Tonume COVID-19 Health and Safety Plan

Tonume Integrated Health’s COVID-19 Plan is broken down into 4 Segments:

I – COVID-19 FACILITY MODIFICATIONS
II – STAFF PROCEDURES AND PROTOCOLS
III – PATIENT – PRIOR TO YOUR TREATMENT SESSION
IV – COVID-19 EXPOSURE PROTOCOLS

I – COVID-19 FACILITY MODIFICATIONS

The health and safety of our patients and our team are our #1 priority. To ensure that we keep
everyone safe, we’ve implemented the following facility modifications to enable us to provide
you with the same Tonume Experience, but slightly altered for all of our health and safety.

Plexiglass dividers
To protect you and our Patient Care Coordinators

Hand Sanitiser Station
To enable you to sanitise your hands upon entry

Personal Protective Equipment
We require all staff, practitioners, patients, and visitors to wear a face mask or covering during their visit.

Physical Distancing Measures
We’ve provided visual cues to create a safe space and experience.

We have limited the number of patients in our waiting area to three.
We have 2 clearly marked seats in the waiting area, and we also have an overflow area for another. All others will have to wait outside until there are less than 2 patients in the waiting area.

Medical Grade Hepa-13 Air Filters in all our HVAC units
We’ve installed state of the art Medical Grade Hepa-13 Air Filters in all three of our Heating, Ventilation and Air Conditioning units. These    are regularly maintained and changed frequently.

Staggered Appointment Times
To assist with limiting the amount of patients in the waiting area, and to allow additional time for our team to sanitise your treatment room we have staggered our treatment times. Our sanitisation sprays need at least 5 minutes of contact time to ensure your treatment room is fully sanitised.

Washrooms – we have one designated for patients and one for staff:
To reduce health risks, contact points and exposure, we will be limiting use of our washrooms. Our South Washroom is barrier-free and is available to all patients, and our North Washroom is available to all staff. 

Contactless Payment
To reduce contact and exposure, we ask that you securely store your credit card on your online profile or for credit card payments, you can use the ‘tap’ feature on our point of sale terminal. We will continue to accept cash payments. 

II – STAFF PROCEDURES AND PROTOCOLS

The fundamental approach to mitigating the spread of COVID19 is conceptually simple and consists of the following pillars. (from Iridia Medical) www.iridiamedical.com                                   

1. Self Assess for Symptoms and Return When Healthy 

The first pillar of the mitigation strategy will be to make efforts to prevent illness from arriving at the course in the first place. The best approach to this end will be to screen everyone coming to the venue on the basis of symptom presentation. This will not eliminate asymptomatic people but goes a long way toward reducing potential arrival of illness. 
For anyone that does have COVID19 like systems, it will be important to have consistent messaging on when they are safe to return to the venue. 

*This is the Best Approach to keeping COVID-19 out of our clinic*

There are two types of Pre-Screening, but neither of these will eliminate asymptomatic patients from coming into the clinic. It does however, go a long way towards reducing potential arrival of the virus.

Active – What we say and Do
Passive – Signage, social media and website

What is our Pre-Screening Plan?

Active Plan

Step 1 – Pre-Screening Calls/Communications
48 hours before the schedule treatment time, we are contacting the patient via phone, text or email to ask them our pre-screening questions, remind them of our mask policy (to be introduced later in this document) and let them know to arrive in a mask, just before their treatment time so that they can have their temperature checked and hands sanitised.
24 hours before their treatment time, the patient will receive an email reminder of their appointment along with a reminder to fill out the pre-screening questionnaire.

Step 2 – Upon Arrival at Tonume
Patients will be required to have their temperature taken by a Patient Care Coordinator.
The patient will also be asked by the clinician to sign a COVID-19, waiver/consent form on their first visit.
The patient will be asked to verbally consent to the same waiver/consent in subsequent visits – this verbal consent is documented in the patient file

Passive Plan – We have signage on our doors asking for patients to stay home if they are experiencing any COVID-type symptoms.

2. Physical (Social) Distancing 

Make best efforts to maintain a physical distance of at least 2m metres (6 feet) between people at all times. In doing so, it becomes difficult for anyone to become infected by someone else, whether they are symptomatic or asymptomatic. 
This is in place for staff, clinicians and patients alike and is the best approach to keep from being infected by someone else when in the same facility.

How do we do this?
Physical Barriers in the reception area to keep PCC’s and patients at a safe distance

Section Off Waiting Area – to allow for only two patients to be waiting for treatment inside the clinic. These two seats are positioned 2 metres (6 feet) apart and are not facing each other. 

Using either the South or North Hallway as a patient ‘overflow’ area for an additional two patients to be seated but still physically distanced while not overcrowding the reception area.

One-Way Flow through the Clinic – Practitioners to escort patients to designated exits when their treatments are completed so as to not overwhelm the front desk/reception area. With signage to help direct flow, as well as PCC’s directing flow.

– Chiropractors can utilize their exit

– Physios can utilize their exit

– Kinesiologists/Physio Assistants can utilize South side to south side rear exit North side to front exit

3. Hand Hygiene 

The third pillar will reduce the possibility of patients, staff and clinicians from infecting themselves via their hands coming into contact with virus droplets on surfaces.

By focussing on keeping hands clean, you reduce the possibility of people infecting themselves via their hands coming into contact with virus droplets on surfaces, and you also reduce the potential to spread the virus via common use objects (railings, door handles etc.). 

Proper hand washing should occur regularly and should entail using soap and washing with warm water for at least 20 seconds. 

This reduces the potential to spread the virus on common use objects (door handles, cupboard handles, thermophore controls)

How do we do this?
Touch Free Hand Sanitiser Stations:

-One in reception Patients are directed to the hand sanitiser station upon entry
-One in North Hallway (near wash station) 
-One in the South Hallway (near wash station)
-Pump Hand Sanitisers are in every treatment room Clinicians are to utilize this once they have entered the room with the patient after anytime the clinician touches something other than the patient
-If you adjust the face cradle
-If you adjust the temperature of the table
-If you turn the thermophore on or off
-If you adjust the lighting
-If you adjust the music volume
-If you open a cupboard door
-After touching your facemask
-After applying/removing PPE
-After handling dirty linens
-After cleaning/sanitising the treatment room

4. Face Touching/Mask Touching Avoidance (e.g. of touching eyes, mouth, nose, etc.) 

Another way to avoid getting infected is to encourage the avoidance of touching your eyes, nose, or mouth with hands. In lieu, suggest the use of one’s shoulder, forearm, or a tissue if an itch must be addressed. 

How do we do this?
-Using shoulder or elbow to scratch an itch

-Making sure that your mask is a good fit

-Using the straps of a mask to adjust it (not the front)

5. Enhanced Cleaning 

Regularly cleaning all high-touch surfaces and common use objects is another way to curtail the spread. 

How do we do this?
-Patient Care Coordinators will be vigilant with cleaning all public areas

-Patient waiting area, washrooms, point of sale terminal, door handles etc

-Clinicians will be required to maintain treatment room sanitisation

-Utilize COVID Cleaning Spray to clean/sanitise high touch areas and common use objects such as:

Door/Cabinet handles, oil/lotion bottles, light switches, ipod/stereo controls, laptop keyboards/track pads, thermophore, face cradle, treatment table, chair surfaces, 

5. PPE (Personal Protective Equipment)/Mask Wearing 

Effective December 26th, 2021 – Tonume’s Mask policy is that everyone is to wear 3-ply medical mask at all times when in the Clinic.

Tonume Mask Policy – Medical Exemption

While we are all now well versed in COVID-19 protocols like proper hand hygiene and correct face mask wearing and know that they are integral parts of limiting the spread of COVID-19, we are also aware that there are some individuals that are unable to wear a face mask due to medical reasons.

If you are one of these patients that are unable to wear a face mask that fully covers your nose and mouth during your appointment, you must follow these three steps:

The Patient is to contact our Office Manager, Helen Tennant (helen@tonume.com), stating their request to be considered to be treated without a mask. 

– The Office Manager is to request and obtain consent from the practitioner the Patient wishes to receive treatment from. 

– The Patient is to provide a copy of the letter from their physician that outlines the medical necessity to forego wearing a face mask.

– The Patient consents to wear a face shield for their entire visit to the clinic.

– If the Patient does not have a face shield, one can be rented from the clinic for a $5.00 (GST included) rental/sanitising fee.

III – PATIENT – PRIOR TO YOUR TREATMENT SESSION

PATIENT PRE-SCREENING & ARRIVAL:

You will receive a ‘COVID-19 Pre-Screening’ Questionnaire via email 12 hours prior to your scheduled appointment.
You may also receive a phone call from your clinician approximately 24 hours before your appointment.
You will be asked to bring a mask for your treatment, or you can purchase a disposable mask for $1.00 or a cloth mask for $18 (with all proceeds going to the Downtown Eastside Women’s Shelter)
Upon your arrival Tonume our Patient Care Coordinators will ask you to sanitise your hands with sanitiser provided and they will administer a temperature check via infrared thermometer on your wrist.
If you are not feeling well, or have had any COVID-19 signs or symptoms, we would kindly ask that you do not come in for your treatment session. Please contact us at 604-428-1399 to let us know that you’re not coming in. You will not be charged a late cancellation fee. We would also advise you to contact your doctor or medical practitioner or call 811 for more information.

STAFF/PRACTITIONER SCREENING:

Our staff and practitioners will be screened daily with a temperature check. We have also asked that any staff with COVID-19 signs and symptoms not come in to work until they are feeling well.

IV – COVID-19 EXPOSURE PROTOCOLS

TONUME’S IMMEDIATE RESPONSE

Any Employees/Clinicians who have COVID-19 symptoms (i.e., sore throat, cough, fever or shortness of breath) are asked to remain at home, and are directed to contact Tonume to make certain that the Patient Care Coordinator at the desk is aware of their absence and the Contractor is asked to assist contacting their patients for the day (especially the first scheduled patient on their shift). Contacting your Doctor is recommended as well as COVID testing if your MD feels it is necessary to do so.

Employees/Clinicians who come down with symptoms after arriving or who become sick during the day should immediately be sent home to recover/self monitor. 

Sick employees/clinicians should follow all CDC recommended guidelines. Employees should not return to work until all the criteria to discontinue home isolation are met, in consultation with their MD.

POSITIVE TESTING (Patient or Employee/Clinician)

If an employee/clinician or patient has received a positive COVID-19 test, should immediately contact public health, 8-1-1, and follow their instructions/recommendations. Our Directors at Tonume will also be contacting the Public Health office and will abide by any and all recommendations. Any of our employees/clinicians who have come into contact with the individual testing positive will be notified of their possible exposure. They will be asked to maintain the confidentiality of the individual, and will self-monitor for symptoms.

The CDC will notify all individuals deemed necessary via contact tracing, and it will be up to them to contact anyone else they feel necessary.

From the Centre For Disease Control Website:
If you are a contact of a confirmed case, a member of the public health team will contact you to let you know you may have been exposed. If you have symptoms, you will be sent for testing. If you do not have symptoms, you will be asked to self-isolate so that if you develop COVID-19, you won’t spread it to others in the community.  Learn about self-isolation.

If you have been contacted you will remain in self-isolation and be required to:

– Stay at home. Do not go to work, school, or public areas, do not use public transport or taxis.
– Wash your hands or use alcohol-based hand sanitizer often. 
– Ask friends or relatives if you require help with buying groceries, other shopping or picking up medication. Alternatively, you can order groceries and medication by phone or online.
-Do not have visitors in your home except if they are providing care or delivering goods and supplies, and in that case, maintain a distance of 2 metres.
– Clean and disinfect high-touch surfaces.

Self-isolation can end 14 days after the last contact or return to Canada if you have not developed symptoms.