Managing COVID-19: Advice for GPs with patients living in aged care facilities

Make sure the RACF:

• has accurate contact numbers and details for you, your practice and after-hours contacts.
• they are stored with the RACF’s COVID-19 Outbreak Management plan.

Keep an up-to-date list of the residents you care for at each site and make sure the site also has a list of the residents you care for.

• Refer to the RACF’s governance chart.
• Ensure you know who is in charge and how to contact them. This may be a facility manager or nurse manager.
• Check you have contact information for the local Aged Care Rapid Response Teams (BRACE, GRACE & ARRT) and understand the likely escalation points.
• Ensure you can contact the pharmacy that supplies your residents, including after-hours, in case of urgent medication needs.

Advise the RACF whether you are willing to continue to physically visit the site in appropriate PPE in the event of a COVID-19 outbreak, for either COVID positive or non-COVID residents.

If you are visiting multiple RACFs, check you will be able to continue to visit unaffected sites concurrently. Potential solutions to this could be the use of telehealth or liaising with a “lead”, onsite GP linked to your other RACFs. SWSPHN can assist with coordination of GP workforce in these situations.

Ensure patients clinical summary and details, including next of kin, are up-to-date and can be effectively used as a handover summary.

Review goals of care and care escalation for each of your patients in the RACF.

Review of Advance Care Plans for all patients. Discuss plans for what would happen to a resident if they were to contract COVID-19.

• Advance Care Planning Australia COVID-19 resources for GPs.
• ELDAC resources.
• More resources listed in HealthPathways.

Review medication charts: make sure prescriptions are up to date. Consider:

• ensuring all prescriptions have at least a seven-day supply remaining.
• AVOID ALL NEBULISERS due to the increased risk of transmission of COVID-19 through droplet spread. Instead, consider prescribing a spacer.
• anticipatory medications for palliative care needs (morphine and midazolam subcutaneously in appropriate dosage).
• Check HealthPathways for latest recommendations.

Transitions of care are high risk for medication errors. Use of MyHealthRecord and the Pharmacy Shared Medicine List is recommended to ensure information can be accessed quickly and effectively.

Ensure flu vaccinations are up-to-date.

Maintain continuity of care through face-to-face care or by telehealth. COVID-19 MBS telehealth items can be claimed, see mbsonline.gov.au for news and COVID -19 telehealth MBS items.

Provide ongoing care for residents who choose to go home with family.

If you will be attending a RACF, always undertake best practice infection control and PPE requirements.

• Check for updates on PPE requirements via HealthPathways.
• Practice donning and doffing your PPE. Consider having someone observe you to make sure you’re doing it correctly.
• Visit the  PPE page for more information on accessing PPE.
• Email SWSPHN’s COVID-19 Respose Team  if you require additional PPE training.
• Review the CEC training videos or RACGP video on use of PPE.

If you are managing patients with COVID-19 and have any COVID-19 specific questions you may: 

• Log in to SWSPHN HealthPathways
• Email the SWSPHN COVID Response Team
• Or visit the COVID-19 resources for health professionals on this website.

Contact families and be a conduit for information for them. Consider having a video conference for several families or all the families of your patients from the one facility at the same time for rapid sharing of information and to allay anxiety.

Plan for surge capacity amongst your colleagues, if possible, in discussion with the nursing staff.

Consider forming a group where one (or more) “lead” GPs continue to visit the site if others need to self-isolate. The visiting GPs can perform any tasks that can’t be undertaken via telehealth. The RACF may be able to advise who the attending GPs are for the facility.

SWSPHN works closely with the Local Health District, Commonwealth Department of Health and the Aged Care Commission by attending outbreak management huddles with RACFs and local hospital in-reach teams to agree how best to manage COVID positive patients.  Email the SWSPHN COVID Response Team for details.

If you have concerns about a RACF’s ability to prepare adequately or to cope with escalating issues, email SWSPHN COVID response.

• Usual RACF staff may be furloughed/quarantined, and replacement staff put in place who do not know the residents, their medical care needs or care wishes. In some instances, this can include surge GP workforce to provide on-site care. However, SWSPHN is encouraging continuity of care with a patient’s regular GP wherever possible.
• RACF management may also have been quarantined/replaced.
• Breakdown in usual procedures when regular staff are replaced.

Some visiting GPs may be in isolation or unable to attend facilities on site. Plan amongst GPs and facility staff. SWSPHN can assist with sourcing GPs from other general practices.

• Difficulty contacting nursing staff within the RACF (e.g. phone calls unanswered or very limited information provided in response to GPs’ calls).
• Difficulties with communication lines within the facility (e.g. messages not being transferred between wings or floors of the facility).
• Frequent contact from residents’ family members seeking information about their family member.