Pandemic in Australia phase 6 - Pandemic Influenza - Victorian Government Health Information, Australia

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Pandemic influenza

General practice - Pandemic in Australia phase 6

General Practice

Practices risk being overwhelmed with flu work and the challenges of sick patients with other chronic diseases. There will be staff absenteeism from sickness, fear or family care needs.
Some practices may decide to merge or collaborate with local colleagues to be able to maintain a viable service to ‘ride out’ the surge.
GPs, their staff and their families will be potentially at higher risk of infection. GPs may decide on a flu roster to allow targeting of prophylaxis.

Broader Community

Many people may be infected in up to three waves over a 12-month or more period with high levels of severe morbidity and death.
Hospitals are likely to be swamped and will have flu streams/clinics.
There may be high levels of absenteeism due to sickness and care needs with the threat of disruption of essential services, food, power, water, fuel and breakdown of public order.
The best source of up to date information will be the Chief Health Officer. DHS will supply antivirals and implement vaccination strategy if/when available.
Municipal disaster plans will come into action with community support and coordination.

Practices

Key actions to help your practice survive

brief doctors, nurses and non-clinical staff on the pandemic phases
talk about reducing risk and staying well
implement practice business survival plan
consider workload management of flu and non-flu patients
know how to order supplies of personal protective equipment for the pandemic phase

Management of non-flu patients

Reduce non-urgent visits for workload management and to reduce the chance of susceptible people having contact with sick pandemic flu patients.

Dealing with anxiety

Anxiety and fear may lead to patients becoming demanding and aggressive. Train your staff how to deal with these behaviours. Realise that many patients will want to see ‘their doctor’ and may try to claim special favours from staff and doctors. Talk to your staff about how to manage these. Staff may be scared, ill, or feel vulnerable. Support and time off to help people through this difficult work will be vital.

Law and order may start to break down. Municipal disaster plans will swing into action and local police or the State Emergency Service if available, may be needed to provide security to practices.

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Clinical

Managing your clinical workload

Mildly sick patients or terminally ill patients with pandemic flu may not be able to be admitted to hospital, once hospitals are overwhelmed. GPs will be faced with an increased workload from the routine care of patients with chronic diseases such as diabetes, asthma, hypertension, and ischaemic heart disease, as well as the additional challenges associated with these patients infected with pandemic flu.

To manage this increased workload, telephone triage may help direct sick patients to appropriate care and also reduce less necessary visits by well patients for repeat prescriptions or routine check-ups.

Sick patients

At first:

triage of patients to flu streams/clinics or designated hospitals where possible
sick patients may require ventilation and treatment of complications.

Once hospitals are overwhelmed:

referral pathways will be changed
- admission only of patients who may benefit from hospital care
- more home care for mildly sick and palliative care of terminally ill patients.

Designated hospitals will have flu clinics or streams to help prevent cross infection, manage clinical workload and provide rapid assessment. A list of designated hospitals is available from DHS.

Antiviral treatment: will depend on availability according to National Medical Stockpile policies

confirmed and suspected cases
- those at highest risk of severe outcome
- in times of scarcity may treat only those with a higher chance of survival
DHS will supply antivirals.

For more information see Interim national pandemic influenza clinical guidelines at the Department of Health and Ageing website.

Antiviral prophylaxis

DHS will control and supply antivirals such as Oseltamivir and Zanamivir:

prophylaxis
- depends on availability
- priority groups to minimise social disruption and maintain health services including general practices
- DHS will distribute
- GPs to fax orders for antiviral prophylaxis for relevant clinical staff to the DHS-provided fax number.

Vaccination

When a vaccine becomes available, DHS will decide on distribution. Local government will provide this through mass vaccination sessions.

When GPs and their staff are eligible for vaccine, this will be ordered from DHS on the usual vaccine order fax number 1300 768 088.

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Public health

During the pandemic the best source of up-to-date information will be the Chief Medical Officer (Commonwealth) and the Chief Health Officer of Victoria at their web sites: www.health.gov.au and www.health.vic.gov.au/chiefhealthofficer.

DHS also intends to use ABC local radio 774 Melbourne to provide updates. GP Divisions will be asked to coordinate support and information to and from GPs.

Infection control

Staying well: doctors and nurses

consider doctors’ roster for flu patients if enough staff
antiviral prophylaxis as provided by DHS
use personal protective equipment when seeing a possible flu patient
after exposure to possible case of pandemic influenza
- self monitor for signs and symptoms of disease
- do not work if you have flu-like symptoms
- self isolate until assessed.

Personal protective equipment will be worn for all possible flu patients.

Gloves for examination of all patients and hand washing will be important.

Waste control

The amount of infectious waste will increase from both personal protective equipment and waste from patients being cared for at home, so more frequent collections of waste will be needed.

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Practice survival

During a pandemic, practice survival means planning for the absence of some of your most critical assets, staff and the intermittent interruption of supply of power, water, and other utilities.

In a pandemic the businesses that supply and service your practice are likely to be under pressure as well. For example pathology companies may not be able to find drivers to collect samples or the cleaner may not turn up. Ask your suppliers whether they have made any plans for a flu pandemic and consider alternative suppliers as well. There is a planning chart in the worksheet section to help you think about this.

Some practices may decide to collaborate with neighbours or even merge to survive.

To help understand some of the pressures that practices may be under, this table sets out different scenarios for a hypothetical practice.

Scenario	10 percent population infected	20 percent population affected	30 percent population affected
Description	There will be up to 10 per cent of staff absent at any one time including doctors and front desk.	There will be over 20 per cent of staff absent at any one time.	There will be over 30 per cent or more of staff absent at any one time.
Description	There will be intermittent disruption over 7-day periods in: food supply medical supplies water fuel/transport electricity telephone system internet.	There may be more prolonged disruption to: food supply medical supplies water fuel/transport electricity telephone system internet.	There will be possible failure of one or more critical external supply for periods of 2–14 days: food supply medical supplies water fuel/transport electricity telephone internet law and order.
Contingency operations	Operations: UNDER PRESSURE maintenance of routine appointments with flu streams or times if still appropriate and home visits for flu patients if possible	Operations: BASIC defer routine appointments if at all possible repeat prescriptions over the phone separate waiting areas for flu and non-flu patients may not be possible	Operations: CRISIS no routine appointments patients seen on turn–up or needs basis patients seen by available clinical staff care of patients with assistance from assessment centres
	Management: practice manager or deputy with managing partner or deputy	Management: practice manager or deputy with managing partner or deputy	Management: practice manager or deputy or most senior staff member available
	Staff: as available with flu stream roster if possible	Staff: roster for doctors’ and nurses’ clinical time rostering of one duty doctor to handle all requests for repeat prescriptions and advice over phone	Staff: whoever still available working roster consider merging with neighbouring practice to share staff
	Communication: to/from patients: website, email and notices to staff: internal email and mobile phone	Communication: to/from patients: website, email and notices to staff: internal email and mobile phone	Communication: to/from patients: website, email and notices to staff: internal email and mobile phone

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Checklist pandemic phase

brief doctors, nurses and non-clinical staff on the pandemic phase
talk about reducing risk and staying well
implement practice business survival plan
consider workload management of flu and non-flu patients
know how to order additional supplies of personal protective equipment

Worksheet: pandemic phase

Worksheet: pandemic phase (29kb, pdf)

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Last updated: 23 January, 2007
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For general enquiries to the Department of Health telephone 61 3 90960000