During these past months of the COVID-19 pandemic, providing immunotherapy treatment to allergy patients has required careful research, thoughtful planning and necessary adjustment of operations to maintain the proper safety protocols for patients and care providers.
SCIT to SLIT Transition
Converting patients from subcutaneous injection immunotherapy (SCIT) to sublingual immunotherapy (SLIT) is an option that many practices are utilizing to provide safe treatment in the comfort of the patient’s home. This can be done whether the patient is on build-up or maintenance dosing. For more information on converting patients from SCIT to SLIT, please email us at AllergyEDGE@fuelmedical.com.
In the cases where in-office SCIT treatments were stopped, the American Academy of Otolaryngic Allergy (AAOA) has provided a helpful resource to safely resume SCIT treatment for patients who you are now able to see again.
USP Sterile Compounding
The United States Pharmacopeia (USP) has also issued this document, which describes operational considerations for sterile compounding during the pandemic.
Considerations for In-Office Treatments
Local Laws & Regulations
Executive orders and directives from state leadership play a large role in how we decide which elective and non-urgent procedures and services are offered.
According to Dr. Faheem Younus, Chief of Infectious Disease at the University of Maryland, “the best we can all do right now is act like we’re already a carrier of the virus and follow the recommendations for preventing transmission.” While healthcare workers who continue to provide services are not required to practice social distancing, they should make every effort to protect patients, staff and themselves from COVID-19. Those efforts include:
- Imposing social distancing requirements for staff and patients for interactions that do not require close contact.
- Screening patients for symptoms of COVID-19.
- Imposing strict infection control practices for providers and staff.
- Using telehealth whenever possible.
The Centers for Medicare & Medicaid Services has put together a resource with non-emergent, elective medical services and treatment recommendations.
Staffing & Availability
If not handled well, staffing shortages can make for an unsafe work environment.
You may want to consider implementing a half-and-half model. This method of staffing involves rotating staff every other week in the event a staff member is exposed to COVID-19 and requires quarantine. This allows you to minimize potential exposure to your team as a whole.
During times when increased and unexpected staffing demands may occur, utilizing the help of healthcare recruiting services such as Fuel Medical healthcare recruiting or staffing agency may help relieve stress on your resident staff.
The Center for Disease Control and Prevention has put together a list of strategies to help mitigate healthcare personnel staffing shortages.
What is your supply of personal protective equipment (PPE)? Many facilities have expired PPE that in the past would be required to be destroyed; these devices may now be used. Battelle Memorial Institute recently designed and built the Critical Care Decontamination System for decontaminating single-use N95PPE, allowing reuse. According to the CDC, this includes facemasks, N95 respirators, gowns, eye protection and gloves. The CDC has released several resources, including PPE burn rate calculators and infection control guidance.
Prepare Your Clinic
The CDC has put together the following recommendations on how to prepare your clinic to reopen.
Before Patients Arrive
You should identify which of your patients are at high risk. Consider and plan for providing more telemedicine appointments, maybe even implementing a policy that all appointments start with telemedicine unless deemed to be an emergency.
Make sure you know how to contact your health department and stay connected. You can stay informed through the Clinician Outreach and Communication Activity, sponsored by the CDC.
Assess and restock supplies, putting together a regular schedule. Consider expanding storage and placing orders well in advance.
Communicate with patients.
- Ask patients about their symptoms during reminder calls and triage.
- Reschedule non-urgent appointments.
- Post signs at entrances and in waiting areas about prevention actions.
- Place tape on the floor at six-foot intervals to indicate patient flow through the office.
Prepare the waiting area and patient rooms.
- Provide supplies (tissues, alcohol-based hand rub, soap at sinks and trash cans).
- Place chairs six feet apart. Use barriers (like screens), if possible.
- Remove or clean toys, reading materials or other communal objects.
When Patients Arrive
- Place staff at the entrance to ask patients about their symptoms.
- Provide symptomatic patients with tissues or face masks and place them in a private room as quickly as possible.
- Limit non-patient visitors.
- Allow patients to wait outside or in their car.
After Patients are Assessed
- Provide at-home care instructions to patients with respiratory symptoms. Consider telehealth options for follow-up visits.
- Notify your health department of patients with COVID-19 symptoms.
- Clean frequently touched surfaces using EPA-registered disinfectants.
Once you are ready to see patients, you will need to determine which allergy patients should be treated right now and how you should prioritize them.
Most allergy immunotherapy can be postponed and handled through virtual care appointments or windshield visits. However, it is extremely important to understand your patient population and screen patients thoroughly to ensure you are not exposing patients to unnecessary risks.
Below are some helpful suggestions. Please note, this is not intended to be an exhaustive list.
- Screen for: fever (100.4 degrees F or higher), anosmia, cough, shortness of breath, cold and sneezing.
- Ask patients if they have traveled outside the country or to a COVID-19 hotspot.
- Direct patients to online self-assessment tools.
Encourage alternatives to face-to-face meetings.
- Identify those with presumptive COVID-19 and implement a triage protocol to assign appropriate levels of care.
- Ensure the patient doesn’t have any exacerbated symptoms.
- Review medication lists and symptomology.
- Make sure asthma patients maintain or reinstitute the use of maintenance albuterol and bee venom patients have a current auto-injectable.
Telehealth and other virtual encounters are crucial for assessing patients’ symptoms prior to any in-office face-to-face encounters. The system also allows you to continue delivering immunotherapy and identifying new candidates for testing and immunotherapy. For more information about implementing telehealth services in your practice, visit our FAQ page.
Permanently Discontinue Treatment
If patients are safe to discontinue immunotherapy, be sure to provide proper medication and solutions to minimize symptoms such as antihistamine and nasal steroids. Provide explicit instruction on usage and remind patients that all allergy symptomatic reliever medicines work better if used in a preventative fashion.