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REMEDY : BNSSG referral pathways & Joint Formulary

Acute Assessment of patients with proven or suspected COVID-19

Checked: 04-05-2020 by Rob.Adams Next Review: 30-06-2020

BNSSG - Remote assessment guidance

Please see TeamNet for the BNSSG Primary Care Assessment and Management Guidance for COVID and non-COVID patients (last updated 25.9.20).

Update 29.1.21

These acute assessment guidelines were developed by primary care clinicians in BNSSG in May 2020. They are currently under review and an update will be published here and on Teamnet in the near future.

The guideline can still be used when making management decisions on patients with suspected or confirmed COVID-19. You do now also have the additional option of referring into the COVID Oximetry@Home service run by Sirona for patients who meet the criteria.

These guidelines advise use of the Charlson Comorbidity Index which may support clinical decision making when discussing appropriateness of admission with our patients.

There is also information in this guidance on:

  • COVID-19 in the community
  • Cardiopulmonary Resuscitation
  • Children and COVID-19
  • Assessing severity of COVID-19 on the telephone
  • Frailty  and comorbidities
  • When to consider antibiotics and antibiotic choice
  • Safety netting
  • Face to face assessment
  • Video consultations
  • Safeguarding, domestic violence and vulnerable people
  • Adults with COVID-19 and asthma
  • Adults with COVID-19 and COPD
  • End of life, death verification and certification

 

NICE has issued rapid guidance on admission to hospital and critical care, which make reference to assessments using the Clinical Frailty Score (CFS) or other comorbidity assessment tools (e.g. the Charlson Comorbidity Index). These guidelines were updated on 3rd September 2020 and make it clear that ‘the CFS should not be used in younger people, people with stable long-term disabilities, for example cerebral palsy, learning disability or autism.’

Use of antibiotics in treatment of COVID-19

The PRINCIPLE medicines trial was a randomised clinical trial to test a range of potential treatments for COVID-19 that might be suitable for use in the community to help people recover more quickly and prevent the need for hospital admission.

Results from the PRINCIPLE trial show that Azithromycin and Doxycycline were found to be associated with a non-statistically significant (<1day) reduction in median time to recovery from COVID-19 symptoms and had no meaningful impact on hospitalisation (in people aged over 50 with certain underlying health conditions, or anyone aged over 65).

Therefore the lead investigator has stated that any practice of using either medicines for treating COVID-19 in the community in the absence of suspected bacterial pneumonia should be re-considered.

There has not been an increase in either azithromycin or doxycycline prescribing within BNSSG so we do not think this practice is routinely occurring.

Please find attached for the full statement regarding the clinical trial.

 

Acute Assessment and Monitoring in Primary Care

 

See the COVID Oximetry@Home page.

Resources

Other resources:

COVID-19: a remote assessment in primary care (25.3.20) - BMJ 10 minute consultation guide.

RECAP (Remote COVID-19 Assessment in Primary Care) project is a collaboration between the University of Oxford and Imperial College London with the aim of developing a tool to assist primary care providers in the identification of those COVID- 19 patients at risk of becoming severe, in order to facilitate the rapid escalation of their treatment and increase the chances of better outcomes.