Home | COVID-19 | ‘Don’t tell us what to do’: facilities ignored PPE warnings from GPs

‘Don’t tell us what to do’: facilities ignored PPE warnings from GPs

‘Don’t tell us what to do’ was the message Victorian GP Sachin Patel received from aged care facilities.

Patel says his practice, Aged Care GP – which services 70 aged care homes in Victoria – has been writing letters to facilities since January about the dangers of COVID-19 and the importance of proper PPE usage, but Patel and his GPs still faced pushback when they turned up in full PPE to conduct check-ups on residents.

“Even on the 21st of May, we said ‘you’re going to be looking into the media, seeing that it seems like this has all passed and it’s all done, and … while everyone else is thinking that, I can assure you, it’s going to be the complete opposite’. So, what we’re saying to you is we’re coming in full PPE and we’re going to double down on it now, and we encourage you to get your staff to use PPE wherever possible,” Patel tells Aged Care Insite.

When his GPs would show up in full kit – which often included hooded APR masks – they were told that it wasn’t a good look and that the appearance of the full PPE might scare people.

Patel said the comments from CEOs and management were often informal, but the message was clear: they thought PPE wasn’t needed.

“I can’t speak on everyone’s behalf. We received feedback from various places that it wasn’t what people wanted,” he says.

Aged Care GP has been involved with eight of the Victorian aged care homes that have experienced large outbreaks in this second wave of COVID-19 in the state, and Patel and his GPs have observed an overall lack of training when it comes to PPE use and infection control in the sector.

“I think it’s a training issue. So, it’s to do with recency of training. You might learn about PPE early on but the thing is this is different to say the flu, because with the flu there is some immunity around. So even if PPE use isn’t stringent, there’s still some protection,” Patel says.

“In this situation, unfortunately if PPE isn’t used 100 per cent right, then there’s a risk of spread.”

Patel also questioned the readiness of some facilities for an outbreak of the virus and criticised the self-reporting nature of the COVID response plans in the sector.

“The other is there was a self-reporting required about being COVID ready, which 99.5 per cent of facilities said they were COVID ready. And if we’re not truthful to ourselves…

“I don’t know the questions, but I presume the question would have been, ‘Have staff had PPE training?’ You might tick yes to that, but if I learned PPE four years ago and then today I’m expected to just remember exactly how to do that, then it’s a tall order.”

Dr Kaval Patel, who also works for Aged Care GP, says it was often the atmosphere, more than anything said with words, that would tell him the facilities he went to didn’t approve of masks.

“You’d get the odd looks in that you’ll be wearing PPE as though, ‘Why are you worried? We’re not wearing anything and we’re dealing with the patients more regularly than you,'” he says.

“You kind of get the feeling that you are wearing PPE to protect yourself, whereas I don’t think they quite got the concept that actually we’re not doing that. We’re actually protecting everyone else rather than ourselves, and if we wanted to protect ourselves we would go full telehealth.”

Patel says that he sees this issue as a result of a larger lack of knowledge about PPE and it’s efficacy in fighting infectious diseases in aged care. And he says that GPs have a moral obligation to point out potential issues they see within aged care, not just during a pandemic.

“Sachin has been in constant communication with facilities, so has our team, and when we think something’s not going right, we give them clinical direction and advice and say, ‘This is what we need to be doing and following.’

“I do have a facility where they have a lot of patients coming in from hospitals. You can’t have patients not coming into facilities. Obviously patients in hospital need to be discharged somewhere, and if they’re not able to go home, then they do need to come into these transitional care units, which look after patients in the interim basis. But I did flag up that that is a potential source of introducing an infection.

“I think we do have a obligation to do that, and if we don’t, then we’ll probably be doing our patients and clients a disservice if we don’t raise those issues with the facilities.”

Both GPs say that the pandemic has been incredibly hard for their patients. As specialist aged care GPs, they spend all day every day with aged care residents, and although the introduction of telehealth has been a good workaround, it cannot compare to the usual one-on-one time they have with patients.

“It’s very difficult because you want to go in and see your residents and patients that you look after, but it’s difficult to do,” Kaval Patel says.

“It’s not as easy to do telehealth consultations, particularly with residents who have hearing impairments, have visual impairments, who may have dementia, and they feel they’re uneasy sometimes or they say, ‘I can’t hear you, Doctor,’ on the phone, or ‘I can’t see you’. Sometimes the residents with dementia will look at you and think, ‘What’s going on here?’ because it’s very confusing and distressing sometimes.

“You do your best and try and do your best as much as possible, but on a personal level, I think I find that difficult. I feel so sad for my patients that they don’t get to see me when they want to all the time.”

For Sachin Patel, the relationship between a GP and patient is very important as we age, as is the relationship between a GP and an aged care facility. He believes that specialist GP practices, such as Aged Care GP, are the best way to treat people in residential care.

“General practice in aged care should be specialised. It shouldn’t be done in the normal framework of a normal practice, which looks after the other 99 per cent of the population because the needs of aged care are completely different,” he says.

“Again, talking from our experience, our doctors will spend as much time as necessary with the residents and they’re seen on a regular routine, scheduled basis rather than if there’s a problem.

“It’s ‘prevention is better than cure’. But suddenly you go into a nursing home and it’s just, ‘Oh if there’s a problem, we call the doctor’, but otherwise the doctor doesn’t come. That’s not right, I don’t think.

“We probably spend a disproportionately large amount of time with our residents because that’s what all our doctors do. It shouldn’t be an afterthought where you pop in before you start your practice or after you finish at your practice, or 20 minutes at lunchtime, which we certainly see. We see that happening elsewhere, but that’s not how we want to operate.”

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  1. Constance Dimity Pond

    This story illustrates how important and valuable GPs are in residential aged care. The facilities no longer have to have registered nurses available, and when there is one s/he is very busy. The GPs could support the RN if there is one (or preferably more than one) in reviewing the facility’s readiness for covid. Most facilities don’t have a clinical person on their board (which makes financial decisions eg about expenditure on PPE) and the facility manager may not be a clinician, so it is no wonder that there decisions are not well informed clinically.

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