Alert level 3
Shivan

Shivan

Alert Level 3 COVID-19: A Week So Far

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The novel coronavirus (COVID-19) has disrupted the traditional flow of the optometry clinic, along with how businesses are run in the entirety of New Zealand.

The effects of this global pandemic have been unprecedented. Alert level 4 saw significant restrictions on how businesses could be conducted with only essential services remaining open. Optometry practices around the country were forced into closure with minimum operational ability.

The national response to the pandemic has been outstanding. The lockdown period has seen a significant decline in the spread of the disease. We as a nation must pat ourselves on the back as well as thank the frontline workers for all that they have done.

As we move into alert level 3, our operational procedures are less restricted compared to level 4. But they are far from normal. We will look at what changes have been made to comply with alert level 3 and better serve the community.

Alert Level 3
Table of summarises alert levels. Original from Unite Against COVID-19 | New Zealand Government

As a disclaimer, they are not hard and fast rules so please do the correct research and risk analysis for your business. A special thanks goes to the optometrists of the Matthews Eyewear Eyecare group for coming up with the bulk of this plan.

Work Bubbles

During alert level 4, there was a restriction in place where people had to stay at home and could not enter the business premises. 

As we move down to level 3, people are encouraged to still remain home if they have the ability to work remotely. In the case of optometry, work from home is not possible (yet). So, staff members are now allowed to return back to work.

The only difference is that the whole team cannot be present at work. 

Staff members have been split into separate work bubbles. Only one group can attend the practice at a time. 

The aim of work bubbles is to reduce the spread. If one person does get sick, the disease is contained in that particular work bubble and does not compromise the entire workplace.

Staff members in the same bubble are required to remain 1 meter apart.

Locking the Doors

Traditionally, you would be able to visit your local optometrist by walking straight through the door, chatting with the delightful staff, and getting an appointment.

Entering into level 3, though staff members are permitted to be at work, customers or patients are not allowed to enter the workspace for non-urgent reasons.

This means the front door has been locked as a precaution to prevent those entering the building unannounced.

Triaging Urgent Patients

Patients can no longer attend the clinic at their own free will. We are only seeing people by appointment and with a maximum limit of one at a time.

Before an appointment can be booked, first they must call. Then, it is determined if their issue is an emergency eye care issue or if it is a problem with their glasses, requiring replacement or repair.

If it is deemed a repair or replacement of their glasses, we can only perform these duties if they have no backup pair and that their sight is significantly impaired without glasses.

An attempt is made to pick the glasses even without coming in to store using the data from the previous pair purchased. If this proves difficult, then the patient will come in for a selection of glasses and necessary fitting measurements.

Introducing Phone Consultations

If the patient is deemed they have an issue with their eye, they are booked for a phone consultation with an optometrist, which is billable.

The optometrist will ask a series of questions like the onset of symptoms, pain, flashes or floaters, and so on to determine if the eye concern is urgent enough to see during alert level 3.

If it is deemed not that urgent, reassurance is provided and then a booking will be made when the alert levels drop.

Questionnaires 

Before patients enter the clinic, we ask them to complete a questionnaire.

Questions generally pertain to any possible COVID-19 red flags such as recent travel, or any symptoms related to COVID-19.

If any questions are positive, we encourage them not to come into the store and any emergency eye care issues are directed to the local district health board, who are more equipped for disease containment.

Example of Door Signage

Door signage is important to explain procedures of entry into the practice, such as sanitising hands-on entry and socially distancing by 2 meters.

It is important to let the patients know that the door is locked, who they need to call to be able to talk to staff, and that there will be only one person at a time. 

The exception to this one-person rule is if the person requires a support person, who presumably will be in the same bubble.

Alert Level 3
Example of door signage explaining alert level 3 procedures

There are excellent resources provided by the New Zealand Government, here, to make your own door signage.

Limited Testing Times

After a patient has been triaged and deemed necessary to come in for a physical examination.

To reduce contact time with patients, we are performing shorter exams to amount to fifteen minutes in length maximum.

For example, a patient has lost their glasses and their previous prescription is unknown. A quick check of the prescription will be performed. Then, the patient will be asked to return to complete the rest of the less urgent examination procedures when the alert levels have been dropped.

When performing history and management portions of the examination, instead of conducting this in the room, the patients can be taken out into an open area to abide by a 2-meter social distancing policy. This decreases contact time, allowing more time for important tests.

Personal Protective Equipment

While a patient is present in the clinic. Staff must wear personal protective equipment.

Personal protective equipment includes nitrile, powderless free gloves, and a surgical mask. No gown is worn.

Staff receives training on how to put and take off gloves and masks. Regular hand washing is a must as well.

Practice Setup

The set up of practice and clinic space is vital to reduce the spread of this disease.

Tape has been laid 2 meters around the reception area to prevent patients and staff members from coming to close to each other. It also is a reminder for patients and staff to maintain 2-meter social distancing.

Clinic rooms must also have bare essential items as these will need to be cleaned routinely and between every patient interaction.

Embracing minimilism in the clinic

Diluted bleach works well for general surfaces, while 70% isopropyl alcohol swabs are good to clean more sensitive devices such as keyboards and mouse.

Contact Tracing

When patients enter the clinic, their details are recorded as per contact tracing regulations.

Conclusion

Alert level 3 has proven to provide a very challenging time for optometry. Operation is definitely not the same as it was before the unprecedented pandemic of the novel coronavirus.

We have worked through some examples in our first week on alert level 3 for procedures to help control the spread of the disease, while also helping the public with the services that we have to offer.

Once again, I hope you have this useful. What are some interesting ideas you have implemented for working at alert level 3? Please comment below.

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