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Providing in-person community care during COVID-19

 Guidance for nurses

The delivery of care in the homes of patients and clients, or in community-based clinics, does not constitute a “social gathering”. As per the Nov. 7, 2020 PHO order, registrants who provide care to patients and clients in these settings are expected to continue to provide care, following WorkSafeBC and the College’s standards/guidance for the appropriate use of PPE when delivering care.

Ongoing pandemic best practices

Public health officials have indicated that COVID-19 is expected to continue to circulate in the general population for an extended period. As such, ongoing measures to control the spread of the disease are anticipated, including requirements to practise physical distancing of at least two metres (six feet) and increased screening for signs, symptoms and risk factors for COVID-19.

Best practices
  1. First and foremost, registrants must adhere to the BCCDC's COVID-19: Infection Prevention and Control Guidance for Community-Based Physicians, Nursing Professionals and Midwives in Clinic Settings regarding IPC measures applicable to the practice environment, including PPE use and environmental cleaning best practices to enable safe practice.
  2. Adherence to all BCCDC and WorkSafeBC guidance regarding occupational health and safety exposure control plans is also required to ensure a safe work environment for staff. This includes robust policies, procedures and organizational cultures that ensure that no one (employees or contractors) associated with the practice attend work when they have symptoms of illness. Self-employed registrants should have a documented plan in place on how they would manage these issues for themselves.
  3. Registrants are reminded that if they are exhibiting signs of COVID-19 or respiratory illness, including cough, runny nose or fever, they must not provide in-person care and should not be in attendance at clinics or other practice settings where other staff and patients are present.
  4. Registrants must follow BCCDC and WorkSafeBC guidance for self-isolation when an employee is sick with any respiratory illness, support access to primary care provider assessment and testing, and provide sick-leave support where possible until symptoms have resolved and it is safe to return to work.
  5. Registrants must implement COVID-19 screening practices for patients:
  6. Patients should also be encouraged to make use of COVID-19 resources by calling 811 or visiting healthlinkbc.ca.
  7. Screen for risk factors and symptoms of COVID-19 prior to attendance at the practice environment.
  8. If patient screening reveals the patient may be at risk of COVID-19, registrants should refer the patient to a COVID-19 testing centre and defer treatment until signs and symptoms have resolved (see this announcement from the Provincial Health Officer).
  9. BCCNP does not expect any registrant to provide treatment unless, in their professional opinion, it is safe to do so for both patients and staff.
Guiding principles and assumptions

The following guiding principles and assumptions have been identified as foundational for reintroducing health-care services in the context of COVID-19:

  • Registrants employed by hospitals, health authorities, and long-term care facilities should refer to guidance provided by their employers and the PHO.
  • All other registrants will follow the guidance, expectations, and direction provided by the PHO
  • The direction in this document pertains to the delivery of care in community settings. These include, but are not limited to, self-employed nurses in private practice clinics, private mobile or community-based practices, and school-based practices.
  • Some services can be safely and effectively provided virtually. Other services require in-person visits including direct patient care.
  • BCCNP Standards of Practice apply, regardless of whether services are provided virtually or in-person.
  • Wherever possible, physical distancing will be maintained during the delivery of care.
  • In-person services must only proceed when the anticipated benefits of such services outweigh the risks to the patient and the health care provided.
  • The registrant is accountable and is the person best positioned to determine the need for, urgency and appropriateness of in-person services.
  • Appropriate personal protective equipment (PPE) must be used for the safe delivery of in-person services; however, all registrants must also act to conserve PPE through its judicious use.
  • Registrants must not recommend unproven therapies for treating COVID-19.
  • Registrants must not prescribe or offer any COVID-19 treatments or therapies if infectious diseases are not within their scope of practice or competence.
  • Registrants are accountable to provide clear, honest, and transparent communication regarding their policies and procedures related to COVID-19.

 Prioritization of patient care services

When services resume, registrants may face difficult decisions regarding which patients to see and the prioritization of service provision. The registrant is accountable for prioritizing access to in-person services based on clinical judgment and with consideration given to the patient perspective and the referral source (if applicable).

When determining priority for in-person care, registrants should reflect upon the following considerations:
  • acuity of the patient's condition
  • functional impairment or impact of the condition on health-related quality of life
  • the impact to the patient if they do not receive services
  • appropriateness of service provision via virtual care
  • necessity of services which can only be provided in-person
  • duration of patient wait times for care
  • Referral/escalation process if unable to address patient's care needs in a timely manner

 Personal protective equipment

Recommendations regarding use of personal protective equipment (PPE) in the practice environment should follow the directives and recommendations provided by BCCDC and WorkSafeBC.

 Background

Some background information on this guidance

​The following guidance has been developed collaboratively by the BC Health Regulators with expertise and direction provided by the Provincial Health Officer (PHO), the BC Centre for Disease Control (BCCDC) and WorkSafeBC. It is intended for all registrants in community practice, which includes self employment, and is applicable for the duration of the COVID-19 pandemic.

Note that this guidance reflects the best evidence available at this time and it will change as required to reflect updates in our understanding of the virus and its transmission. Resources that are linked to in the guidance are also subject to change, and registrants need to watch for updates from BCCNP as well as updated guidance from the PHO, BCCDC and WorkSafeBC.

During COVID-19, BCCNP registrants were directed by the Provincial Health Officer to reduce all non-essential and elective services involving direct physical contact with patients and clients to minimal levels, and to provide virtual care whenever possible except for rare circumstances that might lead to imminent patient harm.  

This guidance to registrants will assist in determining which services are reasonable to resume in Phase 2, beginning May 19, 2020. BCCNP recognizes that registrants would like very clear and specific direction on what is considered reasonable; however, it is not possible to address all scenarios.    

As professionals, BCCNP expects registrants to collaborate with colleagues in similar practices when making these decisions and to use professional judgement to determine what is in the client's interest. BCCNP expects registrants to read this guidance and follow the expectations for infection prevention and control as they resume work in community settings. Please check the BCCDC website regularly for updates.   

BCCNP encourages all registrants to take the time required to review all guidance documents and make the necessary adjustments to community  practice to ensure safe practice. While in-person services may resume on May 19th there is no requirement to re-open by this date.