additional clinical capacity within the MAiD team, and this session is therefore directed at Physicians and Nurse Practitioners. However, anyone who wishes to learn more about MAiD may take part.

Please register with John McCarthy, Medical Affairs Advisor by 12:00 noon, Thursday, April 30th. Those who register will receive a link and login credentials for the Zoom meeting. If you have any questions, please call John McCarthy at 902-220-2968.
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
COVID - 19 Rapid Research Funding Opportunity

The Government of Canada is pleased to announce the launch of a new rapid research funding opportunity to continue to mobilize science to fight COVID-19. This funding opportunity is a partnership between the Canadian Institutes of Health Research (CIHR), the International Development Research Centre (IDRC), the Michael Smith Foundation for Health Research, Alberta Innovates, the Saskatchewan Health Research Foundation, Research Manitoba, the New Brunswick Health Research Foundation, and Research Nova Scotia, with additional potential partners to be confirmed.

Objectives
  • Accelerate the availability of high-quality and real-time evidence to support Canada’s rapid response to the global pandemic in order to better prevent, detect, treat and manage COVID-19;
  • Develop, test, and study the implementation of effective interventions to prevent, detect, treat, and manage COVID-19 at the individual and/or population levels by reorienting or amplifying existing research platforms, networks, and trials as well as funding new research projects within existing and established research infrastructure;
  • Enable Canadian engagement and coordination in national and international large-scale trials and better enable harmonized data collection, sharing of data, quasi-experimental and observational studies, and rapid large-scale evaluation of impact;
  • Provide evidence to inform clinical and health system management and public health response, and/or decision-making and planning within and across jurisdictions in Canada and internationally; and
  • Enhance local, national and/or international collaborative efforts, including in low- and middle-income countries, to mitigate the rapid spread of COVID-19 and related negative consequences.

Funding will support clinical trials, observational studies, implementation science or other relevant study designs to scale-up promising existing projects, reorient current research, or initiate new rapid response research to address COVID-19 in the identified research areas that include understanding the safety, efficacy, effectiveness, ethics, and implementation of:
  • vaccines, diagnostics, or therapeutics;
  • clinical management and health system interventions; and
  • social, policy, and public health responses and related indirect consequences.


Application deadline: week of May 11, 2020

Please note that the source of funds for this competition will not be from the cancellation of the Spring 2020 Project Grant competition but are a part of the strategic whole of Government of Canada efforts.
Given the urgency of this funding competition, recruitment for peer reviewers will begin immediately. If you are interested and available to volunteer as a peer reviewer, please reach out to CIHR immediately at EHTRF-FRNMS@cihr-irsc.gc.ca. We thank applicants and peer reviewers in advance for their flexibility and understanding with respect to the need for this expedited process.
Stronger Together
Piper Kevin Dugas, a social worker at the QEII, was up early this morning to play Amazing Grace at the Camp Hill Veterans Memorial Building garden as part of the province-wide pipers' tribute to those whose lives were tragically taken from last weekend. Thank you Kevin.

Moments of Gratitude
RCMP Visit to St. Martha's Regional Hospital in Antigonish
Between the COVID-19 pandemic and the events last weekend, that were too close to home, there has never been a more honest time to restate that we are all in this together. Thursday evening, after receiving my request to visit St. Martha’s Emergency Department, Constables Coleman and Fahie surprised ER staff by arriving wearing their official Red Serges. We were honoured to have the opportunity to thank them for their service and have our picture taken with them.
Truro Leadership Walkabouts
Following the tragic event in our community this past weekend, Dr. Tanya Munroe (Interim Medical Site Lead) and Archie MacKinnon(Operations Site Lead) decided to host a leadership "walk about" on Site each morning- to be present with our Colchester East Hants Health Centre (CEHHC) family. The intent was for staff and physicians to feel supported by their leaders and to provided some refreshments which always help make space for conversation, questions, or simply to just be present. Various NSHA Leaders participated in the daily walk abouts, including some of our NSHA Executive Team members.

When reaching out to the local Tim Hortons to arrange for ordering supplied, Quinn Mackenzie (owner of Robie Street Truro Franchise) offered to provide all nourishment for the site for the week.

"At times of grief, when the community can provide such comfort, it is healing not only for our staff and physicians, but our community as well. This past week has been devastating for our staff, physicians and our community- this act of caring, contributes to our continued trust in humanity and to our collective healing." 
Dr. Brendan Carr, President and CEO, with members of the Surgical Team.
CEHHC staff and security receive supplies from Quinn Mackenzie of Tim Hortons.
Members of the CEHHC Maternity and Child team receive snacks and a visit from Dr. Brendan Carr.
Provincial COVID-19 Status Update
As of today, April 24, Nova Scotia has confirmed 850 confirmed cases of COVID-19. Twenty-three new cases were identified Thursday, April 23.

The QEII Health Sciences Centre's microbiology lab completed 888 Nova Scotia tests on Thursday, April 23 and is operating 24-hours. Nova Scotia has conducted more COVID-19 tests per capita than any other province.

As of April 23, there were 10 licensed long-term care homes and unlicensed seniors' facilities in Nova Scotia with cases of COVID-19, involving 189 residents and 82 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 24,521 negative test results, 850 positive COVID-19 test results and 16 deaths. Confirmed cases range in age from under 10 to over 90. Eleven individuals are currently in hospital, three of those in ICU. Three hundred and ninety-two 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

Government of Canada toll-free information line 1-833-784-4397

The Mental Health Provincial Crisis Line is available 24/7 to anyone experiencing a mental health or addictions crisis, or someone concerned about them, by calling 1-888-429-8167 (toll free).

Kids Help Phone is available 24/7, by calling 1-800-668-6868 (toll-free). 

For help or information about domestic violence 24/7, call 1-855-225-0220 (toll-free).
This section of our update is a list of helpful resources updated daily for physicians.

Please reach out to Shawn Jolemore with your suggestions for additional content.
Leadership and Wellness Poster
Updated for Week of April 20-27
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.

Setting Personal and Professional Priorities in the Midst of Pandemic
April 27 from 4-5 p.m. with Dr. Lara Hazelton. Join Zoom Meeting. Password if prompted: 050891

Talking About Trust: An Exploration of BRAVING, Brene Brown’s Tool for Having More Effective Conversations About Trust. 
Wednesday, April 29 12:00-1:00 pm with Basia Solarz. Email Dana2.Jakeman@nshealth.ca to request your Zoom link..
Wellness Supports
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 - Join Zoom Meeting Link


DNS Professional Support Program
Feeling overwhelmed or need to talk to someone? 
As we try to wrap our heads around the weekend’s tragic events and the senseless loss of so many innocent lives, I want to remind you that help is available. Whether you were directly connected to it or not, the tragedy intensifies the stress of the pandemic and the pressure on our lives due to the measures we are all following.

Contact the Doctors Nova Scotia (DNS) Professional Support Program at 902-468-8215 or 1-855-275-8215 (toll-free) mail or via email. LifeWorks by Morneau Shepell is also available to members and their families affected by the events in Portapique and surrounding communities. The crisis support line is open 24-7. Call 1-844-751-2133.

Preparing for Crisis: A Healthcare Professional's Guide to Emotional Health
April 29 from 4-5 p.m. with Dr. Angela Cooper. Join Zoom Meeting. Password if prompted: 050891
View the session handout
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. NSHA leaders within the Northern Zone have reached out to our EAP/EFAP provider to arrange additional supports on site 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 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.