Pandemic Practice Recovery Plan

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admin Posted on April 21st, 2020

Just like SARS and 9/11, the world has fundamentally changed and we will not experience “business as usual”. This is the first global pandemic that we have experienced in our lifetime, but it may not be the last. Crisis also represents opportunity. Now is the time to plan and prepare your practice for a full and robust recovery.

As with any recovery process, it will be incremental and will not happen overnight. There are parts of your practice that will take longer to recover, like the hygiene schedules, because the services were deemed non-essential during the critical phase of the pandemic. It is important to deploy all resources available to get everyone on your team engaged in the recovery process when you receive the ‘all clear’.

The current situation is very dynamic and can change at any moment. Doing the best that you can with the most current knowledge is a good starting point, but it’s only the beginning. It’s important to implement a long-term recovery program to keep your practice in good health and be ready for the next emergency. Your health and safety program, infection prevention and control as well as your Pandemic Recovery Program are living documents that require continuous updates, review and adaptations to current events.

Here is a step-by-step plan that you can implement now, before you get the ‘all clear’ to open your doors again.

Preparing the Premises

  1. Disinfect all surfaces in the office including the front desk, telephone, computer, point of sale machine, pens, etc.
  2. Thoroughly clean the reception area including the furniture and remember to clean the legs and backs of the chairs. Remove magazines and toys as well as any unnecessary clutter or decorations that could harbour germs. Wipe down all picture frames and clean the windows. This is a great opportunity to do a thorough spring-cleaning.
  3. If you have plants in the reception area, thoroughly wipe them down with a damp cloth. Plants are good for air purification and studies have shown that they reduce stress and noise.
  4. While your office is closed, it is a great time to do a complete inventory of your supplies. Make sure that you have enough PPE for when you do open. Check all the expiry dates on products.
  5. Order supplies. This is a good time to get the ordering done. Suppliers will likely be extremely busy filling orders and needed supplies may be delayed depending on where they are coming from and the high demand. It’s best to get your necessary orders in early and hope for the best. Try not to over order and remember that everyone is in this together.
  6. Restock the operatories.
  7. Check all of the equipment to make sure everything is in working order. Now is the time to have any needed repairs done. The dental suppliers are providing checklists that will help you keep your equipment in good working order.

Pre-screening Patients

Patient screening should be done by telephone when scheduling or confirming the appointment and repeated again when they enter the practice. You should ask the patient:

  • Have you travelled out of the country in the past 14 days?
  • Have you experienced the following within the past three (3) days?
  • Sudden onset of respiratory illness (e.g., shortness of breath or difficulty breathing, coughing up bloody sputum, wheezing)?
  • Fever greater than 38 degrees Celsius?
  • Muscle aches or weakness?

When the patient arrives at the practice, ask the pre-screening questions again, but do not include the question about travel.

Pre-screening Staff – Fitness to Work Policy

Before returning to work, your staff must also be prescreened. In your Health and Safety program you will have a “Fitness to Work Policy” that will provide you with procedures to follow when bringing your staff back and for the future.

The key points in the Fitness to Work Policy are as follows:

Each employee is responsible for notifying the doctor or his or her designated appointee if they have been in close contact with an individual who is, or is suspected of being, ill with pandemic influenza, (in this case Coronavirus).

A “close contact” is defined as an individual who has cared for or lived with a person known to have an infectious disease or who has a high likelihood of direct contact with respiratory secretions and/or body fluids of a patient known to have an infectious disease. This direct contact would include sharing eating or drinking utensils, and close conversation (within one metre).

If the employee reports illness by phone or email:

The designated Pandemic Liaison should contact the employee by phone and ask if they are exhibiting any of the symptoms listed on the questionnaire.

If the employee’s symptoms do not correspond with those on the questionnaire, the Pandemic Liaison should reassure them, tell them to keep in contact and to see their physician if needed.

If some or all of the employee’s symptoms correspond with those on the questionnaire, the Pandemic Liaison should:

  1. Inform the employee that he or she must stay at home until the symptoms abate.
  2. If the employee has been in contact with someone who has tested positive but the employee does not have any symptoms, he/she must self-isolate for 14 days. Advise the employee to immediately contact a health professional by telephone.
  3. Complete a brief report noting the employee’s condition and any staff and/or visitors the employee has been in contact with.
  4. Arrange for the employee’s workstation to be cleaned and disinfected.

If an employee reports to work exhibiting symptoms of illness:

  1. The employee’s condition will be identified by their response to the questionnaire.
  2. The employee should immediately be provided with an approved surgical mask and should put it on.
  3. The employee should immediately leave work and contact a health professional. The employee should avoid public transport when leaving work.
  4. The employee’s manager should be informed that the employee has left work.
  5. The employee’s work station should be cleaned and disinfected

If an employee exhibits symptoms while on the job

  1. The employee, or someone who observes that the employee is exhibiting symptoms of influenza at work, must contact the Pandemic Liaison
  2. The employee should immediately be provided with an approved surgical mask and should put it on.
  3. The employee should immediately leave work and contact a health professional. The employee should avoid public transport when leaving work.
  4. All contacts of the employee within your company should be advised that they may have been infected and be asked to go home and await further instructions.
  5. The employee’s manager should be informed that the employee has left work.
  6. The employee’s workstation should be cleaned and disinfected.

Preparing the Staff – Compliance Trainings

This time is an opportunity to ensure that your office is up to date with all of the compliance trainings, especially IPAC and Occupational Health and Safety.

Trainings can be provided virtually and have an office visit scheduled for a later time when your office is up and running again. This would prevent you from having to block off precious production time for trainings and/or refresher courses when your office re-opens. Now, more than ever, it is critically important to be compliant with the most current infection prevention and control procedures.

Preparing the Patients – Communications Plan

The flow of good reliable information is more important than ever. Staying in touch with your patients now will help your practice to recover more efficiently. This is not the time to be worried about marketing your practice and competing for patients. This is the time to reach out to your existing patients to let them know how much you care about them and you are committed to their safety and well-being. Provide your patients with information about the steps that you are taking to keep them as safe as possible when they come back to your office. Also, inform your patients about what to expect when they return.

Reach out to your elderly patients and do a wellness check. They will appreciate the contact. Call them on the telephone, don’t just rely on emails. Many of them are isolated and lonely, as well as frightened.

Hygienists should call their patients who are in active therapy as a wellness check and to provide advice and support until the patients can return for their appointments. Revitalizing the hygiene columns will be challenging. You don’t want your patients’ health to deteriorate.

When Patients return to the Practice Prioritize appointments

Doctors and assistants need to work closely with the administrative team to identify the patients who were in mid-treatment when the shutdown happened. For example, follow-up with patients who were seen as an emergency and have been prescribed antibiotics, or who were prescribed medication for pain control and have had to delay root canal treatment. Also identify which patients are in temporary crowns or perhaps have had to see an emergency dentist. The dentist can determine who should be seen first.

The assistant can determine where are the lab cases. What has been received and what cases are pending. Contact the lab to get a delivery date.

Financial Recovery

Prime Minister Trudeau has been announcing relief for small businesses that you will be able to apply for on April 6. Some of the support will require you to demonstrate that you have suffered financial loss of 30%. Since we know your practice well, I will be happy to do an analysis for you to submit with your application when the time comes and we have more details.

The relief is as follows (this information is as of March 30 and it changes daily):

  1. Wage support that will cover 75% of wages. This will prevent you from having to lay off your staff. Even if you have already done so, you can bring them back and apply for this and have the employee cancel the EI benefit. The employee will receive more benefit from this support than they would receive from EI. It’s important to note that they cannot receive both.
  2. $40,000 interest free loan for 1 year and $10,000 may be forgiven if certain conditions are met. The details still need to be fleshed out but this could help you get through the next couple of months. The interest rates are very low and the $10,000.00 forgiveness would be helpful as well.
  3. Emergency Response cash payment $2,000/month for 4 months. This would apply to small business owners who are not eligible to receive benefits from EI. It is not a huge amount but every bit helps.
  4. Loan deferrals for 6 months. Talk to your bank as soon as possible. This is definitely something worth looking into. Your cash flow is important right now. If you have sufficient cash flow to maintain your payments now, which is always best, but ask your banker if the 6-month deferral just means that you have to pay the full 6 months at the end. If that is the case, you might as well continue paying, if you can make it work.
  5. Business loans up to $2,000,000 per practice. The details are a little vague at the moment, but have a talk with your banker. Banks want to keep you in business and they want to keep your business. You have the power to negotiate the best deal now and take advantage of the extremely low interest rates.

Looking to the Future

Paperless Office

If you have been considering going paperless, now is the time to begin an implementation process. Purchase a high-speed scanner and begin the process of creating e-charts. Scan in all documentation that you need to retain into the patient’s record. Shred what is not needed. Indicate on the chart that it has been e-charted. Arrange with your software provider training for your staff on how to work in a chartless environment. If you need help with this, DOCS has step-by-step procedures to guide you through.

Complete your pandemic plans and prepare for the next emergency

If you have received Occupational Health and Safety training from DOCS, your pandemic plan and checklist is in your binder and on your USB key. If you do not have a plan, contact us at DOCS and we will be happy to send you the plan.

We have learned a lot from this crisis and that knowledge provides us with an opportunity to be prepared for whatever the future may hold. Have your pandemic plan and policy on contact, control and monitoring ready. When this crisis is over and there is a comfortable flow of supplies, order a sufficient supply of N95 masks, gloves and face shields so if there is another crisis down the road, you will be prepared.

You may also want to set aside a staff recovery fund, instead of providing bonuses. That fund will assist them during the first very difficult week or two until government assistance kicks in.

The DOCS team is here to help you recover from this crisis. We will continue to update you regularly as things change. If you have any questions at all, please do not hesitate to contact us.