Practice Guideline - Alberta College of Occupational ...
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Practice Guideline
Safe Delivery of Occupational Therapy Services
During the COVID-19 Pandemic
Initially created May 06, 2020
Updated June 11, 2020
Background
The highly contagious nature of the novel corona virus (COVID-19) has brought additional focus on the
importance of safe delivery of all health, social/community and commercial services in order to slow the
spread of the virus until an effective vaccine is available. Alberta’s Chief Medical Officer of Health (CMOH),
along with medical officers and government authorities worldwide, has been basing their public health
orders on an ever-evolving base of knowledge and research relating to the unique properties and
manifestations of the COVID-19 virus.
On March 27th, 2020, Alberta’s Premier and CMOH recommended the stoppage of any non-essential
health services provided by regulated health professionals (CMOH Order 07-2020). Non-essential health
services were defined as “those generally done to protect, promote or maintain the health of an
individual but if interrupted would not endanger the life, health and safety of the individual.” Non-
essential health services were to only proceed if:
The service was deemed urgent by the health professional providing the service.
The service was critical to preserving life, health, public safety and basic societal functioning.
On April 30th, 2020, Alberta’s Premier and CMOH indicated that non-urgent non-essential services could
resume as early as May 4th, “as long as they are following the approved guidelines set by their professional
college.” (CMOH Order 16-2020)
This document formalizes and expands on the information provided to registered members of ACOT on
May 1, 2020 and incorporates additional requirements outlined in CMOH Order 16-2020.
The June 11, 2020 version of this practice guideline incorporates additional content/updated links
requested by Alberta Health to ensure consistency of guidance amongst Alberta’s regulated health
professions. It also clarifies requirements for physical distancing, hand hygiene and continuous masking for
health care providers, regardless of work setting. As well, what to do if you/your staff/co-workers or your
clients report they are symptomatic or have come in close contact with someone that has tested positive
for COVID-19.
Applicability of these Guidelines
• ACOT has prepared the following guidelines for self-employed OTs (solo practice or clinic-based)
and/or OTs whose employers/contracting organizations have either not yet provided guidance or
have asked employees to follow the guidance set out by their regulatory body (e.g. school
boards/divisions/authorities). .
Safe delivery of occupational therapy services during the COVID-19 pandemic 1o ACOT assumes that each OT is best suited to determine whether they will resume service
delivery.
o The type of OT services provided and the way in which they are delivered by OTs, is very
diverse. As such, ACOT assumes that each OT is best-suited to determine how to apply
and implement the following guidelines to their own unique practice in alignment with
ACOT’s Standards of Practice and Code of Ethics.
• Employers of OTs are responsible for directing their employees on how to operationalize and
implement the public health orders. If you have questions or need clarification of your employer’s
guidance, follow-up with your supervisor/manager or professional/clinical practice lead.
• If your employer has not yet provided guidance, you can bring this guideline to their attention for
reference.
**The information in this document is current as of the date of publication/update and reflects the
requirements for OTs in Alberta as of June 11, 2020.**
Guidelines for the provision of OT services during the pandemic
CMOH Order 16-2020 requires that “each college established under the Health Professions Act, must, as
soon as possible, publish COVID-19 guidelines applicable to the members of the college that are
substantially equivalent to the guidance set out in the Workplace Guidance For Community Health Care
Settings developed by Alberta Health.”
Expanding on and complementing the guidance set out in the Workplace Guidance for Community
Health Care Settings document (Appendix A of CMOH 16-2020), during the time of the pandemic, it is
recommended that OTs:
1. Offer services virtually whenever possible.
o ACOT has prepared an Interim Practice Guideline on considerations for delivery of OT
services virtually through videoconferencing applications. CAOT also has prepared
telehealth resources that are accessible to all OTs, whether they are members or not, from
the COVID-19 page of the CAOT website.
2. If virtual service delivery is not an option for your practice, use your clinical judgement to
determine whether in-person services can be delayed or postponed without risk to the client.
o This determination can be done in discussion with your referral source(s) and/or client(s)
regarding what poses the highest risk (i.e. risk to your client’s health if services are not
provided in-person versus risk to you/your client’s health if they are provided in-person).
While the perspectives of your client or referral source are to be respected, you are
ultimately accountable for determining whether to proceed with in-person services
based on your clinical judgment of the safety/risk to each of your clients.
3. Defer/postpone in-person service delivery if client pre-screening reveals risk factors, signs or
symptoms of COVID-19 or if the client has been directed to quarantine.
o Services must be deferred until signs and symptoms have resolved. As per CMOH 05-2020,
this must be a minimum of 10 days from symptom onset, or until symptoms resolve,
whichever is longer.
o Information to guide your client on what to do if they have signs or symptoms can be
accessed from the Isolation Requirements section of the Government of Alberta’s COVID-19
Safe delivery of occupational therapy services during the COVID-19 pandemic 2page. The Government of Alberta has also created information sheets for the public that
have been translated into several languages that may be useful to share with your clients.
In the case that in-person service delivery is the most appropriate option OTs must:
4. Ensure that appropriate workplace controls are in place to mitigate risk of COVID-19
transmission. The controls you implement will vary depending on:
o your service/practice setting e.g. Do you see you clients in your home/clinic? Do you see
your clients in their homes, workplaces, or public spaces?
o your client population e.g. Are your clients more vulnerable if exposed to the virus? Does
your client have a condition(s) that limit their ability to perform hygiene etiquette and/or
hand hygiene?
o the type of service provided e.g. How close do you need to get to your client? Is your client
able to wear a mask during the assessment/intervention? Are other clients seen at the same
time?
o Health Canada has developed risk-informed decision-making guidelines that itemize these
variables and others that may be useful to you when determining which controls you
should have in place (scroll to the table in the “risk mitigation strategies” section).
Examples of the three types of workplace hazard controls include but are not limited to:
Type of Intent of control Examples and resource links
control
Engineering – Measures aimed at Physical Distance measures (2m spacing markers, rigid
to isolate reducing spread of barriers, limiting number of people in clinic or at a
people from pathogens and the home/workplace visit – no more than 15 as per CMOH
the hazard contamination of surfaces Order 07-2020), adequate spacing between treatment
and inanimate objects by areas and staff workstations, removal of communal items
isolating the hazard and in waiting areas, etc.
by physically directing Availability and visibility of hand hygiene supplies and
actions to reduce the instructions for staff and clients.
opportunity for human Signage at entrances, in treatment areas and washroom
error facilities (see various posters created by the Government
of Alberta and AHS.
Safe delivery of occupational therapy services during the COVID-19 pandemic 3Administrative Measures intended to Staff screening (can use AHS’ Daily fit for work screening
– to change reduce the risk of questionnaire); client pre-screening (can use AHS self-
the way transmission of pathogens assessment tool for Albertans). The Government of
people work to staff or clients Alberta has created an assessment tool for health care
workers to assist in determining next steps if you or a
staff member has signs or symptoms of COVID-19.
Infection Prevention Control practices in place including
training on the four moments of hand hygiene and sick-
leave policies for staff to ensure no one attends work if
sick.
Staff training on the enhanced cleaning and disinfecting
requirements for work/treatment spaces and
equipment, using proper disinfectants that have a DIN
issued by Health Canada (see page 8 of the Workplace
Guidance for Community Health Care Settings and the
Reusable & Single Use Medical Devices Standards). For
home visits, consider additional precautions for
environments you work in (i.e. client home or workplace,
your vehicle) to limit virus transfer between clients or
bringing home to your family on devices or clothing.
Client and staff attendance tracking for purposes of
contact tracing. See page 5 Workplace Guidance for
Health Care Settings for the information you would be
required to provide in the case of a staff or client testing
positive.
Personal For use in conjunction Alberta Health/AHS guidance on point-of-care risk
Protective with engineering and assessments and continuous masking* in addition to
Equipment – administrative controls routine practices. See also:
to protect the and determined based on https://www.alberta.ca/assets/documents/covid-19-
worker and point-of-care risk healthcare-ppc-guidance.pdf
client assessment PPE don/doff/disposal training resources (see PPE
training resources prepared by AHS)
* Continuous masking, with surgical/procedure masks (not cloth or homemade masks) is required for
all health care workers providing direct client care or working in client care areas where barriers are
not possible or physical distancing cannot be maintained between clients and/or co-workers for the
duration of a client visit/work shift.
The purpose of wearing a surgical/procedure mask is to limit inadvertent transmission of the virus from
health care workers to their clients and/or co-workers. All other PPE is selected/used to protect a health
care worker and is dependent on the risk of transmission each client poses to them (based on the point of
care risk assessment).
5. If you choose to resume service delivery in-person, you may only proceed when:
o All applicable engineering or administrative controls are in place;
o Supplies of required PPE are available for you/your staff and your client(s) (if applicable);
and,
o You, and any staff under you supervision/employ, are adequately trained in the:
determination of which PPE are required; and,
proper donning/doffing/disposal of PPE.
Safe delivery of occupational therapy services during the COVID-19 pandemic 4Accessing PPE The Government of Alberta was coordinating requests for PPE for service providers that don’t normally use PPE in their service provision but are required to do so now. On May 25, 2020, the Government of Alberta announced that eligible providers can still submit requests using the following form https://xnet.gov.ab.ca/ppe until June 30, 2020 only, and will be charged market value for the supplies ordered. After June 30, you will be required to access PPE from your own sources if you had not been doing so already. You and any staff under your supervision or employ, should not proceed with any in-person delivery of services until required PPE is available and training on proper PPE donning, doffing and disposal has been provided/received. NOTE: ACOT registrants are expected to keep themselves informed about the pandemic and any directives/orders/guidance provided by the CMOH. The COVID-19 Information for Albertans page should be visited regularly as guidance is changing rapidly. Alberta Health Services has also prepared open- access, evidence-informed resources/guidance documents for all health care providers, including AHS staff. These resources are available from the Info for Health Professionals link. **In the event of a discrepancy between this information and the directives/orders of Alberta’s CMOH, the directives/orders of the CMOH take precedence. ** Please contact ACOT if you would like to further discuss requirements in your specific workplace. Safe delivery of occupational therapy services during the COVID-19 pandemic 5
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