DECEMBER 8 TOWN HALL: Q&A
The following Town Hall questions were answered with information that was current at the time. Information around COVID-19 and our response continues to evolve. If you are unsure if the information below is still current, or if you can’t find the information elsewhere on the website, please talk to your leader or email: COVIDfirstname.lastname@example.org
- When are we getting clear masks? Patient care is being compromised for those with hearing loss, who cannot understand speech without lip reading.
- Clear masks do not meet the requirements for filtration and containment of droplets/aerosols. In situations where lip reading is required, please consider other methods of communicating (e.g. writing or typing into a handheld phone/pad).
- Should I wear a mask outdoors? The sidewalks don't allow for a 2-meter distance
- There is currently no order or recommendation from Dr. Bonnie Henry that people wear masks outdoors. Outdoor spaces have lower risk because of better ventilation. However, masks/face coverings can also be worn outdoors as an additional way to decrease risk.
CARING FOR PATIENTS THAT ARE COVID-POSITIVE
- What do you do if you have a COVID patient in your ward and they want to go for a walk and leave the ward? How do you ensure public safety?
We do not have the ability to restrict people/ lock patients onto a unit at PHC except under legislations such as the Mental Health Act or Adult Guardianship. Infection with COVID is not a sufficient cause for restraints, legally or ethically. The risk is relatively low to cause harm especially if others are wearing PPE.
Patients and visitors should be educated about the rules, and the ramifications of their non-adherence especially if it will alter their care plan. Patients’ needs that are resulting in these behaviours should be met wherever possible. The Medicine and Psychiatry teams strive to do as much as possible to encourage and keep patients in self-isolation. They have been creative in solutions such as: food delivery, anticipating cheque day, addictions needs including Safe Supply. We are looking at other ways to help with the desire to smoke. Teams should review these needs and PHC is committed in helping to meet them.
We have an option of discharging , but our patients often have multiple issues making discharge extremely difficult. We don’t want to send people who have COVID into an even more unstructured environment.
Please document all discussions and decisions clearly in patients’ charts including the team members who have been involved.
OUTBREAKS AND EXPOSURES
- What's the difference between calling and managing an "outbreak" vs "enhanced surveillance"?
- The differences between exposures, outbreaks and enhanced surveillance are outlined here on Providence’s COVID-19 website:
OCCUPATIONAL HEALTH AND SAFETY
- Do we come back to work after getting vaccinated?
- At this time, we have no information to indicate an employee won’t be able to return to work after being vaccinated.
- Is PHC required to inform employees of a positive case in their department, outside of the hospital, where there is no physical on-site screening?
- When we are informed of a potential exposure (ie patient or staff tested positive), we are required to confirm that all staff involved wore appropriate PPE, which we do with the manager. We provide that information to Public Health and if they deem it necessary to inform certain staff, that will happen.
- As we wear masks more, some people are experiencing skin breakdown, example behind the ears. Who can staff talk to about ways to mitigate this effectively?
- We do have different mask options, as well as ear savers being available, so if you are struggling, please reach out to your manager or OH&S for options.
- Can we stop wearing masks and meet family after getting vaccinated?
- We will follow direction from Dr. Bonnie Henry and the Ministry of Health regarding the lifting of PPE and social distancing guidelines.
- How will we encourage staff to take rapid COVID tests pre-shift? Will they be mandatory?
- Staff have shown willingness toward rapid tests during this early trial phase, as a possible tool to help prevent outbreaks. Upon expansion of rapid testing, we will follow the guidance of Dr. Bonnie Henry and the BC Ministry of Health regarding whether testing becomes mandatory.
- With vaccines around the corner, can we get a staff webinar to give us an overview of this vaccine, research, safety, so we can be informed and teach it too?
- Thank you for this suggestion. We endeavour to provide our staff with all the latest and most reputable information, and we will certainly continue to do so as more information becomes available to us.
- When will we receive the vaccine if we work for the institution but don’t work with COVID-19 patients directly?
- The rollout of the vaccine is being overseen both federally and provincially. We don’t yet know exactly when all of our staff will be able to get the vaccine, but we will communicate this information when we have it.
- Please clarify the expectations regarding medical masks upon entry in to the hospital.
- As per November 9 provincial direction, health-care workers working in a clinical unit or setting or a patient-care area must wear a medical mask upon entry and while they are on-site, including in common areas and break rooms unless eating or drinking. Clinical staff can wear a non-medical mask while commuting to and from work but it is expected that they will wear a medical mask once they are on the facility premise, as they move from common areas, locker room to the clinical or patient-care areas.
- Will we be getting free street parking again in this second wave? VCH public health has recommended not taking public transit.
- We remain in contact with the City of Vancouver. At this time, the City has not offered any relaxation on parking restrictions for healthcare workers. We also continue to monitor paid lot parking in the area around St. Paul’s and there continues to be capacity.
- I heard last week Providence was involved with a rapid-testing initiative with YVR and WestJet. Can we use that test for staff (especially LTC)?
The WestJet-YVR COVID-19 Testing Study is led by Drs. Don Sin and Mark Romney. This is a collaboration between UBC, PHC, YVR, and WestJet. The methodology of the testing is the same in terms of the rapid antigen test. So, those results will be available as they come up for analysis as, as they would be in a research project. As for the question of using this test for long-term care – that has been approved by public health in collaboration with PHC and Vancouver Coastal Health. Although the ultimate goal is to scale up to ensure that all facilities have the potential to use this, there is some implementation science that we need to consider in terms of how to best deploy this test in different settings.
These tests are not silver bullets; it's not going to be the end of COVID with these tests. So we need to think about frequency, the population in which we're going to use this test for how the results will be given in a rapid turnaround time to inform action.
So the plan is to launch this in several long-term care facilities, have rapid learning feedback and ownership from the facilities to improve on this, and then set up toolkits for residential care facilities, and possibly other settings, to be able to implement the testing where rapid turnaround time frequency is important.
At that moment, if you're COVID-19 positive, all of the other things that we do in terms of our IPAC procedures, our PPE, and social distancing still remain just as important as the rapid testing. And we have absolutely reassured public health in our working with them to set up this trial that we will make sure that no one becomes complacent because of these tests.
- With the rising numbers of COVID-19 cases in BC, will our essential visitor policy be looked at? Even with screening, the risk is high having a visitor on the unit.
We are constantly looking at all of our policies around COVID-19, so anything I say today may not be true tomorrow. We look to a variety of sources to tell us how we should be managing all of the traffic and flow through our buildings.
What we continue to see is that visitors are probably not increasing our risk as much as we ourselves are raising the risk within our own organizations. As a result, we have put rules around our essential visitor policy. We want to identify the right people who can provide the best support for our patients who need it, both from a physical and mental well-being perspective. It is important to the care that we provide here as a team, so eliminating them as a factor does not really sit well with us and with our Person- and Family-Centered care policy. But if we get guidance from Public Health that we need to do something different, we absolutely will do that.
As of November 9, a new policy now says masks are mandatory for visitors and not just any old cloth mask, now we provide proper medical masks for people, which is of course intended to help preserve the safety of all of us who come into this building. We coach each other, including hand hygiene for our visitors, so all of the work that we're doing will continue to keep us safe.
- Our well-being and mental health is struggling more with the pandemic. Taking care of oneself is difficult when extended health is limited to $500 in therapy costs, need to increase.
We can't control how much is in your extended benefits. That's a negotiated with the unions and HEABC, so unfortunately we can't do anything about that. However, we do have supports in place for people to reach out to. We have Homewood Health as our EFAP provider. They're available 24/7, 365 days/year for counseling. They also have incredible resources on their website.
We also have a staff support line that is continuing to be managed by individuals that are trained in psychological first aid: 604.806.9925 or local 69925 – leave your name, number and a time for one of the trained volunteers to call you back. This line is also available to physicians and contracted services (IPS, Sodexo and Crothall). We have spiritual health and we have OH&S.
If you're at a point where you are struggling, please reach out for help. There's somebody at the end of the phone all the time to help you.
- Will the people from the Indigenous Health team with unionized positions have their jobs reinstated?
Whenever we go through a restructure, it is difficult for everyone involved. There is absolutely a process to look after staff to ensure that they get the opportunity for roles. We are pleased to say that one of the individuals involved has applied for one of the new roles and has been appointed and is working already. And we're continuing to support the other individuals through this.
We are appreciative that this has shown a light on our First Nations and Indigenous work. We recognize that that's coming from a very good place and we want to, in plain sight, do everything possible. The iterative developments and changes are a part of a comprehensive process. We are very pleased to see that the people have already begun to apply and we're able to hire one person already. We are hopeful that this is part of the changes that Providence needs to make and that we will continue to be leaders in Indigenous health and wellness working with our partners.
- Why was there no communication from PHC after the media attack last week re: Indigenous health team union positions being replaced by non-contract positions?
- We had originally communicated this change in a memo to all staff as well as a statement on our website. This can be read in full here. However, we know we can do more and will endeavor to do so in the future.
- What is being done regarding staff that are not complying with wearing face masks in their own departments?
As per the Public Health order, if you work in a clinical site you must wear a medical grade mask at all times.
If someone is not complying with that then their manager needs know.
OH&S works with people to ensure that there is a mask that they can comfortably wear. For many people, this is quite new to have this on and it can be annoying, but there are many different masks that we can try.
However, it is an order. It's for the safety of yourself and for everyone we work with. And if people refuse them, then it becomes a performance management issue.
- How can staff safely celebrate Christmas with each other, knowing we need to physically distance and not share food?
- We have to find some joy, so, we want people to be creative with how you celebrate whatever it is you celebrate.
We can't have communal food, but if you bring in individually wrapped food or individually packaged and you place it next to the hand sanitizer so that people are using hand hygiene before and after. And then you move somewhere you are at least two meters away from others, such as one of the new break room spaces, and take your mask off to eat. That's okay - there are ways to do it safely, but do not make an event out of it.
Use your point of care risk assessment to determine: Can I do this safely? Am I allowing myself to participate safely in this?
Around decorations - anything that was on the walls or hanging is okay. Please do not put things on surfaces because it makes it difficult to clean those surfaces which we must do on a regular basis.
As for Christmas trees in Long-Term Care: We know that it’s fundamental to the joy for the people who live there. So we are allowing trees in long-term care. But no trees are allowed on acute care units.
We are also hosting a pop-up Christmas event, in lieu of our regular Christmas Staff Meals, this Thursday December 10, 2020. Click here for more details.
- Will the COVID-19 vaccine be mandatory for non-clinical staff?
- We actually don't have an answer to that question at this point in time we are still waiting for direction from the Ministry.
We know that telling someone that they have to do it sometimes has to be done. What's important is that we look at the evidence and listen to the wisdom of our IPAC team, and the scientists who are doing the work. We have confidence in Health Canada in this vaccine, and that people will look to the leaders and the people they respect for what their judgement is.
- What if the vaccine comes out and we’re asked to get the shot, but it ends up making me very sick, can I sue for damages?
- So just as with the influenza vaccine, if you have an adverse reaction it then falls into a WorkSafe claim.
- Is the Pfizer/Moderna vaccine safe and recommended for pregnant front line staff?
We will follow guidelines from Dr. Bonnie Henry pertaining to administering the vaccine to people who are pregnant.
- Are there plans for another pandemic pay for non-nursing union workers?
- Pandemic pay was a federal decision and at this point there is no talk that pandemic pay is going to be reinstituted.
If the federal government makes a different decision, we will be delighted to pass on any money that they decide to give.
- Will the approach to the COVID-19 vaccine be the same as the flu vaccine? When will we be able to receive it?
- We actually don't know the answers yet but we are working on ensuring that when the vaccine is available we are ready to go with our clinics. As soon as it's available and we have the details, we will communicate to the organization.
- Can someone who has been vaccinated still spread the virus?
- At this point, we do not know with certainty the answer to this question. However, there is some data to suggest that once vaccinated, the potential to transmit may be lower, but that's still inferred from limited studies. Phase four studies, once we roll the vaccines out to a larger population, will provide more understanding of whether someone who's been vaccinated can still transmit the disease and to what degree.
- What about units that have already put their trees up?
- I'm sorry but yes, we need the trees to come down if you already put it up. The only exception is LTC.
- Why are we not testing all the patients that go up to the ward from Emergency? This puts staff and patients at more risk when patients test positive days after being moved.
We follow provincial guidelines as well as interpret those guidelines within the context of the patients we see. We know that in certain populations, the risk is higher. So we think about the epidemiologic risks and the clinical risks.
We rely on your clinical judgment to think about the importance and validity of the COVID-19 test. The guidelines are there for testing, but you have to interpret that with your own clinical judgment as well.
- I have heard that rapid antigen tests do not need you to go as deeply into the nose as the NP swabs. I have had 2 tests and am not mentally prepared to have another NP swab. Are there other options?
We know that the nasopharyngeal swab for some individuals can be uncomfortable. There are factors that can contribute to that and those are modifiable factors with education more understanding of the anatomy by the people performing the test. The test can be done in such a way that it's not painful, and that it's tolerable and acceptable to individuals.
At this time, our pilot is going to be with NP swabs, however we are focusing a lot on educating those individuals who are taking the NP swabs, to do it in such a way that they understand taken into context.
- For essential visitors, if each one is allowed two hours, how many visitors can a patient have in one day?
- Currently, it is on a patient-to-patient basis. We know if a patient is truly at end of life, as an organization, we have worked very hard to actually allow the people to come in to say goodbye to their loved one in a safest way possible. But what our guidelines says right now is that those decisions are made within the care team infection control team risk are always there to participate in those conversations so that we can actually find a way that is equitable for all.
If you need to reach PHC’s Infection Prevention and Control Team (IPAC), please call local 69357. Do not contact individual IPAC team members.