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The Royal Children’s Hospital Operating Brief COVID-19 Pandemic Plan October 2020

Table of Contents

1. Purpose ..................................................................................................................... 2 Definitions........................................................................................................................... 2 2. Emergency Department Process .............................................................................. 4

3. Laboratory Services Specimen Handling and Testing ............................................. 5 4. Wallaby process ....................................................................................................... 7 5. Specialist clinics plan ............................................................................................... 9

6. Medical Imaging .................................................................................................... 10 7. Access .................................................................................................................... 12

Discharge of Patients ........................................................................................................ 13 8. Interstate hospital transfers .................................................................................... 13 9. Access to inpatient wards....................................................................................... 14

Aerosol Generating Procedures ........................................................................................ 15 Hand Hygiene ................................................................................................................... 15

Visiting Policy RCH Parent/Guardian .............................................................................. 16 Equipment ......................................................................................................................... 16

Waste................................................................................................................................. 16 Environmental Cleaning ................................................................................................... 17

Management of Code Grey ............................................................................................... 17 10. Paediatric Intensive Care Unit ............................................................................... 18 11. PIPER Transport /suspected/confirmed COVID 19 .............................................. 18 12. Internal Procedure Operating Theatre .................................................................... 19

13. Crèche .................................................................................................................... 19 14. . Management of Food and Water services ............................................................ 20 15. Managing Staff....................................................................................................... 21 Staff screening at entry points ........................................................................................... 21

16. End of Life care ..................................................................................................... 21 17. Banksia Inpatient Mental Health Services ............................................................. 21 Banksia Ward - Communicating with consumers and carers ........................................... 21

Mental health patient Day or overnight Leave ................................................................. 22 18. Communications .................................................................................................... 22 19. Appendix ................................................................................................................ 23

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Purpose

The purpose of this plan is to provide guidance to The Royal Children’s Hospital (RCH) departments and staff in managing events related to sustained pandemic situations. This document details RCH’s response to both a short-term and sustained event in order to satisfy the following requirements: Effectively manage suspected or confirmed cases and fulfil the role of designated hospital as per the Victorian Health Management Plan for Pandemic COVID-19 2020 Continue to deliver paediatric health care services Minimise the risk of cross infection of COVID 19 cases with staff or other patients This plan will align with the

RCH Pandemic Procedure – https://www.rch.org.au/policy/policies/Pandemic_Influenza_-

_Patient_Management_RCH/ RCH COVID-19 Guideline https://covid.rch.org.au/wp-content/uploads/2020/08/2019-Novel-coronavirus-COVID-19-RCH-guideline-12082020-1.pdf This plan follows the patient flow through presentation to the Emergency Department and the triage and isolation process and testing process and then details the various other possible clinical departmental impacts. Definitions

VIDRL – Victorian Infectious Diseases Reference Laboratory

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Potential areas affected

Numbers of Presentations to ED within 1 week (Monday to Sunday)

0 > 4 4 > 20 21 > 100 101 >

ED Rooms Respiratory clinic – Reception H

Patient Transport

Inpatient Bed

NICU / PICU

Dolphin Pandemic zone activation Admission for case definition

non HDU/ICU

Pts

Pathology Tracking – VIDRL – to & from

Mortuary

Theatres

Food Services

Imaging

P.P.E.

Workforce planning

Crèche alert

Specialist Clinics

Wallaby

Access

Banksia Unit – IMHS

Tenants – communication Campus partners

daily

Communication DHHS Notification positive

Communication – staff and families daily

Communication – GP’s / community care

As required

Communication – M.FB Pandemic

1st Escalation

point

2ndt Escalation

point

3rd Escalation

point

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Emergency Department Process

A patient may be suspected due to the following factors:-

Returned from overseas within past 14 days: OR

Have had contact with a confirmed case within Australia

Meet the case definition: see algorithms Fever, or chills in the absence of alternative diagnosis or acute respiratory symptoms including cough, shortness of breath, headache, sore throat, runny nose, nausea, loss of smell or taste, vomiting or diarrhoea

The patient and any symptomatic family members will be required to don a surgical mask as soon as possible after arrival in the hospital Emergency Department (ED). During triaging assessment, if the patient is clinically well they will be sent in hours to the Respiratory clinic Monday to Sunday access via white lifts to Reception H. After hours they will be seen in ED. For clinically unwell patients, the patient and their family will be isolated in the ED negative pressure room when available or Resus if clinically required. Transmission based precaution practices in this area will apply as per guidelines .When possible a single nurse will be assigned to the child and the number of staff in contact with the patient minimized. Procedures where possible will be performed in the negative pressure room. Where this is not possible ensure cubicle has the door closed, or within Resus. Transfer to an inpatient bed will occur dependent on clinical status. Investigations recommended are upper respiratory tract specimens, include nose and throat swabs or a nasopharyngeal aspirate. Specimens must be clearly labeled with and the request must include accurate clinical details. (Refer to Definitions above).

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Laboratory Services Specimen Handling and Testing

To provide guidelines for the handling and testing of specimens from patients with suspected or probable COVID19

Scope All specimens received by Laboratory Services where the clinician has requested SARS-CoV-2 testing. Responsibility for sampling

Person Responsibility

All staff To follow this procedure and if unsure how to proceed under particular circumstances, contact an appropriate senior staff member for advice. Do not leave specimens un-processed.

Senior staff To ensure that staff are familiar with, and trained in this procedure.

Specimen Collection Details Specimens will generally be collected in the Emergency Department, Respiratory Clinic or in-patient areas. For Respiratory virus testing and SARS CoV-2 testing – use a single dry flocked swab only, order both tests. For SARS CoV-2 testing only – a dry flocked swab or swab in universal transport media is suitable Specimen transport Specimens are transported as per routine specimen transport procedures; place the specimen in the zip-locked area of the biohazard bag and the paper pathology request in the open side compartment. Make sure that the specimen bag is completely zip-locked. Specimens may be sent by Pneumatic tube or in person to the laboratory specimen reception on Level 4 East building Specimen Reception Register Respiratory panel, SARS CoV-2 and other pathology requests according to the tests requested as per standard procedures upon arrival in the laboratory All routine procedures including specimen acceptance criteria and use of PPE apply. Bacteriology & Molecular Microbiology Follow standard laboratory procedures for handling of respiratory pathogens including use of Class 2 biological safety cabinets and PPE. Other samples

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Samples including blood and other fluids from patients with suspected or confirmed COVID 19 should be handled in accordance with routine laboratory practice including use of PPE. Class 2 biological safety cabinets and appropriate PPE should be used where procedures create a risk of aerosolisation Anatomical Pathology Handle fresh histopathology specimens (such as a lung biopsy) in the standard manner in a Class 2 biological safety cabinet whilst wearing appropriate PPE. Once specimens are fixed in formalin there is no risk of infection. At RCH non-coronial autopsies will not be conducted during the Covid-19 pandemic, the process for coronial autopsies remains unchanged. At RWH perinatal autopsies will proceed with the use of appropriate PPE as per laboratory procedure. Results Test results will be available in EMR. Any positive SARS CoV-2 result will be notified to the medical microbiologist by laboratory staff As SARS CoV-2 is a notifiable result, all positive results are auto-faxed to the Department of Humans Services. A daily spread sheet of all SARS CoV-2 results is generated and available on an RCH network drive for the Respiratory Clinic Staff. Results are to be provided to the patient by the medical staff.

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Wallaby process

Principles of assessment by Wallaby nurses:

Patients managed in the community by to Wallaby will be assessed during their scheduled visit The purpose of the Wallaby visit is: To detect clinical deterioration in the patient and ensure deteriorating patients are referred back to ED in a timely fashion. In a well child who presents with new symptoms as per case definition after discussion with medical staff swabs for COVID-19 will be undertaken Wallaby to provide portable oximeter to COVID-19 positive patients for spot check observations in conjunction with telehealth visits where possible. Wallaby staff will advise parents regarding appropriate infection control measures and the need for self-isolation at home whilst they await results. In the event of a child staying at Hospital accommodation such as Ronald McDonald House requiring swabs. Wallaby staff will need to discuss the transfer of the child for admission to RCH until results are back. They will need to inform the House manager of a suspected case so that appropriate cleaning measures can be taken by staff and if possible the family room closed. Alternate parent accommodation may be sought i.e. Hotel room if more than one parent staying with the child. Wallaby screening questions asked before every visit:

Questions for parents/carer/legal guardian o Has your child or anyone in the household had an unexplained fever in the last

24 hours? o Has your child or anyone in the household had respiratory symptoms in the last

24 hours (for example, shortness of breath, cough, sore throat) Has your child(patient) or your family arrived from overseas in the last 14 days?

o Has your child or anyone in the household been in close contact with confirmed OR suspected COVID-19 in the last 14 days?

If the answers yes to any of above: – please wear PPE

If patient has unexplained fever or new respiratory symptoms- discuss with Wallaby Fellow/Consultant and COVID swab to occur during Wallaby visit.

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If family members meet COVID-19 case definition for COVID testing- direct family to external screening clinics.

o Before visit Wallaby request one parent/guardian to be present in the room at the time.

o Wallaby will attempt to group COVID positive face to face visits to one nurse.

Wallaby PPE - This is for all patients with suspected and confirmed COVID-19 or with

unexplained fever or new respiratory symptoms.

Surgical masks: All front line Wallaby staff will wear a surgical face mask every time they visit a family.

AGP’s: aerosol-generating procedures (AGPs) are suctioning, nebulisers, regular airway clearance, spirometry, including huffing and coughing, non-invasive ventilation - for all patients with suspected or confirmed COVID AND all other acute respiratory tract infections requiring AGP’s

o Swap to N95 masks - used with full PPE (gown, eyewear, gloves). o Surgical masks- used with apron and eyewear for all other patients

requiring AGP’s

Don and Doff PPE Wallaby. o Don PPE as per hospital guideline before entering house o Doff PPE as per hospital guideline outside of house and leave in waste

bag at family house. All equipment to be wiped down with Tuffie 5 following each patient contact.

Respiratory Swab on Wallaby Plastics box outside house with lid off

Don PPE

Collect swab leave house and drop swab in box

Doff PPE and put in waste bag outside house

Hand hygiene and put lid on plastic box and take to car.

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Specialist clinics plan

Transition to Telehealth/Telephone Process

Given the specific nature of patient requirements and medical histories the decision for all patients to have either a face to face or telehealth/ telephone appointment is made by each individual clinician. The SPC leadership team providing oversight of changes within a timely manner.

Stage 1 Completion of the first week of appointments. Stage 2 Complete the appointments for the remainder of next 4 week period Stage 3 Department to indicate they ongoing arrangement for the following:

Urgent referral management

Urgent Review appointment management

Waiting list management

Volume of patient per clinics Resources available on the COVID home page:

Telehealth tip sheets have been created to support clinicians.

Support telehealth login provided by the Telehealth Coordinator.

MBS billing tip sheets have been created to support clinicians.

Scripts and Pathology collection process developed – tip sheet on workflow

Setting up of Specialist Clinics Area (barriers, waiting area and signage)

Screening: Phase 1

Initial screening regarding travel status and a wellness check is undertaken at desk reception check in.

Any unwell patient or family member is managed in a room with door closed, staff wearing droplet precautions.

Phase 2

All access to Specialist Clinics areas is through single screening process. All patients and family members presenting have had a temperature check as well as the ongoing travel and wellness check.

Limited the number of parents/guardians to one along with the patient. Exceptional circumstances are taken into consideration.

SMS sent to families before clinic appointment noting wellness screening and visitor restrictions

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Waiting Area:

In line with social distancing requirements all lounges will be removed from Specialist Clinics. Seating is reduced to groups of two seats 1.5 meters apart. All check in lines were also spaced per the requirements.

Communication:

Internal communication is used regarding social distancing and hand hygiene is used throughout the department.

External SMS communication is used for all Specialist Clinics appointments to remind families not to attend if they are unwell as well as the ongoing visitor restrictions.

Clinic Rooms:

All clinic rooms with superfluous stock, toys and should have items removed to assist in cleaning.

Curtains, linen and fabric covered chairs must be removed.

Excess chairs should be removed in line with the visitor restrictions.

Medical Imaging

This procedure applies to all MITs who perform Mobile x-rays.

Ensure appropriate Radiation Protection and droplet precautions are applied to protect staff, patients and visitors

Requests for mobile imaging:

Wards requiring a mobile X-ray will place the order in EPIC contact the MIT on ext.: 57088 to request mobile imaging. The MIT will require the following information before attending the ward:

Patient Name and UR number

Patient Bed Number and Ward

The type of required imaging (e.g. Chest / Abdomen X-ray)

Patient Weight

The urgency of the request Appropriateness of Request: In general, mobile imaging should only be performed when the patient is;

too ill or unstable to attend the MID

under precautions

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The examination must be carried out in accordance with transmission based precaution signage displayed outside room (for contact, droplet or airborne precautions), staff are to comply with personal protective equipment (PPE) required (gown/apron, eyewear, mask), and following practices for hand hygiene.

The imaging plate and machine controls will be cleaned before room entry and on room exit with disinfectant wipes e.g. Tuffie5s,

The imaging plate is to be placed into a plastic bag prior to being placed under the patient

On completion of imaging the plastic bag is to be disposed of in the rubbish bin inside the patient room

Radiation Protection

All X-ray imaging at RCH is performed in accordance and adherence with the ALARA Principle and the RCH Radiation Management Plan. Refer Appendix C

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Access

Normal process regarding referral to RCH remains in place. Where a child or adolescent is referred to RCH and care can be undertaken at another Tertiary Hospital RCH will decline accepting the patient. Refer Appendix D In the event of an inter hospital transfer admission of a positive or suspected COVID 19 result in a well child that requires an inpatient bed (exclusive to PICU/Dolphin) the following process will occur:

Hospital notification of impending arrival

a) The crew to notify the AV clinician via in vehicle radio approximately 10 minutes prior to arrival at RCH.

b) AV clinician to call RCH (Bed/Hospital Manager) on 0402 826 229 with

approximate ETA

RCH prepare for ambulance/patient arrival

Carpark boom gate to be opened. Spotless Security will be notified by Bed/Hospital Manager of arrival ETA, will observe on screen, and open boom-gate remotely Bed/Hospital Manager to request Ward Nurse present to access door to allow entry, and guide to ward location

Ambulance crew arrival

Enter RCH carpark, driving past the Emergency Department drop-off entrance, through the open boom-gate, and towards the windowed fire-door. The specific ambulance parking space will be identified by a sign Please ensure the ambulance does not block the PIPER Unit vehicle/s. RCH staff will open the door and escort to ward location Where possible 2 ward Nurses wearing appropriate PPE will support the access to the lift 24 or 25 and ward using appropriate PPE ensuring cleaning for doors and lift buttons- only in the event of aerosol generating procedures is there an escalation to Carps for full lift cleaning. Ensure that the patient (if possible) and the accompanying family/carer wear masks for transport.

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Discharge of Patients

Confirmed positive patients should be discharged via LG caged car park by family car, staff will escort via silver lifts in Full PPE and open all access doors and ensure cleaning as they go. If no private transport is available a non-emergency ambulance can be used notifying the AV that the child is positive- exiting via the same process Parents who are positive are not allowed on site unless authorized for extreme circumstances by DDHS.

If a positive parent is approved to pick up their child the same process occurs- they must not exit the car on arrival at RCH staff will escort the child to the car in full PPE. Ward staff should speak with the family to arrange an appropriate time for pick up and ensure the car has an appropriate child restraint( avoid any car park delays) Discharge of children whose result is pending can be discharged by family/friend car/ taxi if appropriate (with appropriate child restraint) or non-emergency ambulance

Interstate hospital transfers

The process to accept referrals for interstate patient’s remains as stated in our Access policy- Refer Appendix D for online information. The following hospitals guidelines for repatriation during COVID-19 are as follows- Taking into account that this is current process and may change.

Perth Children’s Hospital

No current change to their transfer process. Note: Patient will be placed in isolation at the hospital until reviewed and parents to self-isolate upon arrival to Perth, as per current Perth Children’s Hospital COVID- 19 infection control guidelines and Western Australia Government guidelines.

Tasmania Hospitals

No current change to their transfer process.

Note: If travelling via commercial flight there are reduced number of flights to and

from Tasmania.

Upon return to Tasmania, require 14 days of isolation as per current Tasmanian

government guidelines

Adelaide Women’s and Children’s Hospital

No current change to their transfer process.

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Note: Upon return to South Australia require 14 days of isolation as per current South Australia government guidelines.

New Zealand Air Ambulance

Ambulance service and intensive care flight teams remain available. New Zealand Air Ambulance crew and medical team are exempt from border restrictions and remain able to retrieve patients throughout New Zealand, the South Pacific and Australia.

Access to inpatient wards

Visitors

Access to all wards is restricted, lifts are available for parents only by the Green Lifts from LG- L5

Car park access is via the yellow lifts from Basement 3 to Ground floor- this lift does not stop at LG

All wards have an intercom system in the North building.

Only Parents will have swipe card access and visitor lanyard (this excludes Banksia PICU and NICU)

Parent/guardian attending daily will be screened on the Ground floor and issued with a visitor label for the day. Anyone without a visitor label will be declined access to the ward and directed back to the Ground floor. Parent/guardian staying on site will also be required to undertake this process daily. Anyone deemed unwell will be directed to attend the either the RCH Respiratory clinic or The Royal Melbourne Hospital for testing and advised to stay at home in isolation until they are asymptomatic and have a negative test result. RCH staff are advised to use the patient lifts for their access and offer limited contact with the public.

Allocation of bed in ward

Patients who meet the case definition and do not require aerosol generating procedures will be admitted to Dolphin- Pandemic ward

Those who require aerosol generating procedures or specialty care where possible be placed in a negative pressure room in Sugar glider 236 or 248 or PICU

If no available negative pressure rooms in any ward then use a single room with door closed under droplet precautions until test is negative

When medical capacity exhausted consideration use of surgical beds as elective

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surgery will be for Cat 1 /emergency cases only

Skill mix of nursing staff will need to be considered

When surgical capacity increases- Pre op COVID 19 testing will continue for rural and metro patients up to 5 days pre admission; a pre op screening questionnaire is repeated again on the day of surgery

In the event that shared rooms are utilized these should be allocated to known tested negative patients/of siblings

Management of overnight leave current inpatients

No overnight leave is to be facilitated except a mental health consumer who is planned for discharge the next day and not returning to RCH.

Transfers within the hospital- excluding PIPER/Ambulance Victoria

Diagnostic and invasive procedures should be performed in the patient’s room if possible. Portable X-rays should be used. If a patient is to be transferred:

Use dedicated lift 24 or 25 access swipe card

Staff, parents and, if possible, patient to wear a surgical face mask. ED Room to be cleaned as per environmental cleaning protocol.

Trolley/wheelchair to be wiped down in the ward before returning to the Emergency Department

Aerosol Generating Procedures

Additional precautions are required to perform aerosol generating procedures, e.g. nasopharyngeal aspirates, high flow oxygen, nitrous oxide, bronchoscopy, gastroscopy, airway suctioning, endotracheal intubation.

Limit number of staff in room

Preferably perform procedure in a negative pressure room

Wear PPE as per guideline

Hand Hygiene

Hand Hygiene is to be performed by staff and parents

Before and after glove removal Between patient care activities On room entry and exit

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Visiting Policy RCH Parent/Guardian

Two parents/guardian will be allowed to be onsite with their child at any time unless discussed with the treating team and an exemption letter provided within a time frame not ongoing. Visitor label will be given for the day only and parents will be advised to be rescreened daily on the Ground floor

No additional visitors including siblings are allowed unless under exceptional circumstances

In the event of a suspected child staff will instruct and supervise the parent/guardian on the donning and removal of PPE and hand hygiene – Refer Appendix E RCH Executive have to seek approval from DHHS regarding the attendance of a parent/guardian in a confirmed COVID 19 case- this is under exceptional circumstances only. Equipment

Minimise amount of consumables which enter the room or anteroom e.g. supply room for one shift.

All non-disposable items must either remain in the room for the duration of the patient stay or be decontaminated before use on another patient.

Semi – critical Items must be reprocessed in CSSD. Electrical equipment to be wiped over with Alcohol wipes. Sterile equipment to be rinsed in the room and placed in CSSD transport containers. Use of Nebulisers to be avoided. Use “spacers” or silicone masks.

Waste

Contaminated disposable items are to be placed into yellow plastic clinical waste bags and sealed before removal from room.

Double bagging is not necessary unless visible contamination of the outside of the bag has occurred.

Linen

Management as per normal process

Toys

The child’s own toys must remain in the room and must be bagged on discharge for the parent to wash at home.

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Any toys taken into the room must be easily dismantled and washable. Either wash in detergent and warm water, rinse or allow to dry or decontaminate in the ward utensil washer.

Communal fluffy toys are not permitted. Fluffy toys can be given to the child to take home.

Environmental Cleaning

Cleaning and disinfection of environmental surfaces are important components of routine infection control in health care facilities.

Keep areas around the patient free of unnecessary supplies and equipment to facilitate daily cleaning

Clean with RCH neutral detergent followed by a disinfectant solution

Dedicated cleaning equipment should be used wherever possible. Mop heads, should be laundered after use.

Environmental services staff and PSA must be trained in the correct methods of wearing PPE and the precautions to be taken when cleaning cohorted areas.

When possible staff should be allocated to specific areas and not moved between influenza and non-influenza areas.

Management of Code Grey

Activation and leadership of Code grey remains the same. In the event of a code grey in ED all responders including security will be directed by staff on the requirement to wear PPE. The same will apply to Dolphin ward and any patient under isolation precautions for COVID-19 admitted to another ward. Victoria Police attending ED will also be directed to wear PPE if required. If they are attending RCH on alternate business they are required to undertake the screening process on the Ground Floor .All enquiries to the main desk by Police in person or over the phone are in hours managed by contacting the Director Clinical Operations Access and Wards and after hours the Hospital Manager. In the event of a Code Black- standard procedure applies-security will escort the attending officers to the scene if required they will be directed to don PPE. During a code black Police will not be screened.

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Paediatric Intensive Care Unit

PICU would accommodate confirmed cases in the room below in listed order and will take all precautions with regards to patient management shift by shift related to the requirement for PPE

1. Negative Pressure rooms 331 and 360 2. Standard room with doors closed 3. Positive pressure rooms must not be utilised 4. PICU POD designated for COVID 19

End of life management - no visitors or siblings will be allowed into the ward only parent or known guardian who must wear PPE. Bereavement management will be undertaken by Rosella staff- social work will not be attending to the family in the room at any time for suspected or confirmed patients

PIPER Transport /suspected/confirmed COVID 19

o All staff moving patients are to be in appropriate PPE Refer to Appendix E. o Call ahead to let receiving team/ area know of transfer o All staff to undertake hand hygiene and change of gloves before departing from

the room/ambulance bay etc. o One staff member allocated to remain clean and do not touch the stretcher. This

person can summons the lift/ press buttons o The team will carry Tuffie 5 wipes on stretchers so that they can wipe down all

surfaces as they go to mitigate contamination o In a very complex patient they may ask for assistance from ED/ PICU on arrival o Lift access by ambulance bay back of ED to patient lifts 24 or 25

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Internal Procedure Operating Theatre

In the event that the patient requires surgery the following procedure must be adhered to:

Theatre in charge team (extension 52001) and Infection Control (via switch) notified

All unnecessary equipment is to be removed from the theatre prior to the patients’ arrival.

A clean outside scout and/or runner will be allocated to retrieve further supplies to decrease movement and equipment within the theatre

The patient is to be recovered inside the theatre and transferred directly to the designated ward negative pressure room or single room.

Equipment for reprocessing is to be collected directly from the designated theatre. CSSD staff donning the appropriate PPE are to be contacted to retrieve the trolley which is to be covered fully using a clean sterile drape. Reprocessing of the equipment is to be undertaken immediately and the trolley disinfected.

Staff who scrubbed for a procedure must replace gloves and gown prior to assisting with cleaning. Staff must wear appropriate PPE while cleaning the room.

Following the cleaning of the theatre and equipment can be used after 30 minutes

Crèche

All parents notified of process for child being checked daily by staff on Ground floor before attending Crèche. If the child displays symptoms the following action should occur:

Unwell child at Crèche

Contact the parent and advise that they need to pick up the child and attend ED for assessment and screening

Isolate the child, by taking the child to the designated room, where there are no other children

Door should be shut

Staff member to stay with child and both should wear a surgical face mask

Staff member to wear gown if the child is held.

Wear gloves to wipe noses

Dispose of tissues into plastic bag, tie up.

Staff member must use wash their hands and use alcohol hand rub after contact with child.

Contacts for Crèche

Record names of all contact children from the suspected child’s room

Record names of all staff who have had contact with the suspected child’s room

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Records to be kept by the Crèche manager Staff should report symptoms of flu like illness in crèche child and themselves to the manager immediately.

. Management of Food and Water services

Main Kitchen (Meal delivery)

Food Service Assistant to wear a surgical mask on designated wards – can be worn continuously for up to 4 hrs. Stores delivery to COVID-19 wards done by order as required rather than daily visit to conserve PPE. Main Kitchen Order in additional supplies as pandemic buffer

Extra Freezer in carpark

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Managing Staff

Pregnant women after 28 weeks should not be unnecessarily exposed to suspected or confirmed COVID-19. See advice in the COVID 19 Supporting pregnant HCW – Refer Appendix A

Staff screening at entry points

Wellness screening for all staff is required on entry to RCH – this can be accessed on the Ground floor or outside designated ward areas staff will receive a daily sticker. Any staff who fail the screening will be directed to the Respiratory clinic or ED.

End of Life care

In the event of a deceased child with suspected/confirmed COVID 19 they should remain on the ward before transfer to the mortuary. In the event of a deceased child in the Emergency department staff can transfer the child and family in appropriate PPE to the viewing room (infectious space) at the back of the mortuary to spend some quality time before being transferred to the mortuary. Mortuary capacity: There are 6 body holds one is for bariatric patients Staff managing end of life patients with suspected or positive COVID-19 will prepare the body by maintaining their PPE and placing the patient in a mortuary bag with appropriate labelling. This to protect the Body Hold whilst patient remains on site Where possible quick retrieval by funeral directors will be required.

Banksia Inpatient Mental Health Services

Banksia Ward - Communicating with consumers and carers

It is important that visitors are informed of COVID – 19 requirements prior to visiting RCH. Screening of all visitors, contractors, and agencies is occurring. All carers should be contacted to inform them of RCH directives and the limitation on visitor numbers, allocated Care Coordinators should attend to this task.

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Intake clinicians will use the telephone script screening tool (attached to triage all admissions) Access to the Banksia Ward is via the front glass door of the north building – level one. These glass doors will remain closed to traffic for the duration of the pandemic. All requests for entry is via the intercom to the Staff Station and Admin.

Mental health Tele and Video Conferencing

Community clinicians, community intake and outpatient appointments will be delivered by tele and videoconferencing as required. All meetings requiring external clinicians and agencies should prioritize tele or video conferencing. The available recommended networks are: Zoom

Mental health patient Day or overnight Leave

If leave is being considered, discharge priority should be discussed. Leave should only apply to long stay patients with complex needs. All patients requesting leave should have clear expectation of leave conveyed prior to consumer and carer. This means discussing current limitation relating physical and social distancing in the community. An awareness of the receiving carer’s health and reminders of COVID screening upon return to the ward.

Suspected COVID-19 in an admitted consumer

If client has become clinically unwell anticipate a decision to transfer to a medical ward into negative pressure room or single room using droplet precautions. In the event of a consumer becoming symptomatic, medical advice should be sought and swabs undertaken. If clinically well consideration for the creation of a hot pod using the 4 bed pod for isolation until results return. Appropriate use of PPE refer Appendix E

Communications

Communications and escalation of concerns will be undertaken through the RCH routine communications channels, including treating teams, for the care and treatment of Covid-19 suspected or confirmed patients or family members.

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Communications pertaining to general Covid-19 specifics will be developed with all key stakeholders, for example staff, tenants, campus partners, GPs and community care partners and in the majority of cases will be developed within the communications team led by the Executive Director Corporate Communications. The DHHS meets regularly with all organization CEOs and will provide an essential communication route. There is the requirement to provide key activity, throughput and capacity data to the DHHS daily through HIS and the COO role

Appendix

Appendix A - resources

The Royal Children’s Hospital Guideline COVID-19 Intranet RCH COVID-19 Guideline

The Royal Children’s Hospital COVID–19 – Staff and Manager Information https://covid.rch.org.au/category/rch-staff-information/

Appendix B

Respiratory infection clinic https://covid.rch.org.au/category/respiratory-infection-clinic/

Appendix C

The Royal Children’s Hospital Radiation Plan Radiation Safety: - https://www.rch.org.au/policy/policies/Radiation_Safety/ Radiation & pregnancy:- https://www.rch.org.au/policy/policies/Radiation_and_Pregnancy/ Protective Garments:-https://www.rch.org.au/policy/policies/Radiation_Protective_Garments_-_Handling_and_Occupational_Health_and_Safety_for_RCH_staff/

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Blood Irradiator: -https://www.rch.org.au/policy/policies/Radiation_Safety_-_Blood_Irradiator/ Radiation & Pregnancy:- https://www.rch.org.au/policy/policies/radiation-safety-radiation-and-pregnancy/

Appendix D

The Royal Children’s Hospital – Access https://www.rch.org.au/policy/policies/Access_-_RCH/ Interstate hospital transfers https://www.rch.org.au/policy/policies/Interstate_Patients/ Perth Children’s Hospital https://www.wa.gov.au/organisation/department-of-the-premier-and-cabinet/coronavirus-covid-19-western-australian-government-response Tasmania Hospitals https://dpipwe.tas.gov.au/Documents/Tasmanian%20Border%20Restrictions.pdf Air Ambulance Tasmania https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+topics+a+-+z/covid+2019/latest+updates/latest+updates+-+covid-19

Appendix E – PPE

Correct usage of PPE at RCH https://covid.rch.org.au/category/correct-usage-of-ppe/