Caboolture Kilcoy and Woodford Directorate COVID-19 Response Plan 9 February 2021

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Published by the State of Queensland (Metro North Hospital and Health Service), February 2021 [IBNN or ISBN if needed]

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) 1019 You are free to copy, communicate and adapt the work, if you attribute the State of Queensland (Metro North Hospital and Health Service). For more information, contact: Metro North Emergency Management and Business Continuity, Metro North Hospital and Health Service, Block 7, RBWH, Herston QLD 4029, email MN-EmergencyManagement@health.qld.gov.au, phone 07 3646 3743. An electronic version of this document is available at https://metronorth.health.qld.gov.au/extranet/coronavirus

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.

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Contents Contents ..................................................................................................................................................... 2

Abbreviations ............................................................................................................................................. 4

1 Introduction ................................................................................................................................ 6 1.1 Situation........................................................................................................................................ 6 1.2 Purpose ........................................................................................................................................ 6 1.3 Authority ....................................................................................................................................... 6 1.4 Scope ........................................................................................................................................... 7 1.5 Assumptions ................................................................................................................................. 7

2 Pandemic phases ....................................................................................................................... 8

3 Overview of Caboolture Kilcoy and Woodford Directorate ................................................... 9 3.1 Infrastructure ................................................................................................................................ 9

4 Community and Stakeholder Engagement ............................................................................ 10

5 Roles and Responsibilities...................................................................................................... 10

6 Activation .................................................................................................................................. 10 6.1 Command and Communication .................................................................................................. 10 6.2 Reporting .................................................................................................................................... 10

7 Response .................................................................................................................................. 11 7.1 Triggers and response activity overview .................................................................................... 11 7.1.1 Tier 0: prevent community transmission and prepare ................................................................ 12 7.1.2 Tier 1: Limited community transmission ..................................................................................... 12 7.1.3 Tier 2: Moderate community transmission ................................................................................. 14 7.1.4 Tier 3: Significant community transmission ................................................................................ 15 7.1.6 Digital resources ......................................................................................................................... 19 7.1.7 Resource management .............................................................................................................. 20 7.1.8 Operational support .................................................................................................................... 20 7.2 Human resources ....................................................................................................................... 21 7.2.1 Staff management ...................................................................................................................... 21 7.3 Aboriginal and Torres Strait Islanders ........................................................................................ 22 7.4 Vulnerable groups ...................................................................................................................... 23 7.5 Financial management ............................................................................................................... 23 7.5.1 Medicare ineligible patients ........................................................................................................ 24 7.5.2 Activity capture ........................................................................................................................... 24 7.6 Private hospitals ......................................................................................................................... 25 7.7 Influenza ..................................................................................................................................... 25 7.7.1 Placement of patients with Influenza .......................................................................................... 25 7.7.2 Vaccination program .................................................................................................................. 26

8 Control ....................................................................................................................................... 26

9 Recovery ................................................................................................................................... 27

Appendix 1: Workforce Staff Query Flowchart ..................................................................................... 28 Appendix 2 : Tier related bed capacity across CKW……………………………………………………………………….35

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Abbreviations ABRs Auditory Brainstem Responses AEFI Adverse Events Following Immunisation AHA Allied Health Assistant AHPCC Australian Health Protection Principle Committee AHPOSILS Allied Health Paediatric Outpatient Service and Inpatient Liaison Service AIN Assistant in Nursing ANDAS Antenatal Day Assessment Service AO Administrative Officer BAU Business as Usual BS Birth Suite BSI Bloodstream Infection CCU Community Care Unit CE Chief Executive, Metro North Hospital and Health Service CHO Chief Health Officer CIN Clinical Initiatives Nurse CIS Clinical Integration Services CISS Community, Indigenous and Sub-acute Services / CN Clinical Nurse CNC Clinical Nurse Consultant CSSD Central Sterilising Services Department DDC District Disaster Coordination (Queensland Police Service) DDMG District Disaster Management Group DPU Day Procedure Unit DTU Day Therapy Unit ECT Electro Convulsive Therapy ED Emergency Department EMP Emergency Management Plan ENT Ear Nose & Throat EOC Emergency Operations Centre EPAU Early Pregnancy Assessment Unit ERP Emergency Response Plan GEM Geriatric Evaluation Management GLAD Gentlemen and Ladies Aging with Dignity GLOW (antenatal online resource for women) GP General Practitioners GUSS Gugging Swallowing Screen HC Hospital Commander HDU High Dependency Unit HEOC Metro North Hospital and Health Service Emergency Operations Centre HIC Health Incident Controller HITH Hospital In The Home HIU Health Information Unit HLO Health Liaison Officer HOD Heads of Department HP Health Practitioner 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 Metro North MN EMC Metro North Emergency Management Committee

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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 MNHHS Metro North Hospital and Health Service MNPHU Metro North Public Health Unit MOC Medical Officer On Call / Model of Care MOU Memorandum of Understanding NDIS National Disability Insurance Scheme NDRRA Natural Disaster Relief and Recovery Arrangements NG Nurse Grade… NMS National Medical Stockpile OO Operational Officer OPD Out Patient Department OT COP Occupational Therapist Community of Practice PAC Premature Atrial Contraction PACH Patient Access and Coordination Hub PCR Polymerase Chain Reaction PO Professional Officer PoC Plan of Care PPE Personal Protective Equipment PT COP Physiotherapist Community of Practice PTA Plasma Thromboplastin Antecedent QAS Queensland Ambulance Service QDMA Queensland Disaster Management Arrangements QHIMS Queensland Health Incident Management System RBWH Royal Brisbane and Women’s Hospital Reg/PHO Registrar/ Principal Health Officer RMO Resident Medical Officer RN Registered Nurse SCN Special Care Nursery SET Senior Executive Team (Metro North Hospital and Health Service) SHECC State Health Emergency Coordination Centre SICU Surgical Intensive Care Unit SITREP Situation Report SMEAC Situation, Mission, Execution, Administration, Communication SMO Senior Medical Officer SOPD Specialist Outpatient Department SSU Short Stay Unit TPCH The Prince Charles Hospital VFSS Video Fluoroscopic Swallow Study VMO Visiting Medical Officer VPD Vaccine Preventable Disease VROA Visually Reinforced Orientation Audiometry WCF Women’s, Children’s & Family WR Workplace Rehabilitation

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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, vaccine or antiviral against this new virus.

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, outline the response plan for Caboolture, Kilcoy and Woodford facilities. Given the potential rapid spread of infection and the possibility of subsequent outbreaks over coming months, this will remain a live document and updated as decisions are made and responses are put in place, throughout the pandemic. The strategic objectives of this plan are to:

• outline the staged measures to be taken to address the health needs and provide medical care to the community, in response to COVID-19

• 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 (Metro North HHS) community and within healthcare settings through proactive identification, testing and isolation, effective infection control activities, and community messaging

• Appropriately treat and minimise comorbidity and mortality if able using best practice protocols.

• determine appropriate responses to increase local 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 World Health Organisation (WHO) declared that outbreak of COVID-19 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 Public Health Agreements are issued by designated Emergency Officers (Environmental Health Officers) under this Act. The issuance of a 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:

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o Facilitate the issuing of quarantine notices to international travellers and relevant interstate travellers at points of entry

o Provide information and guidance to general practitioners and the public regarding testing and isolation requirements

o Support the clinical management of persons who are in isolation o Undertake case and contact trace any persons who are confirmed COVID-19 cases and their

close contacts compliance o Support the clinical management of persons who are in isolation

• 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 was required to develop their own individual pandemic response plan.

1.4 Scope This response plan covers the Caboolture Hospital, Kilcoy Hospital and Woodford Correctional Facility Directorate’s response to COVID-19 to ensure the continued delivery of critical clinical services to existing patients and to the Metro North HHS community.

1.5 Assumptions This plan was developed based on the assumptions that: • the incubation period of COVID 19 is up to 14 days (in line with current WHO advice) • routes of transmission will be via respiratory droplet(>5-10um) or contact route • telecommunication networks (or adequate redundancies) are operating • the Queensland Health ICT Network remains operational • support services (e.g. Australian Red Cross Blood Bank, eHealth, Health Support Queensland

(HSQ) (including linen and central pharmacy), Queensland Urban Utilities, Unity Water and ENERGEX) remain available, albeit at potential reduced capacity.

• there will be impacts to Metro North HHS staffing in relation to redirection of roles and training • additional health service changes will need to be made over time, in response to government and

Chief Health Officer directives. • Health Services that are usually provided within the Hospital may need to be reduced/ changed in

relative to pandemic response. (e.g. Elective Surgery, Outpatient appointments, Allied Health appointments)

1 25 February 2020

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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.

Note 2008 Australian Phases version used over 2019.

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3 Overview of Caboolture Kilcoy and Woodford Directorate The Caboolture, Kilcoy and Woodford Directorate (referred to as the Caboolture Hospital catchment) consists of a large regional hospital at Caboolture (215 beds), a small rural facility at Kilcoy (20 beds) and a prison health service (Woodford Correctional Centre). The region is characterised by pockets of socio-economic disadvantaged and has a larger proportion of Aboriginal and Torres Strait Islander people than Metro North HHS as a whole. There are lower levels of access to General Practice across the area than most of Metro North.

3.1 Infrastructure The following provides an overview of baseline available infrastructure for Caboolture and Kilcoy Hospitals. Locations identified Number/Capacity Caboolture Hospital Total acute beds (exc. bed alternatives and mental health)

2A surgical – 26 3A medical – 25 3B medical (inc GLAD) – 32 4A medical – 32 Maternity – 20 Paediatric ward – 17 CCU – 4 SCN – 12 ED Short stay - 12

180

Emergency Department Ground floor 44 Beds ICU Level 2 8 ICU Beds Isolation Rooms ED – 1

Surgery – 5 Medicine (3A, 3B, 4A) – 13 Maternity – 6 Paediatrics – 7 ICU – 4 SCN - 1

Level 1 = 7 Iso rooms Level 2 = 17 Iso rooms Level 3 = 5 Iso rooms Level 4 = 7 Iso rooms Total = 36 Iso rooms Neg Pressure= 6

Crash Trolley 8 = Level 1 6 = Level 2 3 = Level 3 1 = Level 4

18

Oxygen Outlet pts 32 oxygen and suction outlets in Ward 4A with regulators – Level 4 – 2 spare oxygen regulators

432 outlets (approx.)

Dialysis Machines In ICU 2 Dialysis Machines Mortuary Level 1 9 (there is capacity for 2 more would be

dependent on weight) Kilcoy Hospital

Total acute beds 21 Isolation Room Rooms 3 and 4 4 (if there is a clinical decision to cohort) Crash Trolley 2

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4 Community and Stakeholder Engagement Caboolture Kilcoy Directorate 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. These partners and stakeholders include: • Queensland Police • Queensland Prison Services • Primary Health Network  • GP’s & Health Hubs • Community Pharmacies  • Aged Care   • Red Cross  • Public Health  • Queensland Ambulance Service   • Caboolture Private Hospital • Non-government / NGO homes services. • I-MED Radiology • Morten Bay Regional Council • St John Daily Executive Director Updates to Caboolture, Kilcoy & Woodford Clinical Directorate following the Incident Management Team Meeting. This is provided via email to service line leads and dispersed physically to key areas.

5 Roles and 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. Caboolture Kilcoy Directorate is responsible for local identification and operationalisation of their response plan, which aligns to the MNHHS plan, while considering specific local community capacity, expectations and demographic factors. Responsibilities are outlined in the following table

6 Activation Metro North HHS activated its Emergency Management Plan and its Health Emergency Operations Centre. Caboolture Kilcoy Directorate activated their Emergency Operations Centre on 9 March 2020.

6.1 Command and Communication All incident communication is to be via the Caboolture and Kilcoy EOC account (EOC-Cab&Kilcoy@health.qld.gov.au) and Metro North EOC (EOC-Metro North@health.qld.gov.au ). The planning contact for Caboolture, Kilcoy and Woodford Directorate is the Deputy Director Medical Services or ADON Emergency Operations Centre. Communiques regarding COVID-19 are being issued daily by a range of authoritative sources, including government, (State and Federal), Queensland Health, the QLD Chief Medical Officer, and MNHHS executive. In response, necessary operational changes are being discussed and agreed, daily by Caboolture/Kilcoy executive. A local communication strategy has been developed to ensure information relevant to Caboolture, Kilcoy and Woodford staff is distributed efficiently. This communication strategy is managed by the Senior Communications Officer in conjunction with the CKW EOC.

6.2 Reporting Caboolture Kilcoy EOC completes an internal daily Sitrep which is communicated to the Metro North EOC. Metro North HEOC is responsible for providing HHS-wide reporting to the SHECC.

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As per the Metro North Emergency Management Plan, all incident reporting is to use EOC email accounts, with Metro North HEOC being the single point of contact for all external reporting. The SHECC Sitrep will be distributed as it is received to all Directorates via EOC email accounts.

7 Response

7.1 Triggers and response activity overview Response planning has been considered from the Tier 0 to Tier 5. This plan outlines the Caboolture Kilcoy Woodford Directorate response from Tier 0 to Tier 3. Tier 4 and 5 response planning is considered in the Metro North HHS Response Plan for the HHS as a whole.

Summary of primary care: Presentations with mild ILI symptoms will be moved away from the main ED department, those seeking COVID-19 swabbing will initially be redirected to nearby Fever and Respiratory Assessment clinics primary of which is currently at Morayfield Hub. Those presenting to Kilcoy Hospital will be tested in the respiratory clinic run in conjunction with the current Emergency Department processes. Presentations with more significant ILI symptoms will be triaged to the Emergency Department for assessment in a dedicated triage room and care in an isolation room. Potential expansion capability exists with two beds in QAS corridor off the Ambulance Bay. Those presentations requiring resuscitation will be managed in Resus 1 & 2 or with expansion to further tiers within the procedure room in the ILI area. Summary of admitted care: Patients with suspected or positive for COVID-19 will be isolated in ward 3B. With expanding requirements, positive patients will be cohorted into 2 bed rooms within 3B. GLAD will at this point maintain its patient cohort as has been deemed safest location for same. Upon this capacity being reached within 3B, ward 3A will begin to receive these cases initially to single rooms. It is proposed that patients minimally symptomatic with suspected and confirmed COVID-19 will be admitted to the Metro North HHS virtual ward. In preparation for capacity requiring the use of 3B, patients of the GEMS will be decanted to Kilcoy Hospital and to Community Health Services including HITH and PAC. Upon direction from MN HEOC, outpatient clinics and elective surgery will be reduced. Planning by clinicians will incrementally reduce clinics associated with triage categories where possible utilisation of telehealth resources, referral to and support of GP, and for those patients requiring a face to face consultation, moving to a designated appointment time where the patients remains in their vehicle until they are called into the clinic – reducing the risk of exposure.

SUSTAIN -TIER1

SUSTAIN -TIER 0

SUSTAIN -TIER 2

SUSTAIN -TIER 3

SUSTAIN - TIER 4

SUSTAIN - TIER 5

Tier 0: prevent community transmission and prepare Triggers are determined for each phase however service lines may differ depending on their baseline capacity and capability. This may also be experienced at a directorate level where CKW may differ from the greater Metro North. Tier 0 is the defined by limited community transmission and minimal impact on services

Governance Personnel Emergency Department ICU Inpatient • EOC Active • PPE logistics active, weekly

stocktake, monitoring and maintaining 21-day supply

• MN reporting as directed • MN IMT meeting attendance

and reporting • Service line action plans

updated and available

Staff • Maintain hygiene and social

distancing vigilance • Establish weekly

communications with staff Visitors • Follow CHO direction 5 • Do not attend if unwell Volunteers and consumers • Complete checklist to assess

risk of attendance • Assess optional roles

• Within the ED space an identified influenza care area prepared within the fast track area

• At Kilcoy Hospital Influenza/OVID suspect patients managed within the ED. If admission required discussion with ID team at Caboolture

• communicate changing testing guidelines to all staff

• Maintain services as is • Consider isolation options for

potential COVID-19 patients. • Room 7 maintained for COVID

suspect patients

• Ward 3B identified as COVID -19 designated unit.

• Pending patients will be nursed in rooms 1-7

• Positive patients will initially be cohorted in rooms 19-24

• Minimise movement of confirmed or positive patients within the hospital.

• Maternity birthing women will be managed in Birth Suite

• All services managed within the room e.g. Pathology and Radiology

Meetings Training Service operations Facility Protection Fever Clinic • Social distancing should be

adhered including maintain room numbers as guided

• Virtual meetings where able • Attend MN meetings as

required • Local IMT Meetings • Daily COVID update for

Caboolture, Kilcoy and Woodford Correctional is sent out to all CKW staff. Hard copies OT same displayed on all notice boards across the hospitals

• Continue with adherence to social distancing

• PPE training for all staff • Commence PAPR training

• Maintain screening/testing • Review clinics and review

potential for virtual clinic expansion

• Increase activity in OT and SOPD to maximise category 1&2 with focus on long waits management

• Flexible template preparation for OT and SOPD

• Outsource activity where able • Outreach services continue

• Maintain signage at all entry points

• Separate staff and patient entry points whilst able

• Touch point cleaning • Increase pharmacy stock in

preparation • Work with IMED to discuss

hot/cold allocation of equipment

• Food, Linen and waste services use PPE in accordance with MN Guidance.

Whilst not planned on site at this point to consider possible locations for same.

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Tier 1: Limited community transmission Tier 1 is associated with limited community transmission. Increased presentations to the ED and increased pressures on in-patient medical beds related to COVID-19 patients. Minimal impact on other services.

Governance Personnel Emergency Department ICU Inpatient As per tier 0 plus • EOC formally stood up • Local IMT meeting will provide

oversight of all FTE and budgetary increases.

• PPE logistics active, monitoring and maintaining 21-day supply. Stocktake as per directions from MN HEOC.

As per tier 0 plus Staff • Increase communication with

staff • Minimise inter-ward movement • Consider teams and work from

home arrangements • Review tearooms and other

shared spaces and discourage gatherings

• Activate staff hotline 53162422 Volunteers and consumers • Consider safety on site and

minimise presence

• Staged approach to activation of separate ILI area within ED fast track area.

• Relocation of fast track services to allow for above (initially to Paediatric area and then to Allied Health gym)

• Increase and/or relocate staff • communicate changing testing

guidelines to all staff • Engage with Virtual ED

• Maintain services as is • Consider isolation options for

potential COVID-19 patients • Children requiring ICU will be

transferred as per usual management to QCH

As per tier 0 plus • Assess plan for expansion into

remaining beds on 3B • COVID-19 pending and positive

patients requiring cardiac monitoring to be nursed in 3A in single rooms

• Engage with and utilise virtual ward

• Movement of GEM patients to either Kilcoy or alternative

• Increase/reallocate staff • Minimise inter-hospital

transfers unless higher level care required.

Meetings Training Service operations Facility Protection Fever Clinic As per tier 0 plus • Discretionary suspension of non-

essential meetings to allow staff to respond

• Directorate IMT meetings commenced, frequency determined by activity

• MN IMT attendance by key parties

As per tier 0 plus • Discretionary suspension of non-

essential education to allow staff to respond

• Essential training to be delivered virtually where able

• Continue PPE, OVP, PAPR and other essential training for management of COVID-19

• Restrict non-essential education by external providers. If outside provider engaged requires COVID-19 assessment prior to entry.

As per tier 0 plus • Consider use of level 1 masks for

patients where social distancing not possible

• Maintain activity and management of critical referrals

• Increase utilisation of HITH and virtual ward

• Identify staff that can be reallocated to front line if required

Prepare processes to enable suspension of Cat 3 & 6 surgery, and Cat 3 SOPD referral. Activate on direction from Chief Executive.

As per tier 0 plus • Commence concierge service

at front entry • Follow visitor restrictions as

per CHO guidelines • Review security model and

need for enhanced traffic management,

• Security support for concierge • Increase frequency touch point

cleaning • Access for staff in “hot” areas

to suitable decontamination resources. Extra temporary block has been installed adjacent to the ED footprint.

Whilst not planned on site at this point to consider possible locations for same. Kilcoy Fever clinic running with limited times out of the ED. This is a Monday to Thursday proposal and dependent on ED workload

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7.1.1 Tier 2: Moderate community transmission Tier 2 is associated with moderate community transmission. Increased presentations to the ED and increased pressures on in-patient medical beds related to COVID-19 patients. Increased admissions of COVID-19 positive patients across the directorate with pressure to expand into second ward. Impact on ICU beds with ventilated admissions either COVID or non-COVID-19 three or greater.

Governance Personnel Emergency Department ICU Inpatient As per tier 1 plus • Engage with Caboolture Private

Hospital and meet regularly to contract for bed stock

As per tier 1 plus Staff • Separate inpatient and

outpatient teams • Activate work from home and

remote working where able • Consider reallocation of

vulnerable staff • All staff wear level 1 masks Volunteers and consumers • None engaged

As per tier 1 plus • Expansion of service as

needed. • ILI Zone will increase to

incorporate the short stay area. • Increase access to virtual ED if

able • Staffing supports identified and

activated • Use of PAPRs considered

within this area

As per tier 1 plus • Expand footprint into PACU

area. PACU move to DPU recovery area.

• This will be maintained initially as “cold” ICU

• Staff expansion to meet clinical need.

• Use of PAPRs within area

As per tier 1 plus • Assess plan to expand COVID-

19 services into 3A corridor. Initially single rooms

• Need to relocate cardiac services to 2A with staff split to support safe management of this cohort

• Patients requiring Hi-Flow to be nursed initially in 4A in negative pressure rooms

Meetings Training Service operations Facility Protection Fever Clinic As per tier 1 plus • Suspension of non-essential

meetings

As per tier 1 plus • Suspension of non-essential

training • Orientation move to online or

adapted program as approved by CKW IMT

As per tier 1 plus SOPD - category 1 and urgent category 2 only at the direction of CE. Use of Level 1 surgical masks -Repurpose areas as appropriate Surgery and Theatres -Category 1&4 and urgent category 2 &5 only as directed by the CE. -2A repurposed 8 beds for “cold” CCU and telemetry -review scope of Caboolture private in regards surgical services

As per tier 1 plus • Expand hours of concierge

service at front entry • Review security model and

need for enhanced traffic management,

• Enhanced frequency touch point cleaning

• Visitor logs established all services

Whilst not planned on site at this point to consider possible locations for same and plan for this contingency. Activation decided by MN HEOC and under direction from Chief Executive.

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7.1.2 Tier 3: Significant community transmission

The following assumes at least tier 2 response already activated and are additional items only by exception. Tier 3 will indicate significant community transmission up to a crisis level and support and guidance for our response by MN HEOC and Public Health. It would see considerable impact on all services and cessation of business as usual.

Governance Personnel Facility Protection ED ICU Service

Operations Meetings Training

Tier

3

As per tier 2 As per tier 2 -Consider further staff supports both clinical and psychological

-Infrared temperatures at entry points ensuring arrival temp <37.5 - Engage further cleaning services to meet demand - enhanced security to meet needs

Divert patients as able to private sector

-Expand further into OT -Discussion to utilise Caboolture Private

-convert non-clinical areas to clinical - review options of campus wide clinical areas and association with partner organisations

As per tier 2 No face to face training

Fever Clinic Inpatient COVID-19 Continue to support if commissioned

Expand into 4A -Cold patients managed on level 2. Review requirements for same

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

Rationalisation of patient contact to essential activities is paramount. Maximal use of virtual interactions should be used if physical examination is not required. The clinical spectrum of infection with COVID-19 ranges from mild disease with non-specific signs and symptoms of acute respiratory illness, to severe pneumonia with respiratory failure and septic shock. Deterioration, when it occurs is often rapid, leaving little time for discussions around appropriate levels of care. The below outlines inpatient care principles:

• For patients on the “critical care pathway” every attempt should be made to make this transition, should it be required, as smooth and predictable as possible.

o Have appropriate care plans o Detect and manage deterioration early, preferably in the daylight hours o Avoid MET calls, emergency intubation and resuscitation by obtaining early ICU review.

• For patients on the conservative pathway o Ensure adherence to the AHD and avoid MET calls o Proactive, supportive discussions with patients and families including prognostic

information, potential for reversibility of symptoms and the potential burden of non-beneficial interventions. It will help to discuss the patient’s values and preferences regarding life-sustaining interventions.

o Avoid assumptions based on chronological age or incomplete understanding of health status. Careful consideration must be given to Co-morbities, underlying frailty, quality of life and anticipated lifespan when determining appropriate management.

o Involve palliative care clinicians to help identify, triage and support patients in need of specialist palliative care management. This may include triaging patients who may benefit from transfer to a palliative care unit, transfer home, to another hospital or to an alternative care facility.

o Involve GP’s, community services and outreach services as required. o Accelerate uptake of advance care planning among older at risk populations in hospital,

community settings and RACFs so that advance care plans stipulate circumstances where hospitalisation or aggressive life-support interventions in hospital would constitute forms of futile and inhumane care and unnecessary use of hospital beds.

“The Queensland ethical framework to guide clinical decision making in the COVID-19 pandemic” can be found at https://www.health.qld.gov.au/__data/assets/pdf_file/0025/955303/covid-19-ethical-framework.pdf This framework supports clinical decision making and should be used by Metro North HHS staff to assist during the pandemic.

7.1.5.1 Reception

Patients to Caboolture, Kilcoy and Woodford can present at several locations including: • Emergency Departments

• Outpatient services

• Fever Clinics both on and off site

• General practice

• Home

7.1.5.2 Clinical guidelines Metro North HHS will be published on the COVID-19 Webpage and updates will be sent to EOCs for distribution

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7.1.5.3 Diagnostics for reception Patients presenting to MN fever clinics will be assessed for testing in accordance with the Communicable Diseases Network of Australia (CDNA) guidelines. Those who meet the current criteria will be tested with a single swab passed to the back of both the nose and throat. The swab will be referred to the Laboratory for testing labelled NCV-PCR. Patients who meet clinical and epidemiological criteria are deemed suspected cases and should return home to isolate. Any person with symptoms clinically compatible with COVID-19 who is tested should stay at home until a negative test is returned or symptoms have resolved, whichever is longer (CNDA) . It is important that clinicians in fever clinics ensure that this is viable prior to discharge. Alternative accommodation can be arranged via the MN HEOC. Discharged patients must be informed that test results may take 48hours and should be given information describing their responsibilities as well as pathways to seek help whilst in isolation.

COVID-19 is a notifiable disease. Following testing of the specimen, patients who are positive will be notified to both Metro North Public Health and to the Metro North “Virtual Ward”. The patient will be contracted by both services- Public Health to serve an enforceable “Public Health Order” and initiate contact tracing and the Virtual Ward to ensure ongoing care and early identification of deterioration. Patients who tested negative for COVID-19 will be notified of the outcome by text message if not admitted. It is important that patients must continue in isolation if they fulfil the criteria laid down by the Australian Government such as recent return from overseas.

7.1.5.4 Patient disposition

MET calls and emergency resuscitation carry a risk of staff contamination and infection. For this reason, every attempt should be made to eliminate this process from management. This will entail:

• Development of Advanced Health Plans for every patient on admission

• Clarity of information within wards on every Advanced health Plans to staff daily

• Early recognition of deterioration

• Early use of single rooms

• Early consultation with ICU

• Use of the CKW “MET call procedure for management of COVID-19 patients”. For patients with comorbid disease, escalating or intensive care management of COVID-19 may necessitate communication on care decisions. This may include which therapies should be continued and which therapies should be paused or discontinued. Proactive, supportive discussions with patients and families should include prognostic information, the potential for reversibility of symptoms and the potential burden of non-beneficial interventions. It will help to understand the patients’ values and preferences regards life-sustaining interventions. Palliative care clinicians should be involved to help identify, triage and support patients in need of specialist palliative care management.

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7.1.5.5 Baseline for admission Patients with significant clinical symptoms requiring inpatient care should be admitted under precautions pending outcome of testing for both COVID-19 and a full respiratory screen. A decision to admit will depend on the clinical presentation, for example

• Mild to moderate symptoms – admit to low acuity care or virtual ward as appropriate

• Major symptoms, altered vital signs, saturations <92%- admit to cohorted ward or single room

• Deteriorating vital signs, incipient respiratory failure- admit to ICU if appropriate The decision to admit to in-patient or Virtual ward will be made on a case by case basis, considering:

• The patient’s ability to engage in home monitoring

• The ability for safe isolation at home

• The risk of transmission in the patient’s home environment.

7.1.5.6 Virtual care The Virtual Ward is an option to provide support for patients who are confirmed COVID-19 positive but are well and able to manage at home. Current guidelines have all positive patients managed in the hospital environment, but higher number may necessitate need for this alternative. The Virtual ED will be activated in Sustain Tier 2 response phase by Metro North HEOC. The service is designed as an in-reach service for health professionals to have direct real-time consultations with ED clinicians regarding patients under their care. The service is a clinician to clinician consultation only. Target clinicians are:

• GP

• QAS

• Registered Nurses at Residential aged care facilities (RACF)

• Clinicians from Residential Aged Care Assessment and referral service (RADAR)

• Metro North Community Health Clinicians

7.1.5.7 PPE for staff It is expected that all staff comply with standard precautions, including the 5 moments of hand hygiene for all patients with respiratory infections. In addition:

• Patient and staff should observe cough etiquette and respiratory hygiene

• Comply with transmission-based precautions for patients with suspected or confirmed COVID-19 o Contact and droplet precautions for routine care of patients o 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. For hospitalised patients requiring frequent attendance by medical and nursing staff, a P2/N95 mask should be considered for prolonged or very close contact as per the MN guide for choosing PPE.

Droplet- Contact and Standard Precautions for Standard Care i.e. • Surgical mask

• Long sleeved impermeable gown

• Gloves

• Protective eyewear/face shield Airborne – Contact and Standard Precautions for aerosol-generating procedures (for example, taking respiratory specimens, suctioning, intubation, nebulisers), patients with significant respiratory illness, or prolonged exposure (i.e. >15minutes face -to-face contact or in the same room for >2hours). The

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Australian Government has released an update expanding the use of airborne precautions to include patients with "challenging behaviour

• Negative pressure rooms where possible

• P2/N95 mask

• Long sleeved impermeable gown

• Gloves

• Protective eyewear/face shield CKW PPE Logistics runs through the EOC and contactable on 53165017. This service will adapt to meet the changing environment by responsible for the monitoring, supply, and ongoing management of PPE components essential to provide protection to staff and community alike.

7.1.5.8 Diagnostics for patients admitted to hospital All patients admitted with suspected COVID-19 should have nasopharyngeal and oropharyngeal(throat) swabs performed (unless this was already performed prior to admission) by staff trained to properly perform these procedures in order to maximise the sensitivity of real-time PCR (RT-PCR)testing that is currently the diagnostic test of choice. RT-PCR testing has a turnaround time of 4 to 6 hours but can be significantly delayed by overload within the laboratory. Presentations with COVID-19 are often indistinguishable from other respiratory viruses so additional testing with a full “respiratory panel” is often appropriate. Inpatients who already have lower respiratory tract infection and have a productive cough, after they have rinsed their mouth with water, a deep cough sputum sample should be collected directly into a sterile container. A serology specimen should be collected during the acute phase of the illness (preferably within the first 7 days of symptom onset), stored and tested in parallel with convalescent sera collected 3 or more weeks after acute infection. This has little role in acute diagnosis. Viral cultures and serological tests have no utility in acute diagnosis and should not be requested. Updates for test protocols will be made available on the Metro North COVID-19Web page.

7.1.5.9 Clearances Patients must be free of symptoms including fever for 72 hours prior to clearance. Refer to the CDNA SoNG for latest updates. Coronavirus Disease 2019 (COVID-19) CDNA National guidelines for public health units: https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm

7.1.6 Digital resources The following digital resources are available:

• COVID-19 dashboard – provides the following data elements o Total ILI presentation as proportion of total presentations o ILI presentation via ED per discharge disposition o SSU admitted, D/C or transferred o ILI presentations by geographical distribution o Age group distribution.

• COVID-19 intranet site https://qheps.health.qld.gov.au/metronorth/flu

• Alerts in Patient Flow Manager and TREND for COVID-19 positive patients

• Incoming Passenger App- supports screening and registration of people at any Brisbane airport.

• DcoVA- enables state-wide registration of patients with COIVD-19, and support management of patients under Public Health Orders (PHOs). It has a direct feed from AUSLAB for COVID-19 results and there is further potential for natural language processing of medical imaging results.

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• WAT- workforce attendance tracker. This allows real time reporting of staff absences.

• Virtual Care digital Resources – https://qheps.healht.qld.gov.au/metronorth/digital-metro-north/virtual-care

7.1.7 Resource management

7.1.7.1 PPE stockpiles and clinical consumables CKW will manage PPE stockpiles and Clinical consumables to determine and ensure appropriate stock levels are available to support BAU as well as expected surges. 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 sleeved impermeable gown

• goggles

• surgical/N95 mask

• alcohol hand gel PPE will be available and monitored within wards and appropriately placed at publicly accessible areas – particularly in ICU, Emergency Departments and wards being used to accommodate COVID-19 patients. Clinical consumables notable for management of COVID-19 include flocked swabs for viral polymerase chain reaction.

7.1.8 Operational support Environmental cleaning of patient care areas:

• Cleaners should observe contact and droplet precautions signage and take lead from clinicians

• Environmental cleaning and disinfection of infection control areas will occur in line with current QLD Health and MN guidelines

• Frequently touched surfaces such as doorknobs, bedrails, tabletops, light switches, patient handsets in clinical areas and patient room should be cleaned daily

• Frequently touched surfaces such as doorknobs, bedrails, tabletops, light switches, patient handset in non-clinical areas will be cleaned more frequently

• Perform terminal cleaning of all surfaces (as above plus floor, ceiling, walls, blinds) after each patient is discharged a combined cleaning and disinfection procedure should be used; this is either

o 2-step – detergent clean, followed by disinfectant or o 2 in 1 step- using a product that has both cleaning and disinfectant properties. Any

hospital-grade, TGA-listed disinfectant that is commonly used against norovirus is suitable, if used according to manufacturer’s instructions.

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7.2 Human resources The health, safety and wellbeing of all healthcare workers is a priority for MNHHS and CKW Directorate alike. A staff management portfolio has been established which will manage and monitor the reallocation of staff, ensuring allocation to priority areas and matching as much as possible skillsets required. A survey to identify staff able and willing to be reallocated has been conducted, the outcome of which will be utilised by the directorate to guide the process moving forward. A wellbeing strategy is being developed and implemented to ensure that staff feel supported and that their wellbeing is at the forefront of everything we do during the pandemic. This strategy links staff to available resources and tools to assess and support their wellbeing. The peer support program at Caboolture will be enhanced and encouraged throughout the pandemic.

7.2.1 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 pool and temporary staff

• Increasing hours of part time staff on a voluntary basis

• Active leave management including absenteeism and fatigue

• Accelerated recruitment processes

7.2.1.1 Managing ill workers Ill or quarantined workforce will be managed in line with the QLD Health Human Resources Guidelines available on the intranet. Refer to section 7.2.1.1 for details on managing vulnerable workforce. 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. Quarantine All MNHHS staff impacted by isolation/quarantine must be registered with the MNHHS Emergency Operations Centre via EOC-MetroNOrth@health.qld.gov.au

7.2.1.2 Staff wellbeing strategy The Metro North Wellbeing Strategy- COVID 19 covers the emotional, financial, physical, and social domains of wellbeing. MNHHS values of compassion, integrity, respect, teamwork and high performance form the foundation of decisions and actions relating to the wellbeing strategy during COVID-19. While the position of Chief Wellbeing Officer is accountable for the strategy CKW Directorate is utilising the established Peer Support Program along with a planned approach to staff wellbeing broadly, which includes a strong communication and engagement strategy and a coordinated escalation and response process facilitated by the Staff Wellbeing Group, as well as a staff support response led by the Director of Psychology. Metro North’s Employee Assistance Service (EAS) provider Benestar is offering expanded support as part of the Staff Wellbeing Strategy.

7.2.1.3 Industrial relations Engagement with the various unions will occur throughout the pandemic.

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7.2.1.4 Reallocation MNHHS and CKW may be required to reallocate staff in response to COVID-19 activities. These reasons could include (but not limited to) are:

• Vulnerable staff that are unable to be reallocated within their own teams. Vulnerable workers assessment to be guided by the Metro North Procedure COVID-19 Workplace Risk Assessment for Workers

• Service changes including a reduction or closure of services

• Reduction in workload due to business focus changes.

A range of resources are published on the MN extranet page that support the process of staff reallocation ensuring a streamlined approach. At CKW a central process managed within the workforce unit will prioritize and support this process in conjunction with MNHHS. The Directorate Workforce Coordinators are supported by the MN HEOC Logistics – Workforce team to assist and support these processes.

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

7.2.1.6 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 all new starters will still be required to undertake their mandatory training. These will be assigned in the MN Talent Management System (TMS) as per the policy. The information provided outlines the legislative and mandatory training requirements, standards, and assessments, including the frequency of training that must be completed to enable a safe working environment for everyone including our patients and consumers. Within CKW directorate an adapted program has been developed to assist with the practical assessments and to ensure access to and understanding of electronic medication charts used throughout the establishment.

7.2.1.7 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 11 (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.

7.3 Aboriginal and Torres Strait Islanders Given the significant level of representation of Aboriginal and Torres Strait Islander people living in the CKW catchment area, serious attention needs to be given to ensuring that their health needs and health vulnerabilities are well understood and responded to appropriately. Details of the Health Service wide response to the need to support A&TSI people’s health are contained in the Master MNHHS COVID-19 Response plan. This document outlines and recognises the need for appropriate individual and community infection control and engagement strategies, to minimise the risks of COVID-19 infection within this group in our community. All Aboriginal and Torres Strait Islander peoples are considered part of a vulnerable group when considering ILI and COVID-19. Practitioners should assess all Aboriginal and/or Torres Strait Islander peoples presenting with ILI for chronic diseases and other risk factors. Health professionals should keep the following points in mind when assessing and treating any patients who may have COVID-19 Need to actively identify Indigenous person of Aboriginal and/or Torres Strait Islander Origin The high prevalence of chronic disease in Aboriginal and /or Torres Strait Islander populations that may predispose to severe outcomes The social circumstances and needs of patients that are identified as Aboriginal and/or Torres Strait Islander origin

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The possibility that the patient may be residing with a person who is vulnerable, for example, due to the presence of chronic disease(s) Would the patient benefit from support by the Indigenous Hospital Liaison Officer? Is the information provided in a culturally appropriate manner, so that the patient, contacts and community understand the information by using culturally specific posters, brochures and pamphlets. The First Nations COVID-19 team have developed a range of resources to support HHS’s to address the COVID-19 needs of the First Nations Queenslanders, including checklists and guides which are available online at https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/information-for/first-nations These resources include:

1. COVID-19 Preparing for your community: Information for Mayors 16 March 2020

2. COVID-19 HHS preparedness checklist for Queensland’s First Nations people. 16 March 2020

3. COVID-19 Protection and Containment Considerations for First Nations Communities: Information Resource. 25 March 2020

4. Attachment 1: Community and health service action checklist (as at 25 March 2020

5. Attachment 3: Intersection of community and HHS COVID-19 planning 1 May 2020

6. Fact Sheet Cleaning of quarantine accommodation in First Nations communities

7. A range of screensavers, hospital posters and fact sheets for hospitals and for the Hospital and Health Service

Challenges to infection control in Aboriginal and /or Torres Strait Islander communities are acknowledged. As such, isolating cases from those who are more vulnerable to severe outcomes and recommending keeping a distance of one metre from others may be a more manageable approach to preventing spread of disease. The voluntary home isolation of patients with infection is strongly recommended to reduce transmission but consideration must be given to who else is at home Other measures such as patients using masks can be considered depending on the vulnerability of contacts and living circumstances Information about hand hygiene (hand washing and drying) and cough etiquette should be promoted to patients, contacts and community and are to be explained in a culturally appropriate manner. There is a suite of culturally specific resources for COVID-19

7.4 Vulnerable groups Communities and individuals identified as being vulnerable, and in which mortality and morbidity is expected to be higher, include people with complex and chronic disease, culturally and linguistically diverse people, older persons and persons in residential aged care. Specific plans are in place for residential aged care facilities within Metro North HHS in line with guidelines from the Commonwealth. The Master MNHHS COVID-19 Response Plan has specific content addressing the need for plans to support:

• People with mental illness

• People with disabilities

• People who are culturally and linguistically diverse (CALD)

• Residential aged care residents

A number of support resources for these groups are also identified in the MN Response Plan document.

7.5 Financial management Cost identification and capture of expenses processes will be managed with the support of the CKW finance team. This relates to indirect and direct costs that can be attributed to COVID-19 expense. Costs will be collected including supporting documentation (approval of expenses will be directed by presentation of

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requests to IMT for consideration). COVID-19 is expected to have a negative impact on total Weighted Activity Units (WAUs) for the directorate. The financial delegation matrix in S4 has been updated to ensure that inline orders against emergency event cost centres will workflow to appropriate delegates. Additional financial delegates have been identified at each facility.

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

7.5.2 Activity capture COVID-19 data Definitions for purpose of reporting and operational response (Queensland Government COVID-19 statistics; Coronavirus Disease 2019 (COVID-19) CDNA National Guidelines for Public Health Units (13/05/2020))

Inpatient activity To be sourced via Digital Metro North (DMN) data set- based on matching pathology results with inpatient data Retrospective capture of information/ patients to be achieved through coded patient information and application of specific COVID-19 ICD code

ED activity To be sourced via DMN data set based on reporting flags within EDIS. Existing dashboards and reporting frameworks to be updated to incorporate.

Outpatient activity Initial screening activity to be sourced via EOC (manual data collection at this stage) and information collated by HFDI for reporting. COVID-19 Tier 2 clinic code has been issued and business rules issued to support its use DNA- Likely to utilise specific reason codes for DNAs across all sites DoH advice/ guidelines received and provided to directorates Fever clinics – likely to be scheduled/registered using local tool (ESM, HBCIS, HCARE or

EDIS)

Outpatient Tier 2 clinic cancellation codes Two new cancellation codes have been created in the HBCIS APP Module to accurately reflect reasons for appointment cancellations relating to COVID-19. These codes are:

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Cancellation Code

Description Start Date

31 Pub Health Alert Pt Initiated

05 MAR 2020

32 Pub health Alert Hosp Initiated

05 MAR 2020

7.6 Private hospitals On 1 April 2020 an agreement was reached between the Commonwealth and private hospitals to support delivery of health services during the pandemic. Queensland Department of Health has subsequently signed an agreement with private providers setting out all contractual arrangements. MNHHS has a framework and operational guidelines to support interaction with private facilities and will assist CKW in their associations and partnership with Caboolture Private Hospital.

7.7 Influenza Influenza is a viral respiratory disease of global public health importance. The propensity for Influenza A viruses to mutate, and change the dynamics of the influenza season, is central to this importance. The seasonal pattern is one of outbreaks or epidemics in the winter months in temperate regions of the world, while in tropical areas influenza activity may increase at any time of the year. The disease varies in severity and may be mild to moderate in some people, but very severe in others. Infection in the very young, the elderly, pregnant women and those with underlying medical conditions, can lead to severe complications, pneumonia and death. In QLD, the influenza season occurs annually in southern and central areas typically between May and October. An Influenza surge can generally be identified and tracked; analysis of recent data suggests that influenza has a rapid rise in cases (e.g. tripling of admissions over a six-week period) but takes longer to dissipate (roughly taking 8-10 weeks to subside). Within MNHHS, over the last five years, an influenza surge has begun in the last week of June/early July, peaked in the third week of August and settled by early October. Due to the COVID-19 pandemic, pre-season efforts focused on increasing the resilience of staff and patients and identifying capacity creating options. The initial response to an influenza surge will focus on staff and patient safety and management and the provision of the essential clinical services; and the recovery will focus on the re-establishment of business as usual operations. Criteria for movement through the phases of MNHHS influenza plan activation and the associated actions for Metro North Emergency Committee and facilities will occur in the context of the COVID-19 response plan.

7.7.1 Placement of patients with Influenza For patients with ILI who are not COVID-19 positive but are pending results for influenza or who are confirmed positive for influenza, the following placement preference applies.

• Single room with unshared ensuite

• Single room with shared ensuite

• Cohort ILI in designated ward with >/+ 1-meter distance and curtains closed

• Four bed bays in a ward for cohorting- as designated by facility/service line Executive

Guidance for cohorting patients with ILI In the first instance, patients with ILI are to be managed with droplet and standard precautions, in single rooms with a private ensuite. If no single rooms are available, the following conditions are to be met before symptomatic patients can be cohorted.

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• Minimum distance of 1 meter between patients

• Curtains are to be pulled to create a physical barrier

• Enhanced decontamination of equipment and environment

Due to the dynamic nature of ED, the following risk mitigation strategies are to be considered.

• All ILI patients presenting to ED are to wear surgical masks if their clinical condition allow. Ideally this is provided at point of TRIAGE but should be provided whenever the ILI is first recognised.

• If the patient requires admission, the patients access to an inpatient bed is not to be delayed waiting result- the patient is to be isolated/cohorted based on their ILI.

7.7.2 Vaccination program

7.7.2.1 Staff vaccination Under workplace Health and safety legislation MNHHS has a duty of care and responsibility to control and minimise risks related to the transmission of infectious diseases. Minimising the incidence of vaccine preventable diseases through staff vaccination programs is designed to reduce the incidence of serious illness and avoidable deaths in staff, patients, and other users of MNHHS services. There is evidence that a vaccinated healthcare worker has a decreased risk of transmitting influenza to their patients and reduces absenteeism. Influenza vaccination is an expectation of all MNHHS employees. Immunisations will be available for staff members from the Infection Control Workforce Vaccination and screening service, or they may choose to be immunised by their own GP or at their local pharmacy and provide evidence of this vaccination.

7.7.2.2 Community vaccination A broad Influenza Awareness Campaign has targeted community and other stakeholders, in the context of the current COVID-19 pandemic. The campaign has included a Flu Briefing for media, in partnership with QAS, PHN and GPs. The key focus is to encourage the community to uptake vaccination available within the community.

7.7.2.3 Inpatient/outpatient vaccination To further mitigate the likelihood/severity of influenza in at-risk groups, and thereby reducing the impact on the hospital system., MNHHS is opportunistically offering inpatient/outpatient vaccinations from May until August 2020. Outpatients recommended for vaccinations will be referred either to their GP or community pharmacy as appropriate.

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 possible future waves – Maintain supports and preparation until risk has been removed.

• Undertake a range of monitoring and compliance activities associated with relaxations of restrictions, this is inclusive of key performance indicators, financial implications of the event, return to required FTE for normal services

• Return to a new normal, reactivation of clinic and surgical services

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Upon reaching control phase, MNHHS 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. MNHHS will adopt a phased approach for resuming business activities and determining strategies to assist with “catching up” where necessary.

9 Recovery 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. The Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) outlines activities associated with the 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.

MNHHS will work alongside CKW directorate to consider whether the community requires additional services to enable full psychological, social, economic, environmental and physical recovery from the effects of the COVID-19 outbreak. At risk groups may require additional supports. 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: Workforce Staff Query Flowchart Staff Query Flowchart

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Appendix 2 : Tier related bed capacity across CKW

Area

Contain Sustain Tier 0 Sustain Tier 1 Sustain Tier 2 Sustain Tier 3 Sustain Tier 4&5

ED 44 in total: • Paeds – 4 • Acute – 15 • Resus – 4 • Fast track – 6 • MH – 3 • SSU- 12

• As per Contain

Additional 7 spaces in: Allied Health area operating as the new fast track Conversion of fast track area (6 spaces) to operating as ILI zone

Reorganise the department into COVID and Non-COVID areas Non- COVID Old Depart – 4 beds and 3 recliners for short stay (paeds beds reassigned) + 15 acute + 4 resus + 3 mental health COVID - patients – 12 (SSU spaces) + 6 (fast track spaces) + procedure room (used as intubating suite–1 space) + 7 spaces in allied health

As Tier 2 Explore adjacent school gyms or halls for the hospital Explore alternative onsite arrangements such as OPD/DPU

ICU • 8 Patient

Capacity

As per tier 0 As per Tier 0 8 (8 vent) COVID pt nursed in Room 7

Extend into PACU and OT1 – additional 9 beds

Inpatient Single rooms, isolate for suspected/confirmed COVID-19 patients

As per Contain Single rooms, isolate for suspected/ confirmed COVID-19 patients (3B) assigned as dedicated ward cardiac patients in 3A room 9&10 and those requiring Aerosol Generated procedures in room 20/21 of 4A

Use 3B a primary ward for admission of COVID-19 patients

Expand COVID area into 3A this will be a hot ward meaning positive patients nursed in 3A and suspect nursed in single rooms in 3B. Establishment of “cold” cardiac unit within 2A environment.

Guided by MN

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