Primary Health Care Preparedness

Communication with Staff / Development of a Practice Plan

Note that most areas are actively engaged in developing local plans, all general practices should check with their local PHO/IPA or DHB for the latest local up to date information around planning. Each practice should be inclusive of a community wide response.

It is important to develop a whole practice plan, involving all staff in the development (including the cleaning staff!).

Some examples of primary health care plans:

• Ropata Medical Centre (appendix requires proper referencing)
• Pegasus Plan

Key issues to consider within a Practice Plan:

Preparedness:

• Routine influenza vaccination should be encouraged amongst all practice staff, all eligible patients and those travelling, especially if they will be travelling to an area during a time that there is likely to be a seasonal influenza outbreak.
• Travel-associated respiratory disease: On the alert for an index case. Any patient with an influenza like illness who has, within the past 7 days returned from a country with human cases of avian influenza (at present these are: Cambodia, China, Indonesia, Iraq, Thailand, Turkey and Viet Nam) should be treated as a possible avian influenza. Call the local Medical Officer of Health on suspicion.
• Use of Oseltamivir (Tamiflu^®): Consider having available an information sheet on the use of antivirals for practice staff and patients Refer Ministry of Health information on Tamiflu^® at http://www.moh.govt.nz
• Supplies: Each practice will need an estimation of what likely supplies are needed for their own practice:
  • Consider surgical masks, eye protection, gowns, gloves, handwash and handrubs, cleaning equipment, tissues, paper towels, rubbish bags, rubbish bins with lids, thermometers, supplies of oxygen, extra antibiotics (for secondary infections), oral rehydration solutions
  • It is recommended that all general practices also stock two higher level personal protection packs for staff protection when needing to be in close contact during procedures that could lead to aerosolisation (eg intubating) N95 (P2), gowns, goggles.
    NB: There is a national stockpile of PPE equipment as a backstop. However practices still need to consider purchase of their own supplies as well.
  • Infection control training for all staff - check what is available in your local area
  • Procedures (and training) to deal with patients who have fever and respiratory symptoms and a history of travel to an affected country.

In the Pandemic:

• Coping with patients with possible pandemic influenza: it is to be expected that there will be a significantly increased patient demand for medical assessment when pandemic influenza is imminent or present in an area. The worst-case scenario will be that a large number of patients with possible influenza attend a practice where infection could spread to staff and other patients
• Continuation of routine services: Each practice should consider how it will operate with reduced staff and reduced ability of providers of supplies to operated
• Personal Protection for staff:
  • To reduce the possibility of person to person transmission and to protect frontline staff. It involves the use of standard infection control measures including personal protective equipment.
  • Patients should be discouraged from attending a practice if they suspect they have pandemic influenza. Each DHB/PHO is likely to develop their own scenarios and each General Practice needs to develop their plan to fit in with the local planning. Issues to consider may be the use of telephone triage, outreach home visiting or setting up community-based assessment centres.
• Illness in staff or family member of staff: Staff members who have an influenza-like illness should not come to work until they have completely recovered. If a family member has an influenza-like illness, the staff member should not attend work till one week after the last ill person in the household has recovered, unless they themselves have been affected, in which case they can return to work when well enough to do so.
• Communication: Clear lines of communication will need to be established daily between all staff and regularly with other providers, your PHO and the DHB
• Security: A nation-wide pandemic with high infection rates and high morbidity and mortality may cause panic and an environment of 'every one for him(her) self''. Practices need to plan for this eventuality
• Vaccination: In the event that a vaccine becomes available for pandemic influenza there is likely to be a huge demand requiring reallocation of resources
• Anti-virals: Be aware of local distribution centres for antivirals and where to refer influenza patients