Guideline for Return to Practice During the COVID-19 Pandemic

Dear Valued Patients,

I am writing to inform you that as of Wednesday, May 27th, 2020, the Government of Ontario has permitted regulated health professionals such as chiropractors to begin the process of reopening and providing non-emergency care. Before going too deeply into what reopening will look like, I first want to sincerely thank you for your patience and continued support over the past two and a half months. I made the decision to close down the office in the middle of March based on recommendations by public health authorities in order to help curb the spread of COVID-19. I don’t think anyone, including myself, expected the lockdown to go on as long as it has. As Ontarians, we have done an admirable job of making the sacrifices and changes necessary to help flatten the epidemiological curve, but unfortunately, with case numbers continuing to rise in some areas of the province, we are not in the clear just yet. That said, our regulatory body, The College of Chiropractors of Ontario (CCO), has outlined a framework for the gradual reopening chiropractic offices with public health and safety being the number one concern at all times. Following these guidelines, the decision has been made to reopen True Motion Chiropractic for regular patient care effective Monday, June 1st, 2020.

In order to maximize safety and help curb community transmission of COVID-19, new procedures and protocols will be in place once regular patient care resumes. While things may seem slightly different on the surface, we are all navigating this ‘new normal’ together and it is hoped that the overall treatment experience should remain largely unchanged. In order to make sure everyone is aware of the new guidelines mandated by the CCO and public health authorities, the following changes and guidelines for return to practice are outlined below:

Initial Screening

The Ontario Ministry of Health has issued a patient screening guidance document where each patient will be asked the following questions prior to any appointment:

1. Are you experiencing any fever, new onset of cough, worsening chronic cough, shortness of breath, or difficulty breathing?

2. Have you had close contact with anyone with acute respiratory illness or travelled outside of Canada in the past 14 days?

3. Do you have a confirmed case of COVID-19 or had close contact with a confirmed case of COVID-19?

4. Do you have two (2) or more of the following symptoms: sore throat, runny nose/sneezing, nasal congestion, hoarse voice, difficulty swallowing, decrease or loss of sense of smell, chills, headaches, unexplained fatigue/malaise, diarrhea, abdominal pain, or nausea/vomiting?

5. If over 65 years of age, are you experiencing any of the following: delirium, falls, acute functional decline, or worsening of chronic conditions?

If you answer ‘YES’ to any of these questions, you are advised to:

• Not attend in person for treatment at our office for at least fourteen (14) days

• Complete the Ontario Government’s self-assessment; and

• Contact an appropriate authority such your family physician, local medical officer of health, or Telehealth Ontario

Conducting In-Person Appointments

In the interest of maximizing safety and preventing transmission of infection, the following physical distancing and hygiene protocols must be followed:

1. To help ensure physical distancing and limit the number of people in the office at a given time, initial assessments (new patient visits) will be scheduled for 1 hour and standard patient visits will be scheduled in 30 minute intervals.

2. New patients are strongly encouraged to complete all relevant intake forms at home prior to the appointment in order to ensure that the visit begins on time and allows for sufficient time for all relevant examination and/or treatment procedures to be completed.

3. Upon arrival to the office for your appointment, please wait outside the building in your vehicle or in the parking lot and call the office at (519) 963-1960 to let us know of your arrival. When the provider is ready, you will be notified to come into the building to begin your appointment.

4. In order to help with physical distancing and ensure your appointment begins at the scheduled time, please do not enter the office if you arrive early and do your best to arrive on time and not be late. With the new measures in place, scheduling and timing are of utmost importance in order to adhere to physical distancing measures and allow for sufficient time for cleaning and disinfection of surfaces between patient visits.

5. For payment, the use of credit or debit cards is encouraged with the contactless / tap option being preferred. To help limit exchange of paper, all receipts will now be sent by email moving forward.

Use of Personal Protective Equipment (PPE)

It has been shown that individuals may carry COVID-19 and not demonstrate any symptoms. Therefore, due to the close contact nature of chiropractic care, the CCO and Ministry of Health has advised that all healthcare providers wear surgical/procedural masks when treating patients within a physical distance of two metres. The use of masks by patients has also been mandated by public health authorities to help curb transmission of COVID-19. If possible, all patients are advised to bring and use their own facemasks when attending the office but if you do not have a mask, a disposable mask will be provided to you at no cost. While single use gloves are not required for most chiropractic services, patient comfort is of utmost importance to us, so if you prefer that gloves be worn during treatment, simply let us know and we will wear them. Plastic barriers have also been installed around the reception desk area as an additional safety precaution.

Per CCO guidelines, the following procedures should be followed when donning and doffing masks:

Donning mask:

1. Perform hand hygiene -- wash hands with soap and water or use hand sanitizer.

2. Put on mask. Secure ties to head or elastic loops behind ears. Mould the flexible band to the bridge of nose (if applicable). Ensure snug fit to face and below chin with no gaping or venting.

Doffing mask:

1. Perform hand hygiene.

2. Carefully remove the mask by bending forward slightly, touching only the ties or elastic loops. Undo the bottom tie first and then undo the top tie. Discard the mask in the garbage.

3. Perform hand hygiene.

Cleaning and Disinfection

Providing a safe, clean environment for our patients has always been a main priority since opening our doors in 2011. I want to ensure you that, for your safety, cleaning and disinfection protocols from Public Health Ontario will be strictly followed. While we regularly cleaned the office prior to the COVID-19 pandemic, enhanced cleaning procedures will be implemented in order to help protect the health and safety of everyone who enters our office. Such procedures include:

• Cleaning and disinfecting clinical contact surfaces such as chiropractic adjusting tables, diagnostic/therapeutic tools and devices, and diagnostic/therapeutic surfaces including rehabilitation equipment after each patient encounter.

• Any materials or clinical contact surfaces that cannot be properly disinfected shall not be used.

• Patient contact items such as payment machines, reception counters, seating areas, door handles and handrails will be cleaned and disinfected after each patient encounter.

• Books, magazines, and toys have been removed from the waiting room.

• Single-use equipment will be used instead of shared high touch equipment whenever possible.

While the new protocols and procedures listed above are certainly not exhaustive, they provide a strong framework for returning to practice while prioritizing the safety of all patients, staff, colleagues, and others visiting our office. As the COVID-19 situation is fluid and evolving, advice from Public Health officials may change which, ultimately, may impact clinic operations during such periods. As regulated health professionals, chiropractors are required to follow the directives and guidance from the Ministry of Health, Public Health Ontario, the Chief Medical Officer of Health, and other authoritative bodies regarding practices during the pandemic. If you have any questions or concerns regarding updated treatment or safety protocols, please do not hesitate to ask us at any time. Rest assured that your safety and comfort level will always be our main concern. I want to thank you again for your patience and support as well all try to navigate this challenging situation together.

Sincerely,

Dr. Mark Butkus

Chiropractor / Clinic Director