Please find the full Level 2 guidance below. This is a joint Board and Physiotherapy New Zealand document. Thank you for your patience, and if you have any questions or feedback please get in touch via firstname.lastname@example.org or +64 4 471 2610
Physiotherapy New Zealand
Guidance on seeing patients at Alert Level 2 (non DHB setting)
Updated 8 May 2020
Please note this guide is a living document and will be updated as information from the Ministry of Health is released during the Alert Level changes. Please check both this document and the Ministry of Health website regularly for updates and changes.
This guidance document is based on the Ministry of Health’s Guidance for Community Allied Health Professionals and applies mainly to physiotherapists working outside of the DHBs. Therefore, please adjust the guidance to suit your working environment whether it be clinic or community based.
While much of the information contained may be useful to those working in DHB’s, please check with your manager if you are a DHB physiotherapist as protocols and procedures may vary between organisations.
Ministry of Health’s guidance for face-to-face consultations during Alert Level 2
Under Alert Level 2 the Ministry of Health has stated for community allied health, scientific and technical providers,
‘When the country does move into Alert Level 2 the following changes can occur: Please note ‘telehealth and virtual appointments are still the preferred option in Alert Level 2. Please exercise extra caution when treating vulnerable groups.
Practitioners will be able to see patients in person if the following processes are in place:
Screening for COVID-19 symptoms prior to in person appointment
Physical distancing measures
Infection prevention control measures including PPE where required
Practitioners will be able to travel within and to the neighbouring regions to provide care to patients and receive training.
Group treatment (e.g. exercise classes) can occur so long as physical distancing is in place’.
While physiotherapy clinics can reopen for routine face-to-face consultations under Alert Level 2, protocols must be implemented by physiotherapists and clinics to maximise patient and staff safety, including ongoing risk assessment and appropriate infection prevention control procedures. Despite the easing for face-to-face consultations under Alert Level 2, telehealth should still be considered especially for vulnerable patient groups.
Overarching Requirements at Alert Level 2
be aware that under Alert Level 2, there may still be some community transmission of Covid-19. An extremely high level of vigilance is required. Physiotherapists must use a high level of clinical judgement at all times when assessing and treating patients in order to keep themselves and the public safe
have knowledge of and understand the most current Health and Safety procedures, and the latest advice from Ministry of Health
consider their own safety and that of their own bubble as well as the patient’s safety
screen patients for COVID-19 signs or symptoms when making the appointment and again on arrival. If they are deemed to be a risk, do not allow them into the clinic or see them in the community until they have medical clearance. Consider using telehealth services
carry out a risk assessment and have a plan in place for the premises they are working in whether that be in a clinic or the community. Risk assessment during Alert Level 2 should be ongoing and continuous
maintain a log of all patient and staff contacts in case contact tracing is required
adapt their working practises to allow enough time between appointments to carry out necessary duties including cleaning equipment, surfaces and their own hands before another patient is brought into the treatment room
carefully assess the risks and benefits of a face-to-face consultation if patients are 70 years of age or over or have significant co-morbidities or vulnerabilities. Consider using telehealth services.
Once it has been established a face-to-face consultation is necessary, see below for further guidance. Appendix 1: General practise guidance
and Appendix 2: Adapting practise for face-to-face consultations.
This guide has been written for the clinic setting, therefore adjust the guidance to suit your working environment.
Appendix 1: General practise guidance
Screening or risk assessment of patients and any support persons for risk of COVID-19 prior to face-to-face consultations is mandatory. Patients should be screened when booking the appointment and then re-screened when they arrive at the clinic or you arrive at their home. When making an appointment for a face-to-face consultation, advise patients if they do develop symptoms between booking and attending their consultation, they must to call to cancel the face-to-face consultation and seek medical advice. If the patient, support person or someone within their bubble whānau have any symptoms on screening do not allow them into the clinic or see them in the community until they have medical clearance.
The principle is: if you are sick, you stay home and get tested.
Risk screening should be based on the case definition which can be found here
There is further guidance on how to screen patients in the following the document: Personal protective equipment (PPE) requirement for community care providers who are providing care in people’s place of residence
Further guidance for community based respiratory physiotherapists will follow shortly.
Clinic log and contact tracing records
Physiotherapists and clinics must keep their own current and accurate record of each patient whom they have seen face-to-face. This includes their full name, phone number, address, arrival and departure time. If there is a support person with them, their details are also recorded. This information will be used to aid contact tracing, if it is later required.
This clinic log should also include staff arrival and departure times. Ensure staff contact details are up to date.
The use of Personal Protective Equipment (PPE)
The Ministry of Health has provided guidance around the requirements for PPE; the main page which includes FAQs can be found here. Please read all guidelines relevant to your working environment. Most community and clinic-based physiotherapists however should be included in the following category:
In general, the Ministry of Health advise that if a patient has been screened as above, is not symptomatic, the physiotherapist is not undertaking an aerosol generating procedure, and there is no exposure to bodily fluids, then physiotherapists are not required to wear PPE.
The Ministry has confirmed this advice also applies to close up manual therapy techniques such as cervical mobilisation. Physiotherapists or patients however, may still choose to wear a mask if they wish.
The only departure from this advice for those patients who are at a higher risk of severe illness from COVID-19. If a patient is part of a vulnerable group and maintaining physical distancing of at least 2 metres is not possible, the physiotherapist should wear a surgical mask, irrespective of the type of care to be provided.
PPE gloves/gowns are otherwise only required if there will be exposure to bodily fluids. Vomiting is not considered an aerosol generating procedure so for those working in vestibular rehabilitation, business as usual PPE should be worn for this treatment.
For specific advice on PPE for aerosol generating procedures please see the Ministry of Health website.
We would advise keeping a small supply of PPE on hand however generally physiotherapists should not need to order large amounts and the Ministry have asked clinics not to stockpile. The latest advice from the Ministry of Health regarding the sourcing of PPE, is that ‘if you cannot get PPE from your usual supplier, contact the emergency management officer at your local district health board (DHB)’.
We understand there are still challenges for many trying to source PPE from DHBs; we suggest where possible, contacting local suppliers.
Working with vulnerable people
The government guidance for Alert Level 2 states ‘People at high risk of severe illness such as older people and those with existing medical conditions are encouraged to stay at home where possible and take additional precautions when leaving home. They may choose to work’.
Physiotherapists must carefully weigh up the risks and benefits of seeing patients who may have vulnerabilities to COVID-19, for face-to-face consultations, whether that is in the community or in clinic. They must discuss the risks and benefits with the patient and/or carer before deciding and continuing to make a face-to-face consultation appointment. Physiotherapists can still use telehealth if a face-to-face consultation is not appropriate. If it is decided a face-to-face consultation is appropriate, screening and the use of a surgical mask for the physiotherapist is required as stated above.
Working at multiple sites
We would recommend avoiding working across multiple sites, however where this is not possible, adapt your practice to minimise cross contamination. Examples of this could be a change of uniform, good hand hygiene, car cleaning, staffing roster changes or timetable alterations to minimise the number of sites visited on one day.
What to do if your workplace has a suspected case of COVID-19
If a staff member, patient or visitor becomes a confirmed or probable COVID-19 case and has been at your premises or seen in the community while potentially infectious there are standard processes that will be followed. Please click here for more information
Appendix 2: Adapting practise for face-to-face contact consultations
have knowledge and understanding of relevant and current Health and Safety procedures and advice from Ministry of Health.
develop and implement a cleaning plan for your working environment. Currently the Ministry of Health recommend normal cleaning procedures are to be carried out for non Covid-19 patients, however we strongly advise increasing cleaning of all surfaces in the clinic including door handles, plinths, equipment, keyboards and phones
have cleaning materials and PPE, if recommended, sourced and in stock at the clinic
train all physiotherapists and support staff in new clinic procedures and ensure all procedures are provided to them
ensure there is adequate physical spacing in the clinic waiting room area to avoid patient to patient contact and patient to reception staff contact. Space seating in waiting room at least one metre apart
use signage and floor markings to remind patients/staff about physical distancing and hand hygiene
ensure physical spacing between physiotherapists within office reception and non-treatment space
consider splitting staff including support staff into teams, working in separate shifts. If team A is unable to work due to the need to self-isolate, team B may still able to operate.
set up a register of who has been in the clinic with current contact details confirmed (including staff members) in case contact tracing is later required
have signage in place around the clinic including signs to remind of physical distancing, no contact physical greetings and hand hygiene
do not allow walk-ins off the street. Use signage at the entrance to advise them to call reception from outside so they can be screened before a face-to-face consultation is made.
make available obvious locations for patients to sanitise wash/ their hands pre clinic entry and at reception
all unnecessary items should be removed from reception and waiting areas,
surfaces kept clear and clean, remove magazines, pamphlets, excessive furniture, wall hangings/posters, waste bins, water coolers etc.
screen patients for COVID-19 signs or symptoms by phone or telehealth prior to their consultation at the clinic i.e. at the time of booking. If doing a community visit, ensure no one in the house you are visiting has any symptoms or has been ill recently. If they are deemed to be a risk, do not allow them into the clinic or see them in the community until they have medical clearance
screen patients for vulnerabilities such as elderly or having significant co morbidities which may mean they need to be assessed or treated at a different location, time or by telehealth.
determine if the patient requires input from any other service such as A&E or urgent care/radiology, prior to coming into the clinic
when making an appointment give clear instructions to patients regarding where to come, what to expect when they arrive, and how things may differ from their usual visits. Inform them they can bring their own masks if they wish
ensure appropriate PPE is in place, ready to be used if required (all staff to be trained as above)
only have one physiotherapist using each room per shift and ensure thorough cleaning is undertaken of all equipment (including keyboard), that has been touched or used between patients
avoid sharing of clinic equipment between clinicians and patients. Where this is not possible, thorough cleaning of the touched equipment is required (such as tape measures, tendon hammers, gym equipment).
areas of known contamination should be cleaned and disinfected regularly (lift buttons, stair well handles etc.)
keep entrance and exit doors open to clinic where possible
During Clinic visit
re-screen patient for any COVID-19 signs or symptoms on arrival. If they are deemed to be a risk, do not continue with the clinic consultation or see them in the community until they have medical clearance
require patient, and others, to ‘hand sanitise’ on arrival and departure from the clinic
physiotherapists are to fill out any paperwork and forms for the patient (sign with cleaned pen), if contactless forms are not available (as when doing Telehealth). Note we are awaiting advice from ACC as to whether ACC45 forms may be signed by the physiotherapist. We will update you as soon as we can
where possible allow only the patient to be present in the clinic; a carer or guardian may be allowed to accompany the patient in appropriate circumstances so long as they are screened first and are free from COVID-19 signs or symptoms
confirm current contact details for the patient and each person accompanying the patient and inform them that these details may be used for contact tracing, if required. Enter them onto the clinic log
maintain at least one metre apart one metre separation where possible, for instance, during the subjective examination
follow PPE requirements as advised by the Ministry of Health
use a barrier such as a towel if doing a procedure/examination where the patient’s body is in contact with the therapist. These towels are to be single use only and laundered between use.
minimise contact time closer than one metre
follow all hand and hygiene practices
minimise the use of equipment such as pillows for instance, which are not easy to clean or replace.
Post Clinic Visit
follow cleaning protocol; include all equipment used, pillows and plinths after each patient contact.