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COVID-19 Information for health professionals in cancer care

Up-to-date COVID-19 resources for health professionals in cancer care.

The global COVID-19 pandemic is an evolving situation. Updates to this page will be made as the situation develops.

Provincial Cancer Clinical Management Guidelines in Pandemic Situation (COVID-19)

Current version dated: August 4, 2020


During the COVID-19 pandemic, it is very likely that clinical care will need to be prioritized, deferred and reduced due to capacity issues from health care worker absence and decreased efficiency.

This document is intended as a guidance document to provide recommendations for determining priority for consultation, assessment, and treatment of patients with cancer in the event that the COVID-19 outbreak disrupts access to health care resources.

These guidelines can be used in the event of an activation of an Emergency Management Plan in one or more regional cancer centres. This guideline can also serve as recommendations to the provincial community oncology network clinics and other health authorities delivering cancer care.

In addition to the clinical management guidelines outlined here, the BC Cancer staff will follow the guidelines sent out by PHSA, BC Cancer, Employee Wellness and Infection Control.

Resources

Infection Prevention and Control Guidelines

(Surgical/AGMP/Dental/Nasopharyngoscopy/Nebulized) 

Current version dated: June 25, 2020

The purpose of this document is to provide infection prevention and control guidance for the management of procedures done in a surgical setting at BC Cancer.

Resources:

Infection Prevention and Control Guidelines for Management of Surgical Patients Requiring AGMPs During the COVID-19 Pandemic‎

Current version dated: May 26, 2020

The purpose of this document is to provide infection prevention and control guidance for the management of dental and oral oncology patients at BC Cancer during the COVID-19 pandemic.

It is meant to be used with existing dental, workplace health and infection prevention and control policies, procedures, and guidelines.

Resources:

Infection Prevention and Control Guidelines for the Management of Dental and Oral Oncology Patients‎

‎Current version dated: July 8, 2020

The purpose of this document is to provide guidance for the management of patients requiring nebulized therapy especially in a shared open concept space with no engineering controls in an emergency situation (e.g. due to chemotherapy drug reaction).


Resources:

Nebulized Therapy during the COVID-19 Pandemic Practice Guide

Current version dated: June 4, 2020

The purpose of this document is to provide infection prevention and control guidance for nasopharyngoscopy for patients at BC Cancer during the COVID-19 pandemic.
It is meant to be used with workplace health and infection prevention and control policies, procedures, and guidelines.

Resources:

Infection Prevention and Control Guidelines for Nasopharyngoscopy Procedure‎

Tumour Group Clinical Guidelines

‎Current version dated: April 1, 2020

These guidelines are organized by tumour site and make recommendations regarding how patients should be treated in light of cancer surgery delays or cancellations.
The guidelines are intended to provide general directions and case-by-case multidisciplinary review is highly recommended.

Resources:

BC Cancer Tumour Group Clinical Guidelines in COVID-19 Setting of Reduced Access to Cancer Surgeries

‎Current version dated: May 4, 2020

The purpose of this document is to provide tumour group recommendation on prioritization level appropriate alterations in treatment for each indication if a centre needs to start restricting access to particular priority.

Resources:

BC Cancer Tumour Group Specific Prioritization and Mitigation Recommendations during COVID-19 Pandemic

Serious Illness Care Program

‎Current version dated: April 3, 2020

The Serious Illness Care Program is a well-established method of how to engage in meaningful discussions with patients and families. In regular circumstances, clinicians are encouraged to attend a 3-hour training session, & read through the 20 pg companion guide. In the current climate, we recognize this isn’t possible for most clinicians.

If you need to start using this guide right now – please read the resource page (below).

Resources:

Serious Illness Care Program - Reference Guide for Clinicians: COVID-19 Adaptation

Current version dated: April 3, 2020
 

The purpose of this scripted guide is to discuss potential outcomes of possible COVID-19 infection with at risk adults prior to a health crisis.

Resources:

Serious Illness Conversation Guide - COVID-19 Adaptation

Personal Protective Equipment

Current version dated: June 15, 2020

The Ministry of Health has issued a framework for the use of PPEs in health care settings. The primary motivation behind the creation of this framework is to ensure best practice Infection Control and Prevention (IPAC) practices while ensuring PPE is preserved and use where it is most needed and clinically appropriate.

A procedure has been created for the application of these new PPE guidelines for BC Cancer. Please review these guidelines carefully.

Resources:

Application of COVID-19 PPE Framework for BC Cancer

Current version dated: April 14, 2020

The intention of this document is to provide staff with clear directions in reprocessing eye protection in order to extend use and re-use. Reprocessing of eye protection requires clear guidelines for cleaning, disinfection, storage and reuse.

Resources:

Reprocessing of Eye Protection Equipment Procedure‎

Current version dated: May 27, 2020

This procedure outlines the steps for donning and doffing of non-standard personal protective equipment (PPE) used when performing aerosol generated medical procedures (AGMPs) on suspect and confirmed COVID-19 cases.

Resources:

Safe Donning and Doffing of Non-Standard Personal Protective Equipment for Aerosol Generating Medical Procedures Performed on Suspect and Confirmed COVID-19 Cases

Remote Ordering of Systemic Therapy During the COVID-19 Pandemic

Due to the global pandemic of COVID-19, there will be circumstances where prescribers may need to self-isolate and are not able to be on site at the regional cancer centres to order systemic treatments. This BC Cancer Remote Ordering of Systemic Therapy Policy outlines the requirements for safe remote ordering of systemic therapy treatment as an interim process pending implementation of a fully integrated Electronic Health Record and Computerized Provider Order Entry.

This is a process for exceptional circumstances and not a parallel system to order systemic therapy for physicians working in a BC Cancer clinic or affiliated site. 

Read the associated policy carefully before ordering ST remotely. 

Watch the instruction video on how to use the fillable PDFs.

The fillable PDFs are designed to be accessed, filled out and sent at the time they are needed. They are available at H:\EVERYONE\SYSTEMIC\Chemo\Orders\Fillable Provincial PPOs

 

Fillable PDFs and associated remote ordering workflows have been expedited for emergency purposes as our existing systems can only safely support limited use at this time. Therefore, the remote ordering of systemic therapy is limited to physicians who are required to work off site. The official order form for Systemic therapy is the PPO printable from the BC Cancer website. These meet all the accreditation and professional practice standards and established workflows in your centre have been set up over many years to support their use with a hybrid paper/EHR. We will be reviewing this, however, and will update if this position changes.

 

The provincial repository of fillable PDFs is maintained centrally and the content is updated regularly and aligned with the paper PPOs. This ensures a single "source of truth" and enhances quality and safety. 

 
Our existing hybrid paper/electronic health record and associated systems, means that many of the documents ideally needed for ordering systemic therapy are not routinely available electronically. A fully integrated EHR/Computer Provider Order entry system is the gold standard for remote ordering. Modifying a paper-based chemo ordering system to facilitate remote ordering introduces safety risks and inefficiencies. 

On initial launch we need to get some experience and balance the risks to patients from this system. 

The situation with COVID-19 is being monitored carefully and if circumstances change, we will consider adapting the policy to meet evolving needs. 
No. BC College of Pharmacists regulations, do not allow pharmacists to accept medication orders emailed between Health Authorities. Intra-health authority emailed medication orders are allowed, only with the appropriate policy and systems in place to handle these orders safely. 

Existing systems should be used for these orders at this time e.g CON referral to an onsite physician to order systemic therapy, fax to a CON pharmacy from a BC Cancer centre, phone in a prescription for supportive care medication etc. We are also working with health authority partners so, this could also change in the future. 
 

Pharmacy regulations require each page of a prescription to be signed. Once received at the regional centre, these documents are printed out and placed on the chart as paper. If there are unsigned pages, it would appear there are unsigned orders, especially if the pages get separated.

Use the "Supplemental doctor's order for PPPO" located in H drive H:\EVERYONE\SYSTEMIC\Chemo\Orders\Fillable Provincial PPOs. Fill in associated PPPO protocol code and cycle number to ensure the orders are linked to the appropriate PPPO once printed.  

 

Use the order forms created in your centre. 

 

For more information, read the Systemic Therapy Staff Bulletin

BC Cancer health professionals with questions about the content on this page may email the BC Cancer communications department.

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