COVID19 Risk Assessment

Table 2a. Protection of staff and patients before they visit, and when in, the clinic. We have assessed the following areas of risk in our practice and put in place the following precautions to
	Description of risk	Mitigating action	When introduced
Pre-screening for risk before public/patients visit the clinic	To prevent the risk of infection between the practitioner, the patient and other household members	All patients will receive a pre-screening call before deciding whether they will be suitable for a face to face appointment. If they are to be chaperoned than the chaperone will also be screened.: Screening for any symptoms of COVID 19 (e.g.high temperature or a new, persistent cough, or a loss of smell and taste) in the last 7 days? Screening for extremely clinically vulnerable patients Screening for additional respiratory symptoms or conditions e.g.hay fever, asthmas etc Screen to see if a member of their household had/has symptoms of COVID-19 or are in a high-risk category i.e. shielded as considered extremely clinically vulnerable? Have they been in contact with someone with suspected/confirmed COVID-19 in last 14 days? During the Screening Call Inform of the risk of face to face consultation –and will document that they have informed the patient of risk associated with attending the clinic, and that they are not experiencing symptoms of COVID-19. Will ask patients for consent to face to face appointment. Options for telehealth Inform of the risks of COVID19 and how it is spread and how improved hygiene, PPE and social distancing will help to reduce risk NB: All triage pre-screening information must be documented in the patient notes.	From 1st June 2020
Protecting members of staff		As the sole practitioner, I will not practice and will self-isolate if I experience symptoms of COVID19 and will get tested.
Confirmed cases of COVID by practitioner and patient or other household members	Reduce the risk of transmission of infection	Should the practitioner develop symptoms they will self-isolate for 7 days and apply for a test for COVID19. They will contact any patient they have seen in the last 2 to 3 days and ask them to self-isolate and apply for a test. They will inform the patient whether they have tested positive or negative and the patient should do the same. If the patient experiences symptoms within 2/3 days of visiting the clinic, they should contact the clinic. The patient should contact 111 and ask to be tested but self-isolate at home and away from their household if possible. If they test positive they will have to self-isolate for a further 7 days. If they still have a temperature then they will have to self-isolate for 7 days after the temperature has gone. If they are negative they can stop self-isolating. The practitioner does not have to self-isolate due to wearing PPE, but should monitor themselves for symptoms.
Travel to and from the clinic		The patient will be asked to arrive by car, walking or cycling if possible. They should wait in their car until the time of the appointment. Please leave items such as coat and bags in the car if possible. Please bring as little as possible with you.
Entering and exiting the building		Patients should not arrive early or late for their appointment to avoid overcrowding therefore complying with social distancing if other patients are in the clinic? Patients arriving early will be asked to wait in their car or outside the building (observing social distancing). The buzzer outside the clinic will be regularly disinfected but patients could ring to get let in to prevent touching the buzzer. The front door to the clinic will be open so they do not need to touch it. On entering they will be asked to remove their shoes and coat. They will be asked to wash their hands thoroughly. This will also apply to any chaperone. If they do not have a mask they will then be given one to wear. After the treatment they will again be offered the chance to wash their hands before leaving the building.

Social/physical distancing measures in place		Patients will be asked to come alone unless a chaperone is necessary. Patients from the same household will also be asked to come separately as there will be no waiting in the hallway There will be 30 minutes between appointments even between people of the same household. Patients will be asked to pay by card using the card machine which will be disinfected in between patients. Alternatively they can also pay by BAC payments before or after the treatment.
Face to face consultations (in-clinic room)		Furniture has been removed from the clinic to allow social distancing. The consultation will be conducted on the phone before the appointment to reduce face to face contact time. Treatment techniques will be used to try to prevent very close face to face treatment. One parent/guardian only with visits for children No additional family members except if requested as a chaperone Chaperones will also need to be screened beforehand which will involve a phone call.

Table 3. Personal Protective Equipment: Detail here your policy for use and disposal of PPE
Clinicians will wear the following PPE	Detail here what PPE will clinicians wear and when risk assessed, in what circumstance they will be used Single-use nitrile gloves and plastic aprons with each patient? Fluid-resistant surgical masks (or higher grade) for each patient Eye protection, e.g. if there is a risk of droplet transmission or fluids entering eyes, ie the patient having hay fever or asthma which increases the risk of coughing or sneezing.
When will PPE be replaced	When the mask is potentially contaminated, damaged, damp, or difficult to breathe through,or after 4 hours Gloves and aprons will be single use

Patients will be asked to wear the following PPE	Fluid-resistant surgical masks if respiratory symptoms e.g. from hay fever or asthma provided by themselves or by the clinic at the cost of £1 Face-covering or mask for all patients in the clinic and in the building. The patient can keep the mask if bought it from the clinic but should dispose of it safely and wash their hands afterwards. They can dispose of it in the clinic if they would prefer.
PPE disposal	Double-plastic bagged and left for 72 hours before removal, keeping away from other household/garden waste, and then this can be placed in your normal waste for collection by your local authority. Cloths and cleaning wipes also bagged and disposed of with PPE

Table 4. Communicating with patients: Detail here how you will advise patients of measures that we have taken to ensure their safety and the policies that have been put in place in our clinic
Publishing your updated clinic policy	. Available on request Summary of it will be given during screening call. Available on the website
Information on how you have adapted practice to mitigate risk	Detail here what general information on steps taken and where it has been published Updating of website and via your social media accounts Email to your patient base Significant updates to be sent by email to patient base.
Pre-appointment screening calls	24 hours before/morning, before a scheduled appointment with the practitioner.
Information for patients displayed in the clinic	Notices on other public health measures e.g. hand washing, wearing of PPE