community covid-19 response plan - metro north health

Community COVID-19 Response Plan July 2021

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Published by the State of Queensland (Metro North Hospital and Health Service), July 2021

This document is licensed under a Creative Commons Attribution 3.0 Australia licence.

To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au

© State of Queensland (Metro North Hospital and Health Service) 2021

You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland

(Metro North Hospital and Health Service).

For more information, contact:

Community and Oral Health, Metro North Hospital and Health, Brighton Health Campus,449 Hornibrook

Highway, Brighton Qld 4017, email [email protected] , phone 0437 050 859 for Community and

Oral Health.

An electronic version of this document is available at https://qheps.health.qld.gov.au/metronorth

Disclaimer:

The content presented in this publication is distributed by the Queensland Government as an information source only. The State of Queensland makes no

statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of

Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs

you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information.

V9 Effective: July 2021 Review: October 2021

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Version history

Table 1 Version history

Version #

Implemented by

Revision date

Approved by

Approval date

Reason

1.0 Claire Harrison 2/04/2020 Michelle Kane 2/04/2020 original

2.0 Claire Harrison 9/04/2020 Michelle Kane 9/04/2020




6.0 Kristie Wiesner 29/07/2020 Michelle Kane 29/07/2020

7.0 Kristie Wiesner 12/08/2020 Michelle Kane 14/08/2020

8.0 Sally Ware & Angela Coram

02/09/2020 Michelle Kane 04/09/2020

9.0 Sally Ware 7.7.2021 Michelle Kane 08/07/2021

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Contents

Version history ....................................................................................................................................... 3

Contents ................................................................................................................................................. 4

1 Introduction ............................................................................................................................ 7

1.1 Situation ................................................................................................................................... 7

1.2 Purpose .................................................................................................................................... 7

1.3 Authority ................................................................................................................................... 7

1.4 Scope ....................................................................................................................................... 8

1.5 Assumptions ............................................................................................................................. 8

2 Pandemic Phases ................................................................................................................... 8

3 Overview of Community and Oral Health and infrastructure ............................................ 9

3.1 Community and Oral Health infrastructure ............................................................................. 10

4 Partners and Stakeholders .................................................................................................. 10

5 Roles Responsibilities ......................................................................................................... 11

6 Activation .............................................................................................................................. 11

6.1 Command and Communication .............................................................................................. 11

6.2 Reporting ................................................................................................................................ 11

7 Response .............................................................................................................................. 11

7.1 Triggers and response activity overview ................................................................................ 11

7.2 Sustain – Tier 0: prevent local transmission and prepare ...................................................... 13

7.3 Sustain – Tier 1 response: limited community transmission .................................................. 14

7.4 Sustain – Tier 2 response: moderate community transmission ............................................. 15

7.5 Sustain – Tier 3 response: significant community transmission ............................................ 16

7.6 Contact tracing ....................................................................................................................... 18

7.7 Clinical management for suspected or confirmed COVID-19 positive patient ....................... 18

7.8 PPE for staff ........................................................................................................................... 18

7.8.1 PPE stockpile and consumables ............................................................................................ 18

7.9 Operational support ................................................................................................................ 18

7.10 Human resources ................................................................................................................... 19

7.10.1 Staff management .................................................................................................................. 19 7.10.2 Managing ill workers............................................................................................................... 19 7.10.3 Leave and returning to work ................................................................................................... 19 7.10.4 Quarantine .............................................................................................................................. 19 7.10.5 Staff wellbeing strategy .......................................................................................................... 19 7.10.6 Industrial relations .................................................................................................................. 20 7.10.7 Reallocation ............................................................................................................................ 20 7.10.8 Workplace health and safety .................................................................................................. 20 7.10.9 Recruitment and onboarding .................................................................................................. 20 7.10.10 Fatigue Management ............................................................................................................. 21

7.11 Aboriginal and Torres Strait Islanders .................................................................................... 21

7.12 Vulnerable groups .................................................................................................................. 21

7.13 Financial management ........................................................................................................... 21

7.13.1 Medicare ineligible patients .................................................................................................... 22 7.13.2 Activity capture ....................................................................................................................... 22

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8 Control ................................................................................................................................... 22

9 Recover ................................................................................................................................. 22

Appendix 1: Community and Oral Health COVID-19 Committee list .............................................. 24

Appendix 2: Infrastructure at Tier level ............................................................................................. 24

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Abbreviations

AEFI Adverse Events Following Immunisation

AHPCC Australian Health Protection Principle Committee

BAU Business as Usual

CE Chief Executive, Metro North Hospital and Health Service

CHO Chief Health Officer

DDC District Disaster Coordination (Queensland Police Service)

DDMG District Disaster Management Group

EMP Emergency Management Plan

EOC Emergency Operations Centre

ERP Emergency Response Plan

GP General Practitioners

HC Hospital Commander

HEOC Metro North Hospital and Health Service Emergency Operations Centre

HIU Health Improvement Unit

HIC Health Incident Controller

HLO Health Liaison Officer

IAP Incident Action Plan

ICT Information and Communication Technology

ICU Intensive Care Unit

ILI Influenza-like Illness

IMS Incident Management System

IMT Incident Management Team

LDMG Local Disaster Management Group

MN – EMC Metro North Emergency Management Committee

MN – EMP Metro North Hospital and Health Service Emergency Management Plan

MN - EMU Metro North Emergency Management Unit

MN – ERP Metro North Hospital and Health Service Emergency Response Plan

MN – IMT Metro North Hospital and Health Service Incident Management Team

MN Metro North

MNHHS Metro North Hospital and Health Service

MNPHU Metro North Public Health Unit

MOU Memorandum of Understanding

NDIS National Disability Insurance Scheme

NDRRA Natural Disaster Relief and Recovery Arrangements

NMS National Medical Stockpile

PACH Patient Access and Coordination Hub

PCR Polymerase chain reaction

PPE Personal Protective Equipment

QAS Queensland Ambulance Service

QDMA Queensland Disaster Management Arrangements

QHIMS Queensland Health Incident Management System

RBWH Royal Brisbane and Women’s Hospital

SET Senior Executive Team (Metro North Hospital and Health Service)

SHECC State Health Emergency Coordination Centre

SITREP Situation Report

SMEAC Situation, Mission, Execution, Administration, Communication

TPCH The Prince Charles Hospital

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1 Introduction

1.1 Situation

In December 2019, China reported cases of viral pneumonia caused by a previously unknown pathogen that emerged in Wuhan, China. The pathogen was identified as a novel (new) coronavirus (recently named Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)), which is closely related genetically to the virus that caused the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS). SAR-CoV-2 causes the illness now known as Coronavirus disease (COVID-19). Currently, there is no specific treatment, however the Australian Therapeutic Goods Administration (TGA) has approved the administration of the Pfizer/BioNTech COVID vaccine and AstraZeneca vaccine for use in Australia and a current vaccination program is in place for priority group vaccination.

1.2 Purpose

The purpose of this pandemic response plan is to ensure continuity of health services and minimise the community impact within Metro North Hospital and Health Service (Metro North HHS) of COVID-19, and in particular outline the response plan for Community and Oral Health. The strategic objectives of this plan are to:

• minimise risk to staff responding to COVID-19 through appropriate training, Personal Protective

Equipment (PPE) and infection control practices.

• minimise the transmission of COVID-19 within the Metro North HHS community and within healthcare

settings through proactive identification and testing, effective infection control activities, and

community messaging.

• determine appropriate measures to increase capacity to meet demand during the pandemic.

• ensure the HHS maintains its critical services continuity.

• maximise the health outcomes of peoples with COVID-19.

1.3 Authority

Nationally, the Biosecurity Act 2015 and the National Health Security Act 2007 authorises activities to prevent the introduction and spread of diseases in Australia and the exchange of public health surveillance information (including personal information) between state and territory government, the Australian Government and the World Health Organisation (WHO). The WHO declared the outbreak of COVID-19 was a Public Health Emergency of International Concern on 30 January 2020. The Queensland Department of Health declared a public health event of state significance under the Public Health Act 2005 on 22 February 2020. The issue of Public Health Agreements are issued by designated Emergency Officers (Environmental Health Officers) under this act. The issuance of Detention Order by an Emergency Officer (Medical) (Public Health Physicians) is also under this Act. The Chief Health Officer (CHO) directed all health services to:

• provide health staff to screen and conduct clinical assessment of passengers identified by Australian Border Force including the transfer of symptomatic persons to emergency departments for testing/treatment and/or supporting access to government provided accommodation where travellers are identified as not being able to isolate in the same location for 14 days.

• Via Public Health Units to: o issue isolation agreements to travellers at points of entry who meet coronavirus case

definition, suspect case definition or close contact case definition. o provide information and guidance to general practitioners and the public regarding testing

and isolation requirements. o contact trace any persons who may have been in contact with confirmed cases. o support the clinical management of persons who are in isolation.

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• plan for new or expanded models of care (such as telehealth/hospital in the home, virtual fever

clinics and treatment of chronic conditions at home)1.

The COVID-19 response within Metro North HHS is authorised by the Health Incident Controller (HIC) under the Metro North Emergency Management Plan. Each Directorate within Metro North HHS is required to develop their own individual pandemic response plan.

1.4 Scope

This pandemic response plan covers the Community and Oral Health Services response to COVID-19 to ensure the continued delivery of critical clinical services to existing patients and the Metro North HHS community. This plan is supplementary to the Metro North HHS COVID-19 Response Plan, which will be updated weekly and includes current state and federal policy directions.

1.5 Assumptions

This plan was developed based on the assumptions outlined within the Metro North COVID Response Plan

2 Pandemic Phases

Australian phase Description

ALERT OS3

A novel virus with pandemic potential causes severe disease in humans who have had contact with infected animals. There is no effective transmission between humans. Novel virus has not arrived in Australia.

DELAY OS4/OS5/OS6

Novel virus has not arrived in Australia. OS4 Small cluster of cases in one country overseas. OS5 Large cluster(s) of cases in only one or two countries overseas. OS6 Large cluster(s) of cases in more than two countries overseas.

CONTAIN AUS 6a - January 2020

Pandemic virus has arrived in Australia causing small number of cases and/or small number of clusters.

SUSTAIN AUS 6b – 25 March 2020

Pandemic virus is established in Australia and spreading in the community.

CONTROL AUS 6c Customised pandemic vaccine widely available and is beginning to bring the pandemic under control.

RECOVER AUS 6d Pandemic controlled in Australia, but further waves may occur if the virus drifts and/or is re-imported into Australia.

1 25 February 2020

https://metronorth.health.qld.gov.au/extranet/wp-content/uploads/sites/10/2020/03/covid-response-plan.pdf

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Note 2008 Australian Phases version used over 2019.

3 Overview of Community and Oral Health and infrastructure

Community and Oral Health provides subacute inpatient services, Residential Services, Community based care services, and Oral Health services for the whole of Metro North Hospital and Health (Metro North HHS). Community and Oral Health have expanded services to include the COVID Clinical Response Service. This service line incorporates and oversees, Hotel Quarantine, Fever Clinics and Community Vaccination Hubs. The person-focused, interdisciplinary service model of care is orientated towards flexible service delivery in a range of care settings. Services are provided in community health centres, sub-acute and residential care facilities and mobile service teams working in the client’s home. These services aim to support patient flow from acute facilities in Metro North HHS, provide rapid response by multidisciplinary teams to improve and maintain a person’s functional capacity and maximise their independence, continue to support complex care until usual care arrangements can be resumed or determined. Subacute Inpatient Services are provided at Brighton and Zillmere Campuses. Services include:

• Interim Care is a 28-bed unit based at Brighton which supports older people to transition to a long-

term accommodation in a residential aged care facility.

• The Brighton Rehabilitation Service is a 42-bed unit which supports adult patients of all ages who have

care needs which require them to undertake an intensive multidisciplinary rehabilitation therapy-based

program to help improve general function and independence.

• The Brighton Brain Injury Service (BBIS) is a 24-bed unit which provides complex and comprehensive

rehabilitation for clients with an Acquired Brain Injury (ABI) and those under 65 NDIS approved with

or without an Acquired Brain Injury with complex discharge planning for the community pathway

• The Residential Transition Care Program located in Zillmere is a 60-bed unit over 2 wings. 28 bed

West wing and 32 bed East wing which supports older people who have been discharged from hospital

or a subacute facility to undertake a time limited low intensity therapy program who require 24-hour

care support.

Residential Aged Care Services

Residential Aged Care Services are provided at Gannet House and Cooinda House which together accommodate 100 beds in a residential home environment. Disability Services

• The Halwyn Centre currently provides disability care to 23 residents with the ability to provide respite

care to known clients when requested by the families.

Community Based Care Services

• Hospital in the Home (HITH) provides care in a community setting for acute conditions requiring clinical

governance, monitoring and or input that would otherwise require treatment in a traditional inpatient

hospital bed. The HITH program is focused exclusively on acute admitted hospital care substitution.

• HITH also provides the COVID-19 Virtual Ward service. This service assesses, manages, and

supports people who have been identified as being COVID-19 positive who are clinically safe to remain

in their residence or a designated quarantine hotel. The care of this client group continues until the

patient is fit to be released from isolation.

• Post Acute Care Service (PACS) provides a seven day per week hospital avoidance response to

people who present to emergency departments (and not requiring admission) or discharged from

hospital.

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• Community Palliative Care (CPC) Service provides care for people who have a life limiting illness with

little or no prospect of a cure, and for whom the primary treatment goal is quality of life. The aim is to

support care within inpatient units, Palliative Care outpatient and home care settings.

• Community Based Rehabilitation Team (CBRT) provides a time limited multidisciplinary rehabilitation

service that aim to improve people's wellbeing, functional capacity, independence, and quality of life.

Interventions may be clinic based, home based, or community based depending on the person’s goals.

• Community Transition Care Program contains 80 community-based packages which supports older

people who have been discharged from hospital or a subacute facility to undertake a time limited low

intensive therapy program in their own residence.

• The Complex Chronic Disease Team (CCDT) provides a range of services for people with complex

health issues who are at risk of admission or readmission to hospital or frequent presentation to

Emergency Departments. CCDT provides assessment and intervention to support people in managing

their complex care needs and chronic disease to minimise complications. The Complex Chronic

Disease Team also offer Cardiac and Pulmonary Rehabilitation programs for eligible people in a

variety of locations across Metro North HHS.

• The Diabetes service utilises a multidisciplinary approach to provide clients with diabetes clinical

knowledge and skills for self-management and prevention of diabetes related complications. Services

are provided in Caboolture, Redcliffe, Chermside and North Lakes in-reaching to The Prince Charles

Hospital, Redcliffe Hospital and Caboolture Hospital.

Oral Health Services are described elsewhere.

3.1 Community and Oral Health infrastructure

The following provides an overview of available infrastructure for Community and Oral Health to support

creating capacity in acute facilities.

Locations identified Capacity Notes

Non-clinical/ Non-funded buildings

Brighton Auditorium Brighton-19th Avenue Brighton Wellness Hub

TBC These building could be considered as additional spaces for re-purpose if required – however would need fit out and commissioning as clinical areas

Vacant land Brighton Health Campus TBC Scope for Defence Force Field Hospitals

4 Partners and Stakeholders

Community and Oral Health has a range of local partners and stakeholders who they will work with to deliver on this response plan and continue to provide high level healthcare to the local community. We are partnering with our internal Community and Oral Health stakeholders, MN EOC and IMT. Additional partners include:

• Public Health unit.

• Queensland Medical Laboratory (QML)

• Queensland Disaster Management Arrangements.

• Department of Health, Strategic Policy.

• Deputy Director General Preventative.

• National Disability Insurance Scheme (NDIS) Quality and Safeguards commission.

• Aged Care Quality and Safety commission.

• Local government councils.

• Queensland state emergency service (SES) Local all staff emails and communications is coordinated through the Community and Oral Health Principal Communication Advisor.

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5 Roles Responsibilities

In line with the Queensland Health Pandemic Plan, the Department of Health leads the overall response to pandemic within Queensland and will coordinate and direct response requirements at a system level. Metro North will coordinate and lead the implementation of response requirements at an HHS level and will support Directorates. Community and Oral Health is responsible for local identification and operationalisation of their response plan.

6 Activation

Metro North HHS has activated its Emergency Management Plan and its Health Emergency Operations

Centre. Community and Oral Health activated their Emergency Operations Centre on 11th March 2020.

6.1 Command and Communication

All incident communication is to be via the Community and Oral Health EOC account ([email protected]) and Metro North EOC. The Director of Medical Services for Community and Oral Health is the contact for response planning.

6.2 Reporting

Community and Oral Health EOC completes an internal daily Sitrep which is circulated to the Metro North EOC.

7 Response

7.1 Triggers and response activity overview

The Community and Oral Health Response Plan considers the response plan from Tier 0 to Tier 3. Tier 4 and 5 are considered at a whole-of-HHS level. Metro North Chief Executive may determine modified tiers.

Where a Directorate identifies the need to activate a change to service provision (such as provision of subacute services at one site) consultation and collaboration should occur with the Metro North executive and other facilities that may be impacted by the decision.

Preparation and Planning:

Community and Oral Health stood up the Incident Management Team to review local plans for pandemic preparedness, response, and recovery. Planning considerations have included:

• Clear lines of governance with role cards developed for key personnel.

• Protocols for infection control and management including isolation control procedures, updates, and staff education.

• Processes to report and maintain records of COVID-19 infections and status for staff.

• Processes to report and maintain records of COVID-19 infections and status for patients/residents.

• Protection and potential alternative roles for volunteers.

• Communication plans for staff, residents, and families.

• The role of the Community Liaison Officers in communicating changes to residents and families.

• Protocols for equipment supply and management including PPE and patient monitoring.

• Cancellation of non-critical meetings and activities and expanded use of Microsoft Teams and teleconference for essential meetings.

• Focus on maintaining access to quality care for people with underlying health conditions not related to COVID-19.

SUSTAIN -TIER1

SUSTAIN -TIER 0

SUSTAIN -TIER 2

SUSTAIN -TIER 3

SUSTAIN - TIER 4

SUSTAIN - TIER 5

mailto:[email protected]

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• Seeking clinical expertise on decisions that may reduce or alter access to services.

• Focus on workforce capacity and wellbeing including identifying staff who may be available to work in other areas.

• Culturally appropriate approach and information for Aboriginal and/or Torres Strait Islander peoples.

• Processes to monitor and record activity and expenditure related to COVID-19.

• Processes to support systems reporting as patients from acute services are decanted to bedded services in community.

• Processes to modify Clinical Services Capability Framework (CSCF) in line with the change in service model and patient cohort.

• Working closely with Commonwealth agencies and complying with Aged Care Quality and Safety Commission and National Disability Insurance Scheme (NDIS) guidelines.

• Engaging with Public Guardian and Public Trustee to establish practice guidelines under changed model of care.

• Consideration of enhanced or alternative models of service to be implemented in the targeted action phase including monitoring safety and quality indicators as alternative models are implements.

• Worked with Department of Health E-Health Viewer team to make visible community delivered care (COVID-19 and Community Palliative Care) for other health care providers and clinicians.

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7.2 Sustain – Tier 0: prevent local transmission and prepare

Governance Personnel Fever Clinic STARS and Community COVID Vaccination Clinics

▪ IMT active

▪ EOC – stood up

▪ Report PPE daily, weekly PPE stocktake

▪ Medication stocktake at each site weekly

Staff

▪ wipe down personal ipads/phones; wipe down hard surfaces

▪ establish weekly communication with staff – vidcasts, emails, as appropriate

Visitors – do not attend if unwell, as per CHO Directions.

Volunteers

▪ do not attend if unwell, complete volunteer checklist, risk assess roles, engaged as appropriate

Consumer representation

▪ complete Consumer COVID checklist, risk assess roles

▪ Community-based – adjust capacity

based on demand

▪ STARS Pfizer Hub and Community COVID Vaccination clinics operating up to seven days per week at two external public sites

▪ Community COVID Vaccine Hubs

Hotel Quarantine Inpatient COVID-19

▪ Data collated and interrogated by the State Disaster Coordination Centre informs planning and calculating of demand for a surge capacity, as required

▪ Hotel Quarantine staff to maintain compliance with Vaccination, Fit Testing and Operational protocol for COVID-19 testing of quarantine facility workers

▪ Single rooms, isolate suspected COVID-19 patients until test results known.

▪ Confirmed COVID-19 transferred to a designated COVID19 Hospital (RBWH or TPCH)

Meetings Training Service Operations Facility

▪ Adhere to social distancing

▪ Virtual meetings where able

▪ COH - IMT meeting fortnightly

▪ COH PPE working party

▪ COH workforce working party

▪ No restrictions – social distancing to be observed

▪ PPE training for all staff

▪ Increase HITH capacity

▪ Residential Aged care Facilities –complies with Commonwealth directions

▪ Halwyn Facility –complies with

Commonwealth directions

▪ Community Transition Care – maximise utilisation of Commonwealth places

▪ Pre appointment or home visit

screening conducted for all clients

▪ Signage at entrances alerting patients, visitors, and staff not to enter a health service if unwell

▪ Entrances/Exits – sanitising stations at all entrances

▪ Concierge at key entrances

▪ Security – maintain

▪ Cleaning - maintain

▪ Pharmacy – maintain 6 months’ supply of pharmacy stocks (based on usual supply)

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7.3 Sustain – Tier 1 response: limited community transmission


As per Tier 0 plus:

▪ PPE stocktake - if stocktake variance exceeds 5% (of prior day’s closing balance) for three consecutive weeks, change to daily stocktake

▪ PPE security enhanced

Staff

As per Tier 0 plus:

▪ minimise staff movement across wards and facilities

▪ develop staff teams and minimise contact between teams

▪ consider roles that can work remotely

▪ Support social distancing in communal areas in office spaces

Volunteers can be engaged onsite:

▪ The volunteer must have had at least

one vaccination, preferably at least 10

days ago.

▪ The volunteer must not be a

vulnerable person;

▪ The volunteer must be happy to

continue to work;

▪ The volunteer must work in a non-

high-risk area.

No consumer representatives unless virtual through MS Teams meetings

Visitors – as per CHO Direction

▪ Community-based – adjust capacity

based on demand and increase

and/or reallocate staff.

▪ Private pathology may be utilised to

stand up increased days and hours

at Fever clinic

▪ As per tier 0

▪ **Staff may be redirected for operational

needs within the Fever Clinic


▪ As per tier 0 As per tier 0 plus:

▪ confirmed cases transferred to a designated COVID19 Hospital (RBWH or TPCH)

Meetings Training Service Operations Facility

As per tier 0 plus

▪ COH-IMT weekly meetings

▪ Cancel all non-essential meetings

▪ Daily fever clinic huddle

As per tier 0 plus:

▪ Essential training to be delivered virtually where able

▪ Non-essential training postponed

As per tier 0 plus:

▪ Residential Aged care Facilities, Disability services and Bedded Services comply with government and CHO Directions

▪ Consider telehealth options for clinic appointments and home visiting where appropriate

As per Tier 0 plus:

▪ Cleaning – introduce touch point cleaning

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7.4 Sustain – Tier 2 response: moderate community transmission


As per Tier 1 plus:

▪ PPE supply increase in

line with Metro North

direction

As per tier 1 plus:

Staff:

▪ Consider reallocation of workload for

identified vulnerable staff

▪ Continue COVID-19 HR hotline

referrals

▪ All staff to wear level 1 or 2 flat

surgical mask

▪ Minimise staff working across more

than one site, PPE (modified contact

and droplet) introduced to bedded

services for staff identified working

multiple sites

▪ Home visiting services considered to

wear PPE (contact and droplet) in

client’s homes

▪ Visitors as per CHO directives –

exemptions to be tabled at IMT for

final endorsement by ED

As per Tier 0 plus:

▪ Scoping for additional mobile testing sites

and stand up if and when required

▪ Private pathology may be utilised to stand

up increased days and hours at Fever

clinic

As per Tier 1


As per Tier 0 As per Tier 1 plus:

▪ Confirmed cases transferred to a designated

COVID19 Hospital (RBWH or TPCH) until

capacity reached, refer to Community and

Oral Health COVID-19 outbreak

management plan

Meetings Training Service Operations Facility Protection

▪ IMT daily meetings

▪ 8am daily service lead

and managers

meetings

▪ As per tier 1 plus:

▪ Orientation training delivered virtually


▪ Restrictions applied to f Residential Aged

care and disability facilities as per direction

from governing bodies

▪ Restrict movements of inpatients to non-

essential appointments, outings and

activities unless exemption approved


▪ Swipe access only to buildings

▪ Sign on, swipe or QR scan to record

movements of staff and visitors on site

▪ Cleaning schedule increased in

communal areas

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▪ Inpatients/residents in bedded services to

wear surgical mask if in communal areas or

exiting building for specified reason

▪ Clients and carers required to wear surgical

mask when visiting community health

centres. Avoid additional visitors to

appointments as per CHO directions.

▪ Home visiting services to use telehealth

where possible and only essential care to be

delivered.

▪ Concierge and signage at entrances

alerting patients, visitors, and staff not to

enter if unwell

▪ Allocated Drop off and pick up locations

outside building for patient’s belongings

and clothing

7.5 Sustain – Tier 3 response: significant community transmission


As per tier 2 plus:

▪ PPE supply to increase in

line with Metro North

direction

▪ Additional resources for key

positions in IMT and Supply

As per tier 2 plus:

▪ Increase capacity in casual

workforce

▪ Redeployment of registered staff

(e.g. Education or S&Q) to clinical

areas to assist with capacity

As per tier 2 plus:

▪ Stand up of additional fever clinics at

specified sites

As per Tier 1


As per Tier 1 ▪ Confirmed cases to be located as per

Community and Oral Health COVID-19

Outbreak management plan

Meetings Training Service Operations Facility Protection

As per tier 2 plus:

▪ IMT increase to twice daily

▪ Daily bed meeting of all

services

As per tier 2

As per tier 2 plus:

▪ Consider use of additional infrastructure on

campus for clinical use

▪ Home visiting services to increase capacity

with funding

As per tier 2 plus:

▪ Temperature checking of all entering

facility

▪ Engage contract cleaning team used in

community health centres to increase

cleaning capacity at all sites

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• Waste and linen management to

increase due to demand

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7.6 Contact tracing

Metro North HHSs has 57 public health nurses and environmental health officers authorised as contact tracers.

These officers have the associated function of serving of the legal notices by Emergency Officer (General) - 24

Emergency Officers (General) appointed under the Public Health Act. Contact tracing capacity is 600 to 800 tracers

per day. In the event of a surge capacity can be quickly increased by providing training and authorisation and

drawing on staff from other areas of Metro North and local government environmental health officers available at

short notice.

7.7 Clinical management for suspected or confirmed COVID-19 positive patient

Refer to Community and Oral Health Covid-19 Outbreak Management plan

7.8 PPE for staff

It is expected staff will comply with standard precautions, including hand hygiene (5 Moments) for all patients with

respiratory infections. In addition:

• patients and staff should observe cough etiquette and respiratory hygiene

• comply with transmission-based precautions for patients with suspected or confirmed COVID19

• contact and droplet precautions for routine care of patients

• contact and airborne precautions for aerosol generating procedures

• if patient transfer outside the room is essential, the patient should wear a surgical mask during transfer and follow respiratory hygiene and cough etiquette.

For most inpatient contacts between healthcare staff and patients the following PPE is safe and appropriate and

should be put on before entering the patient’s room.

Droplet - Contact and Standard Precautions for Standard Care i.e.:

• surgical mask

• long sleeve impermeable gown

• gloves

• protective eyewear / face shield

7.8.1 PPE stockpile and consumables

Community and Oral Health will manage PPE stockpiles and clinical consumables to determine and ensure appropriate stock levels are available to support Business as Usual (BAU) as well as expected surge. The provision of PPE must focus foremost on staff but is also required for patients and visitors in certain circumstances. PPE appropriate for COVID-19 includes:

• disposable gloves

• long sleeve gowns

• goggles

• surgical/N95 masks and

• alcohol hand gel. PPE is available and placed at the entrances/triage desks within all publicly accessible areas – Clinical consumables notable for management of COVID-19 include flocked swabs for viral polymerase chain reaction.

7.9 Operational support

Environmental cleaning of patient care areas:

1. Cleaners should observe contact and droplet precautions signage

2. Environmental cleaning and disinfection of infection control areas will occur in line with current Queensland

Health and Metro North HHS Guidelines

3. Frequently touched surfaces such as doorknobs, bedrails, tabletops, light switches, patient handsets in

clinical areas and patient room should be cleaned daily

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4. Frequently touched surfaces such as doorknobs, bedrails, tabletops, light switches, patient handsets in non-

clinical areas will be cleaned more frequently

5. Perform terminal cleaning of all surfaces (as above plus floor, ceiling, walls, blinds) after a patient is

discharged

6. a) A combined cleaning and disinfection procedure should be used; this is either a. 2-step - detergent clean,

followed by disinfectant; or

b) 2-in-1 step - using a product that has both cleaning and disinfectant properties

7. Any hospital-grade, TGA-listed disinfectant that is commonly used against norovirus is suitable, if used

according to manufacturer’s instructions

7.10 Human resources

The health, safety and wellbeing of all healthcare workers is a priority for Metro North HHS. A staff management portfolio has been established which will manage and monitor the reallocation of staff, ensuring allocation to priority areas and matching of skillsets. A survey to identify staff able and willing to be reallocated has been conducted and distributed to the Directorates. Community and Oral Health staff management team/coordinator will manage staff as required. A wellbeing strategy is being implemented with the aim to ensure staff feel supported and that their wellbeing is at the forefront of everything we do during the pandemic. A wellbeing executive has been appointed to oversee and manage staff wellbeing during this time. This strategy links staff to available resources and tools to assess and support their wellbeing.

7.10.1 Staff management

A range of strategies to ensure adequate workforce are available during the pandemic will be implemented in line with the tiered response including:

• new rostering models

• recruiting retired or semi-retired clinicians

• reassigning healthcare workers out of their usual work area

• utilising healthcare students as assistants

• reviewing scope of practice

• increasing casual pools and temporary staff

• increasing hours of part time staff on voluntary basis

• active leave management including absenteeism and fatigue

• accelerated recruitment processes

7.10.2 Managing ill workers

Ill or quarantined workforce will be managed in line with the Queensland Health Human Resources Guidelines

available on the intranet. Refer to section 7.2.1.1 for details on managing vulnerable workforce.

7.10.3 Leave and returning to work

Different leave types, either paid or unpaid, may be granted to employees directly affected by this event. Refer to the MNHHS COVID-19 Virus Pandemic Factsheet for information regarding specific leave options.

7.10.4 Quarantine

All Metro North HHS staff impacted by isolation / quarantine must be registered with the Metro North HHS Emergency Operations Centre via [email protected].

7.10.5 Staff wellbeing strategy

The Metro North Wellbeing Strategy – COVID-19 covers the emotional, financial, physical, and social domains of wellbeing. Metro North’s values of compassion, integrity, respect, teamwork, and high performance form the foundation of decisions and actions relating to the wellbeing strategy during COVID-19 and is supported by the Workforce, Culture and Engagement Unit.

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The aims of the strategy are to ensure staff feel supported and have their wellbeing considered, link to existing resources and provide access to new initiatives tailored to COVID-19. New initiatives include:

• COVID-19 HR hotline

• Peer responder program to provide psychological first aid

• RUOK’ERS to provide a collegiate support network

• COVID Staff Psychology Support – a tailored onsite counselling service for any employee who has increased risk to their mental wellbeing resulting from working directly with COVID-19 patients

Profession focussed support and initiatives are outlined in the Metro North Wellbeing Strategy as well as professional association support included below:

• Medical Professional Association Support

• Nursing Professional Association Support

• Allied Health Professional Association Support Metro North’s Employee Assistance Service (EAS) provider Benestar is offering expanded support as part of the Staff Wellbeing Strategy.

7.10.6 Industrial relations

Engagement with the various unions will occur throughout the pandemic.

7.10.7 Reallocation

Metro North HHS may be required to reallocate staff in response to the COVID-19 activities. These reasons could include (but are not limited to) are:

• vulnerable staff that are unable to be reallocated within their own teams

• service changes including reduction or closure of services

• reduction in workload due to business focus changes A range of resources are published on the Metro North extranet page, that support the process of staff reallocation ensuring a streamlined approach. Resources include:

• Orientation Handbook has been developed to support reallocated (deployed) staff. All reallocated (deployed) staff are required to complete the Orientation Handbook to comply with Workplace Health and Safety, patient safety and scope of practice requirements

• Checklist to support reallocation of Metro North workforce during COVID-29 pandemic

• A Nursing and Midwifery factsheet has been developed to assist nursing and midwifery decision-making in respect to Scope of Practice, Reallocation and Deployment of nurses and midwives during a COVID 19 pandemic response

A central process will prioritise and manage the reallocation of staff across the HHS. Each Directorate has a workforce unit to coordinate this locally, with central oversight by Metro North Executive. The Directorate Workforce Coordinators (DWC’s) are supported by the Metro North Emergency Operations Centre (EOC) Logistics – Workforce team to assist and support the reallocation process of employees.

7.10.8 Workplace health and safety

Workplace health and safety precautions are being taken in line with the Chief Health Officers advice. Public Health surveillance, rapid response teams and case investigation will be available. A range of COVID-19 specific health and safety checklists and factsheets have been developed on local induction, workplace injuries (for employees and line managers), QSuper, Workcover and related to management of uniform/clothing for staff working with patients suspected or positive for COVID-19.

7.10.9 Recruitment and onboarding

All Staff Orientation for COVID-19 has been described in a factsheet and will be delivered to each new starter as an online module. During the COVID-19 emergency response period any new starter joining Metro North will still need to undertake their mandatory training. These will be assigned to them in the Metro North Talent Management System (TMS) as per the Policy. This will include the new Metro North Orientation module. The information provided on the Mandatory Training page outlines legislative and mandatory training requirements, standards, and assessments,

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including the frequency of training that must be completed to enable a safe working environment for everyone, including our patients and consumers.

7.10.10 Fatigue Management

Management of Fatigue across MNHHS occurs in accordance with the MNHHS Fatigue Risk Management

Procedure and the Department of Health Fatigue Risk Management Policy I1 (QH-POL-171). A summary

document has been developed which outlines the general management of fatigue. Specific guidelines for relating to

fatigue risk management for Medical and Nursing and Midwifery professional streams has also been developed.

7.11 Aboriginal and Torres Strait Islanders

Community and Oral Health works closely with the Aboriginal and Torres Strait Islander Leadership Team to

provide support to Aboriginal and Torres Strait Islanders, as well as the broader population throughout the COVID-

19 pandemic.

Specific actions include:

• Allocation of Advanced Health Workers to assessment clinics at Pine Rivers, Redcliffe, and Hotel quarantine screening to assist with screening procedures

• Work with Aboriginal and Torres Strait Islander community organisations to align strategies, provide advice and disseminate culturally specific resources for COVID-19, to the community

• Assist in the development of culturally appropriate COVID-19 literature for the Indigenous community in conjunction with the Aboriginal and Torres Strait Islander Leadership Team

• Responded directly to calls and enquiries regarding COVID-19 concerns from Aboriginal and Torres Strait Islanders

• The Community and Oral Health RAN teamwork with Metro North Virtual Ward to support pathways of referral from the Community and Oral Health and IUIH Assessment and Fever clinics

• Advanced Health Workers and Administration staff from Community and Oral Health are available to provide translation and communication services for Aboriginal and Torres Strait Islanders admitted to the Virtual Ward

• Community and Oral Health Indigenous Primary Care Team provide cultural support to Aboriginal and Torres Strait Islander patients in Hotel quarantine through established referral pathways. This is in partnership with EOC MN Public Health, EOC Metro North and COH COVID19 Satellite

• Data is collected, analysed, and reported by Community and Oral Health DART team of numbers of Aboriginal and Torres Strait Islanders attending Assessment Clinics

7.12 Vulnerable groups

RACF: Residential aged care facilities (RACFs) increased advanced care planning and pandemic planning with

virtual services to increase support to RACFs and reduce physical outreach have been established. A Brisbane

Metro COVID-19 Outbreak Response Plan with clear guidelines on the management in RACFs should there be a

COVID-19 outbreak.

People with disability, support workers and carers — coronavirus (COVID-19) resources available below:

https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/information-for/people-with-disability-

and-carers .

In addition, the NDIS and other organisations have also developed resources available on their websites.

Culturally and linguistically diverse (CALD) people:

https://qheps.health.qld.gov.au/metronorth/cultural-diversity/cald-people/_recache

7.13 Financial management

Cost identification and capture processes are to be captured in incident response cost centres in Directorates (one

for screening and indirect costs and one for direct costs of patient care). Indirect costs are to be captured in the

home cost centre, approval documentation to be provided to Business Manager who will arrange for a journal to

recoup these costs against COVID-19.

Costs will be collected by directorates (including supporting documentation) and claimed by Metro North HHS via

DoH. Funding (to offset actual expense) will be accrued at end of month by Health Funding and Data Insights

https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/information-for/people-with-disability-and-carers

https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/information-for/people-with-disability-and-carers

https://qheps.health.qld.gov.au/metronorth/cultural-diversity/cald-people/_recache

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team. This will be allocated to directorate level against incident cost centres. Adjustments have been made to

monthly performance reports to identify incident related costs.

COVID-19 is expected to have a negative impact on total Weighted Activity Units (WAUs) for Metro North HHS.

Baseline performance metrics have been collated for key metrics and the impact of these have been modelled in

line with escalation of activity in line with the response plan.

Selected staff have been issued with emergency corporate credit cards to be used for identified Emergency

Events.

The financial delegation matrix in S/4 has been updated to ensure that online orders against emergency event cost

centres will workflow to appropriate delegates. Additional financial delegates have been identified at each facility.

7.13.1 Medicare ineligible patients

All patients are to receive the required testing and treatment irrespective if they are Medicare eligible or ineligible.

The provision of commonwealth funding under the National Partnership Agreement with the States will be at 50 per

cent of the costs to provide testing, housing, or treatment of all patients.

7.13.2 Activity capture

COVID-19 activity is to be recorded against the designated Tier 2 code and description (40.63 COVID-19

response). This activity will be recorded and provide MN with a response to the Commonwealth as per the NPA.

Patient records within Community Health are aligned to multiple HBCIS instances, this is dependent upon existing

arrangements with Acute facilities. Community Health Information Managers along with the relevant facility Health

Information Manager are accountable to maintain the integrity of the shared or separate patient records and the

transfer of these records when required.

Once a patient record is established for a patient community activity data collection is recorded in the HCare

application for reporting in the Queensland Health Non-Admitted Patient Data Collection.

Any amendments to existing patient pathways into Community Health Services, including the development of new

services (e.g. fever clinics) will be completed in consultation between the relevant Health Information Management

teams (HBCIS instance) and the Community and Oral Health Systems Support team (HCARE).

All activity is reported following Department of Health advice / guidelines and assigned Tier 2 clinic codes.

8 Control

The Control Phase will be characterised by a vaccine being widely available and the pandemic beginning to be

brought under control demonstrated through decreasing pandemic activity, whilst there is uncertainty if additional

waves will occur.

The focus during this phase is to:

• evaluate the response – what did we stop, what did we start, what did we do differently (clinical and non-clinical and corporate activities)

• determine recovery strategies – what do we continue, what do we stop and when, what do we restart and when, what needs to be “caught up”

• prepare for a possible second wave.

• undertake a range of monitoring and compliance activities associated with relaxations of restrictions.

Upon reaching control phase, Community and Oral Health will evaluate the effectiveness of the innovative models

that have been developed to manage the pandemic to determine what models should be incorporated into the new

normal business environment. Community and Oral Health will adopt a phased approach for resuming business

activities and determining strategies to assist with “catching up” where necessary.

9 Recover

The Recovery Phase is characterised by the pandemic being under control in Australia however further waves may occur if the virus drifts and/or is reimported into Australia. During this phase there is ongoing evaluation of the response, revision of plans and activation of recovery strategies.

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The Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) outlines activities associated with this phase including:

• support and maintain quality care

• cease activities that are no longer needed, and transition activities to normal business or interim arrangements

• monitor for a second wave of the outbreak

• monitor for the development of resistance to any pharmaceutical measures

• communicate to support the return from emergency response to normal business services

• evaluate systems and responses and revise plans and procedures Metro North will work with other government agencies to consider whether the community require additional services to enable full psychological, social, economic, environmental, and physical recovery from the effects of the COVID-19 outbreak. At-risk groups may need additional support.

Analysis of available data to evaluate the epidemiological, clinical, and virological characteristics of the pandemic

will be undertaken and ongoing surveillance measures will be considered and incorporated. Newly developed

policies and procedures will be reviewed to determine their ongoing applicability and be updated accordingly.

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Appendix 1: Community and Oral Health COVID-19 Committee list

Meeting Contact

COH COVID-19 IMT EOC COH

Daily service lead and manager meeting EOC COH

Daily fever clinic huddle EOC COH

Appendix 2: Infrastructure at Tier level

COHD Fever Clinic capacity Isolation Room Beds^

Tier 1 410*

6 single rooms at Brighton

0

Tier 2 0

Tier 3,4 and 5 645** 181

^Capacity for COVID-19 positive patients

Notes:* includes Hotel Quarantine Day 10 Testing Program which equates to 160 persons per day **includes Hotel Quarantine Day 10 Testing Program which equates to 300 persons per day. ^ Contact tracing numbers as at 13 August 2020.

community covid-19 response plan - metro north health

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