Do’s and don’ts for OPD With enough evidence that India is in stage 3 that is community transmission stage OPDs of general physicians ,internal medicine consultants and chest physicians need to be modified to avoid putting HCWs at a risk of getting infected and also to avoid the situation where these setups were portrayed as hotspots of transmission of the virus in some media reports..
With most of the western countries switched to e-data base for OPDs and e prescription ..many of OPDs in india still use physical paper prescription format this being a potential fomite …
Most of patients with GPs are walk ins and triage is difficult..
Number of patients is to the tune of 50 to 100 per day
Although it does not fall in the boundaries of critical care …I feel with the ARDS mortality in COVID reaching 70 percent….every new infection prevented will be a Critical step
Here are some suggestions…say rule of 20-20 …
1. Make your OPDs door less.. keep the doors of consulting rooms permanently open so nobody needs to touch them while opening or closing..
2. Keep a separator or or rope to avoid people touching the registration counter..
3. patients with resp symptoms need not approach the counter…. directly go to a separate room spacious and airy and sit on a stool in the centre of the room where they cannot touch anything in the surrounding…you can quickly examine the patient and come out ….you can discuss about the condition with their relatives in another room
4. Do not issue opd paper in the hands of patient or relative… Give it in their hand after you write the prescription when they are exiting….e prescription better
no patient or relative enters the hospital premises without wearing a a mask/ handkerchief and sanitizing hands
6. Examine the patient with his face turned away… preferably from behind 🙄… after each examination sanitize your hands and stethoscope diaphragm
5.don’t touch the currency given by the patients …keep a box on the counter ask patients to drop the notes into the box.. keep a separate arrangement for returning the change..u can count the currency after 3 days
6. Keep dedicated staff at the entrance to segregate respiratory patients and guide them… No respiratory patient sits on the chair of the waiting room …. preferably directly goes to the examination room quick in and out….
7 . Keep only 5-6 chairs at distance in waiting room…and take in patients accordingly..no crowding at any cost… display such govt rules in ur OPD …also display timings and emergency contact prominently
8. Only one relative with patient and he can also made to stand … remove chairs in consultation room also… only examination stool for the patient enough..
9 avoid touching the old files too… You can ask the relatives to turn the pages and see the reports…and give today’s prescription separately in their hands ..they can later put in their files
10. Once you you come to the hospital avoid going back to home without taking bath or changing clothes ..take a shower in Hospital only if possible…discard disposable PPE
Wash ur clothes separately
11. regulate the patient inflow.. new appointments on phone are call patients after every 15 minutes to avoid crowding..
…one or two patients in the waiting room at a time…
12. you can actually remove the chairs in the waiting room and mark lines at 6 feet where the patient relative will stand away from each other..
13. pharmacist does not handle the OPD paper he can take a photograph of the prescription and take out the medicines accordingly
14. keep minimum contact with the patient… digital blood pressure better… measuring blood pressure only when indicated… pulse oximeter to be sanitized after every patient
15 minimum recommended PPE
( TRIPLE LAYER SURGICAL MASK OR N95)
EYE PROTECTION OR FACE SHIELD
Full sleeves Apron
FULL PPE in COVID supsect case
16. always maintain one metre distance between you and patient except for auscultation and examination …it’s legal..u don’t want to get quarantined
17.remove mask and PPE only after you finish your duty…never touch the face … avoid using toilet or drinking water…keep OPD time short for that
18. refer suspected cases to gvt authorities and maintain its record..
19. The person who examines the patient need not be the one who writes the prescription… keep dedicated person for that.. don’t create an extra fomite by using a pen
20. Always do chest xray if chest findings indicating LRTI
DO YOUR PART
DR AMOL PATHAK
MD DNB MEDICINE