COMMUNITY BASED ASSESSMENT CENTRE CBAC ORIENTATION CBAC Leadership
COMMUNITY BASED ASSESSMENT CENTRE (CBAC) ORIENTATION CBAC Leadership Team: Clinical Leader n. Nursing Leader n. CBAC Manager n 1
Aims and Objectives n Aims n n n To provide an effective “fast-track” training package to all CBAC staff To ensure all staff know how to protect their own and others safety Objectives n n n To enable staff to quickly and safely start working within a CBAC To help prevent the spread of infection using correct infection control methods To present an overview of individual roles within the CBAC 2
What is a CBAC n n Designed to be an assessment centre where patients with more severe flu-like illnesses can be medically assessed and provided with a limited range of treatment and advice The unwell community with mild flu-like symptoms should call the 0800 number 3
n n The aim is to provide minimise disruption to secondary and primary care health services. CBAC will be managing patients through a team approach which may result in changes to the way we normally practice. 4
Your CBAC Team may include: n n n n n Doctors Nurses – from secondary and primary care Nursing Assistants Pharmacists Admin Support – IT, Receptionists, Practice Managers, etc Allied health staff Security Welfare Support Ambulance staff Support staff – cleaners, stock/equipment support 5
Is it dangerous to work in a CBAC? n No – not if you follow good practice with n n n infection control PPE hand washing social distancing cough etiquette health and safety advice at all time 6
Self Care n n Remember to sign on Ensure you take regular breaks, drink lots of fluids Don’t forget - let the “Leadership Team” know if you need assistance, support, feeling unwell and just need “time out”! If you develop any flu-like symptoms then please advise one of the Leadership team. (Care and treatment will be provided. ) 7
Infection Control n n The aim is to stop the spread of infection between people Infection is spread by n Droplet transmission (Spread by coughing, sneezing & n Contact transmission (Spread by direct or indirect n Airborne transmission (Spread by direct inhalation) talking) contact) 8
Hand Hygiene Research proves the most powerful defence against infection is handwashing! Achieved by: ü Hand washing ü Alcohol hand rubs 9
Hand Hygiene with Alcohol-based Hand Rub 10
PPE – Personal Protective Equipment q. PPE protects yourself and your patient from risk of cross infection q Surgical scrubs – all staff to wear q Masks – all staff in close patient contact to wear N 95 masks; others to wear multipurpose masks q Goggles – for high risk only, eg swabbing q Gowns/aprons – all areas q Gloves – clinical areas 11
Sequence for Putting on PPE n n n Wash hands Put mask on Wash hands again Goggles if appropriate Gown/Apron Gloves 12
How to put on a N 95 Mask n n n Only wear a N 95 if you have been personally fit tested Place over nose, mouth and chin Secure on head with elastic – n n n top elastic first & then bottom elastic Fit flexible nose piece over nose bridge Adjust to fit by using both hands to mould the nosepiece to the shape of your nose by pushing inwards while moving your fingertips down both sides of the nosepiece. Always use 2 fingers as pinching with one hand may result in an improper fit and not be as effective Perform a check n Exhale – check for leakage around face 13
Using Goggles n n These are not disposable – please leave at CBAC Wash at the end of each shift in warm water with a detergent and dry with suitable cloth e. g. Chux Check quality of goggles regularly e. g. for scratches, cracks and visibility Throw out as appropriate 14
Sequence for Removing PPE is Critical – PPE is contaminated! n n n n Gloves Gown Wash hands Goggles Mask Wash hands again When any item of PPE is contaminated the ENTIRE PPE must be changed 15
Remember when using PPE n n n Clean hands pre and post use Keep hands (gloved) away from face Avoid touching or adjusting other PPE Remove gloves if they become torn, wash hands before donning new gloves Limit surfaces and items touched Make sure you keep yourself safe when removing your PPE – it is contaminated!! 16
Waste Collection CDHB are responsible for waste management. All waste should be placed in a secure area until collection n Security staff will change the waste bin liners regularly to avoid overfilling and the potential of the bag splitting or spilling n 17
CBAC Patient Journey n n Most patients will be given an appointment by the 0800 line; however there will be some who arrive without one. Entering the CBAC - All patients will be requested to use alcohol hand rub and to put on a mask CBAC Reception – data entry and symptombased questions will be collected Reception staff will be supported by clinical staff. 18
n n Put in the CDHB IT System overview, Appendices of how to enter details and copy of clinical record to be included 19
CBAC Patient Journey cont: n n As with all medical records, please ensure that all patient information and details of management/care recorded accurately and legibly. All patient records must be signed by the provider of care with their name clearly printed. 20
CBAC Patient Journey cont: n n The current model of care in a CBAC is working together - nurses, doctors and clinical assistants. All staff will need to work within their scope of practice and it is important to discuss this with other team members at the beginning of each shift. Initial assessment is generally be done by nursing staff; - documented baseline observations to be done As required a doctor will review with regard to treatment. 21
Patient Journey through the CBAC – the clinical record • • • Symptom history may have been obtained at Reception but additional history will be needed Assessment to be recorded on clinical record Treatment options may be verbal with written advice and/or prescription Limited treatment will be available e. g. , IM/oral antibiotics, bronchodilators through spacers, IV fluids Referrals options to other services will be limited 22
CBAC Patient Journey cont: n There are different categories of care for patients: n n Fast track (see later) Easily managed and discharged More complex patients (advice sought from secondary care) Admission required 23
Fast Tracking of patient care n n n People who appear to be only mildly unwell can be “fast tracked”. They are seen quickly and moved through the system to reduce their risk of crossinfection from other people. An RN may see these patients and seek clinical advice if unsure 24
Swabbing n Nasopharyngeal swabs still need to be carried out on a representative basis for the following patients: n n n n n All healthcare workers All people from institutions e. g. rest homes/prisons/NZ Defence Front line works (Police/Customs/Fire) ONE patient from each new cluster should be swabbed e. g. Workplaces with high levels of absenteeism (Telecom, CCC) Ethnic groups (previously unidentified as affected) Schools with clusters (C & PH) will notify the CBAC daily of the schools with increased absenteeism and this list will be updated – see separate sheet on this trolley) A daily random sample is also done on the first patient of the day (Another appendices) 25
Limitations to diagnosis and treatments q There are very limited access to Laboratory or Radiological services q Your assessment of patients will be based on the history and clinical findings q When prescribing please follow the latest guidelines for who is eligible for Tamiflu. (include this as an appendix) q Our stocks of pharmaceuticals are a finite resource; patients will often have adequate paracetamol etc at home. 26
Standing Orders Nurses will be permitted to supply or administer medicines but this will be a matter of professional judgement for the individual nurse Medicines covered by these standing orders will be limited to: n n n Tamiflu, paracetamol, Ibuprofen, O 2, salbutamol, electrolyte replacement Remember to document on patient clinical record (Copy of standing orders will be appendix) 27
Pharmacy n n There is a range antibiotics and limited stock of other medicines. These are stored on site and all have supporting patient information leaflets If script is required, do not give it to the patient, it must be faxed to a pharmacy and a well relative should collect. (see appendices) 28
Referrals n n Some patients may require additional care which is not available in a CBAC Referral options will be limited and constantly reviewed n n Support care at home e. g. nursing support, personal care, etc – the current CDHB referral form is to be completed and faxed Welfare support e. g. transport, food parcels, child care for sick parents – this is currently coordinated by Civil Defence and the CBAC clinical record can be used as referral form (this is currently under review and may be managed by the CDHB Social Welfare Dept in due course) 29
CBAC Patient Journey cont: n n All patients should receive self-care leaflets There are 2 forms of medical certificates. n n n If clinically diagnosed with flu all patients must receive the isolation certificate; this must be signed by a doctor If a patient requires the normal medical certificate then this can be signed by a registered nurse as part of the standing orders. (Include both as appendices) 30
Data Entry n n n All patient records are entered into the electronic database on a daily basis Copies of all records are faxed on a daily basis to the patients identified GP All clinical records then stored in a secure area (we need further discussion as to where to store the hard copies of these records) 31
Ordering and Storing Equipment/Supplies in a CBAC n n n All supplies/equipment within the CBAC are a finite resource and must be used with care CBAC facilities will not provide PPE to patients or their carers. The CBAC Manager is responsible for the ordering of all stocks and equipment, with deliveries arranged twice weekly. 32
Clinic Hours n n n Current clinic hours are 9 am – 9 pm A GP is designated as “shift leader” for the evening session, and is responsible for the clinical safety of the CBAC during this time The Clinical Leader and Nursing Leader can be called if there any concerns There is 24 hour security, and they are responsible for ensuring the premises are secured upon closure of the CBAC All pharmaceuticals are stored in a secure and locked area at the end of the evening shift 33
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