Authors (including presenting author) :
Chan TC, Chiu PKC, Chan WK, Ng WC, Luk JKH
Affiliation :
Hong Kong West Community Geriatric Assessment Team (HKW CGAT)
Introduction :
Residential care home for elderly (RCHE) and residential care home for disabled (RCHD) in Hong Kong are mostly crowded with high risk of COVID-19 outbreaks if actions are not taken promptly to identify, isolate, and quarantine of close contacts. Older RCHE residents are frail and have high mortality and morbidity after COVID-19 infection. RCHD residents, albeit younger, are physically or mentally disabled and vulnerable to COVID-19 infection and complications.
Amid COVID-19 pandemic, Hong Kong West Community Geriatric Assessment Team (HKW CGAT) collaborates with Centre of Health Protection (CHP), Social Welfare Department (SWD), Hospital Authority Head Office (HAHO) and Food and Health Bureau (FHB) to manage COVID-19 related incidents in RCHEs and RCHDs. It also provides outreach medical and geriatric services to RCHE/RCHD quarantine camp (QC) at Site X.
Site X is a 40-place QC for close contact RCHE or RCHD residents set up in Physically Handicapped and Able-Bodied (PHAB) Camp in Pokfulam, Hong Kong. It is the first local RCHE/RCHD QC which started in operation on 29 April 2020. FHB leads the set-up of Site X, SWD is responsible for the facility management and onsite care team arrangement while CHP takes care of infection control, team training and specimen collection. HKW CGAT provides input in the arrangement, care team operation and essential equipment for elderly care. It also performs regular and ad hoc onsite medical and nursing consultations to residents in Site X. With assistance from HAHO IT team, onsite Clinical Management System (CMS) computer station has been set up in Site X for use by CGAT. The RCHE and RCHD cases are transferred to Site X from different regions in Hong Kong for 14-day quarantine. CGAT provides immediate assessment for newly admitted residents, ensuring seamless medical and nursing care. Drug refill, including those from other specialties, will be arranged if the residents run out of medications. Blood test will be performed onsite if indicated. When deemed necessary, HKW CGAT will seek expert advice from parent psychiatric teams concerning the management of RCHD residents with mental disorders.
Objectives :
To audit the service provided by HKWC CGAT in Site X
Methodology :
A retrospective audit of HKW CGAT service for Site X from 29 April 2020 to 14 Jan 2021.
Result & Outcome :
The first batch of 33 residents were sent to Site X on 7 July 2020. As of 14 January 2021, a total of 154 cases from different regions of Hong Kong have been quarantined in Site X and received HKW CGAT care. Seven geriatricians took turns to support Site X in two weekly rotations supported by two visiting medical officers (VMO), while seven community care nurses (CCN) served the site in two weekly rotations. There was a total of 417 HKW CGAT attendances, including 215 doctor and 202 CCN attendances. All CGAT consultations and management were documented in CMS using onsite computer. The audit showed that CGAT geriatricians and VMOs performed medical assessment, drug prescriptions, blood taking, ad hoc medical consultations and liaised with psychiatrists in managing RCHD cases with mental disorders. CCNs concentrated on nursing assessment and care plan, wound and drug management, assisting doctors in blood taking, advice on special procedures like nasogastric tube and Foley catheter care. There were 100 prescriptions including both medical and psychiatric medications issued by HKW CGAT doctors. Most of the drugs for Site X were collected from pharmacy at TWGHs Fung Yiu King Hospital during office hours. The pharmacy at Queen Mary Hospital also supported drug prescriptions after office hours.
Conclusion
Amid COVID-19, HKW CGAT contributes to the quality medical and nursing management of close contact older residents from RCHEs and RCHDs admitted to QC Site X. CGAT also supports RCHD residents with mental disorders in QC via close collaboration with psychiatrists.
