One Down All Out

Hello Drs,

We hope that you have had a productive week since we last checked in.

How did you progress with identifying your fears and starting to detail a post COVID 19 practice?

Any questions please email us at any time.

This week:

1) Jon’s Perspective on Restarting

2) Patient Update

3) Staff Reassessment

4) Update on Post COVID 19 Practice Protocols + Comprehensive Checklist

1) Jon’s Perspective on Restarting

The statistics are telling us that Australia has clearly started to ‘flatten the curve’ of new cases around the country.

This is quickly followed by media articles talking about ‘restarting’. More specifically discussing progressive restarting.

There is definite pressure from many parts of the business sectors to start up sooner rather than later. However, balanced with these views is the health sector opinion that we should not restart too soon or there is a very real risk of a second wave of infections.

Where controls of social distancing and hygiene can be maintained in any business, then there will be increasing pressure to restart. The protest will state “if the mining and building/construction industries can work through this entire virus crisis, why can’t we?”

Dentistry from the earliest days of the pandemic has been told that we are among the most vulnerable due to aerosol production. Therefore, does this mean that we will be the last wave to restart our businesses?

Prime Minister Scott Morrison stated last Friday that there are no plans to restart business in the next 4 weeks. After this time then we could expect a lifting of restrictions however not for everyone. The key message from him is that we must get health protections in place.

I’m like you and would like a restart sooner rather than later. However, I’m beginning to sense from all the media that a limited start could begin from 1st June. As long as we are fully prepared to accept tough and very strict protocols to be firmly in place.

Let it begin I say.

2) Patient Update

It is time to communicate with your patients about your proposed restart.

Key points to communicate:

- You will have updates for them in the next 4 weeks

- That there will be significant changes to the way they experience treatment in your practice

- Priority is to provide a safe environment for them as well as the team

3) Staff Reassessment

Now that the Job Keeper payments have started for those that registered your team will be breathing a sigh of relief.

Key points for you to assess re staffing requirements:

- Will your practice have a full or partial restart?

- Consider the likely patient response of returning to your practice for treatment. Your patients will have been financially impacted by the crisis, without question. So, you need to consider how long before they return to a stable and predictable income level. This assessment will directly relate to the decision to reopen fully or partially.

The socio - economic status of your patient pool will certainly reflect on this assessment.

Some practices will return to a near full patient response and other practices will have a limited response from patients wanting to return.

- The issue you need to consider now is that if you predict a low patient response then how much staffing do you need?

- How do you reinstate staff? Do you bring back a limited number of staff & terminate other staff or do you bring your entire team back on reduced hours?

This needs some significant planning and discussion with your accountants based on your cash flow assessment and projections.

- The legal implications of staff decisions are significant, so don’t leave this planning until you are ready to reopen in whatever capacity.

It is too early to predict exactly but the government and ADA will give us more specifics when we get closer to the date of restarting.

Caution going forward is essential.

We believe that right now you need to let your staff know that you will inform them of exactly what their ongoing employment looks like once you have greater clarity and direction from the government and ADA.

4) Update on Post COVID 19 Practice Protocols

Have you started to really detail exactly how you will operate and provide the full range of dental treatment services once you reopen?

There is no way that it will be ‘business as usual’.

The critical issue is “one down, all out” which means that if one of your team tests positive then your practice is closed again and you are all in isolation for 2 weeks. Plus, the negative impact of this on the ‘goodwill’ of your practice will be immeasurable.

Some further thoughts from us are:

- Prior to you and the team restarting you should all be tested for COVID19 and provide these results so that it is very clear that no one in the practice team is bringing the virus with them. This is excellent ‘peace of mind’ for you all

- Exactly how do you screen your patients?

You will need a verbal script for your reception team plus signage clearly stating that a patient can’t be seen if they have travelled in the last 14 days; have recently been exposed to symptoms; have cold or flu like symptoms; has not tested positive for COVID 19

- You will need to also communicate that only the patient must attend the practice & if for any reason they need to come with a support person that this must be clearly communicated at the time of making the appointment. Family members and friends will need to be asked to leave so that you have the minimal number of people at any one time in your waiting room

- It will also be very important that you and your staff ask any family or friends to stay away unless they have a scheduled appointment

- Protocol for patients arriving into the practice. Such as asking them to use hand sanitiser

- Your waiting room and reception area must have the minimal number of items in it and if a patient uses any pens or handles a clipboard then these must be cleaned immediately

- Your team also needs a protocol for regularly cleaning all door handles; bathrooms; reception and waiting room furniture and bench tops in communal areas several times during the day

- Consider taking the patients temperature before treatment and ask them to rinse with chlorhexidine

- How will you minimise the use of aerosols?

Following is a comprehensive checklist to work through now.

Summary

The time you spend right now in planning how you will open, exactly what this will look like and how your practice will function is time very well spent.

Important considerations must be thought through now.

If you have any questions, please contact us at [email protected]

In this together

Kind Regards Jon and Erica

www.refocuseddental.com

“One Down, All Out” – Checklist – we can not fail on this

Issue

Person Responsible

Completed

Phone scripts when making appts

- Same information can be emailed or texted to all of your patients

The practice can’t see you if:

- You have travelled in the past 2 weeks

- Have cold/flu symptoms

- Have tested positive to COVID19

- Have been in contact with anyone testing positive to COVID19

When attending the practice for an appointment:

- No family or friends to come with you

- Only one bag to be carried by you

- No reading matter to be brought with you

On Arrival at the practice you will be asked to:

- Wash your hands

- Rinse with chlorhexidine

New Patients

- Wash hands

- Rinse with chlorhexidine

- Complete medical History – practice team to wipe down pen and clipboard used by NP

The above information can also be printed & displayed at the front of your practice

Reception Area

- Remove all brochures, display cards, tissue boxes – everything that is currently sitting on reception bench tops

Reception Team

- Wear scrubs + a disposable clinical gown that can be removed when leaving the reception area

- Wear face shield, mask, glasses

- Wear gloves when touching patient files, credit cards, health care cards, eftpos cards to process payments

- No jewelry except a watch

- Wear practice only shoes that are removed when leaving the practice at all time

- Ideally all reception clothing will be washed & dryed at the practice

Patient Files – if have paper files

- Must be handled with gloves at all times

- Wiped down before leaving the surgery if have a plastic cover

Dentist & Clinical Team

- Must not go behind reception desk with clinical gown on

- Must not sit at a desk or lunch table with clinical gown on

- Be very mindful of their movements in the practice when not in the surgery

Waiting Room

- Re arrange furniture to allow for social distancing

- How many patients can you now have after these changes at any one time in the waiting room

- Remove all items siting in the waiting room such as toys, magazines, newspapers, brochures, display cards, anything at all that is simply lying in the waiting room area

- Fresh flowers would be ok but remove all artificial flowers

Cleaning Roster

- What times every day does the team wipe door handles, front door surfaces, reception & waiting room surfaces including furniture

Bathrooms

- What times every day do bathrooms need cleaning & refreshing?

- Remove all non - essential items

- Top up toilet paper, tissue stocks regularly & don’t leave large quantities in bathrooms

Clinical Team

- Wear face masks, face shields, glasses as per infection control guidelines

- Wear a disposable gown that is removed when leaving the surgery

- Wash hands in between every patient & before replacing gloves

- Rinse with chlorhexidine at the start of every day; after any tea or lunch break & at the end of every day

Clinical For Patients

- Take patient temperature & record in clinical notes

- Ask them to rinse with Chlorhexidine

- Use hand sanitizer

- Re check recent medical history & or travel

Lunch

- Discuss with your team how each of you will manage this time – do you leave the practice after changing out of clinical clothing & go to a café to get lunch or do you organise for lunch to be delivered or does everyone bring their own lunch

- The critical issue is that the less anyone in your team interacts with the public & is out in public spaces the better

Lunch/Staff Room

- Remove all non – essential items that sit in this area

- Re organise the space to be as hygienic as possible

- Review protocol of washing up of all cutlery, mugs, glasses etc

- Wipe down all surfaces in this area 2 to 3 times per day – start, after lunch, end of day

- Don’t leave food sitting out on tables or bench tops – organise for sealed containers for all food items

Staff Travel To & From Work

- All staff to avoid public transport

- If you don’t have onsite parking then consider paying for daily parking

Handling Deliveries

Write a protocol & communicate to all staff plus to all delivery suppliers

- No delivery persons can enter the practice without notification. They need to call & communicate that they are at your practice with a delivery

- They must wait until you say it is safe to enter

- Must use hand sanitizer when entering the practice

- They must not walk through the practice for any reason & only leave items in designated zone

- Allocate a specific area for all delivery boxes & items to be left. Not in communal areas

- Allocate a specific team member to open deliveries wearing protective clothing & gloves

- This designated delivery area must have a complete wash down & thorough clean after all deliveries have been opened, sorted & put away

Lab Drop Off

- Notify your labs of new protocols

- Use same procedure as for all other deliveries

List of Protocols To Write

List of New Items To Purchase

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