TREATMENT

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1. Prior to patient arrival at booking stage patient should be asked regarding COVID-19 Status & asked to update immediately on a change in status [SEE COVID-19 STATUS CHECKER]
2. Patient complaint recorded any change in need/concern is recorded
3. Medical History checked
4. Exempt status checked
5. Payment for treatment taken over the phone where applicable. Where this is not possible patient advised to put exact change in a clear wipeable bag on arrival, patient advised they will not be seen without full pre-payment
6. Full patient service instructions given orally and where possible written copy emailed to patient [SEE PATIENT INSTRUCTIONS]
7. Patient should be reminded not be bring an escort unless necessary such as a parent with a child in which case only one escort brought from patient's household where possible
8. Patients advised not to bring any belongings bags & coat inside
9. Online/ phone translator service should be arranged [TRANSLATORY SERVICE]
10. Risk assess according to the individual patient needs and best interest
11. Information should be gathered to allow comprehensive pre-treatment planning on what treatment may be required including whether it would be AGE/NON-AGE
12. A digital pack should be prepared and sent to patients where applicable to include:

(patient questionnaire, medical history, FP17, risk assessments, patient preparation information, consent forms and payment methods for patients/carers to complete and return in advance of their visit)

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1. Patient asked to wait in the car or outside 2metres from any other person & contact clinic via phone or knock to register their arrival
2. Maintaining 2metre social distancing throughout the whole patient flow except for treatment and assessment and kept as minimal and short as possible
3. Patient called to ask to enter the building and to wash hands on arrival any escort is also to wash their hands
4. Temperature of patient taken using non contact thermometer [NB: This may be unreliable]
5. If pre-payment not taken patient cash collection in a wipeable bag
6. Patient given instructions on patient flow
7. Patient who have bought belongings are advised to leave belongings out of the clinic such as in a car or with an escort otherwise offer to store where feasible however explain there is no responsibility with the clinic for items lost or stolen
8. Where digital versions have not been obtained Medical History and PR1/ FP17 forms checked filled and signed by staff and signed as [COVID-19]
9. Where a parent or guardian could not attend due to vulnerable/shielding they should be contacted via phone to confirm consent
10. Parents and guardian/ escort at this point advised to wait back outside where possible
11. Appropriate chaperoning must be considered
12. Patient is led into surgery by runner staff/ "clean" nurse

Patient must be refused service if

1. ‍Displaying COVID-19 symptoms
2. No longer has an urgent need
3. Failure to provide pre-payment
4. Failure to follow instructions given

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• Post treatment the instrument box should be covered and left in the surgery
• Clinicians should go to doffing station & follow doffing guidelines, they must leave the clinical room with their eye protection and respirators still on.
• After a full hour has been given a terminal clean of full surgery doors, door handles any surfaces that are at risk of contact including floor using appropriate cleaning agent effective against enveloped viruses such as 1000ppm chlorine mix OR alternative disinfection effective against enveloped virus by "dirty nurse" with a FFP3 respirator on
• Post treatment disinfection should follow HTM: 01-05
  

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Suggested Protocol if a Patient becomes unwell during an appointment in a UDC

If COVID-19 is considered possible when an appointment is already in progress, assess a suitable and safe point to bring any treatment to a close.

1.        Isolate patient in surgery you are treating away from other patients. Provide mask and gloves for the patient and chaperone to put on. Provide water and tissues. Advise others not to enter the area. Put out isolation notices to prevent entry

2.        If the patient is critically ill or requires emergency medical care, an ambulance should be requested, and the 999-call handler informed of COVID-19 risk. Normal medical emergency training is appropriate especially oxygen and asthma care if appropriate. Support breathing as primary concern.

3.        Otherwise withdraw from the area, wash hands thoroughly with soap and water. Change PPE and discard in clinical waste. Don new PPE and apron.

4.        If they are so unwell they cannot leave ask them where they have been in the building and clean all touched surfaces, open all doors, and windows. Turn up heating. Recruit help for other duties, such as reception.

5.        Send all other patients home after updating their contact numbers/details. Once patients gone, shut practice. Put up PRACTICE CLOSED sign on front door.

6.        Advise patient to contact NHS111 from their mobile in designated isolation area: –patient will need to state where they are calling from and provide contact details for the practice. If no patient mobile, staff to call on practice phone and relay responses to NHS111.

7.        While waiting for advice from NHS111, communicate with the patient from outside area to check status. If you need to enter the area, wear personal protective equipment (PPE) in line with standard infection control precautions, gloves, disposable apron and surgical mask and keep exposure to a minimum. All PPE should be disposed of as clinical waste.

8.        If a healthcare professional is required to enter the area to offer assistance, they should wear disposable gloves, disposable aprons and fluid-resistant surgical facemasks.

9.        When patient has left the building, clean surgeries thoroughly and ALL communal areas down to front door and time allowed for aerosols to settle.

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