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COVID-19 Visiting Risk Management Plan

3rd Dec 2020

We have reviewed the new measures and advice from DHSC with regards to indoor visiting and contact. Please see review below.

 

The review outcome is that to implement these measures now would lead to a high risk of exposure to staff and residents. We will carefully monitor over the next few weeks and work towards any safe changes to visiting.

 

We have COVID secure ‘indoor’ visiting available for relatives to book appointments at each of our homes. Each has a screen and intercom and although no physical contact, relatives are able to see and speak to a loved one without PPE.

 

Please email amber@pinnaclecare.co.uk if you have any further questions.

 

Concern

Rationale

Resource link

Risk level

 

 

 

 

Accuracy of LFT tests

Based on experience with antigen-based RDTs for other respiratory diseases such as influenza, in which affected patients have comparable concentrations of influenza virus in respiratory samples as seen in COVID-19, the sensitivity of these tests might be expected to vary from 34% to 80%.

Based on this information, half or more of COVID-19 infected patients might be missed by such tests, depending on the group of patients tested. These assumptions urgently require further study to understand whether they are accurate.

World Health Organisation

www.who.int

High risk of exposure due to inaccuracy of tests

Support and time required to implement LFT testing and associated changes

Designate staff to carry out testing. Discuss agreement with staff to do this role. Review staffing levels.

Train staff via 60 minute webinars and complete competency tests.

Designate entrances and exits for visitors and testing/waiting area for results up to 30 minutes. Areas to be designated for storage of LFT kits away from other testing kits.

Await additional PPE due between now and 18th December for visitors.

Consider training and review signage required for visitors.

Consider updates to policies and procedures and visiting policy/capacity.

Department of Health and Social Care.

High risk if not effectively planned and implemented safely.

Allowing ‘contact’ during visits

Concerns around contact when advice continues to be social distancing/space and advises against direct contact outside of households and support bubbles.

Consider designated handwashing and PPE facilities for relatives or visitors.

Consider supervision of visits due to non-compliance or inappropriate use of PPE.

Consider waiting for vaccination.

 

 

High risk if not effectively planned and implemented safely.

Allowing indoor visits

Consider layout of the home due to social distancing and designate areas if possible. Consider viral load and well ventilated areas.

Consider numbers and frequency of visitors. Planning around other pre-booked and unexpected visits i.e. other professionals.

Consider staffing and procedure around temp, screening questions and track and trace info.

Consider additional cleaning requirements and areas.

 

High risk if not effectively planned and implemented safely.

Local prevalence

Tier 3: We are currently in the most restrictive tier. No mixing of households indoors.

 

Local cases

Rate of infection and number of cases were continually and steeply increasing up to mid-November since lockdown this is slowly decreasing.

 

 

Local guidance

Public Health advised closure of all Rugby Homes in September to non-essential visits due to the increasing rates and as we are one of the areas with the highest number of cases in Warwickshire. This has not been lifted since.

 

Care home outbreaks

24 currently in Warwickshire this is an increase from the previous weeks and is affecting approx. 200 residents and 140 staff.

H M Government

www.gov.uk.

 

https://coronavirus.data.gov.uk/details/cases?areaType=ltla&areaName=Rugby

 

 

 

 

 

 

 

 

 

 

Figures released 3.12.20 via WCC

 

 

 

High risk of exposure due to local prevalence and ease of lockdown measures. Cases are likely to increase.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relative and visitor PPE and practise

Staff have been wearing full PPE since April 2020.

Guidance is conflicting and regularly updated. Staff have had regular training and specific training. Ever changing guidance relating to hand washing and donning and doffing PPE. Concerns around relatives and visitors following the correct procedure or not adhering to the procedure.

Consider additional PPE disposal processes for relatives/visitors.

Local Authority

High risk of exposure due to PPE breach.

 

PPE breaches have been identified as one of the main cause of outbreaks in care homes.

Causes of outbreaks

Inadequate hand washing and respiratory hygiene.

Lack of social distancing and understanding of PPE required and how to don and doff PPE.

Poor waste disposal management.

Inadequate cleaning and schedules.

Local Authority

Moderate risk of exposure due to additional consideration for relatives and visitors

Christmas 5 day break

Relaxed restrictions and increased travel and contact for a 5 day period without PPE, social distancing and mixing households indoors.

 

Concerns raised this will cause another peak and extended lockdown measures.

 

High risk of exposure due to relaxed restrictions over Christmas period

Essential health visits

Essential health visits are allowed at all times to prevent risk of pain/discomfort/infection during an outbreak.

Virtual ward rounds completed weekly and where possible video calls or images to evaluate health concerns.

Refer to COVID contingency plan

Moderate risk of exposure due to routine testing at 70% accurate.

Trained staff completing health visits.

Risk assessed against risk of harm due to no visit/treatment.

Essential maintenance and servicing visits

We currently allow only pre planned maintenance and servicing visits. This relates mainly to any work required due to health and safety and infection control.

 

During an outbreak it is advised that only essential health visits take place therefore routine servicing is postponed.

Outside contractors are only allowed in following a strict contractor policy in an emergency i.e. exposed wires, lift breakdown etc.

Refer to contractor visiting procedure and COVID contingency plan

Moderate risk of exposure as usually carried out away from residents and staff or area cleared for work to be undertaken and then cleaned after.

 

Risk assessed to confirm essential.

 

Procedure in place for essential maintenance and contractor visits.

Other professional visits

These are individually risk assessed depending on local lockdown and advice. These are usually reviews, capacity assessments etc. and can usually be carried out virtually or outside.

Outside visits socially distanced and using PPE.

 

Moderate to low risk of exposure as usually outside or virtual visits.

EOL visits

Relative given a copy of and advised of EOL visiting procedure.

One relative only assisted via the closest entrance to visit relative in a bedroom away from other residents and staff.

Refer to end of life visiting procedure and COVID contingency plan

Moderate risk of exposure as usually a one off short visit in a private bedroom with full PPE.

Visits away from the home

Awaiting further guidance.

Currently government and DHSC guidance is that those of ‘working age’ can leave the care home.

They will be required to have a test and isolate for 14 days on return.

Awaiting further guidance

 

Current visiting arrangements

Each homes has an area or shelter with full screen and intercom. ‘Indoor’ visits can be facilitated without the need for PPE.

No physical contact.

Cleaning schedule and booking system in place.

Refer to home specific visiting procedure and COVID contingency plan

Low risk of exposure due to no contact and designated separate resident and relative/visitor area.

 

 

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