Covid 19 - Risk Assessment

Risk Assessments & Updates

27th September 2020

Since the Risk Assessment made in May 2020, Physioplus has been implementing adjustments to processes, PPE equipment and such like.

The current status is that in addition to all of the decisions and pracices implemented 29th May 2020 the therapists will now wear a Mask and Facial Screen together with gloves for each patient before disposing of these single patient use items following clinical waste process controls.

Patients are required to waer personally provided masks from the point of arrival until they have departed the practice.

By way of summarising the general outcome, pretty much every patient has now switched to paying by card prior to appointments with the remained using sealed cash envelopes identifying their name, amount and date. Pre Appointment telephone triages are being done 6-72 hours ahead (allowing for weekends).

We now also have the NHS Covid-19 Track & Trace QR Code on the practice door allowing patients to scan on arrival.

Risk Assessment 27th September 2020

Our next full Risk Assessment is scheduled for 11th October 2020 in good time for the arrival of our newest Therapist

Following on from the full Assessment, the Physioplus+ process for assessing Risks is broken down into stages with applicable dates:

A - Major Review Assessment Date             11th October 2020
B - Review Date                                           18th October 2020
C - Ongoing Review Dates                           every 7 days in October, then monthly until December 2020

29th May 2020
​
Physioplus+ is a professional physiotherapy practice registered with the Health and Care Professions Council (HCPC) which together with the Chartered Society of Physiotherapy (CSP) has been providing ongoing guidance, direction, instruction and help since the Covid-19 pandemic was initially identified.
As part of that process, all staff were furloughed and all physiotherapy and other face to face treatment was ceased in late March 2020. Since then, the premises have regularly been cleaned bearing in mind CSP & Public Health England guidance.

The guidance now is that so long as the practice complies with guidance and rules the treatment of patients can recommence face to face in limited circumstances. These circumstances will be assessed by “Telephone Triage”, but currently are for patients in acute or worsening pain, whose symptoms have not been relieved by any exercises prescribed.

The practice must undertake a series of measures including undertaking an in-depth Risk Assessment for Covid-19, which has to be published to the practice website.
​
Risk Assessment 29th May 2020
At Physioplus+ our process for assessing Risks is broken down into stages with applicable dates:
A - Initial Assessment Date             28th May 2020
B - Review Date                               31st May 2020
C - Ongoing Reviews Dates              every 7 days in June, monthly July 2020 to December 2020
 
The initial Risk Assessment is then sub divided by process and actions

• Telephone Triage (Pre Face to Face Treatment)
• Face to Face Treatments
• PPE – Personal Protective Equipment & Therapists Uniform and Clothes
• Pre-Appointment Processes
• Patients Appointment Notes
• The Appointment
• Patient requires to use the bathroom facilities
• Post Appointment
• Premises - Start of Day
• Premises – Between Patients
• Premises – End of Day
• Therapist Breaks – for meals, snacks and drinks
• Treatment Payments
• Linen Process
• PPE Equipment Process
• General Notes

Risks and Infection Control
By way of summarising the Risks and the appropriate actions that will be taken:

• Passing covid-19 by touching surfaces that may have come into contact with the virus
• Close contact with your therapist, which can pass covid-19 if either party is unknowingly infected
• The risks are being minimised by limiting touching of any surfaces, by careful cleaning processes, by decreasing face to face appointment time, and by the use of Personal Protective Equipment (PPE)
• There will be 72-hour breaks between clinics and thorough cleaning processes to comply with infection control guidance.
• This document is created to illustrate steps, stages, methods and controls set in place to meet these requirements.

Telephone Triage Day (Pre Face to Face Treatment)

• Physioplus+ has prepared a short Telephone Triage form for covid-19 which will be used prior to any Face to Face Appointment. A history of your current medical situation/medication/pain etc will be taken at the same time to establish a) if you fit the current treatment criteria (if not, you will be offered a zoom ‘virtual’ appointment at a later date) and b) to decrease the amount of time that you physically spend on the premises. The covid-19 assessment has to be repeated and signed by patients when they attend a Face to Face Appointment.
• When the therapist arrives at the building, they will change clothes into a fresh clean uniform and as usual give their hands a thorough wash.
• The therapist will clean all working surfaces, doors, desks, light switches and telephones etc in the Reception area.
• They will assemble a “Patient Pack” of couch cover, towels, water bottle, appointment card etc for each appointment and then seal the opening and store these packs in Treatment Room 2. They will also locate and place into a sealed plastic folder Patient notes for the next day’s appointments.
• They will clean and sanitise bins, water bottles etc.

Face To Face Treatments
PPE – Personal Protective Equipment & Therapists’ Uniform and Clothes
Physioplus + has acquired a sizeable stock of PPE items for use by the therapist including:

• Face Mask
• Aprons
• Gloves
• Masks

Pre-Appointment Processes
Pre-appointment, the patient will have taken part in a Telephone Triage with their therapist usually the day prior. The therapist will layout and where necessary explain the following:

• Price applicable from 1st May 2020 - £49 existing patients/treatment. New patients will pay a one time first appointment fee of £65 to cover the additional time required at the first appointment.
• Please attend appointments alone
• If you wish you may of course wear a mask
• Please arrive at the appointed time, not before, and within 5 mins of the planned start at the latest
• Please wear comfy loose-fitting clothes as we will not be asking patients to undress
• Also bring the minimum of additional items such as coats, bags etc, (weather dependent)
• Covid 19 status update
• We will not offer use of the bathroom except in urgent circumstances. In that instance, the therapist will open all doors and turn on all lights. The therapist will provide a single use towel which you hand back to the therapist placing it in the 72-hour linen bin. The therapist will close all doors when completed and switch off all lights. Soap is provided in the Bathroom (as always!)
• Please make payments by card before the appointment at the time of Telephone Triage if possible or at the appointment if you have to. If you wish to pay by cash, please bring the correct money so that we are not handling change. No change will be given but will be carried forward to the next appointment.
• Upon arrival, sanitise your hands to the right of the door. The therapist will then take you straight into Treatment Room 1 with your possessions, which will be stored in a cleanable plastic box. Any coats are to be hung on the pegs provided. If you arrive early because you have a driver or a taxi, you will be asked to sanitise your hands, sit on Seat 2 in reception, and keep coats and other possessions in hand. In effect “DON’T TOUCH ANYTHING”. We feel a bit bossy but it is for everybody’s benefit 😊

Patients Appointment Notes

• Physioplus+ patient notes/communications are stored in a plastic sleeve for each Patient. These will be written up during the telephone triage and any subsequent treatment provided.
• Notes for all patients in a clinic session will be added to a plastic folder in preparation for the Treatment Sessions.

The Appointment

• A standard treatment will be provided by the therapist in the standard way with the exception that adjustments are made taking into account treatment requirements and also Government and Authority guidelines.

Next Appointment

• Therapist uses the diary and agrees next Appointment
• Therapist enters the next Appointment into the diary
• Therapist takes Next Appointment Card from Patient Equipment Bag
• Patient enters the next Appointment and passes the card to the Patient

 Patient requires to use the bathroom facilities

• Patients are being urged to ONLY use the Physioplus+ Bathroom facilities for urgent needs such that the use of these facilities will then be limited in most cases, on most days to the Therapist use only.
• In the event that the Patient does require to use the facility, the therapist will ensure all lights are on, all doors open and a pathway clear with no obstacles to give easy access to the bathroom and limiting any required touching of furniture.
• The therapist will also provide a single use hand towel for the Patient.
• The Patient will after washing their hands place the used towel in a 72-hour linen basket provided.
• At this point, the therapist will not be wearing gloves and will want to limit any touching.

Post Appointment

• When the Patient is ready to leave the premises, they will take their own Coat/Jacket etc from the hooks in Treatment Room 1. Any handbags, briefcases and any other personal possessions will be collected from the container provided.
• The Patient will be asked to use the hand sanitiser.
• The therapist will open and close the premises door.
• The Premises Between Patients & Premises End of Day process will then be implemented.

Premises - Start of Day

• On arrival each day the therapist will place all personal possessions into the Personal Possessions Box in Treatment Room 2, hands are sanitised, and a clean uniform is donned.
• Therapist puts Linen Pack 1 and notes for the first Patient (including a water bottle for patient use) and a water bottle in the kitchen for their own use.
• Therapist switches on Hot Water Heater for 15 minutes and as required through the day.
• Therapist re-cleans the Front Door handles and surfaces as required.
• Card machine sanitised and taken to Physio Table.
• Payment Box sanitised and taken to Physio Table.
• Notes file and Diary from Locked Drawer, sanitised and taken to Physio Table.
• Hands are sanitised again.
• Therapist puts on required PPE in good time for the first patient.

Preparation Equipment in Treatment Room 1

1. Sanitised 72-hour Linen Container with clean bag
2. Sanitised 72-hour pedal bin with clean bag for used PPE
3. Sanitiser, wipes, paper towels
4. Sanitised Patients Possessions box

Preparation Equipment in Treatment Room 2

1. PPE Masks – small box
2. PPE Aprons – large box
3. PPE Gloves
4. PPE Face shields
5. Backup sanitised 72-hour Linen Container
6. Patient Linen Packs (prepared the previous day)

Premises – Between Patients

• Remove all linen used during treatment and covering chairs to 72-hour Linen Bag in Treatment Room 1 and close lid
• Remove PPE to 72-hour pedal bin in Treatment Room 1
• Place used Plastic Water Bottles in 72-hour pedal bin
• Therapist Cleans Hands
• Clean couch aperture (if patient was prone), all doors, door handles, card reader, coat hooks, plastic possession box, lid of pedal bin and laundry basket, chairs, Treatment Room 1 desk, outside door and buzzer and any other potentially touched surfaces. Use sanitiser, wipes and paper towels ensuring the hand sanitiser bottle is cleaned between patients.
• Clean Diary covers
• Therapist to complete a personal clean of hands (to elbows)
• Therapist applies a Clean PPE set in Treatment Room 2
• Physio lays out clean linen pack for next patient
• NB: repeats for every patient visit

Premises – End of Day

• Remove card payment slips and any cash to a 72-hour Payments tin.
• Puts the cleaned patient notes file into a Locked Drawer for 72-hours.
• Diary cover cleaned and placed into the 72-hour Locked Drawer.
• Card Machine cleaned before being returned to the battery charging cradle.
• Clean all touchable surfaces, including desks, telephones, computers, keyboards, switches, door handles, seats and the kitchen and bathroom. A further clean will take place after 72 hours.
• Use the label roll from Treatment Room 2 to date bags of laundry and PPE. The PPE will be double bagged at this point. The 72-hour Linen Container & 72-hour PPE bag will be left in situ but sealed.
• Clean hands
• The therapist will then remove their used uniform into a 72-hour laundry bag and put on a clean set of “personal street clothes”.
• The blinds will then be closed, the lights turned off and the therapist will leave. The therapist will not return for 72-hours when the cleaner will clean and the Treatment Room, Bathroom, Reception and Linen Sets will all be prepared for the next treatment. The therapist will continue with the next Telephone Triage session.
• NB:  the therapist will clean their hands in line with infection control guidelines whenever required to prevent cross-contamination

Therapist Breaks – for meals, snacks and drinks

• The therapist on duty will follow the usual strict hygiene practices during breaks for any liquid or food consumption including new guidelines for removal of PPE, hand washing etc.
• All food and drink consumption will be isolated to the Physioplus+ kitchen area.

Treatment Payments

• The practice prefers cards rather than cash to reduce possible infection transmission, and pre-payment by telephone where possible.

Card

• The card reader which will be positioned at the start of the day on the therapists table in Treatment Room 1
• Therapist removes gloves into the PPE Bin in Treatment Room 1, enters the amount to be paid, the Patient places their own card into the card reader and respond with the Card Security pin number as prompted. The Patient presses the Green (Go) button. The therapist takes the 1st receipt and places it into the Payment Box and gives the 2nd one to the Patient. The Patient will be asked to remove their own card when both receipts have been printed.

Cash

• When receiving payment by cash, Therapist will keep gloves on or add a new pair
• No change is provided (adjusted on the next appointment)
• Cash is placed into the PP Payment Box
• Therapist takes off Gloves - places in PPE Bin (Treatment Room 1)

Linen Process (72 hour process)

• Treatment Room 1 and Bathroom will have their own Linen Container, lined with a plastic bag. The bag will be labelled and dated with labels stored in Treatment Room 2.
• NB, the therapist will be removing their PPE and Uniform at the end of each day or in some instances between Patients. This will all be placed into the most appropriate Linen Container.
• The Linen Containers will be sealed.
• Linen, Uniform and any PPE (to be cleaned) will be retained in situ for 72 hours. The labelled double PPE bags will be disposed of in the appropriate domestic waste bins.
• All linen and uniforms will be washed at 60 degrees C.

PPE Equipment Process

• Any PPE to be cleaned will be retained in situ for 72 hours (face shields only)
• The labelled double PPE bags will be disposed of in the appropriate domestic waste bins after 72 hours unless any patient reports an onset of covid-19 symptoms in the 72 hours post treatment. In this case, potentially infected waste will be disposed of as infected waste to the appropriate infected waste removal service.

General Notes

• Patient Notes will at the time of treatment be taken from the plastic folder for the patient and when used will be placed back into a duplicate folder to take used files. The files will be cleaned before they are added to the duplicate file.

Ends …