Practice guidelines: is your practice ready for COVID-19?

Medical Forum·
Medical Forum Weekly
·3 mins read

As more and more people get infected with COVID-19, GPs need to ensure their practice is ready to treat COVID-19 cases safely. Are you up to date with current RACGP guidelines?

As WA prepares to open borders, COVID-19 cases are slowly creeping up in our state. Treating patients with serious presentations of this highly infectious disease requires preparation and strict adherence to official guidelines.

The RACGP advice that face-to-face consultations should be limited to cases where it is absolutely necessary and should be carefully considered. “The public health ramifications of visiting or having a COVID-19-positive patient on site at a practice must be considered in light of requirements in your jurisdiction, including isolation requirements for close contacts and cleaning/decontamination requirements,” the RACGP wrote in a recent guideline.

Once all factors are considered, GPs need to ensure their practice is prepared to manage COVID-19 patients effectively, while reducing the chance of transmission. With these issues in mind, the RACGP has published a set of guidelines GPs can follow to ensure they can safely treat a suspected or confirmed COVID-19 patient.

Preparing the consultation room
For starts, any GPs wanting to treat a potential COVID-19 patient need to start by prepping a dedicated consultation room. According to RACGP guidelines the key steps GPs need to take include:

  • Removing all non-essential items from exposed surfaces.
  • Taping a line on the floor 1.5 metres from the doctor’s / nurse’s chair /desk as a physical indicator to maintain social distancing when possible.
  • Removing all soft furnishings, if possible.
  • Making sure enough personal protective equipment (PPE) is available, including spares. PPE equipment include gloves, P2/N95 masks, gown, and eye protection.
  • Considering how to safely remove and dispose used PPE and placing a clinical waste disposal bin in a convenient location.
  • Checking that the room has hand washing facilities and enough hand sanitiser / tissues.
  • Putting all relevant pathology forms, examination tools, etc in the room to avoid having to leave the room.

In addition, according to a RACGP representative, while there is no requirement to install specialised HEPA air filters, GPs should ensure that there is optimal air flow in their practice. “Practices should enhance air flow by opening windows and doors (where and when appropriate), and optimising fresh air flow by reducing or avoiding air recirculation,” a RACGP representative told Medical Forum.

During the consultation
First off, GPs should consider if it possible to see the patient outside of their practice. If this is not possible, RACGP recommends the following steps:

  • Enhancing air flow by opening windows and doors.
  • Considering possible ways to avoid patient contact with staff and other non-COVID-19 patients. For example, having the patient use an allocated entry, waiting in the car until the GP is ready to consult and clearing corridors prior to patient entry.

In addition, according to current RACGP guidelines, GPs should implement the following:

  • The patient should wear a surgical mask at all times.
  • The doctor should wear appropriate PPE at all times.
  • The patient should remain behind the line on the floor 1.5 metres from the doctor’s chair/desk where possible.
  • When collecting a specimen, the doctor should stand to the side, in front of the patient.
  • The doctor should swab the tonsillar area of the oropharynx first; then, using the same collection swab, swabs the nasopharynx.

In addition, a RACGG representative told Medical Forum that special care should be taken when using aerosolising generating procedures.

“Aerosolising generating procedures in confirmed or suspected COVID-19 patients is associated with increased risk of transmission and should not be conducted in general practice. These should be performed in a negative pressure room or well-ventilated operating or procedure room (ie in a hospital setting), with staff in full PPE,” a RACGP representative said.

For further details on current RACGP guidelines, follow the links below”

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