COVID-19 Pandemic Preparedness Checklist for Outpatient Settings

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IDENTIFY PLAN AND RESOURCES

Keep informed. The COVID-19 situation is constantly assessed as it continues evolving.
Review the Centers for Disease Control and Prevention's (CDC) "Steps Healthcare Facilities Can Take" for an overview of the steps facilities should take to prepare for an outbreak of COVID-19 and protect both residents and family members, as well as staff.
Review and update your pandemic preparedness plan. Ensure it considers the presentation and demands of an outbreak and it includes triggers for activation (e.g. circumstances and by whom).
Follow these steps to develop a pandemic plan: • Assign a person to coordinate preparedness planning, pandemic response coordinator. • Create a multidisciplinary planning committee or team to specifically address pandemic preparedness planning. Committee should include: o Facility administrator o Medical staff o Nursing o Reception personnel o Environmental services • Identify a point of contact (internal or as a consultant) for questions related to infection control.
Determine if your clinical setting can safely evaluate possible COVID-19 patients — those showing influenza-like illness (ILI) symptoms such as fever ≥38.0°C (100.4°F]), cough, shortness of breath or sore throat: • Identify a room or rooms where patients can be placed, ideally near the entrance/triage area. • Assess waiting areas for how you might separate patients with influenzalike illness from others by at least 6 feet. • Assess if there is a clinic section, unit, or floor that can be dedicated to seeing suspected COVID patients with ILI symptoms. • Identify an alternate space to see potentially infectious patients separately.

PATIENT MANAGEMENT

Implement measures to identify, isolate, and manage patients who may have COVID-19: • Call scheduled patients 1-2 days before the appointment to prescreen for symptoms of COVID-19, and advise them to not come in unless medically necessary or if they have mild to moderate illness. • Place a staff member entrance outside of the facility to screen subjective or measured fever, cough, shortness of breath or sore throat. Place mask on patients with COVID-19 like symptoms. • Consider policies to discourage walk-in visits. Patients should be encouraged to call ahead for a prescreen before entering the clinic. • Place visible signage upon entry to the facility directing visitors with fever or respiratory symptoms (i.e. cough, shortness of breath or sore throat) to notify staff • Train staff to place face masks on patients with COVID-19 like symptoms and ensure facial tissues, disposal receptacles, and hand hygiene materials are available. Keep face masks secured in registration area.
Separate patients with symptoms of COVID-19 from others, ideally in a private room with the door closed. If no rooms immediately available, keep patient separated from others by at least 6 ft.
Screening symptoms should include fever ≥38.0°C (100.4°F), new or worsening cough, new or worsening shortness of breath, or sore throat.
Develop care plans that reduce the number of staff caring for possible or confirmed cases and protocolize care.
Plan for the safe disposition of patients.
Determine at-risk and functional needs populations (e.g. age 50 years or older or who have chronic medical conditions) that may be impacted. • Take measures to assure they have access to care and essential medications. • Provide education on how to stay safe. • Provide remote consultation options to prevent unnecessary visits during widespread community transmission of COVID-19.

INTERNAL AND EXTERNAL COMMUNICATION

Implement a communication plan which includes how signs, phones, email, or other methods of information will be used to communicate with staff, patients, or other persons coming into the facility
Establish an emergency communication plan for staff working in the office and medical and nursing personnel.
Ensure staff have ready access to key clinic and public health points of contact
Identify a person for communicating with public health authorities or local officials during the pandemic.
Develop a list of health care entities and contacts you may need to communicate with during the pandemic.
Triage all incoming phone calls and regularly scheduled appointments for possible COVID-19 infection, including exposure and symptom history (e.g. fever, cough, shortness of breath).

EDUCATIONAL MATERIALS FOR STAFF AND PATIENTS

Designate a person in the facility to coordinate education and training on COVID-19.
Educate on potential harm of COVID-19 and how to protect self/patients. Education and training include information on infection control measures to prevent the spread of the pandemic: Proper identification, isolation, and evaluation of patients • Appropriate and frequent hand hygiene • Respiratory hygiene and cough etiquette, including sneezing/coughing into a tissue or elbow, wearing a surgical mask if needed, place used tissues in waste, and perform hand hygiene immediately • Staff training on relevant protocols including "How to properly put on, use, and remove PPE • Educate patients to stay at home if they are showing mild symptoms of the disease
Plan for providing just-in-time staff education via electronic and other nonclassroom means including information about COVID-19, transmission, infection prevention measures, clinical symptoms and course, treatment, risk factors, and complications.
Provide patients, families, and staff with information about stress responses, resilience, and available mental health/behavioral health resources.
Provide patients on resources on COVID-19 including transmission, prevention, usual clinical course, risks for more severe disease, and when to seek medical care. These materials should also encourage patients to have at least a 30-day supply of usual medications on hand.

INFECTION CONTROL PLAN

Review and update your infection prevention and control (IPC) policies and procedures
Instruct patients to use available advice lines, patient portals, online self-assessment tools, or call and speak to an office/clinic staff if they become ill with symptoms such as fever, cough, shortness of breath, or sore throat. • Identify staff to conduct telephonic and telehealth interactions with patients. Develop protocols so that staff can triage and assess patients quickly. • Determine algorithms to identify which patients can be managed by telephone and advised to stay home and which patients need to be sent for emergency care.
Infection control protocols for care of patients with possible COVID should include use of Standard, Contact, and Droplet Precautions with eye protection. An N95 respirator is only needed when performing aerosol generating procedures or when caring for patients in an intensive care unit. • Avoid any aerosol-generating procedures in the clinic, including nebulizer treatments and high flow oxygen. • If possible, aerosol-generating procedures should be conducted in airborne infection isolation rooms (AIIR). If AIIR is not available, patient should be treated in private room with the door closed. Limit the number of personnel entering the room. Once the patient leaves, the exam room should remain vacant for up to two hours before anyone enters. • Adequate wait time may vary depending on the ventilation rate of the room and should be determined accordingly At this time, outpatient providers are encouraged not to test for COVID-19 and to rely on clinical diagnosis
Protocol for how to properly put on, use, and remove personal protective equipment (PPE)
Ensure recommended PPE is in stock and available to patients and staff who need it. Implement measures to protect and conserve your PPE. • Strategies to optimize your PPE supply • Secure all PPE in a locked cabinet or closet but have supply readily available for when patients present with COVID-19-like symptoms.
Infection control policy should include the protection of non-clinical personnel including security, reception, and triage personnel.
Designate a specific waiting area for patients presenting with COVID-19-like illness. This should be a specific, well-ventilated space that allows patients to be separated at least 6 feet apart. Minimize time in waiting room.
Review, implement, and reinforce a plan to encourage respiratory etiquette through the facility.
Make alcohol-based hand rub accessible to patients and staff. Aid individuals who may have difficulties washing hands or using a hand rub.
Make sure tissues are available and sinks are well stocked with soap and paper towels.
Provide suspected/confirmed patient with a mask for source infection control.

ENVIRONMENTAL CLEANING

Review CDC recommendation on environmental infection control for COVID-19
Regularly disinfect high-touch surfaces including doorknobs, elevator buttons, and shared bathrooms.
Products approved by the Environmental Protection Agency (EPA) for emerging viral pathogens claims are recommended for use against COVID-19. If there are no available EPA-registered products that have an approved coronavirus or emerging viral pathogen claim for COVID-19, products with label claims against human coronaviruses should be used according to label instructions.
Provide disposable wipes so employees can wipe down frequently used surfaces before and after using them.

STAFF OCCUPATIONAL SAFETY PLAN

Enact a policy for a liberal/non-punitive sick leave (e.g. not requiring a provider’s note, allowing extra days when staff’s paid sick leave has been used) addressing the needs of symptomatic personnel. Policy addresses: • Staff becoming symptomatic at home and while working. • Personnel who need to care for an ill family member. • Personnel returning to work after having COVID-19
Plan to educate staff to self-assess and report symptoms of COVID-19. • Consider monitoring symptoms and temperatures of staff twice daily, one prior to each shift. • Personnel and volunteers should not report to work if they are symptomatic with fever, cough, shortness of breath or sore throat.
Plan for managing personnel at higher risks for complications from COVID-19 and try to accommodate them on administrative leave or altering their work location. • Plans should include policies and plans for working remotely
Provide list of mental health and faith-based resources to personnel during the pandemic.

SURGE CAPACITY PLANNING

Include plan for cancelling nonessential appointments and/or blocking off dedicated blocks of time to see potential COVID-19 patients.
Have systems in place for remote triage and assessment of patients to determine who requires a medical evaluation to limit office visits to those that are medically necessary. • Use telemedicine and other remote options whenever possible.
Consider alternate triage spaces and/or block times for patients presenting with symptoms of COVID-19 and those with non-COVID-19-related symptoms
Consider which clinics could be converted into inpatient units (e.g., surgical centers) when there is a surge of patients.
Consider plans for clinically managing higher acuity patients who you would ordinarily recommend seeking care at emergency department (ED).
Plan for staffing shortages • Cross-train staff in different duties, especially for essential services. • Consider how less-trained personnel could assist with operations. • Plan for the use of temporary staff and/or medical volunteers
Develop staffing plan to allow extended or decreased hours of service when needed.
Ensure the specific needs of pediatric and populations at-risk for contracting COVID are addressed in surge capacity planning
Review local testing guidance • At the time of the pandemic, outpatient providers are asked not to test asymptomatic patients for COVID-19 or those with mild to moderate illness
Develop a plan to address likely supply shortages. • Contact your suppliers and vendors to confirm availability. • Review recommendations for mitigating risk when there are limited PPEsupplies