The following standards have been produced to ensure Female Focus is as safe as possible for patients and staff and to help stop the spread of COVID-19 (coronavirus). These standards of operating practice have been produced in line with guidelines issued by the Government, Public Health England (PHE), The Department of Health (DoH) Health and Care Professions Council (HCPC) and The Chartered Society of Physiotherapy (CSP).

Based on the most recent guidance, Female Focus is able to offer face to face consultations where clinically appropriate and necessary. The aim is to protect the physiotherapist, patients, and the wider community across all of the decisions.

These guidelines will be reviewed regularly as advice changes.

1. CLINIC CONSIDERATIONS

General operations:

  • We plan where possible, to operate a policy of, 1 patient in, 1 patient out.
  • If for any reason there are 2 patients in the clinic at any one time, the 2-metre should be maintained. The waiting room and entrance area is large enough to allow a 2-metre gap between individuals.
  • There will only ever 1 physiotherapist in the clinic at any 1 time.
  • There is only 1 entrance door to the clinic – this will therefore be used for both entering and leaving.
  • Payment: card payments will be taken; the card terminal will be wiped between use using an antibacterial screen wipe.

Waiting Room:

  • If patients wish to take a seat in the waiting room, they must do so on the plastic chairs as these are wipeable.
  • The waiting room is large enough to accommodate social distancing: maintain the 2-metre gap.

Social Distancing:

  • During the assessment, the physiotherapist will endeavour to remain 2 metres from the patient.
  • A 2-metre gap will be marked onto the floor in the treatment room upstairs.
  • It will not be possible to maintain the 2-metre gap during certain parts of the physical assessment and treatment.
  • When the physiotherapist is carrying out any ‘hands on’ assessment or treatment, this will be done as quickly and as safely as possible (ideally within 15 minutes).

Patient scheduling:

  • There will be 15 minutes between the end of one appointment and the start of another.
  • This time will allow for cleaning to take place (see ‘cleaning’).
  • This will also reduce the likelihood of there being 2 patients in the clinic at any one time.

2. PATIENT SAFETY AND INFECTION CONTROL

Handwashing:

  • Good hand hygiene is essential to minimise the transmission of infectious droplets.
  • Hand washing facilities are available in the downstairs toilet and upstairs in the clinic room.
  • Anyone who enters the clinic will be required to wash their hands.
  • A poster with the correct handwashing technique will be displayed over sinks.
  • Hands should be washed for 20 seconds with water and soap. Hands should then be dried with disposable towels.
  • Gel sanitisers are available at the entry and exit point and in the treatment room.

Expectations from Patients:

  • If a patient develops symptoms of COVID-19, they must cancel their appointment and must NOT attend the clinic (there will be no cancellation fee in this situation).
  • Patients should aim to arrive at the time of their appointment, not any earlier.
  • All patients will be expected to wash their hands on entering and before leaving the clinic – signage in the waiting room will give clear instructions on this.
  • All patients must wear a mask for the duration of their appointment. The patient will be advised to bring a mask and apply it before entering the clinic. If they do not bring one, they will be charged £2 to buy one.
  • Patients should remove their mask after leaving the clinic and dispose of it at home.
  • Patients are advised where possible, to attend the clinic on their own. Babies and children should not attend.
  • Relatives / carers are only allowed if this is deemed necessary e.g. for those with limited mobility.
  • If a relative or carer must attend, he / she must be screened for COVID-19 prior to the appointment. They will again be screened on arrival.

Measures taken by the Physiotherapist:

  • Screening for COVID-19
    • The physiotherapist will take their temperature each day before attending for work and document this on a personal spreadsheet.
    • The physiotherapist will not enter the premises if they believe they have any COVID-19 related symptoms.
  • Uniform
    • The physiotherapist will change into work uniform (scrubs) on arriving at the clinic.
    • At the end of the working day, the physiotherapist will change out of uniform and place it in a plastic bag so that they can put this directly in the wash when they return home.
    • The uniform will be washed in the following way:
      • Separately from other household linen.
      • In a load not more than half the machine capacity.
      • At the maximum temperature the fabric can tolerate (at least 60 degrees).
      • The physiotherapist will not travel home in her work clothes.
  • Personal Protective Equipment (PPE)
    • The physiotherapist will wear the following PPE during the appointment:
      • Non-latex gloves (single use)
      • Apron (plastic, single use)
      • IIR facemask (sessional use)
      • Eye protection goggles (when within 2-metre gap)
  • The physiotherapist will follow guidelines on the correct donning and doffing of PPE.
  • Hands will be washed (with soap and water for 20 seconds) after removing PPE, and dried using disposable paper towels.
  • Gloves will be changed before cleaning the clinic and any equipment.

Waste Management:

  • There should no ‘known COVID-19 waste’ from the clinic, as anyone with the virus should not be attending.
  • The clinical waste bin (yellow bag) will continue be used for examination gloves and waste contaminated with bodily fluids.
  • As per guidelines, all PPE waste will be disposed of in a normal black bin bag.
  • This will be double bagged, and left for 72 hours before disposal in normal waste.

Cleaning & Infection Control:

  • A thorough deep clean will be carried out at the end of each working day.
  • Disposable, single use couch roll will be used on the treatment bed and pillows.
  • The clinic will be cleaned between each patient. Hot soapy water and disinfecting spray will be used to wipe down any surfaces that may be have touched by the patient or physiotherapist.
  • This includes but is not limited to:
    • treatment bed
    • pillows (these are waterproof and fully wipeable)
    • chairs
    • desk
    • handles
    • taps
    • any equipment used
    • light switches
    • stair banister
    • toilet
    • card terminal
  • No alcohol wipes or bleach products will be used on the vinyl plinth as this results in the fabric cracking and will add to infection risk.

3. APPOINTMENTS

Types of Appointments:

  • Virtual (video) and face-to-face appointments will be available at Female Focus.
  • Home visits will be suspended until further notice.

Face-to-Face Appointments:

  • Patients can independently book a face-to-face appointment on the website.
  • After the booking is made, the physiotherapist will telephone the patient to carry out an Initial Triage & Screening.
  • It is ESSENTIAL that this Triage & Screening takes place before the face-to-face appointment.
  • A joint decision will be made by the patient and the physiotherapist as to whether a face-to-face appointment is appropriate.
  • If considered appropriate, the patient will then be sent a Declaration & Consent Form” via email. This form must be completed right away and prior to the appointment.
  • The patient will be asked to contact the physiotherapist to cancel their face-to-face appointment, or any subsequent face-to-face appointment, if they (or anyone else in their household) develop any COVID-19 related symptoms.

Virtual/Video Appointments:

  • Patients are able to independently book virtual/video appointments via the website if they would prefer.
  • If a face-to-face appointment isn’t possible or isn’t deemed necessary, the patient will be offered a virtual/video appointment as an alternative.
  • Any virtual/video appointment will be carried out using Write Upp (a secure software system used at Female Focus).
  • The patient will receive a secure link via email in order to access the video appointment.

4. SCREENING & CONSENT

Due to the COVID-19 pandemic, there is a strict 3 step screening and consent system in place. 

  1. When a face-to-face booking is made, the physiotherapist will call the patient prior to the appointment to carry out an Initial Triage & Screening. This MUST be completed before the face-to-face appointment.
  2. The patient will be asked to complete a Declaration & Consent Form. This will be sent via email and also MUST be completed before the face-to-face appointment.
  3. Upon arrival for the appointment, the patient will be screened for COVID-19 symptoms. 

Once the patient has attended their first face-to-face appointment, Steps 1 and 2 again will not need to be completed again. The patient will, however, always be screened on arrival for their face-to-face appointment.

Step 1 – Initial Triage & Screening:

  • This is carried out over telephone.
  • Once the patient has made their booking for a face-to-face appointment, the physiotherapist will call the patient to carry out Initial Triage & Screening.
  • This MUST take place before any face-to-face appointment happens.
  • Purpose of Initial Triage and Screening:
    • To check the risks of contracting COVID-19.
    • To check current symptoms of COVID-19 – of the individual themselves and that of members in their household.
    • To discuss patient preference – face-to-face over virtual.
    • Allows the physiotherapist to clinically reason the need for face-to-face.
    • As part of this triage, patients must consent to their name being given to contact tracing in the event of the physiotherapist developing COVID-19
    • Both physio and patient will together decide on whether the face-to-face appointment will take place.

Step 2 – Declaration & Consent 

  • Following Initial Triage & Screening, if face-to-face is going ahead, the Declaration & Consent Form will be sent via email to the patient.
  • This MUST be completed before the face-to-face appointment.
  • All patients who are offered a face-to-face appointment will be asked to declare that they have no symptoms of COVID-19 and confirm they have not been in contact with anyone with symptoms of COVID-19 in the last 14 days.
  • The form asks the patient to consent to face-to-face appointments.

Step 3 – Screen at Face-to-Face Appointment:

  • This will be carried out on arriving at the clinic before proceeding with the appointment.
  • The patient’s temperature will be taken using non-contact forehead thermometer.
  • The patient will be screened for current COVID-19 symptoms and exposure to the virus.
  • If the patient has any symptoms of COVID-19 or their temperature is over 37.8 they will be asked to leave the clinic.

Patient “Self-Screen”

  • The patient is responsible for informing the physiotherapist without delay if they develop any symptoms of COVID-19 or if they suspect they have been exposed to individuals with coronavirus.
  • This can be done by telephone or email. Appointments cannot be manually cancelled by patients via the website.
  • There will be no cancellation fee charged in this instance (even if it’s within 48 hours of the appointment).
  • There will be an option to change the appointment to virtual/video if desired.

5. PATIENTS WITH CONFIRMED AND / OR SUSPECTED COVID

  • Patients cannot attend the clinic for an appointment if they currently have, or suspect that they have, COVID-19.
  • If the patient COVID-19 related symptoms, they will need to self-isolate for at least 7 days.
  • If the patient lives with someone who has symptoms, the patient will need to self-isolate for 14 days.

6. CONTACT TRACING

  • Any patient wishing to have a face-to-face appointment will be asked to consent to their name and contact details being given to the Government’s contact tracing scheme.
  • Details will only be passed on to contact tracing if the physiotherapist develops COVID-19.
  • If a patient does not consent to details being passed on, a face-to-face appointment cannot take place.
  • If a patient that has attended for a face-to-face appointment finds out they have COVID-19, the physiotherapists contact details can be passed to contact tracing.
  • As a result of the physiotherapist being in full PPE during any face-to-face appointment, the physiotherapist should be exempt from going into isolation (as per guidelines).

Written by Barbara Chesworth

For and on behalf of Female Focus Ltd

June 2020