Managing COVID-19 in a Residential Aged Care Facility: The First 24 Hours Checklist UPDATED

2/02/21

On 27 January 2021, the Department of Health updated its Fact Sheet: First 24 Hours – Managing COVID-19 in a Residential Aged Care Facility.

Providers should refer to the full Fact Sheet for details, but if you’re pressed for time or need a quick overview for reference or staff communication, we have set out the key points below in an easy to use checklist.

Key changes to the updated Fact Sheet

The new Fact Sheet contains all the same steps as the previous version. Some minor changes have been made to the instructions within some of the steps, including:

increased involvement of the Public Health Unit (PHU), which is now mentioned at many of the steps, providing general support for the outbreak management team as well as leadership regarding contact tracing and testing
providers are now advised to place “signs to avoid aerosol generating procedures” outside an infected resident’s room
at Minutes 30-60 providers are now advised to activate the outbreak management plan then convene the outbreak management team (it used to be the other way around)
step 21 used to say “Nurse First Responder from Aspen to commence”; it now says “Clinical First Responder assessment”
induction and control processes have been expanded slightly at step 23.

If a COVID-19 positive case is identified at your residential aged care facility, follow these steps in order:

First 30 minutes
Step	Details	Person/Role Responsible	Comments	Done
1	Isolate and inform the COVID-19 positive case(s) Use PPE for any interactions with positive cases.
1A	If the COVID-19 positive person is a staff member they must immediately leave the facility and isolate at home as directed by the public health unit (PHU).
1B	If the COVID-19 positive case is a resident they should be immediately isolated in a single room with an ensuite, if possible OR transferred to hospital or other accommodation if clinically required.
1C	Outside affected residents’ rooms place the following: Contact and droplet precaution signs signs to avoid aerosol generating procedures, i.e. nebulisers Alcohol-based hand rub Appropriate PPE and hands-free bins for used PPE.
1D	Inform the resident and their family of their diagnosis with sensitivity and support as needed
2	Contact your local Public Health Unit (PHU)
3	Contact the Commonwealth Department of Health
4	Lockdown the residential aged care facility
Minutes 30-60
Step	Details	Person Responsible	Comments	Done
5	Activate your outbreak management plan Guidance on appropriate actions based on your COVID-19 situation is outlined in COVID-19 escalation tiers and aged care provider responses
6	Convene your outbreak management team
7	Review screening protocols This includes placing appropriate and clear signage across the facility. You can find advice on entry screening for residential aged care facilities here.
8	Release an initial communication This should include residents, staff, families, and key stakeholders. Inform staff that they should not work at any other facility during the outbreak. Providers with multiple services should consider communications for other sites.
Hours 2-3
Step	Details	Person Responsible	Comments	Done
9	Contact tracing Identify anyone who spent 15 minutes within 1.5 m of the COVID-19 positive person.	Led by PHU
9B	Increase monitoring of all residents for any symptoms of COVID-19. Take clinical observations two to three times a day
10	Identify key documents for PHU and Commonwealth Consider: detailed floor plan list of current residents list of staff employed by the facility specimen records including results.
11	PPE stocktake If you require additional PPE and cannot source it through your usual means, you can submit a request to the National Medical Stockpile at: https://consultations.health.gov.au/health-grants-and-network/18d6cd12.
12	Communication Expect and prepare to manage a very high volume of calls. Establish a single point of contact for media queries.
Hours 4-6
Step	Details	Person Responsible	Comments	Done
13	First meeting of the Outbreak Management Team
14	Bolster your staff and plan your roster. Allocate separate staff for COVID-19 positive, COVID-19 suspected and non-COVID-19 residents. Plan what you would do if key staff or the CEO became unwell.
15	Conduct testing In collaboration with the PHU, urgently arrange testing for all residents and staff for COVID-19 to understand the status of the outbreak.
16	Clinical management of COVID-positive cases
Hours 6-12
Step	Details	Person Responsible	Comments	Done
17	Cohorting and relocation Determine what cohorting/zoning arrangements to implement at the facility to manage infection control.
18	Move to a command-based governance structure Clearly communicate the command and governance structure for every shift. Ensure handovers for all staff occur at the start of a new shift and cover clinical and care needs.
19	Rapid PPE supply
20	Infection control Your nominated infection control lead must ensure: staff refresh their infection control training enhanced environmental cleaning occurs twice daily at a minimum residents’ rooms are well-cleaned daily frequently touched surfaces (including bedrails, bedside tables, light switches, handrails) are cleaned more often the rooms of ill residents are cleaned and disinfected.
Hours 12-24
Step	Details	Person Responsible	Comments	Done
21	Clinical First Responder assessment Where required, the Commonwealth will arrange a Clinical First Responder to help review the facility’s preparedness.
22	Review advance care directives
23	Establish strong induction and control processes Determine who the on-the-ground infection control lead will be for each shift. This person must ensure: screening processes are reviewed and any required changes implemented robust induction for all new agency and surge workforce staff coming onsite that all staff working are competent using PPE infection prevention and control practices are maintained. Consider having workforce competency reviews for all staff.
24	Maintaining social contact – residents and their families/ representatives You will need extra staff to assist residents with communications/use of technology.
25	Follow up communications Establish a clear and consistent pattern of daily follow-up outbound communications. OPAN can assist with residents and families’ communications if needed.
26	Continue primary health care Ensure there is strong ongoing governance of “routine” care. Understand residents will be anxious and need reassurance.
27	Support your staff – they are your most import asset.
28	Continue to monitor state / territory guidelines

Practical Tips

Here’s a few practical ways to use the checklist to your advantage:

review your current outbreak management plan to ensure it reflects the checklist; incorporate the steps as part of your action timeline should a COVID-19 positive case be identified
check that your related infection prevention and control (IP&C) policies and procedures are in line with the checklist, e.g. do your signage policies and procedures cover placing of “signs to avoid aerosol generating procedures” outside an infected resident’s room? Are your staff induction and competency processes up to date?
check that your Plan for Continuous Improvement (PCI) is in line with the checklist.

Other Useful Resources

“Key COVID-19 Regulatory Updates” tracking page – a free resource page from CompliSpace that tracks regulatory change due to COVID-19. Last updated 14 December. Click here to see the latest regulatory updates.

The Weekly Wrap – all the latest aged care news summarised in an easy-to-read wrap with links to the full stories.

Mark Bryan

Mark is a Legal Content Consultant at Ideagen CompliSpace and the editor for Aged Care Essentials (ACE). Mark has worked as a Legal Policy Officer for the Commonwealth Attorney-General’s Department and the NSW Department of Justice. He also spent three years as lead editor for the private sessions narratives team at the Royal Commission into Institutional Responses to Child Sexual Abuse. Mark holds a bachelor’s degree in Arts/Law from the Australian National University with First Class Honours in Law, a Graduate Diploma in Writing from UTS and a Graduate Certificate in Film Directing from the Australian Film Television and Radio School.

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