During a time when many practices are considering reopening or increasing face-to-face treatment service hours amid the current state of COVID-19 turmoil, there are many unanswered questions.
LW Consulting, Inc. (LWCI) has been reviewing the plethora of information posted by the Centers for Medicare & Medicaid Services (CMS), the Occupational Safety and Health Administration (OSHA), Centers for Disease Control (CDC) and various other federal agencies regarding patient quality, safety, infection control, and personal protective equipment (PPE) requirements. While the information seemed to change daily, recent increased coordination and communication regarding re-opening—aligning with the “Opening Up America Again” phased criteria and preparedness—has emerged. This blog was developed to guide practice owners as they consider re-opening and to answer some of the common questions we have received. If your question is not included, or if you need more specific support on a reply, please reach out to LWCI.
The CDC has provided up-to-date guidance on how to handle patients in an outpatient setting. Also, the American Physical Therapy Association (APTA) Private Practice Section released “Considerations for Outpatient Physical Therapy Clinics During the COVID-19 Public Health Crisis” for outpatient therapy providers to use as they prepare for re-opening or expanding “in clinic” treatment services.
Considerations Related to Screening Staff and Patients
The following questions should be asked prior to receiving in-clinic patient visits and upon entry before appointment. Upon entry before appointment, take the patient’s temperature to check if the patient has a fever. According to CDC, a fever is 100.4⁰F/38⁰C or higher. If the patient has a fever or if any of the following apply, the appointment should be rescheduled.
- Are you (or is your patient) experiencing symptoms of COVID-19, or feeling unwell?
- Have you (or has your patient) been in close contact with someone who is suspected to have, or was diagnosed with, COVID-19?
- Have you (or has your patient) traveled to an area deemed high risk?
- Will your patient's condition worsen or deteriorate if physical therapist services are not provided?
- Are you (or is your patient) in a high-risk category, such as diabetes, heart condition, or older age?
- Has your patient traveled recently?
Considerations Related to the Facility’s Environment
Take into consideration the layout and setup of your treatment, entry and waiting areas. These areas should continue to practice safe workspace distancing. Review the following when evaluating your facility:
- Evaluate your treatment and waiting room space design to ensure patients and staff are kept a minimum of six feet apart from one another at all times.
- Assess how patients will be screened for symptoms prior to entering the practice – on phone and physical entrance.
- Consider providing one-on-one patient care only, especially with immunocompromised patients.
- Adjust patient scheduling to minimize the number of patients in the waiting room and to minimize patient overlap in compliance with your state-specific guidance.
- Assess how you will handle the patient sign-in process which may not allow patients to reuse the same pen or may require patients to wear gloves to sign in.
- Assess how to minimize cross-contamination of therapy equipment (i.e. Fluidotherapy, theraputty, theraband). Will you require patients to wear gloves during treatment to minimize cross-contamination?
- Limit visitors to the clinic to only those essential for the patient’s physical or emotional well-being, care and post expectations.
- Assess air-handling systems (with appropriate directionality, filtration, exchange rate, etc.) to make sure they are properly installed and maintained.
Considerations Related to Cleaning
Ensure you are following the proper CDC recommendations for cleaning and disinfecting your facility, including the following:
- Perform proper hand hygiene frequently after touching surfaces and patients, including immediately after removing gloves and after contact with an ill person by washing hands with soap and water for a minimum of 20 seconds.
- Clean all equipment, devices, and surfaces between each patient interaction per CDC recommendations with EPA disinfectant.
- Assess your overnight disinfectant/cleaning process.
- Consider using disposable towels vs. linens for patient treatments.
Considerations Related to Policy and Procedures
Review policies and procedures to ensure they are up to date with the following:
- Staff sick leave policies.
- CDC guidelines on returning to work after an illness.
- Infection control policies and procedures, including COVID-19 related procedures.
Considerations Related to Training
Review the following with your staff to ensure they are up to date with your facility’s policies and procedures:
- Hand washing standard precautions and sterile precautions.
- Staff education, training, and PPE policies prior to caring for a patient, including attention to correct use of PPE and prevention of contamination of clothing, skin, and the environment during the process of removing such equipment.
For more information, contact Deborah Alexander at 717-213-3122 or email DAlexander@LW-Consult.com.