Influenza Assessment Clinic – Activation and Operational ...



Canberra Hospital and Health ServicesOperational Procedure Influenza Assessment Clinic – Activation and Operational requirements in a pandemicContents TOC \h \z \t "Heading 1,1,Heading 2,2" Contents PAGEREF _Toc459027646 \h 1Purpose PAGEREF _Toc459027647 \h 2Scope PAGEREF _Toc459027648 \h 2Section 1 – Governance and Systems; Infectious Threat Committee PAGEREF _Toc459027649 \h 2Section 2 – The purpose of an Influenza Assessment Clinic PAGEREF _Toc459027650 \h 3Section 3 – Establishment, utilisation and administration of an Influenza Assessment Clinic PAGEREF _Toc459027651 \h 4Section 4 – Staffing and operational requirements of an Influenza Assessment Clinic PAGEREF _Toc459027652 \h 7Implementation PAGEREF _Toc459027653 \h 9Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc459027654 \h 9Definition of Terms PAGEREF _Toc459027655 \h 10Search Terms PAGEREF _Toc459027656 \h 10Attachments PAGEREF _Toc459027657 \h 10Attachment 1 - Material resources PAGEREF _Toc459027658 \h 12Attachment 2 - Flow chart for patient journey in the IAC PAGEREF _Toc459027659 \h 13Attachment 3 - Clinical Assessment Flowchart for IAC PAGEREF _Toc459027660 \h 14Attachment 4 - Emergency Department Clinical Assessment Flowchart PAGEREF _Toc459027661 \h 15Attachment 5 - Contact numbers for notifications and alerts PAGEREF _Toc459027662 \h 16PurposeThe purpose of this document is to outline operational systems to ensure effective organisation wide strategies are established in order to protect patients from an infectious diseases threat and effectively manage infections when they occur. This operational procedure provides guidelines regarding the establishment, utilisation and administration of an Influenza Assessment Clinic (IAC) site on the declaration of a pandemic in the ACT. It is a directed care plan encompassing assessment, triage, treatment and follow up during an infectious threat event.Influenza is an infectious disease. All documented information has been aligned with the National Safety and Quality Health Service (NSQHS) Standards actions list for Healthcare Acquired Infections (HAI). For information on the clinical management (including testing) of a patient presenting to Canberra Hospital with suspected Influenza please refer to the Clinical Procedure Influenza and Respiratory Illnesses management for Adults and Children.Back to Table of ContentsScopeThis procedure applies to all Canberra Hospital and Health Services (CHHS) staff, students and trainees undertaking clinical placement and all contracted agents working on CHHS premises.Back to Table of ContentsSection 1 – Governance and Systems; Infectious Threat Committee The role of The Infectious Threat Committee is to provide leadership and direction on infectious disease threat preparedness at CHHS. The committee reports as required to CHHS Strategic Executive Committee through the Executive Director of Critical Care. The functions of the committee are to:monitor ongoing global infectious disease threats monitor and direct ongoing operational readiness to meet infectious disease threats at CHHS including seasonal influenza preparations and readiness, anddirect the management of infectious disease outbreaks involving the services of CHHS.In the event of an infectious threat, the response of the Committee is to call for the establishment of extenuated triage at CHHS Emergency Department and the Influenza Assessment Clinic (IAC). Clinical management of an infectious threat may also call for the involvement of the Walk-in Centres (WiCs). For further information on the role of the Walk-in Centres in a Public Health response such as an Influenza pandemic please refer to the Walk-in Centre Operational Model of Care located on the Policy Register.Back to Table of Contents Section 2 – The purpose of an Influenza Assessment ClinicDue to the large number of patients who would normally require medical services during an influenza pandemic, communities and health care organisations must have guidelines in place in the event that health care facilities are overwhelmed. The establishment of the Influenza Assessment Clinic (IAC) serves to reduce the load that would otherwise be placed on general practitioners (GPs) and acute facilities by providing an assessment and treatment facility specifically for patients with symptoms of influenza. As a result, there would be a reduction in the risk of transmission of influenza in hospitals, community health centres and medical practices by keeping potentially infectious people separated from those seeking acute or community based health care for other reasons.The IAC is intended to provide a dedicated primary care service for the assessment and management of patients potentially affected with pandemic influenza. This involves several key tasks:assessing whether patients presenting with respiratory symptoms fit the case definition for a probable case of pandemic influenzaarranging for virological samples to be taken as appropriate providing Tamiflu as appropriate, andproviding information and advice for home quarantine as appropriate.It is anticipated that the IAC would operate at the Geriatric Registrar Clinic, located in Building 3 on the Canberra Hospital campus. Normal business activity would cease at this site whenever the IAC is required. Establishment of an IAC could be anticipated within 24 hours. The Centre will not be involved in ongoing care. If a person presents to the IAC with a non-influenza respiratory condition, they would be referred to the Emergency Department or their own GP as appropriate.For the patients journey through the IAC please refer to Attachment 2.Back to Table of ContentsSection 3 – Establishment, utilisation and administration of an Influenza Assessment ClinicThis section provides guidelines regarding the establishment, utilisation and administration of an IAC site on the declaration of a pandemic in the ACT. It includes clearly defined roles and responsibilities, procedural information, resource requirements and communication and management strategies. The governance structures and processes described are for one clinic but can equally be replicated across multiple sites should the need arise. Activation of the IAC will be in conjunction with existing ACT Health Directorate divisional and unit emergency plans.Activation ProcedureThe activation of the IAC will be on the authority of the Deputy Director General (DDG) of Canberra Hospital and Health Services, or delegate, following the declaration of a Public Health Emergency by the ACT Chief Health Officer (CHO), or delegate, and direction from the Director General (DG) Health Directorate.The following flow chart illustrates the lines of authority:ACT CHO declares public health emergencyCentral Coordination Group convenesCHHS DDG activates IAC and Chair of Infectious Threat committee implements plan in consultation with the Director of Operations IAC Site controllers assume operational commandIAC commences operationKey Roles and Responsibilities ACT Health Population Health Division:provide direction and advice regarding strategic and operational management of pandemic situations, and information to the public. ACT Health’s Government and Communications Division:provide information and media releases as directed by the CHO and the DG Health, and monitor media information regarding the pandemic.Health Protection Unit/Communicable Disease Control: provide information for distribution to IAC patients, andliaise with Site Controller regarding follow up of identified contacts.Deputy Director General Canberra Hospital and Health Services Will call an outbreak management meeting and then:activate IACadvise Central Coordination Groupdetermine IAC site to be activatedidentify time frame for activationcirculate pre-prepared notification for staff re action if becoming unwellChair Central Coordination Groupprovide regular status reporting to DG Health, and resolve management issuesCentral Coordination Group (CCG)Membership: RACC ED, RACC DON, RACC ADON, ADON Division of Operations, RACC Administration Manager, Infection Prevention and Control, Deputy Director Pharmacy, Security Manager, and invited persons as required.Responsibilities:instigate service cancellation/rescheduling/relocation plan for staff and clinical services affected by establishment of the IACongoing strategic and operational directionworkforce planning issues managementliaison with other health sectors, including security and cleaning services, andmeet daily or as required. Canberra Hospital Pharmacy: coordinate management of post exposure antiviral supply for patients attending IAC, in consultation with Population Health provide information regarding medications, any interaction with other drugs, side effects, issues when breast feeding etc, and maintain the medication supply register.Security Personnel: provide staff security for the waiting area inside and outside the established IAC;provide security for staff in IAC assessment area and antiviral dispensing areaPrevent entry or re-entry of patients through exit doorprovide security for staff transiting to vehicles after hours/in darknessliaise with Supply Department, Mitchell to provide security cover for release, transport and delivery of stock and supplies to IAC site, if requiredprovide security for stored stock and supplies within IAC,liaise with Site Controller regarding providing security for stock and supplies within the IAC site over 24 hours, andprovide security for antiviral recipients departing premises.IAC Site ControllersSite controllers will be nominated and will be rostered to ensure coverage for the IAC.Responsibilities will include:oversee activation and operational management of IAC, including staffing and signage advise Emergency Departments (CH and Calvary) of establishment of IAC and closure of the Registrar Clinic for normal business ensure all IAC staff are orientated to site, roles and responsibilitiesreport issues not resolved to RACC ED as per issues matrix – see Attachment 3report activity to RACC ED dailyconduct shift handover with incoming site controllerliaise with the site controller in other ACT IACs as required; andliaise with Security Coordinator regarding providing security for stock and supplies within IAC site over 24 hours.RACC Administration Managermanage administrative staff rosteringensure adequate supply of patient progress notes and information packsliaise with InTACT regarding any IT issuescoordinate waste removal from assessment area Coordinate daily disposal of clinical and land wastereport directly to Site Controller, and meet daily with Site Controller.IAC Nurse Manager Assistant Director of Nursing (ADON) for the Walk in Clinic (WiC), RADAR, ACAT, will assume this role, with support from other RACC nursing managers as required operational charge of all IAC clinical staffreport directly to Site Controllerconduct daily meeting with Site Controllerconduct hand over between shifts for clinical staffcoordinate stock and equipment managementliaise with security personnel as required, andreport issues.IAC Nursesreport directly to IAC Nurse Manager liaise with IAC Nurse Manager regarding clinical issuestriage arriving patients and oversee management of waiting room areaconduct primary patient assessmentscheck ID and current medicationsliaise with Emergency Department Admitting Officer for secondary assessment of patients as required, See Attachments 3 and 4liaise with pharmacists regarding dispensing of antiviral medicationredirect patients to GP/Emergency Department as per WiC protocolrestocking clinical supplies as requiredassessment and management of patients when they arrive in the IAC or ED See Attachments 2, 3 and 4 IAC Administrative Assistantsprepare assessment forms for use as requiredensure adequate supply of stationary such as: toner and paperregister patients on ACTPASestablish and maintain sufficient waiting area equipment and supplies such as: waste bins, masks and hand washing solutionfacility requirementsACT Ambulance Service (refer to the ACT Health Emergency sub plan for more information):provide transport to acute facility for acutely unwell patients on request from nursing Manager in the event an additional IAC is located off hospital campus.Cleaning Personnel – contracted agents: entry floors and toilets are to be cleaned regularly as per cleaning contractrubbish bins and waste removed may require emptying fourth hourly and as required, (including after hours) in assessment and waiting areas;daily cleaning for office areas, and weekly cleaning for windows/glass petitions/curtains.Back to Table of ContentsSection 4 – Staffing and operational requirements of an Influenza Assessment ClinicOperational RequirementsThe projected operational requirements are based on estimated assessments of 80 – 100 patients per day per IAC; and Hours of operation are recommended to be from 0700 to 2300 hours (i.e. 16 hours per day), 7 days per week.Waiting RoomThe waiting room is to be stocked with personal protection equipment (PPE) for staff and patients to use. Reception staff will advise patients to attend to hand hygiene and use tissues or masks provided to cover their mouth and nose if coughing or sneezing to minimise the risk of infection to others.Assessment roomsEach room must be stocked with an oxygen saturation monitor, sphygmomanometer, stethoscope, tympanic thermometer and covers, tissues, alcohol wipes, gloves, replacement masks for patients, hand hygiene product.Entry and Exit FlowPatients should enter through one main entry and exit through a separate exit point so that cross infection is minimised. See Attachment 2- Flow chart for patient journey in the IACWaste Managementclinical and landfill waste is be collected and disposed in accordance with ACT Clinical Waste Act 1990 and ACT Waste Minimization Act 2001, and all clinical and landfill waste is collected daily. Facilities Management is accessible through TCH switchboard.Material resources The stock and supplies are only to be ordered from Mitchell Supplies. Orders should be placed in advance to ensure adequate supplies available for operational material requirements of IAC (See Attachment 1 and 5).Human resources The following staffing requirements for each IAC have been recommended as a guide for a 24-hour period, 7 days a week, factoring in relief for meal and tea breaks, handover, and restocking.Table of staffing requirementsStaffAMPMSite Controller1 0800hrs – 1630hrs (Mon – Fri)On call after hours and weekendsNurse Manager1 0800hrs – 1630hrs (Mon – Fri)On call after hours and weekendsNurses2 0700hrs – 1530hrs1 0900hrs – 1730hrs1 1200hrs – 2030hrs 2 1500hrs –2330hrsAdministration Officer 1 0700hrs – 1530hrs1 1500hrs – 2330hrsSecurity1 0700hrs – 1530hrs1 1500hrs – 2330hrsMedical OfficersAs requiredAs requiredPharmacists1 0800hrs – 1630hrsOn call after hours CleanersContractual arrangement and as required(Monday – Sunday)Contractual arrangement and as requiredBack to Table of ContentsImplementation This procedure is to be communicated to all CHHS staff via CHHS Deputy Director General email alerts notifying staff of new Policy.Back to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationPoliciesACT Intensive Care Pandemic Guideline PolicyProceduresCHHS Healthcare Associated Infections Procedure, CHHS15/072CHHS Influenza and Respiratory Illness Management procedure, CHHS16/078Walk in Centre Operational Model of Care, CHHS13/621Australian Immunisation Handbook 10th Edition 2013-Place Holder document, CHHS15/064Guidelines Guidelines for the Prevention and Public Health management of Influenza Outbreaks in Residential Care Facilities in Australia ; Communicable Disease Network of Australia (CDNA) August 2015.Legislation Health Protection Services, Communicable Disease Control Public Health Act, Public Health (Infectious and Notifiable Diseases) Regulations 2007 to Table of ContentsDefinition of Terms Epidemic - a disease that spreads and affects a large number of people at the same time with a common localised demographic featureInfectious diseases - are transmissible illnesses caused by infectious agents. Patients with an infectious disease (confirmed or suspected) require isolation and infection prevention and control managementInfluenza - is an acute viral illness caused by infection with influenza viruses A, B and rarely C.ILI - Influenza like illnessNotifiable disease - an illness or disease which by law must be reported to governmental agencyPPE - personal protective equipment worn by healthcare workers to prevent the transmission of infectious microorganisms.Tamiflu (oseltamivir phosphate) - an antiviral medicine for treatment of flu in people 2 weeks of age and older and for prevention of flu in people 1 year of age?and older.Back to Table of ContentsSearch Terms Healthcare Acquired Infection, Influenza, Influenza Assessment Clinic, Infection Control, Infectious Diseases, Infectious Threat, Intensive Care, Pandemic, RACC, Respiratory, Walk-in CentreBack to Table of ContentsAttachmentsAttachment 1 - Material resourcesAttachment 2 - Flow chart for patient journey in the IACAttachment 3 - Clinical Assessment Flowchart for IAC Attachment 4 -Emergency Department Clinical Assessment FlowchartAttachment 5 -Contact numbers for notifications and alertsDisclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.Date AmendedSection AmendedApproved ByEg: 17 August 2014Section 1ED/CHHSPC ChairAttachment 1 - Material resourcesConsideration for 12 hour delivery timeframe should be given to ensure adequate supplies of the follow stock items are available in the IAC: DescriptionP2/N95 masks for staff Surgical masks for patients and carersSingle use gown – non sterile - yellow or blueGloves – small – non latexGloves – medium – non latexGloves – large – non latexSafety glasses/ face shield – non disposable500ml pump pack bottle 0.5% chlorhexidine hand rub Alcohol surface wipes Liquid soap for public toilets for wall mounted dispensersTissuesRubbish bags / bins liners 50 L Disposable covers for tympanic thermometers Disposable LinenO2 saturation monitors Tympanic ThermometersAttachment 2 - Flow chart for patient journey in the IACPatient arrives in the IAC waiting room and is asked to put on a mask and clean their hands with the hand hygiene product Clerical staff give patient a pack for registrationClerical staff enter Patient registration details into ACTPAS Patient enters consultation room for assessment by IAC nurse Patient has an oropharyngeal viral flocked swab collected for testing and is commenced on Tamiflu if indicated by clinical criteriaPatients are notified of positive results by the Centre for Disease ControlPatients are provided with oral and written information about influenza including what to do about isolation and infection control at homeA sick certificate for 7 days is provided for patients with positive flu symptomsAttachment 3 - Clinical Assessment Flowchart for IAC Patient presents to Influenza Assessment Clinic (IAC)Standard and droplet precautions apply. Give patient a mask and direct them to use hand hygiene products to clean their handsTriage the patient for flu like symptoms (fever, cough, fatigue, myalgia)Flu like symptomsNil SymptomsRefer patient to ED or GP depending on reason for presentationPatient to wear maskStaff to wear contact & droplet PPETriage for abnormal oxygen saturation, respiratory rate and chest auscultationAbnormalNormalRefer to Emergency department for ongoing assessment and managementTreat in IAC and manage as per patient journey (refer to Attachment 2)Attachment 4 - Emergency Department Clinical Assessment FlowchartPatient presents to EDStandard and droplet precautions apply. Give patient a mask and direct them to use hand hygiene products to clean their handsTriage the patient for flu like symptoms (fever, cough, fatigue, myalgia)Flu like symptomsNil SymptomsPatient to wear maskPatient is to remain in the waiting room for normal triageStaff to wear contact & droplet PPETriage for abnormal oxygen saturation, respiratory rate and chest auscultationNormalAbnormalRefer to Influenza Assessment Clinic (IAC) for managementTriaged in ED with full observationsPatient to be managed in EDTriage and registration in IACAttachment 5 - Contact numbers for notifications and alertsACT Health DirectorateMobileLandlineDirector of Operations0419 960 019N/AADON of Operations0423 294 387624 42831Executive Director, Rehabilitation, Aged & Community Care 0409 460 789624 43579Director of Nursing, Rehabilitation, Aged & Community Care0466 770 2366244 2205Assistant Director of Nursing, Infection Prevention and Control0478 408 7876244 3695 Assistant Director of Nursing (WiC, RADAR, ACALU)0403 050 9676205 4926Clinical Nurse Consultant, Walk-in Centre Nil6205 4437Administration Manager, Rehabilitation, Aged & Community Care0421 158 6346244 2767Walk-in Centre ReceptionNil6205 4437ACT Public Health Unit – Emergency Ops. Centre Emergency Management CoordinatorChief PharmacistFax 6205 31390417 691 9760419 516 399NA62082146205 0961ACT Chief Nurse 0414 192855620 50893CHHS – Senior Medical AdvisorContact through TCH switchboard 624 42222CHHS – Executive Director Nursing & MidwiferyCHHS – Director of PharmacyCHHS - SecurityCalvary – Director of Medical ServicesContact through Calvary Switchboard6201 6111Calvary – Director of NursingOccupational Medical Unit (on site TCH)Not Applicable624 42321 / 42323Supply Operations Manager - Mitchell Supply – on call person0434 660 7340419 216 602620 50800Not ApplicableFacilities Management – water, power, air con., sewerage, general and clinical waste etc.Contact through TCH switchboard 624 42222Cleaning contractorACT GovernmentACT Policing/AFP – operations 24/24 hours000 – life threatening emergency6256 7777ACT Ambulance Service 6207 9988 (duty manager). ................
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