October 26 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
Mission: Forward - Year 2
- What is the current anticipated timeline for the move into the New St. Paul’s Hospital?
- The initial timelines announced in February 2019 for the hospital opening remain the same – 2026.
- How come our strategic plan isn’t basically the same as that of VCH or PHSA or the Ministry of Health? Shouldn’t we all be working toward the same goals?
- All health authorities and Providence Health Care must ensure alignment with the strategic priorities set out by the Ministry of Health. Providence Health Care’s strategic planning development process has included those priorities and developed our goals and strategies accordingly. Our process also included engagement, input and alignment with our key health authority partners, including VCH, PHSA and the First Nations Health Authority.
- Hasn’t COVID thrown off the timelines for the start plan? How can so many of those priorities still be pursued when we’re so busy managing the pandemic?
If we look at what we achieved in year one, there were definitely some things that didn't get done. And we hope that would have been done if we weren't managing COVID. And let's just be honest about that. We're not expecting people to be superhuman. But actually, I do think that first of all, as I said before, COVID
aligns with a lot of the things we're trying to do anyway, just accelerates, the need to do that. In some areas COVID has opened some doors, in terms of allowing us to do things because there has been a crisis, there's a prioritization, and some of those provincial rules and policies get a bit opened up. So we've been able to get on with things.
Also the way that I've seen COVID so far in this province, is it has been like localized very, very hot fires. And those fires move around. So if you're in the middle of that fire, if, if you're in Holy Family this summer, or if you've been in Urban Health in the last month, is absolutely all encompassing, and the rest of the organization has really tried to support you. But there are also other people in the organization who can't contribute in that area, and therefore can get on and do all the other things which are really important for our patients and our residents. And there's a hard balance. But we have so many people who need things who are not suffering from COVID, that I think we also have an obligation to keep going on our other things, whilst at the same time being realistic, and also being careful that we don't ask too much of our staff, and just kind of being kind and honest, when there's something that we can't do because of COVID.
For example, Virtual Health — the adoption rate was around zero percent to start. We saw a 25-30% adoption rate because of the crisis. I also think that what we're seeing too, is that COVID gave us permission to stop doing a lot of things. And we can be intentional about how we decide what things to start doing again, and to hopefully create space in that way.
- We see many visitors on the wards, what are we doing to implement the visitation policy?
- The visitor policy has been shared with all program and unit leadership. Please speak to you program area leader if you have concerns.
- What is the info on performing/documenting a risk assessment and enforcing restricted visitation when a Essential visitor refuses to comply with EV policy?
- When an essential visitor refuses to comply with the policy, please follow the basic steps of ensuring the understand the policy.
If education is provided and the visitor refuses to adhere, then escalate the concern to your unit leadership.
- What are we doing to improve cleaning at SPH?
- There are service level agreements for cleaning/disinfection of all clinical and non-clinical areas. If you have concerns, please bring these to your unit leadership.
PPE & Professional Image Policy
- New Professional Image Policy: What steps are being taken if staff are not following this protocol?
- In the event that this occurs, your leader will meet with you to discuss the concerns regarding the breach of this policy. The requirements outlined in this policy are mandatory and non-compliance is subject to discipline. Please ensure you have familiarized yourself with the changes and how they may impact you. If you have any question please connect with your leader.
- Please clarify if goggles/eye covering is required if not able to physically distance in non-clinical areas (e.g. in shared offices)?
So the concept of Point of Care Risk Assessment may not be quite as well known in the non-clinical areas. But this truly is what we're asking you to do if you work in an area where everyone has a mask on. And in non-clinical areas, it is more controlled around who is there. So you either are working where everyone has a mask on, or you are within your own cubicle, which puts a physical barrier between you and others. There is no one who whose droplets are going to hit your eyes so the goggles are not required. That is the difference between those non clinical spaces.
Again, though, we don't want to be taking our PPE off and on every time you touch your mask, you're potentially contaminating your hands you need to be washing. So if you are going to be in and out of a space where you couldn't guarantee that someone else's droplets might not be coming into your space put your goggles on and leave them for an extended time. I wish we could be more black and white around the answer but Victor's right, every scenario is different. If you think that there's a possibility you could be exposed to others then put them on and leave them on. That's the safe thing for you to do. Nobody's going to tell you can't do that.
Long term care
- What is being done to study/address the effects of outbreak measures on the physical and psychological well-being of LTC residents? E.g. falls and PTS
So there are two things, I think, provincially. The first one is that there is a lot of work being done provincially on the side effects of outbreak measures on the whole population, actually, in terms of everyone's mental health impacts, but also things like cancer diagnoses, we're increasingly seeing internationally that the shutdown of services in the spring had a big impact on people who had other really important health conditions. And we tragically know that the impact on opioid overdoses has been really significant, particularly in this province.
In terms of specifically long term care residents, there is also another piece of work being done. The seniors advocate, Isabel Mackenzie has done some work with the families of long term care residents. And they I'm sure are good people to illustrate the talk about the impact, and particularly, the reduced visitation has had a significant impact. I think, across this whole pandemic, and obviously, long term care is that the hardest place at the minute, we're all on public health and the government are trying to make that balance between the tough measures that are needed to control COVID. Also, balancing all those unintended consequences. And that's a very, very difficult balance, because there is often I think, no good answer, because whatever is done, there will be a detrimental impact on us all and particularly the most vulnerable people in society.
- Without sounding too opportunistic, has the pandemic improved our chances of getting new LTC beds and sites (renewal)? Has there been any concrete progress?
So, personally, we are good with being opportunistic. The pandemic has caused so much pain and distress and death across the world. It's our duty to take some good things out of it if we possibly can. And I think the short answer is yes. A pandemic has absolutely brought to the attention of everyone — the importance of long term care and how vulnerable our seniors are.
We are advancing plans for St. Vincent and Heather. We feel that we have clearly needed to wait for our new government, but I feel a lot more optimistic about that than I did a year ago. Obviously, Providence Living, of course, is also advancing their plans for Comox. I now feel that our initial step which is to aim to have to, to dementia villages, one urban one rural, which can then be replicated across the province is absolutely closer to coming to fruition. And so yes, we absolutely need to fight and advocate on behalf of our residents.
Sick time and absenses
- Are COVID-related absences (for getting tested) coded differently in the Attendance and Wellness Program?
- No, they are not coded differently. Someone is getting tested because they have symptoms, which means they are sick. If someone tests positive, that is a longer absence and is removed from the calculation, which is the same thing with a flu diagnosis.
- Should staff call EARL and get a COVID test if they feel unwell after getting the influenza vaccine?
The flu vaccine, like all vaccines, will have associated side effects; the side effects are generally mild. The symptom is going to be localized pain around the site of injection, then, and makes no sense that it's related to an adverse event from the flu vaccine versus COVID symptoms of muscle aches, if it's only that area. If however, the symptoms can be more systemic, in some cases, mild fever, then it will be hard to tell because the temporal association of side effects can happen shortly after the vaccine or within the first generally within the first 24 hours. So in all likelihood, if that's the only symptom, probably the flu vaccine adverse event if it's just mild fever, however, because we are in a time where cold COVID can present with many different manifestations, given the availability of testing, it would still be recommended that if you have more systemic symptoms that you get tested, and wait, when you call it for the EARL line, it there's no hundred per cent sort of clinical risk factors that can help us differentiate, but I think that there are some factors such as localized pain at the injection site that would be more consistent with an influenza vaccine then then say, coping illness.
- Why is there a discrepancy on exposure? FH tells staff to isolate/monitor for symptoms; PHC says to put on a mask and to come to work and monitor if symptoms arise?
This has been confusing because sometimes what are non-high risk exposures are heard by people that may have been affected through rumors or chatter at work that this was a definitively an exposure. So public health works closely with occupational health. And with AIPAC, and depending on the situation where the exposure occurred, there is an assessment that is done during that assessment, risk assessment factors such as how long the exposure was, in what context where their masks were used — these all play into the decision of whether or not staff will be asked to quarantine or on in certain workspaces that the impact is high, too.
That's why sometimes there's this confusion of hearing that different health authorities have different instructions. But ultimately, it does depend on that individual risk assessment for case which is going to be done collaboratively with public health, occupational health. And if AIPAC has input, our input as well. So we try our best to make that assessment. There's no hundred per cent, like in terms of which way is most correct, it's going to be based on the risk from that assessment. So if you feel that there has been an exposure, have a discussion with the leadership in your area, they will connect you with Occupational Health and Safety to review that case.
Vacation & isolation
- Why are nurses allowed to come back to work after going to vacation outside Canada? Is "Isolation" defined as going to work and then going home directly?
- Nurses are not exempt from the mandatory 14-day quarantine orders from the governments of Canada and British Columbia. Anyone arriving in B.C. from outside of Canada is required by law to self-isolate for 14 days.
Outbreaks & learnings
What has been learned from the outbreak at HF to prevent a future outbreak on a similar scale? Why did it take so long to contain?
- There were probably many different factors that contributed to the severity of the HF outbreak. Both VCH and PHC are doing ‘Lessons learned’ reviews to try to be more prepared in the future. An emphasis on infection and COVID control principles such as environmental optimization, PPE training and staff screening has already been incorporated into our preparedness and outbreak work.
- If there is another outbreak in LTC, what measures will be implemented to prevent the adverse effects of lock-down & withdrawal of spiritual/emotional support.
- The limits on staff and services due to outbreaks certainly can have unintended consequences, and certainly we need to balance the complex needs of residents and protecting them from the severe consequences of COVID. This will be a key discussion for the working groups going forward.
- When there is an exposure/"outbreak" in any area, How come we cannot be told exactly how many people are affected and whether they are staff/patients exactly?
- There are confidentiality issues for both our staff and patients/residents that mean we need to maintain strict anonymity when we report cases.
- What are the plans for the physical spaces at Holy Family Hospital and Mount Saint Joseph Hospital sites in the short and long term?
- The organization and leadership is definitely aware of the limitations and risks of the LTC infrastructure, particularly at HFH and MSJ where acute services are co-located. Presently we are making sure the separation of staff before and during an outbreak is being planned for, and investigating ways to improve social distancing for all LTC residents is underway.
If you need to reach PHC’s Infection Prevention and Control Team (IPAC), please call local 69357. Do not contact individual IPAC team members.