COVID-19 POLICY & PRECAUTIONS

ACHIEVEPHYSIO WORKING IN THE CONTEXT OF COVID-19

[Based upon, and utilising, advice and guidance from the Government, Health and Care Professions Council (HCPC), Chartered Society of Physiotherapy (CSP) and Physio First and subject to change]

 Statement of intent

• To endeavour to safeguard the health and safety, so far as is reasonable, of all individuals who attend or work at the clinic, and the people with whom they come into contact with subsequently; and to thereby endeavour to mitigate the risk of achievephysio contributing to the spread and perpetuation of the current global Covid-19 pandemic.

 What are the new additional risks relating to Covid-19?

• Transmission of the Covid-19 Virus between individuals who enter the clinic or who have contact with individuals or objects that have been in the clinic.

 Who is at risk?

• Anyone entering the clinic, particularly patients attending for face to face (F2F) treatment and the treating Physiotherapist, but also, indirectly, members of their respective families, and the wider general public.

 Routes of transmission

• Infectivity appears to be highest just before symptoms start or very early in symptomatic infection.
• The transmission of COVID-19 is thought to occur mainly through respiratory droplets generated by coughing and sneezing, and through contact with contaminated surfaces. The predominant modes of transmission are assumed to be droplet and contact.
• Contact contamination can occur directly (e.g. by patient touching a surface/object), or indirectly (e.g. via Physiotherapist’s hands after touching patient) or via airborne droplets.
• During aerosol generating procedure (AGPs), there is an increased risk of aerosol spread of infectious agents irrespective of the mode of transmission (contact, droplet, or airborne), and airborne precautions must be implemented when performing aerosol generating procedure (AGPs.
• Initial research has identified the presence of COVID-19 virus in the stools and conjunctival secretions of confirmed cases. All secretions (except sweat) and excretions, including diarrhoeal stools from patients with known or possible COVID-19, should be regarded as potentially infectious.

 What are the additional actions required to address the risks relating to covid-19?

• Follow advice and guidance issued by the Government, HCPC, CSP, and Physio First.
• Adapt the clinic environment and permitted behaviours of those attending and working therein, including enforcement of ‘social distancing’.
• Develop and apply enhanced cleaning, waste disposal, handwashing, and hygiene procedures including the use of Personal Protective Equipment (PPE).
• Undertake remote screening of prospective patients attending the clinic and those accompanying them prior to every attendance on the day of the appointment.
• Undertake remote triaging of patients to establish the appropriate type of intervention, if any, in the context of Covid-19 related precautions and restrictions.
• Inform patients and, if appropriate, relatives, carers, and chaperones of changes to practice and the associated limitations and risks and legal obligations thereof and gain informed consent, including reference to compliance with contact-tracing exercises.
• If face to face (F2F) appointments are offered and undertaken, then the format, nature and duration of interventions to be adapted and patient to be informed of this, and of the requirements of them when they attend the clinic in order to endeavour to mitigate the risks relating to Covid-19.
• No AGPs to be undertaken.

 PPE

Physiotherapist to wear:

• disposable gloves and apron – to be changed for each patient.
• disposable mask – to be changed after each clinic session
• visor if considered necessary after risk assessment – to be cleaned after each patient.

Patient to wear:

• disposable mask – to be disposed of after each appointment.

It is important to use PPE properly and wash or sanitise hands before putting it on and taking it off.

PATIENT – ACHIEVEPHYSIO  RELATIONSHIP/RESPONSIBILITIES

In the context of Covid-19 and the associated advice and restrictions from Government, Regulatory and Professional Bodies, there has had to be a change in the Physiotherapy services that achievephysio provides, and the basis upon, and the way in which, those services are provided in order to endeavour to mitigate risk of infection to all patients, staff and visitors and their respective families. However, despite this, it must be understood that it is impossible to offer any guarantees in these respects.

Upon first contact with achievephysio, documentation will be emailed to the patient for completion, signature and return via email. Then Covid-19 remote screening will be arranged for all prospective patients (subject to consent). If the patient passes the screening, they will be triaged in order to establish if their problem lies within our scope of practice and, if it does, upon which basis to proceed, namely no advice/treatment, onward referral to another medical service, remote advice/treatment, or face to face (F2F) treatment. Appropriate ‘Safety Netting’ monitoring will be undertaken where indicated. It should be noted that achievephysio is not obliged to treat anyone and, whilst all decisions will be arrived at through discussion, the final decision lies with achievephysio.

In providing answers and information during screening, triage, assessment and treatment processes, patients (and carers/chaperones/relatives) must be aware that they have a moral and legal duty and obligation to be completely full and open in doing so, as to do otherwise could compromise their own health and safety, and that of the Physiotherapist, other achievephysio patients, staff and visitors and/or their respective families and contribute to the continuation and spread of the Covid-19 pandemic. Patients also have an ongoing duty to update achievephysio of any changes to their status or that of people they have been in contact with prior to attending each and every F2F appointment, therefore re-screening will be undertaken remotely on the day of each and every such appointment.

Equally, in addition to the normal duties of care and professionalism required of achievephysio, in the context of Covid-19 there are heightened obligations in respect of prevention and control of infection which have necessitated increased cleaning and infection control measures, including the use of Personal Protective Equipment (PPE) and social distancing so far is practicable, and also changes to our practice and working patterns and methods.

Patients (and carers/chaperones/relatives) should be aware that remote assessment and treatment is not comparable to F2F assessment and ‘hands-on’ treatment and is considered second best, but nevertheless can be of benefit and is worth trying if F2F is not offered for whatever reason.

Normally, F2F Physiotherapy with achievephysio, is very much a ‘hands-on’ experience and so it is impossible to maintain social distancing at all times. However, where F2F appointments are offered, to minimise ‘close contact’, patient’s history will be taken remotely and physical assessment and treatments will be adapted and rationalised and some types of assessment and/or treatment techniques will not be utilised. Duration of appointment will be reduced. 

The Physiotherapist will wear appropriate Personal Protective Equipment (PPE) and all patients (and carers/chaperones/relatives) will be required to:

• travel directly to clinic, by car, bicycle or on foot (not public transport or taxis/cabs etc), and not to go into any shops or other premises before attending the clinic, and maintain social distance at all times outside and inside the clinic;
• attend alone, unless there is an pre-agreed or legal need for a relative, chaperone or carer, in which case that person should undergo screening and sign a declaration prior to attending, and should maintain social distancing whilst within the clinic so far as is practicable;
• arrive at appointment time and not before and phone achievephysio and wait outside or in car until invited to enter clinic;
• go to the toilet at home just before leaving for clinic to mitigate the chance of them needing the toilet whilst at clinic;
• wear clean clothing and the minimum amount;
• not bring bags and other possessions to clinic, any minimum possessions, e.g. keys, to be placed in clean plastic bag (provided by clinic) on entering clinic and then taken away upon leaving clinic;
• have their temperature taken using a ‘contact-less’ device prior to entering the clinic – if patient’s (or carer’s/chaperone’s/relative’s) temperature is not normal and/or they have Covid-19 type or other symptoms the F2F appointment will be cancelled and assessment and treatment will be continued remotely if appropriate and agreeable to both parties.
• sanitise their hands upon entry and exit;
• wear a face mask provided by the clinic and avoid touching their face;
• only touch chair and treatment plinth and avoid touching/coming into contact with all other surfaces, fixtures and fittings, including door handles, doors, walls, light switches, bins, hand basin so far as is practicable when in the clinic;                                    

Patients (and carers/chaperones/relatives) attending for F2F appointments must appreciate that whilst additional cleaning protocols and other measures and precautions have been introduced to mitigate the risks associated with Covi-19 (which can be transmitted mainly through respiratory droplets generated by coughing and sneezing, and through contact with contaminated surfaces), it is not possible to guarantee that all such risk has been eliminated.

By proceeding, patients (and carers/chaperones/relatives) accept the nature of risks and consent to the way they will be assessed and treated, whether remotely or F2F, and agree to keep achievephysio updated regarding any changes to their status and undertake to be completely open, full & truthful throughout. Also, patients accept that treatment may have to be curtailed or cancelled in the event of a change in their or the Physiotherapist’s health or risk status, or that of their household or other contacts, or changes in restrictions and guidance from the Government, HCPC, CSP or Physio First.  Additionally, patients (and carers/chaperones/relatives) consent to their details being provided to the appropriate Authorities if requested in the event of a contact tracing exercise.