Risk Assessment : COVID-19

Falmouth Chiropractic Clinic

Risk Assessment : COVID-19

Simon Coad – Risk Assessment Manager

Date assessment was carried out : July 2020

1.         Visitors to our clinic/offices, patients, chiropractic staff and employees

1.1       Entering Waterside House

Our practice rents office space within Waterside House.  Our offices are located on the second floor at the rear of the building.  All visitors, patients and our employees may either enter the building from the front of the building – the route we recommend to the front of the building is the closest entrance to the adjacent Ocean Garage – or to the rear of the building – through the large double doors, again at the end of the building adjacent to the Ocean Garage.

On approaching the building all visitors will see that there is a notice affixed to the doors requesting that all visitors to the building use the hand sanitiser station which is available inside the building.

When entering through the front of the building, all visitors to our offices must either ascend two flights of stairs to reach the second floor where our offices are located, or, alternatively, visitors may take the lift to the second floor.

At present, there are reminders on the floors and on the doors regarding the need to maintain social distancing to a distance of two metres. There are also reminders on doors to all parts of the building to continue to maintain social distancing.

At present, there is a sign on the lift doors requesting that the lift is used by one person at a time and only operated between the hours of 9.00am and 5.00pm.

Upon reaching the second floor of Waterside House the reminders to socially distance are visible on walls, doors and on the floor.

Doors to the entrance to our offices and the toilets which are adjacent to our offices are left open to ensure that there is no need to touch door handles.

There is a hand sanitiser dispenser on our floor and patients are requested to use it prior to entering our offices.

1.2       How we manage our patients’ visits to our offices

Risks identified

1.2.1    Need to avoid having any more than two patients in the waiting/reception area at any one time Having measured the floor space within our offices it is not possible to have no more than two people visiting our waiting/reception area at any one time.  To ensure that we maintain this limit, we have done the following :

  • We have asked our patients to contact us once they are outside the building and only to enter upon being invited to do so by a member of the reception team
  • There is a notice by the door asking patients to wait outside the office if there are two people already in the waiting room. These patients will be asked to maintain social distancing whilst waiting outside our entrance and, in so far as it is possible, once they are inside our premises.
  • Parents who are accompanying their children to chiropractic treatment appointments are reminded that they are responsible for supervising their children at all times.
  • Where we find that there are two people in our reception area, further patients who arrive are asked to wait – socially distanced – outside in the corridor.  Plastic seating is provided and sanitised when they leave it.

1.2.2    Need to avoid patients unnecessarily touching surfaces and items within office Patients are asked to leave their personal belongings in their vehicle – if they have one – including coats, handbags etc. Patients were formerly invited to change into gowns and robes using our changing cubicles prior to a chiropractic treatment.  For the time being, we will not be asking patients to get changed but will instead encourage them to wear loose and appropriate clothing. We have removed all fabric covered chairs from within our waiting area and have instead provided plastic seats which are spaced in accordance with social distancing rules within that space.  We have also provided a limited amount of seating outside the office in case patients arrive unannounced and have to be asked to wait elsewhere.  Once someone has finished sitting on a chair, a member of staff – wearing a face covering – will sanitise the chair using an appropriate sanitising liquid and paper towelling wipes which are then immediately disposed of. There is no seating available for patients within the chiropractors’ treatment rooms. To enable their chiropractic treatment to take place, patients are invited to enter the treatment room.  The door will have been opened by the chiropractor so that there is no need for patients to touch the door handle.  We have also left the entrance doors to the office open for the same reason. Once patients have entered the treatment room they are immediately invited to take their place on the treatment table where their treatment plan is discussed; an examination takes place and treatment and advice is dispensed.  Once the treatment is concluded the patient is ushered out though the opened door.  After the patient has left the chiropractor then sanitises the treatment table, washes their hands and changing their PPE. All patients have been asked, if at all possible, to pay for their treatment by contactless methods.  If patients only have a chip and pin card then our credit card machine is sanitised before and after use.  The card machine has a flat glass screen and is easily sprayed and wiped with sanitiser. Where patients cannot pay by card or Apple Pay but need to pay by cash or cheque, we request that they place their cash or cheque within an envelope with their name and date on the outside of the envelope. We have removed all magazines, toys and leaflets from our waiting area space.

1.2.3    Need to ensure that no one visits the office without permission (ie extra visitors, only booked appts etc.) We have informed all patients that they must attend the office on their own unless it is necessary for them to be accompanied to the office either by reason of their need for assistance by a carer, or because they are a minor and must have a responsible adult/parent in attendance for their appointment.  We have politely made it clear that we currently have no extra safe space for visitors to wait. We record the names of all adults who accompany patients either as a parent or carer.

            1.2.4    Need to maintain social distancing Everyone entering Waterside House is reminded to maintain social distancing by means of signs and tape on the floor.  It is much harder to do this in some parts of our office – the corridor outside the chiropractic treatment rooms is very narrow and does not permit people to pass one another.

Our chiropractors are mindful of this when taking patients into, and asking them to leave the treatment rooms.

Our reception staff are also careful to ensure that they do not enter that corridor when patients or other members of our team are present in that space. All members of staff and visitors to our office are reminded to maintain social distancing within our offices. We do this in a number of ways – by signs reminding people to maintain their distance and by posts on our website and Facebook page. By the nature of the service that we offer, it is impossible for our chiropractors to maintain social distancing whilst treating patients and with this in mind, they wear PPE (see below) and maintain hand washing, sanitising of their treatment rooms and changes of PPE between every patient unless those patients are part of the same household.

2.         PPE + Protective Equipment + Personal Safety

  • Our chiropractors:
  • Wear scrubs which are washed every day at the end of their shift.  The scrubs are washed at the office or removed and taken home in a specially prepared “scrubs bag” which is washed along with the scrubs inside by the chiropractors.
    • Wear disposable aprons and gloves which are changed between each patient appointment.
    • Wear face shields and protective glasses for very close contact work.
    • Always wear face coverings and face masks within the office
    • Appointments are booked for patients to see our chiropractors, one person at a time.  The only exception to this rule is if the patient is a child and needs to be accompanied by a parent, or, the patient needs a carer to be in attendance with them.
    • Our chiropractors have information regarding the symptoms of COVID in their treatment rooms.  If they feel that a patient is displaying symptoms of COVID that patient will be asked to leave immediately.  The chiropractor will immediately change into their clothes and wash their scrubs.  They will sanitise their room and document within the patient’s file and notify the Risk Assessment Manager of the situation.  The Risk Assessment Manager will then decide the action necessary to ensure the health and well being of the chiropractor, their patient and all the other staff and visitors in the office. The symptomatic patient will be advised to contact the NHS 111 service, to request a test and to notify us of the result in order that we can track and trace anyone who may have been potentially exposed to the virus.

The Risk Assessment Manager will also ensure that the owner of Waterside House is also immediately notified of the situation to ensure that the building is sanitised as necessary and other occupants of the building are notified of the potential for possible infection.

The Risk Assessment Manager may choose to ask the chiropractor, receptionist and anyone else who was present when the patient visited, to leave the office, to go home and isolate themselves and contact the NHS 111 and request a COVID test.  Alternatively, the Risk Assessment Manager may deem that a change of scrubs, PPE, hand and room sanitising as well as sanitising of the waiting area may be all that is needed by means of a more cautious approach. 

  • Our reception and administration staff
    • Have been offered and provided with fabric face coverings and medical face masks.
    • Have been provided with sanitising spray to not only sanitise their own hands but also to sanitise all computers, phones, desks, credit card machines, door handles, filing cabinets, cash tins et cetera during and at the end of their shift.
    • Sit in a specially designed reception area behind a plastic screen to shield them from patients in the waiting area.
    • Sit behind a closed door.
    • Some members of staff have chosen not to share the office space with another member of our team.  This is a personal choice and we are happy to support them in this and respect their decision.
    • For those that choose to share the reception area, we would prefer that they wear a face mask at all times, but, again, this is a matter of personal choice. The way that the desk space has been configured within the reception area, it is possible for two people to work in a back to back position.  We would also encourage members of the reception team to keep the window in their room ajar when working there.
    • Our reception team have been provided with sanitising fluid which sanitises equipment but is also gentle enough to sanitise their hands also. We encourage frequent handwashing and sanitising of their hands and work spaces.
    • We encourage our staff to be involved in the ongoing development of our risk assessment procedures.
    • At the end of the clinic day, the reception staff are responsible for sanitising their own working area and the seats in the waiting room and outside the office which have been used by patients – if this has not been dealt with previously.
    • Our receptionists have a document outlining the symptoms of COVID.  They are responsible for reminding patients – when booking appointments, during any telephone interactions and when inviting patients to come in to the office, that they should only do so if they are not displaying symptoms of COVID or if they are unwell.
    • Where a receptionist believes that a patient or other visitor to our office may be symptomatic with COVID they must immediately contact the Risk Assessment Manager or other senior member of our team present at the office or off-site.  They will politely ask that person to step outside our office space whilst the Risk Assessment Manager decides how to proceed.  Details of the symptomatic person must be documented.  If the patient or visitor to our office later tests positive for COVID, our receptionist may well be asked to go into quarantine depending upon the circumstances, their own personal situation and the decision of the Risk Assessment Manager.
    • All our receptionists are aware that if they display any symptoms of COVID that they must stay at home and quarantine.  They must contact the NHS 111 and request a COVID test.  It is essential that if they test positive that they immediately contact the Risk Assessment Manager who in turn will alert all other members of staff and anyone who may have come into contact with that member of our reception team.
    • Our Patients

2.3.1    Our patients are actively encouraged to enter Waterside House wearing their own mask or other face covering.  Once they are in our reception area if they are not wearing a face covering of some sort we encourage them to wear a mask and have supplies of masks which we distribute to them to wear whilst present in our office space. They are then asked to take the masks away with them for disposal at the end of their visit.

2.3.2    Our patients are asked to sanitise their hands once they enter Waterside House and prior to entering our offices.

2.3.4    Our patients are reminded via our reception team, our website and Facebook page that they should not attend our premises if they, or a member of their household is displaying signs of COVID19, or if they are in quarantine or are in any way feeling unwell.

2.3.5    Our windows are left open to ensure insofar as is possible that there is a constant flow of fresh air coming in to our offices.

3          Identification and contact details of all visitors to our offices

All members of our team realise how important it is to know who is visiting our offices at any given time.  As regards our patients we ensure that our patients’ contact details are up-to-dateand operate and booked appointments/diary system.  We are also currently requesting that only those with booked appointments attend our offices unless it is necessary for them to be accompanied by a parent or carer. We are recording the names of those accompanying children or entering the office as a carer in our diary.

4          Ongoing development and implementation of our risk assessment procedure

We will continue to monitor and develop our risk assessment plan.  We will do this in light of changing Government and scientific advice and in conjunction with our professional body, the British Chiropractic Association, and in response to patient and staff concerns and suggestions.

We will review our risk assessment place regularly to ensure that we are up-to-date and compliant.

Our intention is to provide a safe and professional environment for our patients, visitors and staff whilst maintaining the highest degree of infection prevention.