Outbreak Management Planning in Aged Care – from Aged Care Quality and Safety Commission

The Commission recently released their Outbreak Management Planning in Aged Care guide that provides practical guidance to support COVID-19 outbreak management planning and preparation in residential aged care facilities. As stated by the Commissioner in the message to providers, “A COVID normal environment is one in which you need to continuously monitor for, and actively manage, the risk of COVID-19. You will need to practise an adaptive approach to managing COVID-19, escalating and deescalating your service’s activities in response to changing conditions and risks. As a provider of aged care, you have an ongoing duty of care in relation to outbreak management planning. You must understand your responsibilities around outbreak management and remain vigilant, including by practising enhanced infection prevention and control and being ready to act at a moment’s notice.”

The critical elements and principles have been summarised from the guide including actions and questions to test outbreak management planning.

Contact Critical Success Solutions for assistance with implementing these actions and for Business Continuity Planning and Testing.

Infection prevention and control (IPC)
Actions:

  • Ensure your IPC procedures are up to date and comprehensive.
  • Ensure staff are trained in relation to IPC.
  • Continually remind staff about their IPC responsibilities.
  • Prepare IPC resources.
  • Ensure you have sufficient stock of hand sanitiser and soap.

Test your outbreak management plan:

  • How do you know that your infection control processes align with the current minimum expectations regarding IPC for COVID-19 and of any specific requirements in your jurisdiction?
  • How do you know that all staff at the service understand their infection control responsibilities?
  • What infection control protocols will visitors at the service need to observe?

Screening, monitoring and testing
Actions:

  • Develop a process for the ongoing monitoring and testing of residents.
  • Ensure you are familiar with your local pathway to refer residents for COVID-19 testing and the role of your public health unit in relation to testing.
  • Develop a strategy for notifying residents and their representatives of a positive test result for COVID-19.
  • Review the service’s human resource policies and leave arrangements to ensure they require staff to stay home if they are unwell.
  • Develop a process for the routine screening of staff and any visitors to the service.
  • Maintain a visitor log and ensure all visitors entering the service sign in and out.
  • Maintain accurate records of staff attendance.
  • Assign a person who will be responsible for supporting contact tracing and consider how they will obtain information to support contact tracing in the event of an outbreak.
  • Develop a system to manage close contact testing.

Test your outbreak management plan:

  • How do you know that staff can identify typical and atypical signs of COVID-19?
  • What is your local pathway for COVID-19 testing?
  • In the event of an outbreak, how do you know that you have all the information required to support efficient contact tracing of all residents, staff and visitors to the service?

Isolating and cohorting residents
Actions:

  • Communicate with people receiving care and their representatives prior to any outbreak.
  • Using your floorplan, develop a plan for cohorting residents.
  • Identify the additional equipment you would require to cohort residents.
  • Prepare a template for recording which residents have tested positive, have been in close contact with a positive case or are showing symptoms.
  • Consider how you will physically relocate residents.
  • Prepare signage to display at the entrance to isolation areas.
  • Determine how you will manage residents with wandering behaviours.
  • Identify how you will manage residents who have completed their isolation period following a confirmed case, and their placement in the service.

Test your outbreak management plan:

  • Check that your plan for cohorting residents aligns with the advice provided by the Department of Health, the Commission and the public health unit. 
  • What do you need to do with regards to cohorting consumers at the service, including in relation to the size and layout of your service and the care needs of the consumers?

Personal protective equipment (PPE)
Actions:

  • Ensure you have sufficient supplies of PPE for 48 – 72 hours.
  • Identify how PPE will be sourced, stored and disposed of during an outbreak.
  • Ensure staff have been trained on how to use different types of PPE.
  • Prepare signage to guide staff in donning and doffing PPE.
  • Develop a strategy for monitoring appropriate use of PPE.
  • Ensure that PPE will be accessible for staff close to where they need it.

Test your outbreak management plan:

  • How do you know that infection control measures will be taken, and PPE will be appropriately used by staff and visitors to the service?
  • How will the service source additional PPE during an outbreak?

Cleaning
Actions:

  • Ensure cleaning supplies are available.
  • Develop a plan for enhanced cleaning of the service environment during an outbreak.
  • Develop processes for using and cleaning equipment during an outbreak.
  • Ensure staff are trained in relation to environmental cleaning practices and the cleaning of reusable equipment.

Test your outbreak management plan:

  • How will the service access additional cleaning supplies during an outbreak?
  • How do you know that the service will be able to meet additional cleaning requirements should your cleaning staff become furloughed or need to be replaced?
  • How do you know that equipment will not be a source of contamination between people receiving care or staff?

Waste Management
Actions:

  • Consider how you will ensure waste is stored safely on site.
  • Removal of contaminated waste during an outbreak.
  • Ensure staff have undergone training on handling and disposal of the different types of waste.

Test your outbreak management plan:

  • How will the service access additional waste removal services during an outbreak?
  • How do you know that your waste will be handled safely even where your usual staff may be furloughed?
  • How will you safely store waste?

Human Resources
Actions:

  • Determine your minimum staffing requirements.
  • Develop a plan for cohorting staff.
  • Identify staff who are willing to work during an outbreak and any mitigating arrangements that can be put in place
    in the event of an outbreak.
  • Identify ways to manage the increase risk of fatigue on your workforce during an outbreak.
  • Consider how you could utilise staff that are furloughed (or otherwise unable to work on site) to continue to support the service.
  • Develop a plan for quickly engaging, inducting and managing additional staff in the event of sudden staff shortages.
  • Identify how you plan to manage the return of furloughed staff to the service.
  • Consider essential training needs for new staff (with a strong focus on IPC) and assign responsibility for ensuring all new staff
    are appropriately inducted and trained.

Test your outbreak management plan:

  • What are your minimum workforce requirements to deliver care and services in the event of an outbreak, including necessary staff numbers, roles and qualifications?
  • What is your plan to quickly engage additional staff as required and what mechanisms have you put in place to ensure these staff can ‘hit the ground running’?
  • How do you know that new staff have been equipped to deliver the care and services required?

Communications
Actions:

  • Consult and communicate with residents and representatives at all times.
  • Update your resident representative contact list.
  • Prepare a templated email to advise residents and their representatives of a COVID-19 case at the service.
  • Prepare a strategy for communicating sensitive news and information to residents and their representatives.
  • Establish a process for providing regular advice to residents and their families.
  • Establish a team that will be responsible for managing inbound calls to the service.
  • Communicate regularly with staff at all times.
  • Ensure staff are familiar with the outbreak management plan and their role in it.
  • Prepare a templated email/communication to advise staff and service providers of a COVID-19 case at the service.
  • Establish a mechanism for communicating critical information to staff and service providers.
  • Ensure the service has devices and resources to help staff to communicate both onsite and remotely.
  • Involve other service providers and government agencies in your outbreak management planning.
  • Develop a process for notifying external agencies of an outbreak.
  • Develop a strategy for managing media.

Test your outbreak management plan:

  • How will you ensure that care recipients will be sufficiently informed and prepared for the likely changes in the event of an outbreak?
  • How do you know that communications with representatives will be regular and appropriately managed?
  • How will all relevant staff and service providers be contacted at critical times?
  • What is the procedure to ensure that new, emergency or agency staff will be quickly added to the distribution lists and contact lists to receive these communications?
  • How will staff be provided with up to date information about their obligations and what is expected if they are a close contact or feel unwell, etc.?
  • How do you know that you will be able to comply with your obligations in relation to notifications when an outbreak occurs?
  • How are you going to effectively manage ongoing communications with external agencies

Supporting Access
Actions:

  • Prepare signs that can be placed across the service.
  • Determine how you will manage visitors who are not required to be onsite at the service.
  • Prepare a strategy for communicating visitor restrictions with residents and their representatives.
  • Consider ways to enable visitors to attend the site.
  • Establish protocols to enable residents to leave the service.
  • Enable residents and their loved ones to provide feedback on your access arrangements.
  • Establish alternatives mechanisms for communication.
  • Identify the external health professionals and service providers that provide care and services to residents.
  • Identify any partner/s in care for each resident and establish or update partner in care arrangements.
  • Establish a mechanism for health professionals, service providers and partners in care to handover any important care information to staff at the service as required.

Test your outbreak management plan:

  • How will you be able to quickly identify who is onsite at the time a positive case is confirmed and identify who can remain onsite and who will be asked to leave?
  • How will you maximise the ability for residents to engage with their loved ones (and enable continued visitor access in line with State and Territory directives) wherever possible?
  • How do you know who are the service providers and partner/s in care involved in each resident’s care?
  • What protocols do you have in place to enable continued access for service providers and partners in care?

Care and Service Delivery
Actions:

  • Ensure there is a system for readily identifying residents and their care needs for staff who don’t know them.
  • Check that care plans are up to date, accurate and comprehensive.
  • Identify residents with high risk clinical conditions.
  • Consider how you will deliver care to residents with cognitive impairment.
  • Undertake a risk assessment.
  • Ensure staff (existing and new) can readily access information relevant to the delivery of care.
  • Understand and record details for the external supports that can be accessed.
  • Determine the systems you will need in place to monitor residents’ clinical needs and to be responsive to deterioration.
  • Consider how you will administer and manage medication during an outbreak.
  • Consider how you will monitor and manage the weight and nutrition of all residents during an outbreak.
  • Develop a strategy for supporting residents to engage with family and friends in line with local public health directions.
  • Ensure the service has devices and resources to help residents to communicate with their families via phone and video.
  • Consider innovative strategies for supporting residents to engage with the activities that are important to them during an outbreak.
  • Determine how you will monitor the emotional well-being of residents during an outbreak.
  • Have a plan to prevent the physical deconditioning of residents.

Test your outbreak management plan:

  • How will you ensure that all residents will get care and services in accordance with their care plans?
  • How will all staff (including new staff) be able to access clinical information and know where to record care delivery?
  • How do you know that you will have sufficient medication for people receiving care at the service and that best practice medication administration will not be affected by an outbreak?
  • How will residents be appropriately monitored for hydration and nutrition during an outbreak?
  • How will residents be able to communicate and connect with their representatives and family members, and be supported to participate in their community?
  • What changes will need to be made to activities to allow these to continue during an outbreak?
  • How will you keep residents connected with their family and friends during an outbreak? 
  • How will you monitor the emotional well-being of people receiving care at your service during an outbreak?

Kitchen and Food Services
Actions:

  • Ensure infection control procedures are in place for kitchen staff.
  • Determine how you will engage additional kitchen staff if kitchen staff are furloughed in the event of an outbreak.
  • Consider how meals will be provided to each resident in the event of an outbreak.
  • Identify contingency plans for providing meals if the kitchen needs to close due to contamination.

Test your outbreak management plan:

  • How will all residents be able to receive food that meets their nutritional needs during an outbreak?
  • How do you know that the service will have sufficient staff to manage the preparation and delivery of meals (including feeding care recipients where needed)?
  • How do you know that the infection control procedures in place in relation to meal preparation and delivery will be sufficient during an outbreak?

Laundry Services
Actions:

  • Ensure comprehensive infection control procedures are in place for laundry staff.
  • Determine how you will engage additional laundry staff if laundry staff are furloughed in the event of an outbreak.
  • Consider how laundry services will be managed in the event of an outbreak.
  • Identify contingency plans for providing laundry services if the laundry needs to close due to contamination.

Test your outbreak management plan:

  • How do you know that the infection control procedures in place in relation to laundering are sufficient to reduce the likelihood of an outbreak?
  • How will the service maintain laundry services should staff be furloughed?

Transferring Residents to Hospital and other settings
Actions:

  • Update and maintain your resident contact list.
  • Contact representatives in advance of an outbreak about the possibility of transfers and the additional support available should transfers occur.
  • Understand the available options for residents who indicate that they wish to be transferred out of the service in the event of an outbreak.
  • Update and maintain your hospital and medical service contact list.
  • Ensure relevant staff know how to access and complete any transfer advice forms.
  • Ensure residents have reviewed their advance care directives.
  • Ensure you know what information, medications and equipment must be transferred with the resident.

Test your outbreak management plan:

  • Do you have the correct contact details for representatives for all residents?
  • How will you support care recipients to safely relocate out of the service if this is their preference?
  • How do your systems support you to readily identify which residents are onsite, in hospital or have relocated at any given time?
  • How do you know residents will be transferred with sufficient information about their clinical care needs and with all relevant equipment, medication and belongings?

New and Returning Residents
Action:

  • Determine how your admission process differs to your normal processes and what additional steps/information may be required.
  • Subject to room availability and occupancy, identify where you can place a new or returning resident within a service to reduce their contact with other residents in the short term.

Test your outbreak management plan:

  • How do you know your procedures mitigate the risk of admitting or re-admitting residents who may introduce a COVID-19 risk?
  • How do you know that new and returning residents are informed about the infection control procedures at the service to reduce the risk of an outbreak?

Care of the Deceased
Action:

  • Review your processes for the management of deceased bodies to consider changes required in the event of an outbreak.

Test your outbreak management plan:

  • How will the body of a deceased resident be managed to avoid any infection control concerns?
  • How will you be able to effectively communicate with representatives following the death of a resident and ensure the safe return of their belongings?

End of an Outbreak
Action:

  • Identify the parameters for declaring an outbreak over.
  • Consider how you will communicate the end of an outbreak.
  • Consider what supports you will provide to residents.
  • Consider what supports your staff might require following an outbreak.
  • Determine how the service will undertake ongoing surveillance.
  • Identify the infection control measures that will remain.
  • Plan for how your workforce requirements may change.
  • Determine how you will conduct a review.

Test your outbreak management plan:

  • How will the service transition back to ‘business as usual’ operations following the end of an outbreak?
  • How do you know that your systems support ongoing vigilance against COVID-19 being re-introduced?
Aged Care

Keep Informed #COVID19 December 2020

26-02-21
Home Care

Outbreak Management Planning in Aged Care – from Aged Care Quality and Safety Commission

26-02-21