During the current situation, we need to adapt how we deal with you to ensure everyone’s safety:
Please read this prior to your appointment with us.
Following updates from the Infection Protection Society, Gov.UK, and in alignment with ENT UK and BSO, it is possible to arrange appointments if you have an identified audiological need that cannot be met remotely. A suitable telephone or video call triage system will have been used by an appropriately trained person to eliminate any persons symptomatic with COVID-19 or those that should be otherwise self-isolating because a member of their household has symptoms.
Before an appointment, you will have been asked these screening questions :
• Do you or anyone in your household have coronavirus?
• Do you have a new, continuous cough, fever, a loss or changed sense of normal smell or taste (anosmia)?
• Do you have a high temperature (37.8C or over)?
During each appointment, the following must be observed by all parties:
• Best practice hygiene. Hands must be washed/sanitised consistently.
• Optimise distance and stay at least 2m apart wherever possible.
• The correct PPE should be used when within 2m – see the table below.
• Minimise time within 2m when using PPE e.g. cluster all close contact procedures and upon completion, separate to a safe distance.
We, the audiologists should select equipment wherever possible that optimises separation, such as the new VIDEO OTOSCOPE; perform essential components only to make informed clinical decisions (move at speed) – that is, delay any additional tests or information which can wait until a later date.
The table below explains required PPE following advice received from the Infection Prevention Society on audiology-specific procedures.
Our Record Keeping:
Our records kept during this time should be clearly marked with COVID-19. Gathering and updating information for a patient record should be completed at a 2m distance or when the patient has left.
At all times accurate records of joint decision making, consent and outcomes should be completed in line with employer ways of working as appropriate, and guidance on capturing outcomes and in linewith, as relevant for each practitioner the: HCPC standards of conduct, performance and ethics / Standard of Proficiency, RCCP Standards of conduct, performance and ethics Standards of Proficiency, or Academy of Healthcare Science standards of proficiency and BSHAA guidance on record keeping. Follow-up actions post COVID-19 should be clearly recorded, prioritised, and actioned.
Our Guidance from our joint professional bodies:
- Only offer appointments to asymptomatic people who have not been advised to shield or are in self-isolation. No appointments should be offered for anyone with symptoms or living with someone with symptoms.
- Request that the patient travels by car or otherwise avoids peak travel times on public transport.
- Request that the adult patient attends alone unless accompanied by someone from the same household. If the companion is present in the appointment you must be able to maintain a2m distance at all times. Consideration should be given to offering the companion a mask if within 2m.
- Request that the paediatric patient attends with only one parent/guardian.
- Provide instructions to the patient on which entrance to use (where available & relevant use a quieter entrance route) and where to wait on arrival. This may be on arrival, to call clinic
and await instructionsto stay in car untilspecific time or when notified orto wait in a specified location.
- Hand sanitizer/hand washing facilities should be made available and patients asked to clean
- Patients should be advised that physical distancing is being observed and to sit where indicated and not to move furniture.
- Patients should be advised not to enter a consultation room until invited.
- Patients should wash their hands on arrival. It is recommended to include a poster in the same area to promote best practice hygiene.
- Patients should be advised that they can only be seen with a pre-arranged appointments; there is no walk in service.
- Patients should be advised that they will be questioned on arrival with regard to their wellness and may have their temperature checked.
- Appointment scheduling – Appointments should be scheduled so that for a single clinic there is no overlap of waiting patients.
Appointments should be staggered for a site offering multiple clinics so there is no overlap of waiting patients in a “waiting area place”.
Intervals should be left between appointmentsto allow equipment and surfaces to be cleaned.
Appointment lengths should be adjusted for the content of appointment and to allow for donning & doffing of PPE as required.
- Waiting areas:
Patients should be encouraged to arrive in time for their appointment to reduce time in waiting room.
Chairs should be arranged to optimise a 2m spacing and excess chairs removed to discourage breaking of physical distancing requirements.
Ideally mark floor to indicate 2m spacing.
Signs should display local guidance and request not to move chairs and to clean hands on arrival.
No magazine, newspapers or information leaflets should be freely available in common areas.
No water machine/fountains, tea or coffee should be available, only bottled drinks can be offered, which the recipient could clean the outside (have wipes available) if they wish to partake. They should take the bottle away with them.
All surfaces that patient has been in contact with whilst waiting should be cleaned in line with guidance here.
- Conducting face-to-face Appointments:
Practitioners should ask patients to wash or sanitize hands and do self-assessment for any COVID-19 symptoms before conducting appointment. Provision should be made for the “dialogue, case history, explanations, results & rehab to be conducted in a space that allows for privacy and optimises physical distancing ideally at 2m. Best practice hand hygiene should be observed throughout the appointment. This might include hand washing several times for the same patient visit in addition to donning and doffing PPE. Content requiring contact within 2m should be clustered together to optimise use of PPE in single appointment and actual time at close proximity should be minimised. Critical components for diagnostic and informed onward management should be conducted only, and methods that allow some separation, such as video otoscopy, wireless programming and impression guns, should be used in preference wherever possible. Clinic surfaces should be kept clutter free to aid easy cleaning. It is recommended to use alcohol-based disinfectants (ethanol, propan-2-ol, propan1-ol) in concentrations of 70-80%.
- Personal Hygiene: Practitioners should be reminded that the availability and use of PPE does not replace the need for robust hand and respiratory hygiene including avoiding touching face, nose, and eyes. Practitioners should be confident and informed on safe hygienic principles, donning and doffing PPE procedures, and safe disposal of clinical waste including used PPE. Practitioners are reminded that donning & doffing of PPE should be at 2m away from patient, and hand hygiene must be performed before and after. If using a fluid resistant surgical mask (FRSM) continuously (i.e. for more than one patient/consultation) it cannot be removed or touched until the usage period is concluded. Masks should be replaced as soon as damaged, soiled, damp, uncomfortable, causing skin irritation, or become difficult to breathe through. Due to communication requirements it may not be practicable to retain mask in-situ between patients. Consideration should be given for written test procedures to show the patient during the appointment. Eye protection is reusable but must be cleaned in-between patients and should never be shared between practitioners. If damaged, soiled, or uncomfortable, or becomes a skin irritant, eye protection should be replaced. Gloves and apron should only ever be single use. Practitioners are reminded that they should keep their fingernails short, and false nails and nail polish are not to be used. To ease hand hygiene, practitioners should have no clothing below the elbow. It is recommended that clothes worn in clinic are changed/washed daily and washed separately from other clothes. Ties and fashion scarfs should not be worn at this time.
IF YOU ARE NEW TO US, and are attending a hearing test THIS IS WHAT YOU NEED TO DO IN PREPARATION (3 online tests)
- To pre-screen your hearing, if you can, try this online hearing TEST
- To pre-screen your speech discrimination, please try this short online TEST
- manage the need to look in your ear canals, please complete this brief questionnaire before we meet. It will generate a score that we need:
WHAT YOU NEED TO DO ON YOUR VISIT
- On arrival outside, summon the receptionist or press the doorbell.
- Enter when acknowledged. Avoid using hands on the door if possible.
- Stand just inside the doorway.
- Wait for instruction from the receptionist.
- Remove any face covering and place in the provided poly bag (if required).
- Place mask provided on your face.
- A bottle of water is available on request. Please take this with you throughout your visit.
- Try to avoid visiting our toilet.
- Observe and use the cough screen between you and the receptionist.
- When asked, please make your way to the consultation room.
- Use thermometer provided.
- Do not move any furniture. Please refrain from using hand rests unless you need to.
- Use hand sanitizer where indicated.
- If you wish to remove your mask temporarily, please do so and then request a new mask. Use the disposal bin provided.
- If you need to cough or sneeze, try to make sure you have a mask on and do so into your elbow.
- We will be moving through the consultation rapidly. Certain parts may be revisited at a later date.
Guidance on providing Domiciliary Services:
This document is intended to provide suggestions on safe practice, it is not an exhaustive list, and interpretation will be required to meet local situation and organisational guidelines.
This supplementary note should be used in conjunction with the official guidance on Personal protective equipment (PPE) – resource for care workers delivering homecare (domiciliary care)
When is it appropriate to offer a home visit?
• If digital remote solution not applicable
• If no-one available for drop-off and collect for repairs
• If patient cannot attend clinic for reasons other than COVID 19 symptoms.
• If patient is shielding a risk assessment should be carried out before proceeding and only conducted if the patient determines that the appointment is absolutely essential.
• If no other inhabitants have COVID 19 symptoms. In the case of a care/ residential facility a “safe clean” room must be available to see the patient and the practitioner must comply with the organisations requirements to minimise transmission risk.
Scheduling a Home Visit
• Follow triage questions to identify safe for patient and practitioner to visit.
• Ensure have consent to visit, consider sending written/email confirmation pre-visit. Update records regarding source of request and who agreed to the visit. Where appropriate ensure a family member is informed of intended visit.
• Where a visit takes place in a residential care facility, ensure that the management are informed of the request and are in agreement for the visit to happen.
• Follow own organisation’s guide on scheduling, use of transport and timing.
• Patients to be advised who is calling, when, and that they will require optimum space, will use PPE and wherever practicable to have no one else present in the same room when the visit occurs. Where another person needs to be present all effort must be made to optimise distance.
• As per clinic appointments contact time should be minimised.
Preparation for a Home visit
Practitioners are advised wherever possible:
• to use “online/offline synchronisation” record-keeping systems in preference to paper records.
• that records should be updated at >2m distance or outside of the home environment.
• to familiarise with all planned visits and purpose.
• to pre-programme hearing aids.
• to ensure all anticipated consumables & accessories are pre-assembled and bagged to take into home to avoid taking whole stock into house.
• to ensure adequate PPE for number of visits.
• to ensure hand sanitiser available for use in car pre & post visits.
• to ensure they have adequate waste bags and disposable covers.
• Robust hand and respiratory hygiene must be observed.
• Practitioners are reminded that they should keep their fingernails short, and false nails and nail polish are not to be used.
• To ease hand hygiene practitioners should have no clothing below the elbow.
• It is recommended that clothes worn in clinic are changed/washed daily and washed separately from other clothes.
• Ties and fashion scarfs should not be worn at this time.
• Clearly, practitioners cannot control the environment in which they are visiting therefore single use PPE per home or in the case of care home, per resident is recommended. If seeing multiple asymptomatic residents in a care setting for instance for hearing aid maintenance it is permissible to leave PPE on for duration of visit provided it is not removed until the visit
ends or it becomes damaged, damp, or soiled.
• PPE required for all visits is FRSM, apron & gloves. Eye protection should be used if concerned.
• PPE should be donned before entering premise or at 2m away from patient.
• Practitioners should carry disposable covers such as plastic/paper sheeting to lay down upon which they can place their equipment. Practitioners must also carry 2 waste bags per visit.
• Practitioners should not accept any refreshments when in a home and where possible avoid using toilet facilities in a patient’s home.
• Upon completion of a visit and before leaving the residence PPE must be doffed and placed in a disposable waste bag, knotted, and then this bag placed inside a 2nd waste bag to also be
tied securely. These bags should be left at the home but requested to be kept separate from other waste and put aside for at least 72 hours before being put in the usual household waste
bin. Remember hand hygiene post doffing.
• Equipment should be carried to the car in the disposable covering, cleaned before placing in the car, and the disposable cover placed in a rubbish bag and knotted. At the end of the day all knotted bags should be placed in one larger bag and tied securely. This should then be kept separate from other household or clinic waste and put aside for at least 72 hours before being
disposed of in usual waste. Hand sanitizer must be used each time this procedure is completed.
Any questions? email [email protected]