WNSW PHN Webinar: Preparing your Practice for a Pandemic with Dr Ai Vee Chua

WNSW PHN Webinar: Preparing your Practice for a Pandemic with Dr Ai Vee Chua

so hi everybody katie pryor here from the western new south wales phn thank you all so much for joining us at short notice tonight we really appreciate um you attending and realize this involving situation it’s really important to come together and share some really important information to start the meeting tonight i would like to acknowledge the lands that we’re meeting on i’m here in bathurst and i’m on orangeryland i also acknowledge all the different traditional lands that participants are meeting on tonight i would like to pay my respect to elders past present and emerging and acknowledge their contin continuing connection to land water culture and community and i warmly welcome aboriginal and torres strait islander australians who are present here this evening before i pass over to dr ivy chura who has kindly agreed to present for us tonight i’d just like to run through some housekeeping um if everybody could please type your full name in the chat box when you log in this is just for us to get an accurate record of attendance if you were dialing in via phone if you could please apologize my slide show is playing up there if you could um email cpd at wnswp if everybody could also please mute if you are not speaking and when we get to the q a session if everybody we really want your participation tonight and to hear all of your questions so if you can unmute yourself identify who you are and ask your question if you’ve got lots of people speaking just turn your webcam on put your hand up and let us know that you have a question and we’ll facilitate to you and if none of that’s possible then please pop it in the chat box and we can take it from there but without further ado i will now pass to ivy thank you so much ivy for presenting tonight and i will just make you the presenter here thank you katie good evening everyone um welcome everyone to these very challenging times um and it’s good to see so many people jump on board i see a couple of names from my practice as well um and for those people we’ve we’ve lived um what a one about to present this evening um i’m just going to say straight off that i’m not um any expert in uh in pandemics i’m not an expert in the delta strain um but i absolutely have picked up a lot um from my uh work with um as part of the new south wales health coverage clinical council but also an rac gp new south wales um the cop group where i’ve derived a lot of my learnings um and certainly had to put a lot of things in place um quite rapidly over the past uh week and a half nearly two weeks now um so what i’ll do is um share my screen which is a rapidly thrown uh together set of slides but feel free to type your comments and questions in the chat as we go um and i’ll keep an eye on on those as we talk but um hopefully there’s lots of time for a sharing of information qna session at the end as well so how’s that looking katie that’s perfect ivy is that working okay if you can switch your present to over in your display settings you can switch your presenter view display setting yeah just uh s swap presenter view and slideshow that’s it perfect better terrific okay so um for those of you don’t know who don’t know me i’m one of the gps at double family doctors um and we’ll talk through what’s been happening at our practice and this last uh almost two weeks now but a bit of background first up so um this is the stats that i got from uh two days presentations um by western lhd and also far west lhd so a total of 283 reported cases and sprinkled through lots of different towns now um dubbo obviously having the majority of the cases right now um but certainly we’ve seen a very very rapid rise from 1 to 234 cases since the 10th of august and in the far west um we’ve got the 28 cases that have been reported but actually there’s another 15 so that will add to tomorrow’s figures and a lot of that is concentrated on broken on will kenya but um some cases now emerged in broken hill um a few things about the delta variant that we’re seeing at the moment i mean all of this is the delta varying outbreak um and it is different than the original virus i think we all got pretty complacent with the original environment because we didn’t really see a lot of it out in western new south wales and what we did see um we seemed to contain fairly well but this one’s a different beast it’s much more transmissible um there’s evidence that it leads to more severe disease certainly uh seeing more people uh put into hospital and icu and ventilation than we did with the original strain and breakthrough infections look to be more common with delta so um meaning to say that those who’ve been fully immunized um tend to there seems to be a high predisposition to have some infections compared with the other variants of kovu it is a rapidly changing scenery and what you decide on one week within your own practice may well have to change the next week and it’s really difficult for the teams we all look after because it involves bringing everybody on the journey with us to make sure that everybody understands what’s going on and the need for change and that we’re all on the same page and adaptability is absolutely key um and and you know for those those of us who really like things to uh run a certain way and you want things to be as perfect as possible um right now it’s about just going look let’s do the best that we can out of the probably not so great options um but we gotta adapt as we go so i’ll talk through a few considerations that’s infection control things things to do with staffing the rapidly changing space with vaccinations um and last but not least maintaining communication with your team but also your community so kick starting with infection control i don’t know where am i getting there is um so um a few things here look at in terms of screening and your staff are so used to doing this i’m sure asking every single person at time of booking and a time of arrival about what symptoms they might have but certainly were found in dubbo now we’re also absolutely asking every single venue of concern and there’s so many listed now on the new south wales um health benefits of concern site that in fact what we’ve got on our entry to our practice is a whole print out each and every day of all the venues of concern so that patients can spot them as they come in um we’re also finding that we’re needing to ask about people who are awaiting test results or that they’re supposed to be in isolation because we absolutely don’t want those people coming into our practice with risk of infection to their teens but also to the other patients entering the surgery as well absolutely her recommendation to switch to video and phone consultations where possible when in greater sydney they first had their numbers rise uh the the college of gp sent a message pretty rapidly out to all of the greater sydney um gp community to say um a big recommendation to go to virtual care uh telehealth um and it would be at the exception rather than the world to bring people in face to face and again um because of the uh that delta variant is a different beast on the other hand though face-to-face consultations um are still important for the things that you just really can’t you know can’t delay so um you know the paediatric communities of practice with new south wales health have voiced the concerns very much around the fact that um in sydney they’re seeing uh childhood vaccinations being delayed and particularly when it’s the six week vaccinations um it it really needs to still be there so um you know some of those things that just need to happen face to face anyway at our practice we’ve had things like wound care that just can’t be deferred um yeah a few things can but prolly injections and and you know depot injections all those things just need to go ahead anyway in that undefined period of time a reminder i’m sure you guys all have your qr code check-ins there um but be extra vigilant i guess that all the patients are actually checking in by qr code um you don’t want a patient who subsequently turns up as covert positive um and then you know coming to your pr who’s come to your practice and it becomes a vague two-hour period that they may have been at your practice when in fact it might have been half an hour or less so um be quite firm about that qr code check-in but also the carers that might come in with them and absolutely every one of your staff members so you know exactly when they’re in and when they’re out and if it might align them with the time of somebody who’s a covered positive uh not known as yet coming into your practice in terms of ppe um the red alert um situation at the moment in all of uh new south wales um i mean that that pertains to the hospital setting um but it’s a good idea to sort of follow what they’re doing and trans translate what they’re doing in the hospital setting to what we ought to do in general practice um and so red alert very much means you know reduce the number of people coming into your premises as much as possible um but from a ppe perspective your p2 n95 masks are the way to go and ensure that you’ve got eye protection now there’s varying information that comes out about ppe um but i think right now we’ve got aerosol uh you know very much that recognition that um the covered virus spreads via error aerosol spread and not just droplet transmission um the the p2 and 95s rather than surgical masks is what we should be using you also got to bear in mind that you know if there is a um a case coming through your surgery if you’ve got everybody with the pta 95 mast on and the eye protection on all the time your likelihood of having to be shut down by public health is significantly less um of course minimizing the time that patients are in there also helps as well um and then last but not least um we know very much um in melbourne we saw it a lot um in sydney as well but basically health care worker transmissions tend to happen in staff rooms it’s that um time where we sort of try to relax a little bit we’re not in our patient to um doctor or patient to nurse or or patient to admin staff interaction um and we’re relaxing we’ve got our marks on we’re having our meals but that absolutely is the time that transmission happens so unfortunately it’s kind of the time to be a bit lonely um and not be congregating in staff rooms um different teams might consider doing a different way with ways whether you have you know a team a and team b that takes turns and spends time in different staff areas whether you just mandate that everybody goes and finds an outdoor spot to eat and separated from each other but that’s certainly something you need to think about um how can you keep your workers safe and not potentially transmitting infection to each other in terms of staffing now this has been one of our biggest challenges um because i think almost every single staff member of ours has over this past um week and a half being designated either a close contact or a casual contact meaning to say um you know the close contact means that they’ve got to have the test done and then isolate for 14 days um the casual contact is variable the fine print does vary from many of concern to being a concern some of them have just been have a test isolate until it’s negative and then you can go back to work um and other venues of concern have talked about um having a test uh isolating until that test result comes back but then having a second test as well at day five um or beyond day five if that time period’s already passed um but that with that second test you don’t need to isolate until that result has come back that you can mean your staff member can come back to work um whilst they’re awaiting that second swab result so very much read that fine print um i might even click on this and show you an example i’m thinking lots of you have i’m probably not going to be close enough to figure this out while sharing my screen um but it’s that case location page on the new south wales health website and you know you can go in there and type double or orange or wherever to find out all your videos of concern um and then click click on it to then find out the further instructions associated with that particular video concern we found ourselves in a bit of a pickle though with some of our locations um nine i think nine nine of our schools our local schools were shut down because there had been cases identified amongst the school community and so those ones have been particularly difficult because there’s nothing posted on the new south wales health website it’s just a message that goes through to families of that school saying that they need to isolate and in some schools they’ve gone got to isolate for the full 14 days and in the other schools they’ve said you need to get a test and isolate until the results are back in other schools yet again it’s been the whole family all the household members in that family have had to get tested um so if you need to seek clarification around that in particular and don’t hesitate i think to call a public health unit and find out what needs to be done appropriately how to minimize down time the key is knowing how to obtain your test results quickly and so we on our first day um one of our staff members was designated a close contact um public health didn’t give really clear instructions about what the rest of our team needed to do i think it was all pretty new to them locally at that point in time however we felt that it was appropriate thing to do to have all of our um staff members who had been on site in the past two days when that close contact had been at work um we had all of our staff members tested um and on that particular day it meant we ended up taking our own swabs um we haven’t routinely swabbed our patients during this pandemic but we absolutely had to on that day to swap each other um in order to get that done quickly otherwise the lineup at all of the testing locations in dubbo on that day was going to take hours and hours so fortunately we got the results back by that evening and you’re able to be semi-operational by the next day but um in your own locations know all the testing um locations um in dubbo for example um it seems to vary a little bit from day to day but right now for us uh seems to be that the show ground one of the one of the companies at the showground seems to know how to test fairly quickly um the the hospital seemed to be fairly fast for a period of time until the pathology staff had to end up going on isolation and they were short stuff um so whichever location you need um know your testing facilities well know how you can get those test results back quickly of course right urgent healthcare worker in there um but we’re finding that for our gps they do seem to push it through but not necessarily for all the other staff if you haven’t already worked out how to work from home for all of your team members in for our gps you know i certainly thought about our gps working from home and we had that early on in the pandemic so we had some things set up with that um but i certainly didn’t think about how to set nurses up from home and admin and allied health from home so um with that i mean for us and you might have things a little bit differently but for us it was certainly access to a computer or laptop in people’s homes absolutely access to a phone for our surgery we’re a little bit lucky with our phone system because it can be actually implanted into people’s mobile phones so that becomes an extension of our phone system at the surgery um e-scripts electronic referrals for radiology and pathology um if you haven’t already sorted that out with your companies that you normally refer to absolutely do that now before you get increasing numbers in your towns and then have a think about where you might be able to source additional helpers and that might be local additional helpers it might be people from elsewhere it might be people providing a virtual service to your patients from elsewhere um but uh yeah have a think about that and and it’s just been amazing across new south wales we’ve had so many people have been really keen to jump in and give us a helping hand um so moving on to vaccinations um ama new south wales i think this is a great line um i sit on the amanda southwest council and and uh one of our members and that council um said look the best vaccine is the one you can get now and seriously in the outbreak situation that’s exactly what it is so if the one you can get now is astrazeneca then that’s what our patient should be getting 18 years and over if the one we can get now is the fisa then yep go for that as well um but really the atari recommendations from way back about you know in a non-outbreak situation um people under 60 their preferred vaccine is pfizer um doesn’t hold when you’re in the middle of an outbreak situation so absolutely it’s a no-brainer to get either vaccine um if you’re going to uh be having the astrazeneca recommending that through seneca um absolutely fine just to make sure that that patient knows how to monitor for symptoms of tts and get to urgent testing with d-dimer and platelets if they do get any of the symptoms that may suggest tts so whichever vaccine they can get really push the point to your patients that uh whichever one it is just whichever they can access first um the other challenge that we’ve had to face of course is that um with the astrazeneca vaccines in an outbreak situation the recommendation is to bring that second dose forward to somewhere between four and eight weeks instead of the 12-week interval and so for us that’s meant a mammoth amount of reception time making 800 phone calls to bring those vaccine doses earlier and that’s been a huge amount of work but then we’ve also had to staff those second dose clinics so we’re still working through that this week hopefully we’re done with that mid-next week with our earlier second doses and in terms of fives of vaccines um nissanthos health recommendation right now is to consider increasing that that interval up to six week period and if it means that you get more people in there to be able to have the first doses i mean the the infection um protection after a first dose is is very high from a serious infection anyway we’re talking 83 which is quite remarkable after the first dose that sort of serious infection that lands people in hospital and ventilators etc so um the idea being to cover a bigger volume of your population rather than to have a part of your population covered extremely well and then some that may not be protected at all and then last but not least maintaining communication um go virtual make sure your staff know um what’s going on um and hold it all virtual because you just certainly don’t want to be all congregating in your staff room having a meeting and being a super spreader event in itself um and then have a think about how you’re going to be able to quickly communicate with all of your team if you’ve got everybody’s phone numbers and you can do a quick group um text message all good um if you’ve got bigger numbers um we’ve gone to whatsapp um as a means of quick communication for staff um but i found that that’s been um a real positive as well because you know when you don’t get to sit and chat with each other or hang out in the corridor um it’s a it’s also a really good way to debrief and keep everybody’s spirits up when we’re going through pretty tough times at the moment have a think about your cons to your patients everybody’s worried and if you haven’t already faced it your reception staff will be drowning with a number of phone calls that will be coming through people who want to know whether they their appointment needs to be converted to a video or a phone and what’s going to happen do they need to come in people asking about vaccinations people want to book in for more vaccinations um people who are just stressed and and don’t know how to navigate people who want to know whether they’re a contact situation or not and who to turn to where to go so um those phone calls will come in thick and fast um if you haven’t already got a phone message system in your practice have a think about that because if you can manage to put a phone message that deals with say 50 of the phone inquiries that are coming through um then at least your receptionist can get to work doing other things like rescheduling vaccine appointments and then do remember your vulnerable patient groups so for us that really meant to met looking our disability group in town ensuring that they were all fully vaccinated looking at the disability staff of that population and to my alarm i found out that they were only 11 vaccinated so we’ve been going hard trying to jab them the last thing we want is is them to be bringing covert into their disability houses but same goes for your aged care groups i think most of them should be done by now but think about your patients at home as well who might have difficult access um you know for all sorts of reasons social reasons financial reasons or mobility transport reasons remember those groups and and you know flag them particularly to touch base with them i think that’s enough talking from me so open that up to chatting might in fact close my screen slideshow do i unshare from up here katie i can just um take you off being presenter ivy will just do that momentarily yeah so if everybody wants to if anyone wants to unmute themselves and ask a question or type it in the chat box we also might hear from sonia berryman to give a bit of a phn update while people are just thinking about their questions if that suits everyone hello my name is nisha i’m a gp from the canambal aboriginal health service uh my question is that i’ve been having a fair few pages 360 and requesting for uh fisa vaccination i just wanted opinions and about how others have been managing that situation you so much nisha i think we’ve just lost ivy while i was taking her off katie sonya can you hear me yes we can okay nisha um currently the eligibility criteria still remains that pfizer is only available up until 59. the only option you have after that is like if you feel that that person has conflicting um issues that mean that they can’t have the astrazeneca vaccine there are some forms that need to be filled out that go through to new south wales health um to allow that patient to be then then can have access to the fisa but vaccination vaccines that are distributed through primary health care from the department have to meet the department’s eligibility criteria and that is a little bit different um to what the state eligibility will be and how they run their clinics because a lot of the state-run hubs will they will only have fisa for everybody that goes through there so it makes it a little bit difficult but currently that’s what the um the rules are for the depart from the department of health thank you thanks sonia has anyone else got any questions i’m thinking katie i might just give an update to everybody around what the phn is focusing on at the moment and that might prompt a few questions as well as everyone knows we have had a coordination role with the department of health in the rollout of the vaccination program um what we spend a lot of time is is going back to the department on your behalf to get your allocations um get you onboarded for vaccines get your allocations increased as needed go back to them for all your questions so we spend a lot of time doing that on your behalf so hopefully everybody who now would like to be participating in the vaccination program has been onboarded and you currently have the vaccines that you wish to have if you haven’t and you would like to receive the fisa vaccine please reach out to us anybody who has put in an eoi for that should have by now received a letter letting them know when they will actually be on board for pfizer and that potentially will be over the coming weeks for september into october as allocation as supply increases um with the department of health uh we’re distributing comms to you all the time as they come out from the department of health so bulletins come out regularly and we will continue to share them with you as well as media releases as they come through our comms department we’ll send them out to you as well so that you’re kept up to date with the daily case numbers and where um where they are situated the biggest thing one of the biggest things we’re concentrating on at the moment is ppe the department has actually given us access to some different ppe that we are happy to share with you um we it is in limited supply but please reach out if you need ppe and the process for ordering that is through our website there’s a ppe request form on our website that needs to be completed so that we can then organize distribution to you for your needs please reach out if you need a hand with any of your digital health technologies so telehealth or e-prescribing our digital health team are more than happy to support you with that and ensure that everything runs smoothly we’re focusing on um our 1a frontline workforce as well in getting anybody in that 1a cohort that still hasn’t been vaccinated we’re working with you guys on the ground to try and fit them in as necessary and we appreciate anybody that has been doing some in reach or setting up clinics for us in regards to our residential aged care staff and residents that it becomes mandatory for them to have their vaccinations by the 17th of september so we reach out to you guys and we appreciate anybody that’s helped in that um in helping us get that done as well as fitting in our police force and our ambulance so we’re concentrating on those at the moment as well and we already know there’s also some frontline workforce that still aren’t vaccinated across our region so we’re hoping that we can assist the lhd in getting them done as well disability is is another area that we’re working with working with the department in facilitating some of that and there’ll be other katie will talk about it probably around some other cpd sessions that we’re running some webinars over the coming weeks as well but please reach out to your practice support officer or anybody in the phn if you need anything we’re here to support you and your teams as best as we can reach out if you would like access to the eap program we haven’t reactivated it yet but if the need is there we will definitely reactivate it so that you and your teams have access to it to eap with some mental health support thanks everyone over to you katie for questions thanks for that sonja um a number of questions have come into chat and ivy has answered those so would anyone like to unmute and ask any further questions of the phn team or ivy or all of your colleagues who are online tonight we’ve got 78 people here so it’s a wealth of knowledge in this space over here i’ll just make a comment about the um staff testing um that has been a changing scene in in southwest sydney and other um areas where they’ve been um lgas of high concern they’ve certainly had their health care workers undergo regular testing regular swabbing but i understand from the ama new south wales council unfortunately that’s actually stopped this week um there is a discussion at the um charlotte hisp daniel mcmullen kerry transitive level about um doing rapid antigen testing as a screening process um and that might be something that’s going to be rolled out in the not too distant future um but there’s some concerns about that at the moment because of its high fairly high high a false positive rate um so i think this is a watch this space um i know one of our nurses who also works at dubbo based hospital uh vaccine vaccination clinics um she was talking about the fact that they’ve now started swabbing the well she’s had to be undergoing um sobbing every three days associated with her work there so it’s a moving scene i think from a individual gp practice perspective um it is something to consider um uh you certainly wouldn’t have to isolate most your weighting swab results um but um yeah an internal decision to be made within your own practices there’s certainly no directive coming through from departmental health or our college about that thanks ivy um we’ve got a question here from courtney who is wondering if there’s a deep cleaning protocol if a practice has an exposure and if there’s any further information or links that we can provide for that so katie with that one there i think the um my knowledge is that that it’s under the uh jurisdiction of public health unit to actually organize the deep cleaning so it wouldn’t be something that our individual practices would have just thought out should we be unfortunate enough to be um identified as a location of exposure thanks ivy oh katie it’s michelle i’ll um find a link for um recommendations for ordinary cleaning between you know like um clinics and things if somebody’s got any concerns around that you know disinfecting and yeah wonderful we can send any links as a resource out tomorrow to everyone that’s attended um i think they’ll recently updated the cleaning was recently updated as well as the young ppe [Music] thanks michelle we’ve got a question here from maria where do we send people for the second dose of astrazeneca if they have had significant side effects but no contraindications michelle or sonia i can answer that one over here thank you um it’s tricky because you know the having um fairly florid uh reactions in the first 48 hours is quite common um and so the recommendation would actually be you know unless they’ve had those specific five things which is an anaphylactic reaction to the first dose of vascular or that they’ve got one of those four clotting things so antiphospholipid syndrome with recurrent thrombosis uh cbst print induced thrombocytopenia and psychic vein thrombosis unless it’s one of those things um the recommendation is absolutely that they still get the second dose of astrazeneca um and to expect that the reaction will be significantly less with the second dose there’s the specialist near south wales what is it n-s-w-i-s-s new south wales immunization specialist service um which has a a phone number that you can ring um monday to friday um to get advice on what to do with these tricky patients where you might have some concerns about the first dose of astrazeneca and and they’ll and they’ve been really helpful in terms of uh directing what best next to do thanks ivy we’ve got a question here from dr maniam what level of ppe is recommended for vaccinators including the admin staff from our perspective and this comes down to again the likelihood of um exposure um for us in dubbo where we’ve got you know my calculations it’s that there’s about one in 250 residents um have got confirmed covert um plus the awareness that we we had um infected people in the community not quite isolating so the likelihood is that there is quite a lot of covert going around um and so we’ve taken the uh perspective that consider every single patient potentially infectious and so even during vaccination clinics or all our admin staff as well as nurses and and doctors are all wearing um the npt p2n 95s and eye protection um and our doctors and nurses that have got that closer contact we’re also wearing the gowns and gloves of course when we stream the vaccinations thanks so much ivy um this is a question to the group and and to you ivy from monica um do we know what is the incidence of pericarditis and myocarditis that we are seeing um does anybody have any idea about this in our region and in general last thursday’s stats was 180 this is a tga update and if my figures are 188 uh reports of myocarditis pericarditis in australia out of 6.8 million doses of fisa vaccine that have been given so extraordinarily rare very very rare um but even even so um you know there’s not been any uh long-term problems arising from the people in australia who have developed um fisa associated myocarditis pericarditis tends to be a mild thing um and and tends to resolve nicely people people get monitored for a while maybe some anti-inflammatories and they do pretty well there were a few case reports overseas of particularly as young men that developed myocarditis and then kind of ignored the symptoms um and and then undertook vigorous exercise and then went into cardiac arrhythmias and didn’t have such good outcomes after that um but uh yeah again it’s just a matter of ensuring that particularly in the first five days after this vaccination um people know it’s they’re unlikely to get myocarditis but just be sensible if we’ve got symptoms with chest pain chest tightness breathlessness palpitations or fainting episodes that they do in fact sick medical care thanks so much ivy we’ve got a general question here from nadine to the group is anybody running drive through vaccine clinics at the moment and how is this going potentially nadine um if i do hear from anybody i will let you know their feedback it also comes down to with the drive-through clinic um people can’t um if they’re vaccinated in a drive-through you have to be able to manage anaphylaxis if that did happen and then what do you do with the people sitting in their cars they can’t sort of drive off after a vaccination in case they do have an event so um so it’s a yeah it’s something that’s really not there’s no real protocols around it there was something released last year about vaccination in car parks which i consent to nadine that was developed by new south wales health but they weren’t sort of advocating for it but it was some some sort of framework around it so i consider that is that nadine over at forbes uh yeah i can let you know michelle that’s fine yeah yeah thanks and there’s a few comments coming through that it’s a lot of hard work nadine to do that um i must say we did think about it in our practice but um i think you would need a lot a lot of car parking space um and you’d need a lot of staff to ensure that that post vaccine monitoring happens well and then the thought of having to pull somebody out of the car with an anaphylactic reaction and work on them on the car part floor was too much for me to contemplate so um we we haven’t gone with car park drive-throughs i’m sure it works on mass if there were plenty of staff around to make it happen well wonderful thanks ivy there’s also quite a lot of links um being posted in chat to end swiss and covert evidence um ppe guidelines a number of things i’ll make sure we collate these and get them to everybody tomorrow to access the resources there’s another question here about vaccination what is the advice for a patient who has had first dose astrazeneca is now pregnant and is being advised by an obstetrician to have pfizer as their second dose any advice yep go with the pfizer so the rams cog that’s a rural australian new zealand collegiate obstetricians and gynecologists the rams called statement um talks about uh pregnant women having the fisa vaccine and that’s very much around the fact that um the whilst they’ve been limited studies for pfizer there’s really not very much um done in terms of uh studying astrazeneca and pregnant women so um pfizer is the definite recogni recommendation for pregnant women so this um there’s been lots of discussion around this in the various groups um i mean um you know outside of western new south wales um the uh so it’s a bit tricky because if someone’s planning for pregnancy um they’re not actually eligible for fisa unless they’re eligible for other reasons but um if they’re the typical age group for someone who’s planning pregnancy and otherwise well not a healthcare worker etc they actually need to have the astrazeneca vaccine but once they fall pregnant then they’re eligible to have the thysa vaccine and that’s absolutely the recommended one to have during pregnancy wonderful thank you so much ivy um courtney’s just asked uh that she’s seen on facebook that dubbo family doctors provide information to patients in groups and then vaccinate them privately to achieve greater throughput um can you provide some any further information about how this is working and if it’s successful yeah so we did little crazy 400 and whatever 420 vaccinations on the in the last two days um and it was a test but it worked okay in the end uh basically we had two streams of doctors running um with paired up with uh well the intention was to have two nurses per doctor so the doctor would grab you know around five or six patients at a time they’re all booked in quadruple whatever you know five six booked in at the one time slot um we have our paperwork beforehand so they’d come into the room and have their questionnaires all filled out so just a matter of really glancing through that questionnaire making sure there’s no contraindications to them being jabbed on that day delivering the spiel about the vaccine asking if there’s any questions offering one-on-one um separate chats if they had personal questions about their own health um and then moving them fairly quickly then on to our second waiting area and our nurses would then peel them off one at a time and give them the jab so um yeah with with that we sort of managed to get through uh quite a lot of people were pretty big days though um we certainly had concerns about social distancing um so we ended up putting out tents outside for people to be waiting pre-vaccination and then post-vaccination that they sat in our waiting room so they could be observed by our reception staff thank you so much for that ivy um there’s a couple of questions in the chat from a number of people about indemnity and being protected from law suits regarding the fisa vaccination um do those group meetings cover that or do people feel they are covered i suppose eyes of vaccination or estrogenic or just covered vaccination in general pfizer has been specified in one comment and then just indemnity in general for covert vaccinations uh my understanding is that um the department of health has said that um that we’ve been identified if there’s any issues i know the college of gps are still working on making that watertight okay thanks ivy veronica’s made a comment about doing group information sessions um their practice run group sessions at their vaccination hub and it’s working extremely well or they do questionnaires prior to coming to the information session so that’s another process that people have put in place anne’s got a question here is there any scope with the second dose of the astrazeneca or pfizer to not observe the patient for 15 minutes to reduce the number of people within the practice at the one time i think that’s actually written into the um the things that we sign our life away on when we uh when we agree to be a vaccination site so i don’t think we can do away with that one there um interestingly the astrazeneca uh vaccination in australia to date i don’t think there’s actually been an event of anaphylaxis um with astrazeneca but fisa there’s certainly been um yeah cases of anaphylaxis with that um pfizer also seems to carry with it um that acute stress response reaction i know um some some gp colleagues who work in um the big vaccination hubs in sydney that they run those um yeah big vaccination hubs uh one of them talked about the fact that he was seeing about one or two um what’s termed acute stress response uh reactions to pfizer out of about one thousand or two thousand patients um another gp colleague works elsewhere and she was saying that they were seeing somewhere about 15 or 20 acute stress response reactions after with the first um each thousand or so fives of vaccinations um we had two vasovagals on the weekend with our um with our clinics um but not the acute stress response itself and certainly not anaphylaxis so yeah i think it’s certainly worthwhile monitoring post post vaccination don’t want someone to be driving home and having a problem on the way home wonderful thanks so much ivy i think we’re we’re getting through all the questions um there’s one here just going back to the pregnancy vaccination is about the interval between the first astrazeneca vaccine now pregnant and needing pfizer how many weeks apart should they be not sure if anyone else knows the answer to that one but that’s one i would be calling the new south wales immunization specialist surface to check with that end swiss absolutely and we will send the details around to everyone for that and a question here when will 12 to 16 year olds be entitled for the fisa vaccine i’m not sure if there’s an answer to that one yet i think from the department of health’s perspective that looks to be and watch this space um but having said that um we certainly all know um with all the things that have been happening with the vaccine roll out um all it takes is one press conference and our prime minister or uh sometimes one of our premiers saying something and all of a sudden it’s changed so who knows whether that might be in the imminent future and certainly with the transmission of infection amongst young people um and some teenagers have become extremely sick with the delta variant i’m thinking it won’t be too far off down the track i think um what i’ve heard is will the target of approved for 12 to 15 year olds in the sorry the tga have approved and then a target recommended for as somebody said i think ivy said that remote so for 12 to 15 year olds living in far remote areas um 12 to 15 year olds with um you know chronic medical conditions and um aboriginal children so yeah so i think um i think you’ll be far away before otagi sort of releases something thanks michelle it has sorry sorry to jump in um so there is also um the the department sent out a provider bulletin today to all vaccinating partners and to advise that children aged 12 and over who are on the national disability insurance scheme are eligible for pfizer thanks claire we’ve had a couple of comments to say that children who are aboriginal or torres strait islander between 12 and 16 are currently eligible as well so i think we have covered all the questions if we haven’t please unmute yourself and um ask away there’s been a lot going on in the chat box there um we’d really appreciate your feedback tonight um so there’ll be a surveymonkey link sent around i’m just going to share my screen so everybody can scan that now momentarily bear with me katy perry here we go so if everybody could just um scan that qr code it’s a really really brief survey not as long as what we normally have it’s really just to get a sense if people need ongoing meetings any further support or information that you need from your colleagues from the phn and we will certainly do our best to arrange whatever you need we realize it’s a really quickly evolving situation that we’re all in and everyone needs support so please take a moment to do that let us know what you need and we’ll we’ll certainly do our best um thank you so much to to dr ivey tua tonight for all your your insights and your valuable information it’s really appreciated um by everybody everybody in the room um thank you also to the phn team who have been here to answer any questions and we’re always here for you so please reach out if there’s any any help that you need as i said i will send around any of the resources and the links that have been shared tonight we’re also recording this so if you had colleagues that had other meetings we realised it was at short notice so we have recorded it and we’ll make that available to anyone who needs it just having a quick look in the chat i don’t think there’s no more questions lots of thank yous and i’d just like to say a thank you to to all of our healthcare workers and to all of our gps and our practices for the amazing work that you were doing and i really hope everybody can stay safe and we work together to get through this katie uh just one question um there’s uh sunil jacob you know um that um they like the media or western western new south wales local health district has focused so much on their response to new south wales health adf what their response is like saying that they’re doing about 400 500 a day but general practice has done far more that in the last in the last three months but we don’t know we won’t know the exact numbers is there any way of finding out what general practice the general practice response is in terms of how many vaccines have been given out like in one day alone we we did about 600 vaccines in our two three sites and so um and so when they talk about these there’s a lot of media in front on the second or third pages of the daily liberal about the adf coming in do they have anything from the general practice front yeah that’s a good point do you have any information it’s a bit it’s a bit disheartening when everything is so focused with nissa wells health western they called in the adf saying that like our what our response is inadequate that’s why they have to call them and so that’s where i would say like you know the phn really needs to say that the general practice is doing there but i think what you have said is so valid and it’s so i agree with you wholeheartedly i think the whole phm would agree with you wholeheartedly it’s something that i think will um take this further and we’ll advocate for for us to be able to um get some data to be able to share but at the moment um the data is only to be released um or published by the department of health we’re not actually able to um we’re not allowed to do it to to release anything around um general practice and vaccinations um the numbers so but yeah we will definitely take this further and thanks for raising it because i think it gives us a bit of um evidence to suggest that you know we do really our um community really want this information it’s not it’s not right yeah no because like i think like you know a nissa whale’s health or whoever is responsible for that aged care aged care workers to be vaccinated um um like they were supposed to be vaccinated way before all of this happened the paramedics were supposed to be vaccinated the police officers are supposed to be vaccinated so what’s happened over there like you know in the end like general practice has to kind of prioritize all these people as well well it should have been done by aspen health or it should have been done by you know the groups that have been flying in flying out yes exactly hi sunil it’s claire trot from the primary health network look i completely agree with you and i do know that sonia has been in discussion with dougal saunders around um ensuring that there is visibility around what primary what primary care and what our response has been so yes i i completely agree with you and i would have to say that you know even when it comes down to the ambulance officers we are so appreciative of our primary care partners that have been able to prioritize our ambulance staff and aged care staff for their vaccinations so yes totally take that on board and i do know that sonja is communicating all of that information to our uh certainly our members of parliament to ensure that they know thank you and we’re taking it up through the national center for immunisation research and surveillance and up through the senior policy from new south wales health so we are you know nearly daily on the phone to them and emailing them and in conferences with them to try and we’re all wanting that data to be released yeah thank you thanks sunil are there any further comments questions well thank you all it’s eight o’clock um we’ve run to the hour that we promised so thank you all for joining us um thanks again to ivy and to everyone have a lovely evening and i’m sure we’ll be talking to you all really soon please reach out if you need us thanks everyone keep safe good luck take care everyone thanks katie thanks katie see you all yes this is
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WNSW PHN Webinar: Preparing your Practice for a Pandemic with Dr Ai Vee Chua

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