Patient Management protocols during the COVID

Objectives

To be part of essential health care services as per government directives and guidelines
To keep our staff and doctors safe from infection while rendering the vital services
To take care of vision care emergencies and consultations for preventive care

Policy

We, at Maxivision Eye Care Hospitals Group, have seen over 6 million patients in 25 years across Hyderabad, Warangal, Vijayawada, Vizag and Bhimavaram. And it is our duty and responsibility to be of service to those who need continued eye care and emergency services.

As the majority of our hospitals are in one city, Hyderabad, we are opening only three centres in three different areas of the town, enabling the patients to visit their nearest centre. Other standalone branches in other districts are also being opened.

We can only serve those patients who are calling us for vision care consultation, emergencies, postoperative guidance, eye drops or medicine prescriptions, change of glasses, or repair of glasses, pathological examinations, diagnostics or investigations related to eye problems. Apart from this, we will also serve patients for the continued care of Retina which includes lasers, and other diagnoses, any mature emergency cataracts threatening vision, or any other corneal or glaucoma procedures, which are progressing, or hampering their vision.

All patients will be seen or registered only on strict sterility protocols from the entry levels, and submission of self-declaration on travel history. Staff and Doctors who will be examining the patients will also follow strict guidelines of sterility protocols.

Minimal infrastructure will be used to perform these services to avoid the risk of infections. Patient intake will also be minimal in numbers and hours.

Protocols

Infrastructure Arrangements

All hospitals must have only one entry to the premises guarded by security personnel restricting any unauthorized entry
Plan OP operations only on one floor, preferably on the ground floor and shift all diagnostic equipment from other floors to the OP operational floor
Keep the optical shop entry limited to one customer at one time
Keep the pharmacy doors closed and use only the billing counter to facilitate transactions
Keep all the doors open with stopper to avoid touching doorknobs
Reduce the number of seats and place the waiting chairs with social distancing measures
Use armless chairs and steel chairs which are easy to wash and sanitize
Mark the entry map with floor markings and place it at the entrance
Arrange the Front Desk with one computer and one staff seating
Keep a barricade in front of the Desk while registering to maintain social distancing
Keep sterilium bottles in the Entry area, Waiting area, Front desk, Consultation rooms, Optometry rooms and Washrooms
Demarcate separate washrooms for patients and staff including doctors
Restricting the movement of the patients in unauthorized areas by laying out barricades with waiting chair units or temporary partitions
Decommission lifts in case of only one floor, and in case of multiple floors keep a lift operator to operate the lift
Prepare the staff roaster in 2 or 3 batches with multitasking skill staff so that number of staff can be reduced
Every batch should be designed to meet the unexpected absenteeism of any one of the staff member and assign a replacement of that member
Batch 3 must act as a backup batch to replace any batch that might get infected and needs to be quarantined
These batches can be rotated on alternate days or alternate weeks
In case of any infection in one batch, the entire batch must be regrouped, and their duties must be assigned to another batch until the end of their quarantine period
Take voluntary undertaking from all staff and doctors who are working in this period
Ensure that the staff and doctors are trained on safety and sterility protocols on an everyday basis
Staff and Doctors have to be insured for COVID under existing coverage or with a new policy
Document the staff and doctors’ addresses, number of family members, their general health conditions etc.
Arrange one ambulance/vehicle to pick up and drop the staff
The vehicle should be sterilized every day, and the driver should also follow the safety and sterility protocols
Give written authorization letters to all staff and doctors as emergency health workers with the hospital address and the hospital working timing

At the Entry

All patients must write their name and phone numbers in the register available at the security desk
Patients are allowed to enter the hospital with one attendee, if necessary
All patients and their attenders must wear a mask. If they do not have a mask, they can purchase the mask from the pharmacy in the hospital premises.
On their arrival, the patients and their attendees will get their temperature checked and recorded by a thermal non-contact thermometer. If their temperature is found to be more than 100-degree Fahrenheit, they will not be allowed to register for any checkup and will be advised to consult a physician
The temperature will be noted in the entry slip/gate pass which will be handed over to the patient before entering the hospital
If the patient is not cooperating, security personnel will retain the patient politely and inform the manager to intervene
The patient and attendees will be asked to remove their footwear at the entrance
All the patients and their attenders must wash their hands with hand sanitizers before entering the hospital

Guidelines for Security Staff

Security staff will undergo thermal check and hand sanitization before resuming duty
Security will wear the mask, gloves, face shield and maintain social distancing
Security staff found to have temperature will be sent back or referred to a physician
Security will not misbehave or be rude to any patients or guests
Security will ensure all persons who are entering into the hospitals, be it doctors, staff, visitors, patient or patient attenders follow the protocols of removing the footwear, thermal check and hand sanitization
Any patient having a high temperature will be informed to the manager immediately

Registration Desk

Hand sanitizer and paper napkins will be placed on the registration desk
The registration desk will be placed away from the entry point and will have markings of the one-meter distance between each patient to maintain a queue for social distancing
A barricade must be placed at a 1-meter distance from the Desk to avoid any touching of the Desk by the patient and to maintain social distancing with the staff
A pen tied to the Desk will be available for the patient to enter the forms
Front office staff will collect the entry slip from the patient in a tray and read the temperature
Front office staff will then hand over the Self Declaration Form to the patient and ask them to fill in all fields. They will verbally assist the patient in entering the form or fill the form interviewing the patient and get their signature
Ask the patient repeatedly, if necessary, of any history of foreign travel and reconfirm that they have not travelled anywhere out of India, after 31st of January 2020
If they report of any foreign travel, ask the patient to wait and inform the manager
Insist on wearing the mask throughout the process and offer hand sanitizer on the Desk
Register the patient and prepare the case sheet and ask the patient to wait while maintaining social distancing
The patient should maintain social distancing in seating even with their attenders
Attach the self-declaration forms and temperature screening note in the case sheet
Keep the case sheet in a tray available for the next process

Guidelines for Front office staff

Have only one staff at the Desk
Wear masks, gloves and face visor at all times
Wipe the Desk and computer keyboard frequently with sterilium
Attend the intercom only through speaker mode
Request the patient to make card payments only
Keep change notes in one box and ask the patient to drop the cash in another box
Give the balance amount from the change box
While counting or bundling the collected cash wear gloves and pack the cash in envelopes
Wipe the card machine with sterilium after every transaction
Be polite even if you have to reject a service or instruct the patients

Optometry Room

Optometrists should come out to the Desk, collect the next case sheet and call the patient
Make the patient sit inside the optometry room with social distance
Request the patient attender to wait outside
While doing refraction maintain maximum distance from the patient’s head
Wash your hands with sterilium before and after touching the patient
Optometrists must not do NCT, Syringing and Contact lenses trail
Regular refraction can be done with AR/ARK
Trail sets, Trail frames, AR chin rests, Slit Lamp Chin Rests will be cleaned with sterilium after the examination of every patient
Optometrists must take a detailed history, and case sheets must be documented properly
Optical prescriptions can be given, and patients are asked to purchase from our optical store
In cases of surgical intervention, optometrists must take the patient directly to the doctor and explain the case in detail

Guidelines for Optometrists

Optometrists must wear masks, gloves, face visor, apron fully buttoned and disposable gown over it
Leggings must be worn and disposed of after using the washrooms and also while leaving the hospital
Change the gloves after contact with any infectious cases or conjunctivitis cases
Optometrists must wash their hands with sterilium after every examination
If the patient sneezes or coughs, extra precautions must be taken for sanitizing the room
Patient instructions must be explained properly
Optometrists working in Conjunctivitis patient station must not enter the main clinical area

Consultant Room

Consultants must follow the standard protocol on thermal check at the entry point
Consultants must change their dress to their regular OT dresses before examining the patients
Appointments are given on every half-hour basis to one consultant to avoid crowding and long waiting inside the premises
Patients must be examined and interviewed with social distancing
Restrict patient attender inside the consultant’s room. In case the consultant needs to talk to the attendee, they must go out of the room to speak to the attendee
Slit lamps will have a sterile acrylic shield which must be cleaned after every patient examination
Use sterile buds to examine the patient’s eyes instead of touching the eyes
Clean the Gonioscopy, lenses, and Applanation tonometer after every patient examination
Wash your hands and gloves with sterilium after every patient examination
In case of intervention with conjunctivitis patients, discard the gloves after the examination
Be extra careful while doing Indirect Ophthalmoscopy or slit lamp examination
If dilatation of the eyes is required, advise patient care executive to follow extra precautions not to touch the eyes of the patient while administering the dilating drops
If emergency surgery is recommended inform the patient about the protocols and our OT days for surgeries
If the patient is given a pharmacy prescription, advise the patient to collect it from our store
If the patient requires investigations, inform them about our lab services
Give a gap of at least 5 to 10 minutes after every patient examination to prepare the room for the next patient
Case sheets will not be given to the patient and must be handed over to your patient care executive
The patient may be given a case summary and prescriptions wherever required

Guidelines for Consultants

Sterilization is essential for the treating doctor so all doctors must follow the sterilization protocol strictly
Consultants will wear masks, protective glasses, gowns, face visor, leggings and gloves before treating any patient
Keep your door open with stopper and minimize the use of AC inside your room
If any staff member or patients are not wearing masks or not sanitizing their hands properly, instruct them to follow the protocol
Ensure that the chair unit and the slit lamp and other instruments should be cleaned with sterilium after every patient examination
Consultants must bring their water bottles or take water in disposable glasses only
Dispose of the gown, leggings, gloves properly while leaving the hospital premises
If you are feeling any discomfort in treating any patients, please let the manager know
If you are identifying any symptoms of COVID during your diagnosis, please inform the patient politely to have further tests done from a Physician

Optical Store

There will be only one entry to the store
The optical shop must have a thermal check at the entry point for staff and patients
Request the patient/customer to come in without attender or maximum of one person
Maintain social distance while interacting or helping the customer in sales
If a customer tries on a frame or any other products, replace it on the rack only after cleaning it with sterilium
Please be polite with all customers and handle them as you handle them regularly, without compromising on sterilization protocol

Guideline to Optical Staff

Wear Mask, Gloves and use hand sanitizer after every contact with a patient/customer
Have only one desk for sales and cash transactions to reduce contact
Request cashless payment modes, or if cash is accepted, please follow the same protocol as suggested in the Front office section
Keep the doors open at all times with stoppers
Do not do any contact lens trial
IPD Marking instruments should be adequately cleaned after every usage
Do not group up between colleagues and maintain social distancing between everyone
Keep the patient data with complete details in separate registers or sheets
Offer home delivery of frames/glasses

Pharmacy

Close the pharmacy door and do not allow others to enter the pharmacy store
Do all the transactions through the glass counter only
Follow the same protocols of the Front office on cash payments
Wear gloves and masks at all times
Sanitize your hands and gloves with sterilium at all times and after every transaction
If a patient is returning any drugs/vials, clean them with sterilium and place them separately

General Rules & Ethics

The above protocols are to keep patients, staff and doctors safe from infections and will be relaxed depending on the pandemic ease and government directives.

As a staff of Maxivision, ensure that you:

Do not discriminate against any patients or isolate them rudely
Handle all patients with extra polite manners as this is a stressful time for everyone
Serve beverages or food only in disposable glasses and plates and dispose of them safely
Ensure that the entire premises are cleaned and disinfected at the end of the day
Allocate separate bathrooms for patients, and staff and doctors
Ensure that the frequency of housekeeping cleaning is more in washrooms and on floors
Managers should be alert and always on the floor to supervise the operations

A blog Written by
Dr. Anil Kumar
Sr. Glaucoma Consultant

Patient Management protocols during COVID pandemic and lockdown period