NORTH CHANNEL NURSE PRACTITIONER-LED CLINIC
HOW WE CONDUCTED BUSINESS DURING COVID19 – OUR QUALITY COMMITMENT

ALTHOUGH A FORMAL QUALITY IMPROVEMENT PLAN (QIP) WAS NOT REQUIRED FOR SUBMISSION IN 2021/22, THIS QUALITY SUMMARY ENSURES THAT STAFF, CLINICANS AND PATIENTS / CLIENTS AND THEIR FAMILIES HAVE RECEIVED EXCELLENT CARE DURING THIS PANDEMIC.

Since March 2020, when COVID-19 became a significant challenge to all sectors that make up our health care services, the North Channel NPLC made changes on how we conduct business.  The focus has been to provide comprehensive health care services to our patients and community, keep our patients as well as staff safe, and to comply with the orders and recommendations from the Algoma Health Unit (APH) and Ministry of Health & Long-Term Care (MOHLTC: Primary Care Guidelines).  Our clinics have remained flexible throughout these difficult times and has adapted to changes in real time as the environment constantly changes.

Many precautions have been made to lessen the transmission of the virus.  At the entrances, doorbells have been installed in both clinics to stop patient traffic and allow for COVID-19 screening.  Various policies and procedures have been implemented to address testing and travel outside of the Algoma District.  Social distancing was implemented and clinic traffic has been kept at a minimum.

Daily staff meetings were held initially to discuss all the various aspects of service delivery and how we could synchronize our efforts to support the most vulnerable populations during this time.  Currently, the meetings are held weekly to ensure that all safety measures are in place and patients are managed in an effective and timely manner.  

The staff has submitted information for a Daily Activity Log to record what we were doing plus many telephone surveys have been conducted to determine if what we were doing is working.  Staff is screened daily in accordance to government guidelines and recently rapid tests are provided the first thing each morning for the staff to be screened on a daily basis.  The entire staff is fully vaccinated and provide educational information to patients inquiring about vaccination safety and effectiveness.   As well, all staff completed an online certificate course on Personal Protective Equipment (PPE).

Here is a list of some, but not all, of the things we did to provide patient care throughout the pandemic:

• Wellness cold calls were made to vulnerable patients to check on their wellbeing.
• The Social Worker makes numerous calls regularly to patients to monitor well-being and mental health.  As an example, in one month, she recorded 201 phone calls and through this time still provided some CBT/DBT, EFFT and Exposure Therapy for parents faced with new challenges of home-schooling.
• The Social Worker participated with a team from the North Shore Health Network to develop protocols and initiatives to support the medical staff at the North Shore Health Network. 
• Radio announcements on two stations were run for a week reminding and thanking people for following social distancing.
• Staff have attended virtual educational sessions related to COVID-19. 
• Most patients had their regular appointments via phone.  Virtual options have been made available as appropriate, as well as in person appointments when medically required.
• In 2020, funds became available via a Federal mental health initiative, enabling us to procure an Ontario Telemedicine Network (OTN) machine, therefore allowing easier access to face-to-face appointments.
• PPE inventory is reported to the MOHLTC, on a weekly basis, as per the Government of Ontario orders.  New venues and avenues to secure PPE have been researched.
• Our by-annual Geriatric Clinic has continued and has been run virtually due to the pandemic.
• Blood work and immunizations continue to be available at the clinic for all patients.
• Surge planning was started at the onset of the pandemic.  Flags have been placed in the Electronic Medical Records (EMR) software to ensure screening protocols for cancer screening and chronic disease management resume as various waves of the virus have taken place.  The Nurse Practitioners, as well as the nursing staff, routinely audit patient charts to ensure that regular attention is paid to testing and cancer screening. 
• Some scheduled community sessions and workshops were paused although individual phone and in person appointments were conducted including management and education on cardiovascular disease, hypertension, diabetes, and smoking cessation.  
• The staff and administration, in conjunction with APH, have been involved in planning and participation in community immunization clinics. In-house vaccinations clinics have been made available to our patients as needed.
• Home visits have continued to be conducted as required and have increased due to the pandemic. 

Here are some of the patient survey comments made during COVID19 in respect to care given by the North Channel NPLC:

• Great care always.
• The phone appointment is an excellent option.
• Really appreciate your care and calls to see how I was doing and explaining things to me
• I like the phone appointments, informative and easy to attend. Great people at the clinic.
• Appreciate the call.
• Love the phone call process.
• Really like how the Social Worker and NP collaborate on my plan of care.
• Would welcome telephone contact appointments when needed.
• Thank goodness for you. I’ve never had such good care.

 All aspects of care will be adjusted if the number of COVID-19 cases increase or recommendations are provided by APH or the MOHLTC.  

The North Channel NPLC has been actively involved in the planning and deliver of community clinics during first and second vaccinations.  There have been several in-house clinic days for patient who have missed the community clinics. Plans are being made to assist in the delivery of the third dose and booster shots as well as delivery of vaccinations for 5 – 11-year-olds. These will be underway soon.  Notably, the clinic has also continued to provide the annual flu shots to patients.  

October - December 2021: Wave Four:

In October of 2021, COVID19 cases began to significantly climb in the Algoma District. Although the communities within the district maintains a Phase 3 approach to practices to create barriers to virus transmission, the North Channel NPLC has reverted back to earlier and more stringent phases and practices to ensure that patient and staff safety prevails. The clinical staff provides essential primary care via telephone, virtual and in-house visits.  

As cases become more prevalent in the district, the Nurse Practitioners maintain increased contact with our patients ensuring that their essential needs are met and they are provided with the medical care and support needed to get through pandemic.

The staff at the North Channel will continue to support their patients throughout this pandemic and are dedicated to see us through these difficult times.  All patients are encouraged to get vaccinated and practiced social distancing. Each patient gesture allows us to look forward to a healthier future.