CSHBC has compiled questions and answers about Provincial Health Officer Dr. Bonnie Henry’s March 23, 2020 update for regulated health professionals (PDF). The update provides expectations for health professionals regulated under the Health Professions Act when providing patient and client care in community settings.
Q: What does this update from the Provincial Health Officer mean for CSHBC registrants?
Dr. Henry’s update is consistent with the recommendation issued by CSHBC on March 18, 2020 that all Registered Audiologists (RAUDs), Registered Hearing Instrument Practitioners (RHIPs), and Registered Speech-Language Pathologists (RSLPs) who work in private practice conduct a risk assessment, suspend in-person elective and non-essential services, and only provide urgent and emergent services.
The update is also consistent with the recommendation issued by CSHBC March 18 that RAUDs, RHIPs, and RSLPs who work in public health clinics, hospitals, health agencies, long-term care facilities, school districts, and other public sector settings conduct a risk assessment and follow the direction of their employers and public health officials.
In her update, Dr. Henry said: “All non-essential and elective services involving direct physical contact with patients and clients should be reduced to minimal levels, subject to allowable exceptions, until further notice.”
Q: What is considered to be non-essential or elective care during the COVID-19 pandemic?
CSHBC recognizes that our registrants have the training and expertise to make decisions and provide care based on the unique needs of each patient/client. However, in light of the extraordinary situation brought about by the COVID-19 pandemic, the College is providing more detailed guidance.
CSHBC strongly recommends that registrants cease delivery of non-essential or elective (routine) care during the special situation of the COVID-19 pandemic. This is care that is neither emergent nor urgent.
In general, emergent care is defined as immediate management or treatment of potentially life-threatening conditions. For CSHBC registrants, this may include very limited cases where a new or exacerbated condition could result in the client being sent to an emergency department.
- This is most likely limited to swallowing disorders such as those with a high risk of aspiration pneumonia, including but not limited to: degenerative neurological conditions, new acute swallowing disorders, and those with potential obstructions. Registrants should also be aware that in the community, the use of procedures such as naso-endoscopy carry an increased risk of COVID-19 spread because the virus is centered around the nasal cavity, and should only be used in emergent situations, while adhering to the strictest personal protective equipment requirements, and enhanced infection control and sterilization techniques.
- Certificate G holders may be required to see specific voice restoration (protheses) clients in the community, in order to avoid having them present at an Emergency department. In most cases, these clients are managed through cancer agencies.
In general, essential (urgent) care is separate from emergency care and focuses on the management and treatment of conditions that require prompt attention. For CSHBC registrants, urgent care needs may include:
- Clients reporting any or all medical red flags: In these instances, the registrant should confer with a medical professional where possible. The clients may not need to be seen in person by a CSHBC registrant. These red flags for adults include:
- History of sudden or rapidly progressive or fluctuating hearing loss;
- History of active drainage activity or bleeding from the ear(s), in the preceding 90 days, or visible drainage on examination;
- Ongoing pain or discomfort in the ear;
- Unilateral or pulsatile tinnitus;
- Acute, recurring episodes, or chronic dizziness or increasing imbalance;
- Evidence of a foreign object in the external auditory meatus (ear canal).
- Clients being discharged from hospital and who are at increased risk of complications if they are not seen in the community in a timely manner.
- Isolated clients (especially the elderly or persons who live alone) and are dependent on functioning hearing aids or other communication technology in order to be safe in their environment. This includes those who need to be able to communicate with the outside world by phone and other means and may require urgent replacement hearing aids/loaners or assistive technology.
- Urgent vestibular testing cases (e.g. those with multiple falls, drop attacks, high anxiety/suicidal ideation related to dizziness).
Dr. Henry noted that health professionals who provide emergent, urgent, and/or essential care “must assess and screen patients and clients for symptoms of COVID-19.”
Q: How should I screen my patients for COVID-19?
- Ask the patient if they are experiencing any symptoms of COVID-19, as described by the BC Centre for Disease Control (BCCDC), including cough, sneezing, fever, sore throat, and difficulty breathing.
- Ask about any recent travel outside of Canada.
- Ask about any contact with individuals who have a confirmed or presumptive diagnosis of COVID-19.
- Try to pre-screen patients by phone if possible.
- As suggested by BCCDC, individuals can use the COVID-19 BC Support App and Self-Assessment Tool to help determine if they need further assessment or testing for COVID-19.
What are the implications of providing hands-on care?
- When direct physical contact is required for the care of patients with presumptive or confirmed COVID-19, health professionals must use infection control practices. See the BCCDC’s page on COVID-19 Infection Control. Also see the CSHBC Notice to the Professions on Enhanced Infection Control for Private Clinics.
- If you are not able to ensure adequate infection control, do not provide care to the patient. Seek an alternate approach to meet their care needs (e.g. referral to another provider or facility).
“Where possible and appropriate, health professionals are encouraged to provide care to patients and clients via telephone and video technology,” said Dr. Henry.
Q: Where can I find more information on providing virtual care?
See CSHBC’S comprehensive and updated Notice to the Professions on Providing Virtual Care during COVID-19 Pandemic. The notice covers:
- CSHBC standards of practice, Code of Ethics, and other guidelines registrants must comply with when delivering virtual care.
- A response to registrants who have requested information on virtual care service providers (i.e. software, platforms, and applications).
- Privacy guidelines for registrants transitioning to virtual care provision.
- Relevant privacy legislation.
Dr. Henry said in making decisions regarding the reduction or elimination of non-essential and elective services, health professionals should be guided by their regulatory college and a series of principles, including “reciprocity”.
Q: What does reciprocity mean?
Dr. Henry explained reciprocity by saying, “Certain persons or populations will be particularly burdened as a result of a reduction in non-essential services. As such, patients and clients should have the ability to have their health monitored and it be re-evaluated as required.”
To follow this principle, CSHBC recommends the following:
- That registrants develop a plan for patients who have contacted your office requesting care that you have determined to be non-essential due to the COVID-19 situation. This is so you can act should their needs change and they require essential (emergent or urgent) care.
- This plan may include giving them specific instructions to contact you should their condition change; providing ongoing follow up from your office to assess their condition; or immediately directing them to an alternate source of care, such as another health care professional or medical care facility (e.g. hospital, cancer agency, or urgent care centre).
For more information, see the March 23 CSHBC news story on Dr. Bonnie Henry’s update to regulated health professionals in BC. All CSHBC news stories and notices to the professions on COVID-19 are compiled on the COVID-19 Information for Registrants page.