The Novel Coronavirus (COVID-19) pandemic is currently sweeping across New Jersey, and it is threatening, at least in the short-term, our ability to safely care for our patients. As doctors, most of us are now in the difficult position of having to care for urgent and emergent patients, and therefore cannot completely shut down our offices.
To help you navigate this crisis, the NJDPA has drafted a comprehensive set of policies and procedures for your offices. Please feel free to use this as a template, and modify it as you see fit.
Yours in Health,
Peter DeNoble, MD, FAAOS, President
Stavros Christoudias, MD, FACS, Board Chair
COVID-19 Precautions – Immediate, Interim Office Policies and Procedures
PATIENT SCREENING PRIOR TO OFFICE VISIT
Screen for fever, cough, and/or flu-like symptoms – Patients should be screened both at the time of booking and reminded the day before their appointments for any signs of fever, significant cough, and/or flu-like symptoms such as body aches, headache, weakness, fatigue. If a patient is exhibiting any of these signs, their appointment should be canceled, and they should be instructed to call their primary care physician. They should be instructed to reschedule their appointment for when they are afebrile and feel well again.
- Temperature check – Patients should check their temperatures the morning of their appointments. If their temperatures are over 100.4, they should NOT come to the office.
- Recent travel? – Anyone who has traveled domestically or internationally in the prior 10-14 days should not be seen until 10-14 days after their return, and only if afebrile/asymptomatic.
Limit patient accompaniment by family members, friends, or children – Patients shall be encouraged to come to their appointments alone, or limit accompaniment to 1 person if accompaniment is necessary. Exceptions may be required (e.g. those who are frail or elderly who require help ambulating). Exceptions should only be made when absolutely necessary and for the well-being being of the patient.
UPON PATIENT ARRIVAL TO OFFICE
Practice social distancing
- Patients in the waiting room shall sit at least 6 feet apart from one another. This could be achieved by either removing chairs or placing paper signs on chairs/couches such as “Do Not Sit.”
- If there is not enough room for patients in your waiting area, patients should be asked to wait in their cars after check-in and can be called or texted when they will be seen next. This will help minimize risk of patient-to-patient contact and allow time for sanitizing between patients.
- Offices are encouraged to space out the scheduling of patients to help minimize overlapping of too many patients, e.g. schedule patients no closer than every 15-30 minutes, depending on the rate you see patients.
Maintain sanitary check-in items
- Encourage online patient portal use prior to coming to the office when possible.
- iPads- If intake forms are on tablets or similar devices, wipe down in between every patient use with approved antiseptic agents.
- Pen and paper– Use clean pens for each patient. After use, a “used pen” bin should be provided, and pens should be cleaned with approved antiseptic agents before being distributed for use again. Alternatively, patients could be instructed to bring their own pens, both for intake and for signatures on consent forms.
- Clipboards and all countertops should be cleaned and wiped between direct patient contact.
Practice social distancing amongst co-workers – Staff should remain at least 6 feet apart from one another if they are working in an office together.
Staff Surfaces (cellphones, mainline phones, light switches, keyboards, computer mouse, break room) – Should be wiped clean at the beginning, throughout, and finally at the end of each day. **Note – take your cell phone out of its case and clean both the phone and the case separately.
Surfaces frequently contacted by patients (door handles, countertops, chair arms)
- All office door handles and countertops should be cleaned with antiseptic wipes approximately every 30-45 minutes.
- Door handles and office countertops inpatient rooms and in the flow of patient traffic should be wiped clean with antiseptic agents after EVERY patient.
If possible, main office doors should be wedged open – This should help discourage direct contact with door handles. As the weather warms, this may be feasible, so as to discourage touching doorknobs or door handles.
Face masks – Employees should be encouraged to wear face masks during office hours, to prevent touching of their faces, and potential transmission of asymptomatic infection to co-workers and patients.
Take patients’ temperatures – Patient temperatures should be taken by intake staff upon arrival to the office.
- Preferred – disposable thermometers (e.g. “Tempadot” brand).
- If a reusable thermometer must be used, thermometers with disposable covers are mandatory. These thermometers should be thoroughly wiped clean with antiseptic agents between use.
Encourage patients to wash hands – Patients should be encouraged to wash hands thoroughly upon arrival and departure from physician offices or any healthcare facilities.
- If possible, clocks with second hands should be placed next to sinks with signs clearly stating to wash for a minimum of 20 seconds.
- If clocks are unavailable, wash hands long enough to finish singing the alphabet.
Break room cleanliness – Break room should be devoid of multi-use condiments (e.g. single-serve packets for salt, sugar, ketchup, etc instead of communal receptacles). Counter-top surfaces should be routinely wiped down.
Remove common reading materials from waiting room – This includes all shared magazines and books.
PATIENT – DOCTOR INTERACTION
Washing hands – Doctors should thoroughly wash hands before and after each patient encounter.
Personal protection equipment – When working with a screened patient population, wearing a surgical mask during patient visits is up to a doctors’ own discretion.
Avoid hugs, handshakes, and contact outside of a physical exam.
Exam room cleaning (e.g. countertops, exam tables, door handles) should be thoroughly cleaned with an antiseptic agent between patients.
Temperature Self-monitoring – Doctors should regularly check their temperatures and if they are above 100.4, office hours and surgeries should be rescheduled immediately. Additionally, doctors with flu-like symptoms should avoid patient and staff contact at all costs.
If Physicians and Health Care Providers have not stopped wearing ties, long sleeved shirts and white coats please do so immediately.
PROTECTING OUR FAMILIES
Doctors and staff should wear uniforms (e.g. scrubs) that can be easily washed with bleach at the end of each day.
Changing home shower schedules to shower upon arrival at home prior to interacting with family members may be prudent.
If feasible, non-clinical staff should be offered the option to work from home at least on a part-time basis.