Your Practice & COVID-19

As the effects of the COVID-19 pandemic continues, the Indiana Podiatric Medical Association wanted to share some important messages with you and your practice. Our goal is not to add to the hysteria or suggest a reason to panic; instead, the IPMA simply offers the following as reasonable guidance for your practice operations during this challenging time. These are only suggestions and you can decide if or how they may benefit your practice.
First and foremost, as a health care professional, it is essential that you remain healthy yourself and abide by the health department restrictions. As health care professionals, we need to lead by example and be cognizant of the perceptions and precautions associated with the present COVID-19 situation.
How Are You Handling Patient Interaction in Your Office? 
If you have not done so already, the IPMA recommends communicating with your patients. For instance, are you planning to maintain regular office hours? Additionally, communicate with them about your standards of care and sterilization. As health care professionals, remind them that you already maintain the highest standards for sterilization and disinfection at all times. Remind your patients that your standards for every patient, every procedure, requires full sterilization, sanitizing, and disinfecting every critical item and surface every time. The coronavirus is killed by your sterilization and sanitizing techniques.
Also, remind your patients that the Coronavirus is low risk for children, young and moderately aged healthy individuals. However, your patients over the age of 70 and those patients with immunocompromised systems are at higher risk for severe sickness. The ‘Social Distancing’ recommendations by Governmental authorities seem wise to slow the spread and avoid the medical system being overloaded by severe cases. That said, you obviously know what is best for your patients and the care they may need from you.
Some suggestions on patient communications include: 
  • Obviously, patients who have Coronavirus or patients that have been exposed to individuals who have or are being tested for Coronavirus should cancel/reschedule visits. 
  • Any patients exhibiting any signs of fever, significant cough, and/or flu-like symptoms such as body aches, headache, weakness, fatigue, should cancel/reschedule visits. 
  • Any patients over 70 years old should consider postponing non-emergency visits. Or offer to work with those patients for alternative treatment and patient care. 
  • Inform patients to not bring any unnecessary extra people with them to an appointment. 
  • Inform patients that minors should be accompanied by an adult as usual, and any minors not receiving care should have arrangements made for their care so that those minors are not in your office unnecessarily. 
  • Patients requiring special caregivers or relatives that assist them are welcome to bring accompanying individuals as always. However, remind everyone visiting your office that they should also be free of symptoms and not have had high risk recent history (travel from high risk areas, interaction with sick individuals, not exhibiting any signs of flu or flu like symptoms). 
  • If you have patients come to your office to pay bills, consider telling them to pay via credit card or online payments to limit exposure and lines in your office. 
  • Remind patients in your office to practice “social distancing” to keep themselves 6 feet away from other patients. 
  • If your waiting area is not large enough, consider telling patients to wait in their vehicles until you are able to treat them. 
  • Practice sterilization in your office constantly. Use clean pens for each patient. After use, treat your pens with antiseptic agents before being distributed for use again. Alternatively, patients could be instructed to bring their own pens, both for intake and for signatures on consent forms. Clipboards and all countertops should be cleaned and wiped between direct patient contact. Chairs, armrests, doorknobs, etc. should all be disinfected periodically (once an hour perhaps). 
  • Though it is still cold outside, if possible, consider propping doors to open. As the weather warms, this may be feasible, so as to discourage touching doorknobs or door handles. 
  • Encourage patients to wash hands. Patients should be encouraged to wash hands thoroughly upon arrival and departure from your office.
How Are You Handling Patient Care at Nursing Homes or Assisted Living Facilities? 
As the President noted last week, he and his health care advisors are recommending that only necessary health care professionals be in contact with and treat those in nursing care, assisted living or elder care homes. With that in mind, if you have not done so already, the IPMA recommends you reach out to the administrators at each of the facilities you aid and ask how they would like to proceed. You may also want to reach out to your liability insurance provider and see if they have any steps or precautions for you take during this challenging time.
From a perception standpoint, as you would in an office setting take extra steps to remind the administrators and your patients that you maintain the highest standards for sterilization and disinfection. Perhaps, make it a point to perform extra hygienic steps you might be taking in front of your nursing home patients. While your standard of care and hygiene was no doubt top notch already, it might help ease any lingering fears if they see you taking extra hygienic care in front of them.
The following recommendations for assisted living facilities, adult day care programs, and senior living facilities are from the Centers for Disease Control (CDC). If you treat patients within any of these types of facilities, then you should be prepared to follow and use these protocols yourself: 
  • Encourage personal protective measures among residents, clients, and staff, including handwashing and covering coughs and sneezes. 
  • Encourage residents, clients, and staff to stay home (or in their private quarters) when sick and to notify program administrators of illness. 
  • Regularly clean and disinfect frequently touched surfaces, like doorknobs, keyboards, cell phones, and light switches. 
  • Ensure hand hygiene supplies are readily accessible throughout the facility. 
  • If caring for an individual living in a care facility, monitor the situation, ask about the health of the other residents frequently, and know the protocol if there is an outbreak. 
  • Implement social distancing measures as feasible, such as reducing large gatherings, altering meal schedules to reduce mixing, and limiting programs with external staff. 
  • Limit visitors to only those who are absolutely necessary and implement screening of visitors for temperature and respiratory symptoms. 
  • Maintain contact with individuals at risk of severe illness who are no longer able to attend day care programs.
Patient Care at Patient Homes 
If you can avoid patient care at their homes, consider limiting exposure to patient homes in non-emergency situations. When in home treatment is needed, the IPMA reminds you to demonstrate the highest standards of sterilization and disinfection. Limit your patient exposure as much as possible, and practice sound hygiene to limit liability and exposures. Again, it may be worthwhile to reach out to your liability insurance provider and see if they have any steps or precautions for you take.
How are You Handling Employee Situations? 
The flu may have already impacted many IPMA members throughout the fall and winter. Should employee absenteeism increase as a result of COVID, are you ready?
As schools and daycares close as a result of COVID, are you and your employees prepared with those effects on your practice and your patient care?
There may be no “right” answers to these questions but it’s important to ask them before the moment comes. Please consider how your company and its employees will respond to the potential workforce impacts of a COVID-19 outbreak.
Additionally, make sure your staff practice some of the same measures as you ask your patients. Practice social distancing amongst co-workers. Staff surfaces that are frequently used (like cellphones, mainline phones, light switches, keyboards, computer mouse, break room), should be wiped clean at the beginning of the day, throughout the day, and finally at the end of each day. Door handles and office countertops should be wiped clean with antiseptic agents after EVERY patient. If you have access to face masks, employees should be encouraged to wear face masks during office hours, to prevent touching of their faces, and potential transmission of asymptomatic infection to co-workers and patients.
Finally, as the situation continues to unfold, the IPMA recommends you play close attention to the CDC recommendations and recommendations from the State of Indiana. 
The IPMA is proud of each and every member. The IPMA has complete confidence in each and every member and its employees. Again, please take this message as simply sharing ideas and tips for you and your practice to consider during this challenge.