COVID-19 Safety Plan

As part of the resumption of services provided by regulated health professionals practicing in community settings, we are enhancing our safety protocols.  We must note that all in-person services must only proceed when the anticipated benefits of such services outweigh the risks to the patient and the health care provider. The registrant is accountable and is the person best positioned to determine the need for, urgency and appropriateness of in-person services.

This Safety plan follows the guidance of WorkSafeBC and  in accordance with the order of the Provincial Health Officer will be posted at the worksite. 

Because our clinicians cannot maintain physical distancing in the treatment room, we are doing the following to minimize the risk of viral transmission: 

  • Ongoing self -assessment for signs of COVID-19 by patient, therapist and admin.
  • Physical distancing for all non-treatment interactions.
  • Hand hygiene and avoidance of face touching.
  • Enhanced cleaning protocols.
  • Appropriate use of personal protective equipment.
  • Meeting of all professional obligations, particularly related to informed consent and liability insurance.   

Pre-Screening Process

  1. Patients
    1. Our priority is to get  informed consent from patients. They should understand that we are taking measures to minimize the risk of viral transmission and one of these measures is ensuring that all clinicians, patients and admin staff are  pre-screened for signs of COVID-19 daily.   To create a low risk environment there are multiple pre-screening measures for patients.  The day before their appointment (FOR RMTs only)  RMTs will contact their patients to do a pre-screening. The day of treatment, patients will be required to fill in a self assessment form before they come into the clinic. If they are unable to do this Self-Assessment, they will be asked to do a verbal or written pre-screen with our admin team.  During treatment, clinicians will review the pre screening and review informed consent. 
    2. INFORMED ON PROCESS: Patients are informed about the pre-screening process (by RMTs) and the self-assessment form in an email they get when they book. 
    3. Patients with high risk: For patients at greater risk, take additional precautions. Clinicians should discuss with their patient to ensure that the benefits of care outweigh the risk to the patient. 
    4. PRE-SCREENING FOR RMT PATIENTS: One day prior to patients’ appointment, all RMTs must contact their patient to do a COVID-19 Pre-Screening and talk to their patients about informed consent and other procedures we have at the clinic.   Equilibrium has provided a template script for RMTs to work with and a chart template in JaneApp. This is set up with all the questions RMTs might need to ask patients, so it can be opened and saved into the patient file.
      1. If any signs are present: Tell your patient to stay home if experiencing any signs or symptoms of COVID-19. If patients are experiencing any symptoms of COVID-19 and have not been tested, you should recommend that they do so. They can start by calling 8-1-1
      2. The RMT is allowed to be more thorough and ask about the patient’s use of physical distancing or contacts. 
      3. Creating a low risk environment for massage therapy practice includes communication between patients and RMTs about the steps to minimize risk of virus transmission. They should communicate honestly with each other about what each needs to feel safe to return to a massage therapy treatment. 
      4. Each RMT is required by CMTBC to have their own Restart Plan which outlines what they will do if they cannot connect with their patient prior to the appointment. 
  1. SELF-Assessment:  All patients coming into Equilibrium will be required to answer self assessment questions taken from the BC COVID-19 Symptom Self-Assessment Tool. They will be emailed a Self Assessment survey in JaneApp 5 hours before their appointment.The admin staff will review the survey to ensure that all patients have been pre-screened. If the patient has not completed this self assessment, when they arrive in the clinic, the admin staff will verbally ask the questions and fill out this form for the patient or give them a paper form to be scanned in.  We will cancel the appointment if the patient doesn’t meet the pre-screening criteria or the clinician determines the risks of treatment outweigh the benefits and our cancellation fee will be waived. 
  2. SCREENING IN TREATMENT ROOM:  In the treatment room, the clinician uses their clinical judgement to ask or clarify any screening questions before starting treatment.
  3. Signed CONSENT FORM: The first time back to our clinic all patients will be be provided with a paper consent form for treatment, outlining that we have done everything we can to minimize the risk, but that there is still inherent risk in virus transmission and  the nature of getting a treatment  means that physical distancing is not possible in the treatment room. This consent form must be renewed for every patient, as the nature of consent has changed. The consent form is scanned into their file. 
  1. Clinicians & Admin Staff
    1. As part of training, all clinicians and admin staff have practiced filling out a google form  that contains COVID-19 self assessment questions taken from the BC COVID-19 Symptom Self-Assessment Tool. 
    2. Before entering the clinic, clinicians and admin are to complete this Self Assessment and they can record their answers by filling out a google form. If they have answered no to any of the questions, they follow the sickness protocol. Exceptions are with pre-existing conditions or allergies and these need to be reported. 
    3. If at any point during the shift, one of the questions becomes a yes, then the clinician will immediately alert the front desk and leave the clinic and follow the steps to report and get tested. 
    4. The Clinician is responsible for completing their own COVID-19 self-assessment every day prior to going into work. We are documenting these COVID-19 self assessments when a google form is filled out, the answers are stored in a google spreadsheet. All clinicians and admin have been asked to save the self-assessment to their home screen on an easy to access device to make it a lot easier to open up.  Signage has been posted in the staff room at the clinic to remind everyone to have ensure they have completed and documented their Self assessment. 

Physical Space of the Practice Setting

We are taking the following steps to minimize physical distancing for all non-treatment interactions:

  1. Staggering Start / End Times of all clinicians to try to minimize the number of patients that are arriving at the same time, and to spread out the clinician breaks. 
  2. Clinicians now have assigned treatment rooms, which limits the number of clinicians that use each room.
  3. At our Yates location, we have implemented a One-Way Hallway system to limit the opportunities for people to walk past each other in a narrow hallway.   
  4. When clinicians started back at practice there was 30 Minutes between each Massage/acupuncture and 15 minutes between chiro and physiotherapist appointments, so the clinician can get used to the pace, and cleaning requirements.  The time between patients is up to the clinician after the first 2 weeks back at practice.
  5. At all clinics, we installed Plexiglass barriers at the Reception Desk to separate patients from our admin team.
  6. While BC was in Phase 2 of re-opening, we asked clinicians to remain in their room between appointments, where possible.
  7. We identified areas where people gather, which is in the staff room for washing hands and doing laundry, and the charting spaces.  WE have posted occupancy limits in these spaces.
  8. Patients are asked to wait in their vehicles or outside the clinic and use the self-check in option until a few minutes before their appointment. An exception is made when patients have not filled out their intake forms, and we have provided space for them to practice physical distancing in the reception area.
  9. Contactless payment option – Credit cards will be placed on file at the time of booking
  10. Rebooking appointments via phone and online rather than in person when possible. 
  11. Waiting rooms seating has been reduced and removed so that 6 feet of distance can be maintained. 
  12. If possible, doors will be open into the clinic so patients do not have to touch the handles.
  13. It is understood that 2 metres physical distancing is to be maintained as best as possible within the clinic at all times, except when direct contact is needed for treatment. 
  14. Patients must arrive unaccompanied unless the patient is a minor.
  15. We are creating spaces in all clinics for storage of extraneous items / clutter. 
  16. It is impossible to maintain physical distancing in the treatment room. Pre-screening, hand hygiene, and enhanced cleaning will help reduce the risk of transmission. 
  17. We are asking patients to use the restroom prior to coming into the clinic. 
  18. Shared reception clinic equipment and electronics will be sanitized after shift by the admin using it. 
  19. Bins are provided in each clinic room. This bin may be used to store all patient’s belongings during the treatment. Post treatment, this same bin will be used to carry used linens to the laundry room for washing.  Between patients this bin will be disinfected. All bins that are used will be disinfected between each patient before cycling back into use.

Hand Hygiene

  1. Patient
    1. Patients use the hand washing station, or wash their hands in the restroom and then they dry their hands with clean, provided towels. 
    2. We have alcohol based sanitizer available and patients are asked to wash their hands and use the alcohol based sanitizer after. 
    3. The hand washing protocol is provided to patients in the bathroom, lobby and through email. 
    4. Patients are advised by their clinicians to wash or sanitize their hands after treatment. 
  1. Clinicians
    1. Clinicians wash their hands often and before and after each patient, following hand hygiene. 
    2. Hand washing protocols are posted at all sinks used by clinicians to wash their hands and all clinicians have taken hand washing training. 
    3. Clinicians will verbally confirm with patients that they have washed their hands before treatment to maintain trust.  
    4. Clinicians have all received training in hand hygiene.
  2. Administrative Staff
    1. Admin have all watched hand hygiene videos as part of their ongoing training. 
    2. Admin will wash or use an alcohol based sanitizer on  their hands  frequently throughout the day, especially after but not limited to  – doing laundry, after touching their face, before and after eating, before and after their cleaning procedures, after touching money. 

Face Touching

  1. Patient
    1. Tissues are available for patients’ use in reception and treatment rooms. Masks are available for patient use. 
    2. During treatment, if the patient has an itch, the clinician will hand them a tissue or other barrier to use, and there is hand sanitizer in the treatment rooms, to spray patients hands if necessary. 
  1. Clinician
    1. Will use a hand towel or tissue to touch their face. 
    2. Will share information on how the coronavirus can be spread by transferring the virus from one’s hands to one’s face which is the reason for not touching one’s face.  This is also the reason to not cough or sneeze into one’s hands and the reason hand washing is so important. 

Point of Sale

  1. Patient
    1. Patients are encouraged to have a credit card on file. 
    2. If the patient uses the point of sale system, we will sanitize it after. 
    3. If they pay cash, the admin team who handled the cash, will wash their hands immediately after. 

Enhanced Cleaning

  1. The poster for cleaning and disinfectants for clinic settings from the BC centre of Disease control is posted in the reception area, washroom, and staff rooms. 
  2. Training for all staff and clinicians in sanitation processes
    1. Donning / doffing mask training
    2. Hand washing training
    3. Enhanced cleaning protocols
  3. Admin Staff
    1. Admin has a schedule of cleaning & disinfecting routines 
    2. Reception area 
      1. High touch areas cleaned and disinfected regularly throughout the day. We have identified these high touch areas as: washrooms, pens, hand washing station, door handles, POS machine, clipboards, etc
      2. Tea service, water and wrapped candy have been removed
      3. Low touch areas are disinfected at least twice daily, which include the plexiglass barriers and the reception chairs. 
    3. Daily checklist includes sanitization and cleaning checks / protocols
    4. Spray bottles of disinfectant, cleaner, and bottles of hand sanitizer are found throughout the clinic. 
    5. Admin Staff will vacuum and wash clinic floors daily. 
  4. Bathrooms 
    1. Bathroom doors are left unlocked so there is no key for the doors
    2. Bathrooms are cleaned several times a day.
    3. Each clinic has spray bottles of disinfectant cleaner to clean the bathrooms before they are used. Staff and Clinicians will clean as they use the bathrooms.  
    4. Patients are asked to use the bathrooms before they arrive at the clinic if possible.
  5. Clinicians
    1. Clinicians are responsible for cleaning and disinfecting their treatment room. 
    2. All linens will be single use only and laundered in hot, soapy water
    3. All touch surfaces are cleaned and disinfected between patients
      1. This includes headrests, lotion tubes, door handles, stools, table adjustment levers
      2. At end of shift, table is thoroughly disinfected and left clear of linens for the next clinician to set up
    4. Our clinic has ceased the use of blankets, table warmers and thermophores.
    5. Each room is provided with spray bottles of  disinfectant , cleaner and a hand sanitizer.  There are adequate rags available that are laundered in hot, soapy water.
  6. Staff rooms
    1. Both Clinicians and Staff are responsible for cleaning and sanitizing the staff room after they touch surfaces.
    2. Cleaning and disinfecting spray bottles will be available in the staff room for this cleaning to occur.  

Laundry 

  1. All clean laundry is touched only after having washed hands. 
  2. A face mask will always be worn when doing laundry. 
  3. Laundry should not touch the body while being carried or folded. 
  4. Surfaces used to fold laundry are sanitized prior to folding or putting laundry on the counter.
  5. Laundry baskets are sanitized daily as part of the admin teams cleaning schedule.
  6. Cloth masks can be washed in delicates bags to prevent damage
  7. Laundry totes are provided in all clinic rooms that use sheets for clinicians to transport the used linens and will be disinfected between each patient.
  8. The laundry machine’s buttons and handles will be sanitized frequently throughout the day.  

Gym Space at Equilibrium Therapeutics on Tillicum 

  1. Managing People in the Space:
    1. An occupancy limit of 8 people is maintained and  has been posted in the gym. 
    2. Ensure that 2 meters of physical distancing is maintained between clinician and patient, unless necessary for the treatment.  Ensure that 2 meters of physical distancing is maintained between all others in the gym.  
    3. Clinicians will limit their time in the gym when they are not with patients. If another clinician and their patient is in the gym, please leave the gym if you are not with a patient. 
    4. Doors will be left open when possible, and if they are closed, will be disinfected before and after. 
    5. If the clinician and patient determine that it is in the best interest of the patient to minimize contact, equipment may be taken from the gym and used in the treatment room. Equipment must be immediately returned to the gym and disinfected. 
  2. All clinicians, staff and patients have completed a COVID-19 self assessment before entering the clinic, and thus,  we are restricting  people exhibiting symptoms of COVID-19 from the gym. 
  3. Hand Hygiene:
    1. Patients are asked to wash their hands upon entry to the clinic. 
    2. Upon entry into the gym, there will be a hand sanitizing station that will be used before and after the gym use.  
    3. When transitioning between areas of the gym the patient and clinician will use hand sanitizer again. 
    4. When transitioning  between pieces of equipment,  hand sanitizer is available for the patient to use. 
  4. Equipment Layout:
    1. The layout of equipment ensures adequate space between patients in the gym. 
    2. The exercise bike, which is a piece of aerobic fitness equipment where high exertion is possible, will be used when 2 meters between people can be ensured or moved to a space where this is possible.
    3. There are currently 2 “rehab spaces” , a bike area,  a soon to be curtained area, a free space with a TRX unit and a sanitizing station in the gym.  Physical distances can be maintained between all these areas. 
    4. We are using equipment to define the above areas and may use tape on the floor to define these areas.
  5. Equipment Cleaning:
    1. Gym cleaning policies are posted in the gym.
    2. If possible, all equipment touched will be disinfected immediately after each use. 
    3. Any equipment not able to be immediately disinfected will be placed in the bin labeled “To be Sanitized” and be disinfected as soon as possible.
    4. Rags, hand sanitizer and cleaning supplies will be kept stocked so there are adequate supplies always available.   Garbage and used rags bins will be emptied regularly. 
    5. Floors, mirrors, windows and all equipment will be cleaned regularly.  
    6. If the climbing wall is used, hand sanitizer will be used immediately before and immediately following use.  

Personal Protective Equipment

  1. Patients
    1. Patients are required to wear a face mask when they enter the clinic and in shared spaces. However, once they are in the room, it is the clinician’s and the patient’s decision if they want them masked during treatment
    2. Admin will advise patients about PPE recommendations. This is done verbally when a patient is booking an appointment and in an email. 
      1. They will bring their own face mask to the clinic and wear upon entering the reception area. 
      2. We will have extra masks available for patients who aren’t able to acquire a mask or who do not bring one.  Patients can purchase a disposable mask for $2 or use one of our freshly laundered cloth masks
      3. They are not required to wear masks in the treatment room, however it is up to the clinician to decide their level of comfort in treating each patient and if they prefer their patients to wear masks, it will be required. The same applies if the patient wants their clinician to wear a mask or other protective equipment. 
    3. Cloth or surgical masks will be worn in shared spaces in the clinic by admin staff and clinicians and patients
    4. When we are providing cloth masks to patients or paper masks, the patient will be required to wash their hands prior to putting it on. 
  2. Clinicians
    1. Clinicians provide the mask for themselves, but the clinic will provide masks for patient’s use. The clinicians do not have to purchase / provide masks for the patient as the clinic will do that. 
    2. RMTs will have discussed the expectation of PPE use in the treatment room when they called the patient the day prior to treatment. If a patient requests their clinician to wear a mask, the clinician must respect this request. 
    3. Cloth masks are switched regularly and laundered between uses. 
    4. Cloth or surgical masks will be worn in shared spaces in the clinic by admin staff and clinicians and patients. 
    5. All clinics have outdoor spaces for breaks from masks, if needed. 
    6. Clinicians have taken donning / doffing training for masks and must don and doff their masks according to their training. 
    7. Gloves are available for use, if patients request the clinicians wear them. These gloves are sterile
    8. 1 set of goggles are provided at each clinic and are to be disinfected after each use. 
  3. Admin Staff
    1. Freshly laundered cloth masks or surgical masks will be worn in shared spaces in the clinic by admin staff at all times. Equilibrium will provide these masks, but admin are welcome to bring their own. 
    2. All clinics have outdoor spaces for breaks from masks, if needed.
    3. All admin have taken donning / doffing training for masks and must don and doff their masks according to their training. 
    4. Masks must be changed when wet or soiled. 

Professional Obligations

  1. Clinicians will read the professional obligations section of their professions’ guidelines.
  2. No clinician can say that they can treat or prevent COVID-19 . 
  3. Clinicians are advised to contact their insurance to determine their professional liability regarding whether or not they are covered for claims related to COVID-19. 
    1. Informed consent discussion at the onset of treatment is critically important.
  4. Clinicians returning to practice at multiple locations must be particularly conscientious about other clinics’ safety protocols. 
  5. As per CMTBC guidelines for RMTs only: If a patient alleges they have caught COVID-19 from the clinician
    1. The RMT must immediately call public health to report the alleged transmission and to provide the RMT’s name and the name and contact information of the patient as per the CMTBC guidelines
    2. The RMT must not provide any further treatment to anyone until public health has investigated and provided direction. 
    3. The RMT must immediately self-isolate until the matter has been investigated and public health direction has been provided. 
    4. If the RMT is working in a team setting, it is the RMT’s duty to immediately inform their colleagues of transmission risks. 

Sick Policy

  1. Any patients, staff or clinicians who have symptoms of COVID-19 are prohibited from the workplace
  2. Following the Ministry of Health’s recommendations,  if any admin or staff have symptoms of a cold, flu or COVID-19 , even mild symptoms,  testing is recommended. We recommend anyone with any COVID-19 symptoms contact 8-1-1 or their nearest medical center. 
  3. Any clinician or staff with symptoms must self isolate as per the requirements of the Provincial Health officer.  If you choose not to get tested, as of May 23, 2020, this means self-isolate for a minimum of 10 days and you may return to your regular activities after 10 days since onset of symptoms AND your fever is gone, AND you are feeling better.
    If you get tested, as of May 23, 2020, and it is a negative COVID-19 test result, you must continue to isolate until your symptoms resolve. If your symptoms worsen, contact your health care provider or call 8-1-1.
  4. If COVID-19 symptoms develop at work, the sick person must wash and sanitize their hands, don a mask and go straight home.  If they are seriously ill, 9-1-1 will be called. All surfaces in the rooms the sick person was in, will be cleaned and disinfected. 
  5. Patients who are sick, or have symptoms will not be charged a late cancellation fee. 

Ongoing Monitoring

  1. Things may change as our business operates. We will continue to make changes to our policies and procedures as necessary. 
  2. We will continue to train new staff or independent contractors in our policies and procedures.