Jo Scott-Jones discusses the different approach general practice need to consider to keep people safe now Alert Levels are a thing of the past.
What’s the “new normal” now?
The country has shifted from “levels” to “traffic lights” (also known as the COVID-19 Protection Framework) to describe the way the public are advised to behave as COVID-19 surges across different areas. We need to understand how this advice might impact the way we manage our patients and how we keep them and our staff safe when they need our care.
As the prevalence of the virus in the community increases, it is vital that high proportions of the population are fully immune. Vaccination makes a difference to the rates of hospitalisation and deaths from the disease. Vaccination reduces the risks people bring and face when they congregate in a place of healthcare. Vaccination is vital, but is only one aspect of infection protection and control that we need to apply.
The “new normal” we recommend now looks very similar to the things you already had in place.
Throughout the different traffic light levels:
People ask is that 30/50 or 70 per cent virtual? We don’t think it is useful anymore to put numbers to this advice – keep people away from your clinic if you can provide a high quality of care. Focus on EQUITY – make it as easy as possible for the people who need your help most, to get the services they need.
In the event of your locality being in a “red” zone under the COVID-19 Protection Framework, your threshold for seeing patients in person might be higher than if the area is a “green” zone, but fundamentally the same infection and protection control measures need to take place.
What about spirometry?
Spirometry, in common with all investigations, can go ahead with usual infection control and COVID-19 streaming precautions.
What about pulse oximetry in people with dark skin?
This has been coming up for a while now. I am not at all surprised that the media has picked up on this issue but we have to guard against undermining the public confidence in this tool. I agree with the Anaesthesia Patient Safety Foundation "that patients are safer with continued use of pulse oximetry to estimate arterial oxygenation. It is potentially more harmful if the known bias in measurement related to skin tone resulted in a lack of confidence in pulse oximetry as a monitoring tool for patients with dark skin tones."
The issues are reflected in Healthpathways advice, with the most practical approach reiterated by Trish Greenlagh et al: "A study of hospital inpatients found that those with black or brown skin were three times as likely as those with white skin to have occult hypoxia—that is, pulse oximeter readings in the normal range but arterial blood gas levels in the hypoxic range. The oximeter reading gave false reassurance in 11.7% of patients with black or brown skin and 3.6% of those with white skin. However, other authors have found that inaccuracy of pulse oximeters in those with darker skin relates mainly to saturations below 90%—substantially below the level that would trigger a hospital referral. For the purposes of home monitoring, we suggest some rules of thumb to mitigate skin colour bias. First, ensure that the patient is using a quality-marked oximeter (all the ones bought from medical suppliers or provided by the DHB/MOH in NZ meet this standard) since cheaper products marketed directly to the public may be less accurate. Second, take account of deviation from the patient’s own baseline if known. Third, take particular care to assess the patient holistically rather than relying solely on the oximeter readings. Finally, be prepared to act on any reading below the normal range in a patient with darker skin, regardless of ethnicity."
Advice and resources to assist you in offering virtual care.
N95 masks are recommended for clinicians to use whenever they feel at higher risk of contracting COVID-19 or any other airborne infectious disease such as measles.
During the COVID-19 lockdown virtual consultations for POAC cases were funded. We are pleased to announce that this will be a permanent change.
Read moreDo you know someone in the respiratory field or community who deserves recognition for their achievements in the community? Nominations are open for the 2024 Respiratory Achievers’ Awards, recognising people with respiratory conditions, and those working in the field of respiratory health, who have made personal achievements and/or positive impacts in their community.
Read moreThis funding is available for a GP/NP consultation with patients eligible for an advance prescription for COVID-19 anti-viral medication, prior to them testing positive for COVID-19. There is no obligation for a clinician to issue an advance prescription.
View details