COVID-19 (Novel Coronavirus)

Updated June 16, 2020  – If a Member is required to provide care at a LTCF, the Member must communicate directly with the administration of the LTCF prior to the visit to establish and ensure that all the LTCF protocols are in place including the requisite screening (of Member and resident), and that the Member has all required PPE or ensures that the facility will provide the required PPE.

Members should be fully aware of all the implications and responsibilities of providing care in long term care facilities and the potential risks associated with the transmission of COVID-19. Members must be fully aware of all policies for individual LTCF’s as well as directives from Public Health Ontario, the Ministry of Health (MOH) the Chief Medical Officer of Ontario and relevant Standards of Practice of the College of Chiropodists.

May 10, 2020 – COCOO strongly advises that members do not currently provide in-home care for patients. Members should be fully aware of all the implications and responsibilities of providing in-home care and the potential risks associated with the transmission of COVID-19. In addition, members must be fully aware of all policy directives relating to COVID-19 from Public Health Ontario, the Ministry of Health (MOH) the Chief Medical Officer of Ontario (CMOH) and relevant Standards of Practice of the College of Chiropodists.

 Revised May 20, 2020

Update

• To improve patient access to orthotic therapy from Chiropodists and Podiatrists.
• Assessment, Casting and Dispensing of custom foot orthoses must be performed in compliance with Directive # 2 from the Chief Medical Officer of Health (CMOH) and in adherence with the COCOO Prescription Custom Foot Orthoses Standard of Practice
• Patients that were casted for orthotics prior to the CMOH directives will be able to access their custom foot orthotics and begin their orthotic therapy IF, based on patient presentation and your clinical judgement, they are determined to be ESSENTIAL as per Directive # 2 from the Chief Medical Officer of Health.
• Inclusion of orthotic therapy as essential DOES NOT mean that all patients who require orthotics will be scheduled at this time. All appointments will continue to be scheduled according to the COCOO and PHO requirements

Protocol

• Members are still encouraged to provide telehealth/virtual care as first line assessment/intervention when possible.
• A point-of-care risk assessment (PCRA) must be performed by Chiropodist and Podiatrist before every patient interaction.
• Assessment, Casting and Dispensing of custom foot orthoses must still be completed in adherence with the COCOO Prescription Custom Foot Orthoses Standard of Practice:
• Follow up on dispensed orthotics must still be completed as per the Orthotic Standard:
  • The requirements for follow-up to the dispensing of prescription custom foot orthoses include: Provide short term instructions for usage of the devices. Offer a follow-up appointment within a reasonable period of time after dispensing the orthotic devices (such as 3-4 weeks). This should be documented in the patient record. A telephone follow-up would suffice, if the patient does not require or attend a follow-up visit. Advise the patient regarding the need for periodic long-term check-ups..^[1]

Triage Considerations

• Triage assigns degrees of urgency to all patients
• A structured and consistent approach that can be applied to all patients should be followed.
• Example questions that may comprise your triaging may include, but are not limited to:
  • What are the possible consequences to the patient if the orthotics/treatment are not provided?
  • Is the patient at risk of further foot injury or complications if the treatment is not provided?
  • If a patient does not receive their PCFO/treatment at this time will their condition deteriorate and to what extent?
  • Am I able to meet my patient’s needs using alternative means?
  • Is the patient reporting that they are having difficulty working because of foot related pain?
  • Is the patient unable to perform daily physical activity because of foot related pain?
• If the answer is yes to any of the above questions, they may be categorized as requiring an ESSENTIAL appointment.
• Clinical judgement should be used to determine if orthotic therapy is required at this time under Directive # 2 from the Chief Medical Officer of Health- for Urgent Care. Patients with ESSENTIAL foot conditions/concerns can be assessed and receive their treatment that may include casting and dispensing of PCFOs.
• The COCOO understands that public access to orthotics is essential and can have a direct impact on patient health outcomes. At this time, under Directive # 2, patient circumstances that could be determined as requiring ESSENTIAL care,
• If a Member believes that a patient needs to be examined in-person to rule out a significant problem, patients should be provided with an ESSENTIAL appointment.

Clinical Requirements

• Refer to updated COCOO COVID-19 IPAC and PPE Requirements
• If you do not have access to proper PPE and do not have IPAC measures implemented in your office setting, then you will need to reschedule patients at a later date.
• Patients must be masked (fabric mask, scarf, face covering of mouth and nose) for the duration of the appointment

Clinical Considerations

• Special Attention in regards to contact with footwear of patient – ensure change of gloves after touching footwear and before coming in contact with the patient.
• Ensure adequate disinfection (IPA 70%) of feet before and after gait analysis*
• Consider having the patient remove footwear at the entrance before walking through the clinic*
• Consider providing patients with disposable booties to wear over socked feet when walking to the treatment room *
• When possible, areas for gait assessment should be separate from high traffic areas such as near the entrance/front desk/other treatment rooms*

*These considerations are for patient safety during gait assessment

As this outbreak evolves, the COCOO will continue to review updates from the Ministry of Health (MOH) and other provincial authorities, to determine the most appropriate measures required to protect Members and their patients. Guidance documents will continue to be revised to provide Members with the most comprehensive information available at the time.

References

^[1] http://www.cocoo.on.ca/pdf/standards/standard_orthotics.pdf
^[2] http://cocoo.on.ca/wp-content/uploads/2020/03/CMOHDirective2-RHPAprofessionals2020-03-19.pdf

Revisions
Originally published: May 20th, 2020
2nd Revision COVID-19 Orthotic Advisory: Mary 16th, 2020 (current)