Covid Guidelines and Procedures


 

In order to limit the potential transmission of Covid-19 between patients and employees, Dr. Singer of Prime has developed what is called "universal precautions". These precautions apply to patients coming to any Prime clinic or surgery center.

For Patients:

We want you to know that you are safe during your clinic visit or office surgery. We are following CDC guidelines to keep everyone safe.

  • For new patients, we will email all registration forms prior to your clinic appointment. Consent forms for surgery and injectables will be completed by patient in the clinic
  • Pre-screening all patients and caregivers (temperature check and health/travel inquiry) (Do you have a fever, are you feeling sick or have you been around anyone sick, have you been traveling?) We want to know that you are feeling well
  • If you feel sick prior to your appointment please call our main number to cancel your appointment
  • Office surgery patients to complete Covid-19 attestation form on the morning of surgery
  • Patients that have encountered a positive COVID-19 individual must notify the clinic
  • The clinic door will be locked. Please call the number on the door and we will let you in.
  • We will ask you to wash your hands when you get here, check your temperature, and ask you to wear a mask.


Please come to your appointment alone or with no more than one adult. That adult will be pre-screened and asked to wash hands and temperature check. Please do not bring your children.

You will be escorted to a freshly-cleaned examination room for treatment or consultation. The room will be decontaminated when you leave and aired out.


For Staff:

The following precautions are performed daily:

  • Do not come to work if you are not feeling well, have a temperature, cough
  • Take your temperature when arriving to work
  • Wash your hands upon arrival at work
  • Wear surgical scrub outfits that are washed nightly
  • Wear a face mask at all times
  • Wear face mask and gloves when around patients
  • Practice social distancing in the workplace as work duties permit
  • requently clean and disinfect work surfaces and exam rooms


Employee Advisories

  • Do not stay at work if you become sick
  • Do not share headsets or objects used near face
  • Do not congregate in the break room or other crowded places


Scheduling Protocols:

  • Go through pre-screening with patient
  • Obtain email address and let patient know they will get their paperwork and Covid-19 consents via email. They will need to fill them out, print them and bring them in
  • Go through safety measures that will be done upon entering the facility


Pre-Screening Questions:

  • Do you or have you had a recent fever?
  • Have you traveled recently?
  • Have you felt sick or been around anyone sick?
  • Have you had a cough, shortness of breath, rash, sore throat, runny nose, etc?


Confirmation Protocols:

  • Call the day before
  • Ask pre-screening questions again or ask if anything has changed since you last spoke (if it was within one week since scheduling)
  • Make sure the patient has received the Covid-19 consent via email and confirm they will bring that in with them
  • Ask if they have any questions about our safety protocols or their consent forms


Talking points during confirmation:

  • To ensure your safety, we will require that you wear a mask into the office and use hand sanitizer upon entering
  • We will check your temperature when you arrive. If you have a temperature of greater than 99.6, we will kindly ask you to follow up with your primary and reschedule your appointment with us
  • If you feel sick prior to your appointment, please contact our office to reschedule
  • To reduce the number of patients in the office at one time, we are staggering appointments and asking patients to come alone or with no more than one adult for the following exceptions:

            o If the patient is under 18
            o The patient is postoperative and has a necessary caregiver

  • No children will be allowed
  • You will be escorted to a freshly-cleaned exam room for treatment or consultation. The room will be decontaminated when you leave


When patients arrive:

  • Make sure the patient is wearing a mask
  • Squirt hand sanitizer into their hand. Do not allow the patient to do it themselves
  • Take no-contact temperature
  • Collect forms
  • Put patient directly into exam room. Do not allow them to sit in the waiting room if possible


When patients check out:

  • Please ask the patient to contact us if they become sick or find out that they have had an encounter with a COVID-19 positive person
  • Wipe down credit card and the machine after each use
  • Disinfect each room
  • Clean door knobs and countertops where the patient has been


Guidance for screening visitors:

  • Ask all entrants if they are a patient or visitor
  • For visitors, say "Out of abundance of caution, we are not allowing visitors at this time. There are limited exceptions, including one parent for children under 18 or supervising caregivers for certain postoperative patients."
  • If the visitor is not an approved exception, say "I apologize for any inconvenience, but we cannot allow you to enter at this time. Thank you for understanding and for your help in keeping everyone safe."
  • If a visitor is an approved exception say, "That is an approved exception. I'm going to ask you a few brief questions and take your temperature".
  • Ask them the following:

           o Have you had any fever, sickness, cough or sore throat, or any other symptoms of a cold/flu?

  • If the visitor or patient answers yes to any of these questions or has a temperature greater than 99.6 say:

           o Do you feel as if you need emergency care? If so, I will connect you with someone.
           o If no emergency care is needed, say "Out of abundance of caution, we kindly ask that you return home and contact your primary care provider."
           o If you experience a medical emergency, please call 9-1-1
           o I understand that these restrictions may cause inconvenience, but it is an important step to keep everyone safe. We appreciate your help in protecting our patients, staff and visitors


General Principles


Employees:

Do

  • Do not come to work if you are not feeling well, have a temperature or cough
  • Take your temperature when arriving at work
  • Wash your hands upon arrival at work
  • Wear surgical scrub outfits that are washed nightly
  • Wear a face mask at all times
  • Wear a face mask and gloves when around patients
  • Practice social distancing in the workplace as work duties permit

Frequently clean and disinfect work surfaces and exam rooms

Don't

  • Stay at work if you become sick
  • Share headsets or objects used near face
  • Congregate in the break room or other crowded places


Patients and Caregivers

  • Pre-screen all patients with the Covid-19 Questionnaire
  • Patients will be instructed to stay home if they aren't feeling well
  • Have patients and anyone with them wash hands and take temperature
  • All patients need to wear a mask during their appointment when possible
  • Wipe down bathroom and door handle after every patient
  • Wash gowns and wipe down exam rooms after every patient 
  • Wipe off office surfaces, pen and clip boards often 
  • Handle all freight boxes with gloves, wipe off boxes and place them in the room of purged charts over night prior to unloading them


Covid-19 Exposure Policy for Symptomatic Employees

  • If an employee or a member of an employee's family comes in contact or has become infected with Covid-19. Contact Dr. Singer immediately.
  • The employee will have to be quarantined for 14 days. If testing is available, they will need to test negative prior to coming back to work
  • The office must thoroughly be cleaned prior to re-opening
  • The office will continue to be open and utilize policies and procedures to limit coronavirus exposure


Ensuring safe, high-quality, high-value care of the surgical patient across the Five Phases of Care continuum.

  • Utilize quality improvement programs/care standards to help support achieving safe, high-quality, high-value patient care.
  • Patients to complete Covid-19 attestation form regarding their personal health condition and have temperature check during pre-op or procedure, the morning of surgery or procedure, and during aftercare.


Ensure optimal patient care across Five Phases of Care: 

Phase 1: Preoperative Period

  • Consider guidelines for repeating laboratory results, radiology, history and physical informed consent

           o Consider use of Telehealth for caregiver training

  • Assess comorbidities: obesity, sleep apnea, chronic pain, hypertension, diabetes, with regards to increased risk

            o  Consider use of Telehealth

  • The composite assessment, in conjunction with sound clinical judgment, provides the surgeon and other decision makers with the information needed to make decisions regarding clinical appropriateness as well as surgical venue
  • Office, clinic, hospital public areas (e.g. reception) should continue to practice physical distancing in reception areas (e.g. six-feet spacing of chairs)
  • Consider review of patient advance directive, especially older adults, frail, Covid-19+, other
  • Evaluate and discuss patient's potential need for post-acute care facility (rehabilitation medicine, skilled nursing facility, other) before operation (given known COVID-19 outbreaks in post-acute care-type facilities)
  • Preoperative setting (e.g. clinic, office or non-COVID-19 care (NCC) areas) should consider screening all patients before the appointment of symptoms of COVID-19 disease, including temperature checks, and routinely screen all staff and others who would be working in the facility (physicians, nurses and others)
  • As stated above in PPE section, aligning with CDC and CMS recommendations, consider a policy for all health care providers and staff to wear surgical face masks at all times. Procedures on the mucous membranes, including the respiratory tract, that have a higher risk of aerosol transmission should be done with great caution, and staff should utilize appropriate respiratory protection such as N95 masks and face shields.
  • Patients should wear a cloth face covering that can be bought or made at home


Phase II: Immediate Preoperative Period 

  • Review nursing, anesthesia, surgery checklists for potential need to be revised re: universal precautions


Phase III: Intraoperative Period

  • Review whether time-outs and briefings need revision with regard to Covid-19 risk, Covid-19 testing results, and ensure PPE use guidelines are being followed
  • Consider guideline for personnel to be present during intubation, and consider including waiting time (e.g., with regard to air circulation cycling time) before beginning operation
  • PPE use guidelines
  • Review specimen pickup protocol


Phase IV: Postoperative Period

  • Adhere to standardized care protocols as much as possible (e.g., enhanced recovery protocols) for increased reliability in light of potential different personnel as standardized protocols optimize lengths of hospital stay and efficiency are associated with decreased complication rates


Phase V: Post Discharge Period

  • Post-acute care facility availability 
  • Post-acute care facility safety (COVID-19, non-COVID-19 issues)
  • Home setting
  • Avoidance of contact with pets


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