03/10/2020
Coronavirus & Patient Safety in the Medical Office
Provided by:
Debbie Hill, MBA, RN, Senior Patient Safety Risk Manager, The Doctors Company
The 2019 novel coronavirus (COVID-19) continues to spread across multiple continents. Given that outbreaks are expected to occur at a community level, medical offices will undoubtedly experience an influx of patients seeking assistance. The question is: Are medical offices doing enough?
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The following are some recommendations in the event a patient with suspected COVID-19 seeks care:
- Follow the CDC’s patient assessment protocol for early disease detection. If a patient calls to schedule an appointment for an acute respiratory illness (e.g., fever, cough, and difficulty breathing), he or she should be screened using the Flowchart to Identify and Assess 2019 Novel Coronavirus.
- If presenting symptoms, travel history, or patient contacts are suspicious, immediately isolate patients coming into the office (segregate them from other patients in the facility) in a designated exam room with dedicated patient care equipment. A back entrance may be utilized, if available. Since most medical offices don’t have negative pressure airflow, a spare bathroom with negative exhaust fans may be an option in the medical office setting instead of a regular exam room. The CDC provides guidelines for environmental infection control in healthcare facilities. Be aware that it is unknown how long the virus remains airborne once a room is vacated, and there are currently no CDC instructions on length of time before the room may be used again.
- Once suspected patients are inside the facility, instruct them to put on a face mask, utilize tissues, practice good hand hygiene, and dispose properly of any contaminated protective equipment/tissues in a designated waste receptacle. Educational resources, including posters for use in the medical office, are available from the World Health Organization (WHO).
- Follow Standard, Contact, and Airborne precautions including gloves, gowns, protective eyewear, and NIOSH-certified N95 respirators that have been properly fit-tested. This applies to all healthcare staff interacting with patients.
- Limit staff exposure to suspected patients, with the exam room door kept closed.
- When there is a reasonable presumption that a patient may have been exposed to COVID-19, contact the local or state health department to determine if the patient needs to be tested.
- Maintain records of staff-patient contact, i.e., who was assigned to work with the patient, either in a log or in the medical record.
- Once the patient exits the room, conduct surface disinfection while staff continues to wear personal protective equipment (PPE).
- Provide up-to-date, factual information on the virus to the patient and close contacts, including how to follow infection-control practices at home, such as in-home isolation, hand hygiene, cough etiquette, waste disposal, and the use of face masks.
- Remind patients and their families to access information about the virus through reputable sources such as the CDC, not social media.
- Check with your local public health authorities for locations designated to triage suspected patients so exposure is limited in general medical offices.
Suspected cases must be reported to applicable local and state health departments. The CDC provides instruction on their website for reporting requirements by medical offices to state and local health departments, who, in turn, report “persons under investigation” (PUI) to the CDC for further evaluation and testing. Also, any unprotected occupational exposure by staff members should be assessed and monitored.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.