8.COVID 19 Mental Health Community Acute Pathway Guidelines ACOS CAMHS....pdf

If printed, this document is only valid for the day of printing.

COVID-19: Mental Health Community Acute Pathway &
Guidelines (ACOS, CAMHS, Older Adult, and Adult)
Unique Identifier
[Category]
Document Type
Clinical Guideline
Risk of non-compliance
may result in significant harm to the patient/DHB
Function
Clinical Practice, Patient Care
User Group(s)
ADHB only
  Organisation(s)
Auckland District Health Board (ADHB)
  Directorate(s)
Mental Health
  Department(s)
All
  Used for which
All
patients?
  Used by which staff?
All
  Excluded
Nil
Keywords
COVID-19, PPE, Urgent Assessment, Community
Author
Nurse Director
Authorisation

  Owner
<Nurse Director>
  Delegate / Issuer
<Designation>
Edited by
Nurse Director
First issued
23 March 2020
This version issued
17 April 2020 - updated
Review frequency
As Required

COVID-19: Mental Health Community Acute Pathway & Guidelines (ACOS, CAMHS,
Older Adult, and Adult)
Page 1 of 7

link to page 3 link to page 3 link to page 3 link to page 6 link to page 6 link to page 6 link to page 6 link to page 7

If printed, this document is only valid for the day of printing.

1.  Purpose and Scope
This document provides guidelines for all Mental Health clinicians (medical, nursing, allied health) working
at Auckland District Health Board in Acute Community Services across the age continuum. Clinical
pathways have been developed to support staff to continue to offer Mental Health assessment and
interventions for people presenting to acute community teams with suspected or confirmed COVID-19.

2.  Screening for COVID-19
a.  All staff need to complete the COVID-19 triage questions (as per the community acute pathway
(appendix 1)) prior to and before EVERY contact (face-to-face, telephone or video call).

b.  Te Whetu Tawera, CFU/MBU, BRC & FMU admitting staff will also need to ask these questions
prior to a service user being admitted so they can ensure that a person is isolated if required.

c.  Please see the ‘Community Acute Pathway’ guidelines (Appendix 1) if you need to do an urgent
mental health assessment of a person with a confirmed or suspected case of COVID-19. Ensure
that you follow the escalation process, which includes informing you CTL during business hours
and Level 4 Manager out of hours.
3.  Clinical Pathways
Assessment Type
Location
Who
Precautions
Initial assessments
1.  Service user home  All staff
Basic precautions:
or medical reviews
address
1.  Complete screening questions prior to
2.  Service user home
arrival - If fail screening questions follow
address via video-
Community Acute Pathway (Appendix 1)
conference (VC)
2.  Complete hand hygiene routine prior to
3.  CMHT
leaving the office.

3.  Complete hand hygiene prior to leaving
Consider video-
the car
conference capability
4.  Use anti-bacterial wipes to clean car
at initial assessment
surfaces before travel
for any required
5.  Conduct assessment using PPE (for
follow up
suspected or confirmed COVID-19
6.  Wash-hands as per MOH guidelines
following assessment.
7.  Wipe down car surfaces following return
to office or before next assessment.
8.  Wash hands as per MOH guidelines.
Mental Health Act
1.  Service user home  All staff
Basic precautions:
assessments
address
1.  Complete screening questions prior to
2.  Service user home
assessment – if fail screening questions
address via video-
follow Community Acute Pathway
conference (VC)
(Appendix 1)
3.  CMHC
2.  Complete hand hygiene routine prior

to leaving the office
Consider video-
3.  Use anti-bacterial wipes to clean car
conference capability
surfaces before travel
at initial assessment
COVID-19: Mental Health Community Acute Pathway & Guidelines (ACOS, CAMHS,
Older Adult, and Adult)
Page 3 of 7

If printed, this document is only valid for the day of printing.

for any required
4.  Complete hand hygiene prior to
follow up
leaving the car
5.  Conduct assessment using PPE (for
suspected or confirmed COVID-19
guidelines
6.  Wash-hands as per MOH guidelines
following assessment.
7.  Wipe down car surfaces following
return to office or before next
assessment.
8.  Wash hands as per MOH guidelines.
Follow up medical
See follow-up
All staff
Basic precautions (if required):
review/assessment
assessment plan in
1.  Hand-washing prior to visit
notes of initial visit
2.  Screening questions asked pre-visit
3.  If pass screening questions, then maintain
2 metre distance, good hand hygiene
Police Station
1.  Use VC option if
All staff
1.  Complete screening questions prior to
assessments
available
arrival – if fail screening questions follow
Community Acute Pathway (Appendix 1)
2.  Complete hand hygiene routine prior to
leaving the office
3.  Use anti-bacterial wipes to clean car
surfaces before travel
4.  Conduct assessment using PPE if
suspected or confirmed COVID-19 case
5.  Wash-hands as per MOH guidelines
following assessment.
6.  Wipe down car surfaces following return
to office or before next assessment.
7.  Wash hands as per MOH guidelines.
Respite facility
Consider video-
All staff
Basic precautions:
assessments
conference capability
1.  Complete screening questions prior to
at initial assessment
arrival - If fail screening questions, discuss
for any required
with Community Team Leader re VC
follow up
options

2.  Complete hand hygiene routine prior to

leaving the office
3.  Use anti-bacterial wipes to clean car
surfaces before travel
4.  Complete hand hygiene prior to leaving
the car
5.  Conduct assessment
6.  Wash-hands as per MOH guidelines
following assessment.
7.  Wipe down car surfaces following return
to office or before next assessment.
8.  Wash hands as per MOH guidelines.
COVID-19: Mental Health Community Acute Pathway & Guidelines (ACOS, CAMHS,
Older Adult, and Adult)
Page 4 of 7

If printed, this document is only valid for the day of printing.

Home visit
Covid-19 NEGATIVE,
All staff
1.  Complete hand hygiene routine prior to
but requires self-
leaving the office
isolation
2.  Use anti-bacterial wipes to clean car

surfaces before travel
3.  Conduct assessment maintaining 2 metre
distance and wearing face-mask – service
user to be asked to wear face mask.
4.  Wash-hands as per MOH guidelines
following assessment.
5.  Wipe down car surfaces following return
to office or before next assessment.
6.  Wash hands as per MOH guidelines.
Home visit
Covid-19 POSITIVE and  All staff
1.  Complete hand hygiene routine prior to
requires self-isolation
leaving the office

2.  Use anti-bacterial wipes to clean car
surfaces before travel
3.  Conduct assessment maintaining 2 metre
distance and wearing full PPE gear –
service user to be asked to wear face
mask.
4.  Wash-hands as per MOH guidelines
following assessment.
5.  Wipe down car surfaces following return
to office or before next assessment.
6.  Wash hands as per MOH guidelines.
Admission to Te

1.  Phone unit to confirm admission.
Whetu Tawera,
2.  Clarify and confirm where the admission
CFU/ MBU, BRC &
will take place on the unit, including how
FMU if suspected or
to enter the unit
confirmed case of
3.  Confirm estimated arrival time so the unit
COVID-19
can prepare for the admission
4.  Phone the unit on arrival and follow the
unit guidance re-entering the unit and
admission process.
5.  Complete hand hygiene process prior to
leaving office, home visit or police station
6.  Use anti-bacterial wipes to clean car
surfaces before travel
7.  Complete admission following usual
admission processes
8.  If clinically indicated use PPE and follow
Community Acute Pathway (Appendix 1)
9.  Wash-hands as per MOH guidelines
following assessment.
10. Wipe down car surfaces following return
to office or before next assessment.
11. Wash hands as per MOH guidelines.

For service users presenting with flu-like symptoms requiring acute admission discussion with CTL,
referring and accepting SCD & NUM to occur prior to admission
COVID-19: Mental Health Community Acute Pathway & Guidelines (ACOS, CAMHS,
Older Adult, and Adult)
Page 5 of 7

If printed, this document is only valid for the day of printing.

Arrangements will be made to have all COVID-positive service users assessed medically on a daily basis.
4.  Duration of Observation and Treatment
As with all other service users, individuals will be discharged upon completion of their mental health
treatment. Discharge plans will include the plan for the individual to complete their period of isolation
and the plan for any necessary medical monitoring.
5.  Maintaining cleaning environment
This will follow organisational direction.
6.  Service User information and support
Staff need to direct all our service users to the MOH site for latest and most accurate information.
7.  PPE
Orders have been submitted. Community teams requiring PPE prior to stock being delivered will need to
escalate this to CTL during business hours and Level 4 on-call Manager out of hours to source and obtain
stock from inpatient units.

COVID-19 Mental Health Community Acute Pathway & Guidelines v3.
Document Owner: Tracy Silva Garay
Approved by: Ian Dittmer, IMT Clinical TAG, 21.04.20
Approved by: Emma Maddren, IMT Incident Controller, 21.04.20
COVID-19: Mental Health Community Acute Pathway & Guidelines (ACOS, CAMHS,
Older Adult, and Adult)
Page 6 of 7

If printed, this document is only valid for the day of printing.

8.  Appendix 1: Community Acute Pathway
All Community Acute Pathway (ACOS,
CAMHS, Older Adult and Adult)
Service user presents and needs to be
seen urgently for crisis assessment
Ask the following symptom screening questions:
NOTE: COVID-19 Screening Tool must be completed in
conjunction with this flowchart and placed in patients file.
Dos the patient have an acute respiratory infection with any of
the following:
1.
Cough, sore throat, shortness of breath, runny nose,
No
sneezing, post nasal drip
Yes
2.
Loss of sense of smell (With or without fever)
Ask the following contact screening questions:
Ask the following contact screening questions:
Has the patient:
Has the patient:
1. Had close or casual contact with confirmed or suspected
1. Had close or casual contact with confirmed or suspected
COVID-19 +ve case <14 days before onset of symptoms
COVID-19 +ve case <14 days before onset of symptoms
2. Travelled within the last 14 days
2. Is the a Health Care Worker
Confirmed or Probable
Low Risk COVID 19
Possible COVID-19
COVID-19
- Arrange usual face to
Notify:
face assessment
Infectious Diseases (Dial 0 and ask to speak with the ID Consultant) and Charge
- If a S/U is noted to
Nurse or Clinical Team Leader or Level 4 On Call After Hours to follow after
hours escalation process  and  Public Health  (09 6234600)
have symptoms
despite answering no
to screening questions
rapid reassessment will
•
Staff to wear PPE (where
•
Provide advice regarding
be required
possible pre inform service
self-isolation
users and whānau)
•
Notify Public Health (09
If  not requiring
If requiring inpatient admission
•
Patient and whānau to be
623 4600)
inpatient admission
provided with a surgical
•
Health professional to
mask and encourage them to
phone Healthline for
wear it
advice re: testing
Admitting Senior Nurse to:
•
Inform ID Consultant re:
Admitting community clinician
Admitting unit follows their
admission. (Dial 0 and ask to
notify inpatient unit suspected or
protocols and environmental
speak with the ID
confirmed COVID-19 service user
zoning for suspected and
Consultant)
requires admission steps above
confirmed COVID-19 service
•
Follow escalation process
have been completed.
users
below for informing service
leaders
Business Hours Escalation
After Hours Escalation
Process:
Process:
Admission note documents this
Charge Nurse and Hospital
process has occurred on HCC
Admitting Nurse
CNM
typing template csq/
↓
↓
CCN or Shift Coordinator
Nurse Unit Manager and
↓
Ops Manager
Level 4 On Call Manager
↓
and Hospital CNM
SCD
↓
↓
Level 3 On Call Manager
Email
For advice regarding testing refer to the COVID-19 clinical
↓
Mental Health COVID-19 &
guidelines on the COVID-19 page on HIPPO
SMOC, DAMHS and
Phone Director
Director
↓
Executive Leadership Team
Version
Published: xxx
Author: Mental Health & Addictions Nurse Director

COVID-19: Mental Health Community Acute Pathway & Guidelines (ACOS, CAMHS,
Older Adult, and Adult)
Page 7 of 7