Over recent weeks we have seen an exponential rise in confirmed cases of COVID -19 within aged care settings. This rise has sadly been accompanied by a rising rate of deaths in this vulnerable group of residents. As the outbreaks have occurred, EMPHN has noted that there can be a breakdown in communication between facilities and their visiting GPs due to multiple causes including turnover of staff due to quarantine rules, lack of notification by the facility of cases, and gaps in planning for the event of an outbreak.
Residents in aged care are among the most vulnerable in our society, and many of them suffer with multiple morbidity requiring ongoing administration of prescribed medications. In the case of a facility or pharmacy experiencing an outbreak, this does not change. Residents will continue to require their medications and in fact there may be a sudden need to adapt or add to the medications according to clinical outcome and in consideration of potential palliative care needs.
The role of a GP in a Residential Aged Care Facility (RACF) outbreak
Whilst during the event of an outbreak DHHS step in to help the facility, they do not typically provide full ongoing medical support. Their role is to ensure safety and prevent further infection, and they also may be involved in replacing quarantined staff. In most facilities the medical management of residents, both COVID positive and not, is not managed by DHHS. It is key that any GPs who have residents in an aged care facility continue to engage with them, even in the event of an outbreak, in order to continue to meet their patients care needs. Residents in care facilities with outbreaks continue to develop their normal exacerbations and care still needs to be managed.
Health pathways contains a comprehensive suite of pathways for COVID 19 Aged Residential Care Assessment and Management https://melbourne.healthpathways.org.au/index.htm
What GPs can do now
GPs should consider all eventualities with their residents and especially communicate with residents or their families about their future goals and ceilings of treatment. The patient’s regular GP is a vital source of information and support for a resident and their family during these uncertain times. Their wishes should be recorded in updated Advance Care Plans and where relevant anticipatory prescribing provided to support the plans.
What Pharmacies can do now
Pharmacies which are providing for an aged care facility should plan for the event of an outbreak of COVID -19 within these facilities by considering:
- How and where medications will be obtained if a pharmacy must close due to infection or quarantine
- How the facility will notify the pharmacy of an outbreak
- How the pharmacy will plan for a potentially sudden change in needs for medication, especially in relation to palliative care prescribing
- All contact details must be up to date for in hours and out of hours.