November 25, 2020
Patient visiting doctor office

COVID-19: SOP For OPD/ Doctor Clinics

PROTOCOL AND SOP FOR OPD/ Doctor Clinics/ ENT Clinics/ General OPD Wards, etc.

This document outlines the guidelines and protocols laid out for Doctor Clinics, Out Patient Departments (OPD) in Hospitals, Nursing Homes, Private Doctor Practices, etc.
These guidelines are aimed to minimize the spread of COVID-19 infection among Doctors, especially ENT doctors, nursing staff, support staff, patients and their attendants.
This has been developed in accordance with the official guidelines and documents issued by the Ministry of Health and Family Welfare, Government of India.

Teleconsultation

Teleconsultation is most preferable.
 Prior Tele-consultation (via Audio or Video) can be done to identify patients requiring physical examination in clinic.


Appointment Management System

(time-based appointment to limited numbers)

 One patient at a time in examination room, if possible, without their attendant.
 Sufficient time should be given for patient evaluation and for time in-between patients.
 Walk-in patients without appointment should be discouraged.


Patient Screening at the OPD Entry

All patients entering the OPD or the Clinic or the Examination room should be screened using the Screening guidelines/ protocol and Thermal Screening.
The objective of screening is to minimize exposure and ensure the safety of staff and the patients.
Screening is to be done to pre-screen all the patients before entry and to minimize entry to the OPD or Clinic premises.
Patients having symptoms suggestive of Covid19 ( Whether ENT Symptoms or Respiratory Symptoms) should be seen in a separate “Covid-19 screening Clinic” and not in the OPD/ Clinic.
This is so that other patients in the OPD or Clinic are safe.
Also, personnel manning the Covid-19 Screening Clinic will have a different level of PPE due to High Risk.


At entry point of OPD

Regulate the entry of patients and ensure use of Mask, Hand Hygiene and Social Distancing, as per the standard protocols advocated by M/o Health & Family Welfare.

Within the OPD or Consultation Room

 OPD room or consultation room should be well-ventilated.
 Doctors, especially ENT doctors should wear Level I PPE kit (N95 mask, gown, gloves, goggles/ face shield) in OPD chamber.
 Avoid performing endoscopy (Nasal endoscopy, 90 rigid or flexible endoscopy for larynx) in routine OPD.
 If endoscopy has to be performed, it should preferably be performed in a separate demarcated area with Level II PPE kit (Cover-all gown, N-95 mask, gloves and goggles).
 Doctor should change gloves if they get soiled and refrain from eating/drinking during OPD timings.
 Doctor should encourage patients and their attendant to follow-up with teleconsultation based upon his/her assessment.

USE OF PERSONAL PROTECTIVE EQUIPMENT

Health care personnel
Guards – N 95 mask
Health care worker – Level I PPE kit (N 95 mask and gown)

Patients and care taker – Gown & Triple Layer Mask

Examination of patients/ Tracheostomy/ Tube change/ cleaning the ward (aerosol generating) — HCP should wear Level II PPE (cover all gown, N 95 mask, gloves, goggle and face shield)

References

https://www.mohfw.gov.in/pdf/ENTCOVID0306.pdf

https://covid19.karnataka.gov.in/storage/pdf-files/ADVISORY%20-%20CLINICS.pdf

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