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Seeing patients face to face during COVID – FAQ

FAQ

These FAQs are for physiotherapists working outside the DHB setting. DHB’s have systems and processes in place so please if you are a DHB physiotherapist and have any queries discuss them with your local DHB leadership team or line manager.

Can Physiotherapy Services open for face-to-face under Covid Alert Level 3 and is it Business as Usual (BAU)?

Recently we informed you that the current COVID-19 Public Health Response (Alert level) Order enables non-DHB physiotherapy clinics to be open under Level 3. Although face-to-face physiotherapy services may be provided under Alert Level 3 it is not pre-Covid-19 Delta variant business as usual.

The Order is mandatory and requires physiotherapy practices to comply with the following rules under all Alert Levels:

  • Display QR codes in workplaces (clause 9)
  • Workplace systems and processes to enable keeping of contact records (clause 11)
  • Systems and processes for contact record rule (clauses 28 and 44)
  • Additional face covering requirements for individuals (clauses 23 and 39)

In addition, health professionals have an ethical duty to take all the required precautions to practice safely and mitigate risks related to the COVID-19 pandemic. Vigilance in meeting all infection prevention and control (IPC) measures is required during this time.

The Board’s guidance also states the need for physiotherapists who are persons conducting a business or undertaking (PCBU) for the purposes of health and safety legislation to consider their obligations to ensure, so far as is reasonably practicable, the health and safety of those working at or within their business and others who could be put at risk by the work of the business.

Physiotherapists should consider the current Ministry guidance for working under Alert Level 3 and apply it where considered appropriate. Helpful information on PPE and cleaning is also available on the Ministry of Health’s website.

Please ensure you read and understand the requirements for provision of face-to-face physiotherapy services in full. The links for the information sent out by the Board on the 15th and 16th October 2021 can be found here:

In summary, using their clinical reasoning and judgement, physiotherapists may select who they see for face-to-face consultations. However this must be undertaken in a manner that complies with the Order and is consistent with their ethical obligation to protect the public.

Vaccinations in the healthcare sector- what is the latest update?

Although the government has announced the mandating of vaccinations in the healthcare sector, the COVID-19 Public Health Response (Vaccinations) Order 2021 has not yet been updated to require workers in the health and disability sector to be vaccinated. This is expected to happen later this week, based on Ministry of Health advice. There is currently no definitive guidance as to how this Order will work, how wide the mandate will be or who will be covered by the Order.

Importantly, any vaccine mandates for health and disability sector workers will be made by the Ministry of Health, not by individual responsible authorities such as the Physiotherapy Board.

Can I ask a patient’s vaccination status?

As part of a health and safety risk assessment physiotherapists may ask patients their vaccination status. Patients are within their rights to refuse to answer this question. If they refuse to answer the question physiotherapists may assume that they are unvaccinated.

Can I refuse to see a patient face-to-face who is unvaccinated or is unable or unwilling to wear a mask?

Physiotherapists may refuse to see a patient face-to-face in accordance with principle 4.5 of the Aotearoa New Zealand Physiotherapy Code of Ethics which states:

“Physiotherapists should feel able to refuse to treat a patient if they have good reasons. The patient should be informed of the reasons, alternative options of care, and where appropriate to refer to another healthcare provider.”

A physiotherapist who refuses treatment would need to be able to provide good reasons that justify the refusal. Those ‘good reasons’ must be objectively reasonable and informed by a risk-based assessment. In the case of a patient seeking physiotherapy services who is unvaccinated or is unwilling or unable to wear a mask, the risk assessment might include consideration of whether the needs of the individual patient are outweighed by the need to protect the health and safety of others, including the health and safety of vulnerable patients or staff who may be present at the clinic when the patient attends.

The clinical reasoning for your decision should be documented.

If you decide to decline treatment, you should explain your reasons for doing so. As stated in principle 4.5, the patient should also be informed of alternative options of care, and where appropriate, referred to another healthcare provider.

In relation to alternative options of care, you could offer telehealth services if they would be an appropriate alternative option. In addition, if you decide to refuse treatment to a patient you should refer them to another healthcare provider whom they can contact and enquire about treatment options, if one is available.

You may wish to consider implementing a clinic policy (if you have not done so already) regarding the use of masks by patients seeking treatment at your clinic.  This may help to clarify the situation at the outset for patients and staff.

What to do if a I, a member of staff or a patient has been exposed to or tested positive for COVID-19?

Contact your Manager/Director immediately
Contact the Ministry of Health’s, Healthline on 0800 358 5453 24 hours a day, seven days a week to determine:

  • contact tracing requirements
  • who needs to be tested
  • their advice around the clinic/organisation remaining open

If awaiting guidance and instruction from the Ministry of Health, conduct a risk assessment to determine if it is safe to remain open or if the clinic or organisation needs to be closed.
Deep cleaning of the clinic in line with guidance from the Ministry of Health Cleaning following a confirmed or probable case of COVID-19
Guidance for this can be found here: https://www.physioboard.org.nz/resources/covid-19

What is adequate ventilation?

Recent Ministry of Health advice following an allied health meeting was that while no scientific information is available at this time, steps should be taken to maximise available air exchange and changes within clinics and physiotherapy services. This includes:

  • opening windows as much as possible to provide outside air
  • leaving doors open (where appropriate)
  • alternating treatment rooms or leaving time between patients to allow for room air exchange