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COVID Alert Level 3

On Wednesday 31 August those south of the Auckland boundary moved into Alert Level 3. We acknowledge those in the Auckland and Northland regions who are still in Alert Level 4. Kia kaha.

There has been ongoing work with the Ministry of Health (MoH) following the last lock down in 2020 and on Monday 30 August MoH released revisions to the ‘COVID-19 Guidance for Community Allied Health, Scientific and Technical (AHST) Providers in Alert Level 3’.

As with previous COVID-19 guidance from MoH this is for physiotherapists working outside of the DHB sector. Physiotherapists working in DHBs are providing essential services under all levels and each DHB has its own pandemic plan operating.

There are differences between the MoH guidance for COVID-19 Alerts Level 3 in 2020 and August 2021. This communication is to assist in the interpretation of the revised COVID-19 Alert Level 3 guidance; it does not replace the full MoH release. Please check the Physiotherapy Board and MoH websites regularly for updates and changes.

At Alert Level 4 MoH issued a Notice which was mandatory. At Alert Level 3 they have provided Information and Guidance that specifically defines what urgent is and under what circumstances a face-to-face appointment may be considered.

As stated in the MoH guidance at Alert Level 3 telehealth and other virtual methods of assessing and treating patients are the main method of service delivery in the community, due to the transmissibility of the Delta variant.

Physiotherapists are to follow MoH Guidance as well as the Physiotherapy Board Serious Events Standard and use sound clinical judgement as to whether their patient meets the criteria for a face-to-face consultation.

Covid-19 Alert Level 3 guidance – From the MoH 30 August 2021

MoH has updated the ‘Urgent Care’ criteria for AHST services delivered in Alert Level 3 [dated 30 August 2021].

The criteria have been expanded for use in the delivery of effective treatment, preventing deterioration or sustaining the progress of healing in other health conditions, while protecting the public from COVID-19.

The following statements in bold have been added to the scope of ‘Urgent Care’ services for Alert Level 3:

  1. a condition which is life or limb threatening; or
  2. treatment required to maintain the basic necessities of life; or
  3. treatment that cannot be delayed or carried out remotely without risk of significant harm or permanent and/or significant disability, or
  4. where failure to access services will lead to an acute deterioration of a known condition; or
  5. where delay in access to services will impact the consumer’s ability to maintain functional independence and significantly negatively impact quality of life

AND

  1. which cannot be delivered by a service which is currently operating or by clinicians that are already in contact with the patient for ongoing care.

 

Clinical Reasoning

At all times during Alert Level 3 the provider needs to ensure their clinical reasoning for choosing an ‘in person’ contact is within the scope of ‘Urgent Care’ criteria and can be justified in line with protecting the consumer.

The workforce is therefore asked to:

  1. Consider and weigh up the risk of contact to the consumer versus the risk of not seeing them, and the impact of deterioration on the consumer. (note: Refer to the Risk Assessment Guidelines for PPE on the MoH website. This will guide you on the level of PPE required.)
  2. Consider the appropriate use of digital technologies to facilitate delivery of services.
  3. Prepare an alternate plan for treatment and be equipped to respond to changed
    circumstances.

The full MoH guidance is available here (PDF)

In using this revised COVID-19 Alert Level 3 guidance:

  • deliver physiotherapy services via telehealth
  • if telehealth is not possible or has failed, use clinical reasoning and judgement to determine if the patient is urgent and meets the MoH criteria for a face-to-face consultation

There is guidance for face to face consultation here.