Created May 21, 2020
RELAX RESTORE REBALANCE MASSAGE THERAPY (RRRMT) PLAN TO RETURN TO CLINICAL PRACTICE WITH RESPECT TO COVID-19
Registered Massage Therapists are directed under the legislation of the government of British Columbia, as well as the College of Massage Therapists of British Columbia (CMTBC) to mitigate risk by creating a critically thought out plan to return to clinical practice. This plan was created with required guidelines approved by both governing bodies and the recommended practice guidelines provided by the Registered Massage Therapists Association of BC (RMTBC). This plan will change and be updated as the requirements provided by these parties change. The overall aim of this plan and resulting protocols is to reduce the risk of exposure to coronavirus and potential coronavirus transmission, for both patients and RMT within our clinical setting, by outlining:
• Required ongoing self-assessment for signs of COVID - 19 related illness in both the patient
• Physical Distancing measures for all non-treatment interactions.
• Hand hygiene requirements
• Avoidance of face touching
• Enhanced cleaning protocols
• Appropriate use of Personal Protective Equipment (PPE)
• Professional Obligations with respect to informed consent & liability insurance
1.0 Self-Assess for symptoms and return when healthy: For patients and Crystal Stauch, RMT
PRE-SCREENING – PRIOR TO ARRIVAL
1.1 A notice of new procedures, including provisions made for Personal protective Equipment (PPE), that have been implemented due to COVID-19, will be available at https://www.rrrmt.ca/covid-19. There will also be this website reference on the online booking site at https://rrrmt.janeapp.com/ and in email communication. Patients either book appointments via the online booking system or by email and, therefore, will be considered informed about the new procedures.
1.2 Patients understand that a specific COVID-19 screening and waiver of liability form will be required at every appointment. The consent will state that: the patient understands that while Crystal Stauch, RMT is following all of the health and safety guidelines outlined by the College of Massage Therapists of British Columbia, the Provincial Health Officer, the Registered Massage Therapists Association of British Columbia, and that she is taking all reasonable precautions to clean and disinfect the clinic and all the surfaces within the treatment room, there are no guarantees that the patient may not come into contact with COVID-19. The patient also agrees that: the patient believe that the benefits of this massage therapy appointment, outweigh the risk of possible exposure and viral transmission of COVID-19, and will not hold Crystal Stauch or Relax Restore Rebalance Massage Therapy liable if they contract COVID-19. They consent to treatment and want to go ahead with the treatment despite the risk.
1.3 Before booking your appointment please complete, thoroughly and honestly, the BC COVID-19 Symptom Self-Assessment Tool at https://bc.thrive.health/covid19/en . Do not book an appointment if you answered yes any of the questions and contact 8-1-1 or your family physician to find out how to get tested for COVID-19.
1.4 Crystal Stauch, RMT will use the BC COVID-19 Symptom Self-Assessment Tool herself on treatment days and will cancel appointments if experiencing COVID-19 symptoms and will immediately call public health at 8-1-1 and/or her family physician for further direction and testing. She will print her results to share in person with patients at each appointment.
(a) If testing is positive, patients will be informed and Crystal Stauch, RMT will not return to practice until cleared by a public health official, AND the fever is gone without medication, AND she is feeling better, AND not before 10 days beyond the onset of symptoms
(b) If her spouse, housemate, or any other close contact becomes ill, she will cancel appointments and only return to practice once negative testing results come back or clearance to return from a public health official.
1.5 One day prior to your appointment, you will be emailed a clinical survey that needs to be completed, thoroughly and honestly. This will be added to your medical records chart at Relax Restore Rebalance Massage Therapy. The survey will instruct you that you may keep your appointment or to cancel your appointment immediately (no cancellation fee will be charged) and contact 8-1-1 or your family physician to find out how to get tested for COVID-19.
1.6 If you are a patient with greater risk/a higher risk profile/ a weakened immune system, please seek alternatives for care at this time. Massage Therapy treatment will only be provided when both therapist and patient agree that the benefits of massage therapy outweigh the risk to the patient, which includes possible transmission of the virus that causes COVID-19. Therefore, I will not be treating those with greater risk at this time.
1.7 Patients who are health care workers (HCW) and who have been exposed to patients with COVID-19 or patients with symptoms of COVID-19: Please consult the risk assessment tool offered here: BCCDC’s Exposures and return to work for health care workers. If you fall into the No Risk category, you may book your treatment. This risk assesment tool will be preformed upon arrival as well.
1.8 Patients who develop even mild illness or symptoms should cancel booked appointments immediately, even without notice (no cancelation fee will be charged).
1.9 Patients will not be charged a cancellation fee if they cancel due to illness during the COVID-19 Pandemic.
SCREENING UPON ARRIVAL
1.9 The patient understands that at the first massage therapy treatment back, after the cessation of massage therapy due to COVID-19 pandemic, there will be an informed consent discussion. The informed consent discussion will address the fact that there is always a risk of transmission of the coronavirus from the clinic space, from Crystal Stauch, and during massage therapy treatment, and that I have done everything I can to minimize the risk.
1.10 Every appointment, the patient will be required to complete a COVID-19 screening and waiver of liability form via a provided tablet. Any questions the patient has, are encouraged to be asked. If patient does not agree to sign this form, they will cancel their appointment with no cancelation fee charged.
1.11 The RMT will cancel treatment if patient does not meet the pre-screening criteria.
1.12 The patient will cancel the treatment, at any point, (with no cancelation fee charged) if they do not feel safe, in any way, at the clinic or receiving treatment for any reason.
2.0 Physical Distancing
RECEPTION / ENTRY
2.1 Clinic area is small, including reception. RMT and patient will try to keep as much space as possible between them at all times.
2.2 Patient must arrive unaccompanied.
2.3 Patients are required to have all forms complete before entering the clinic.
2.4 Signage will be placed at the front door asking patient to not enter the clinic if they have any of the signs, symptoms, or travel risks associated with COVID-19
2.5 Patient is required to wait in their car or in the parking lot. I will physically open the door for you once the clinic has been cleaned and I am ready for you. The chairs in reception have been removed.
2.6 Patient will be expected to use the center of walking areas to avoid touching walls and door frames. Patient will not touch anything unnecessarily.
2.7 It is not possible to maintain physical distancing in the treatment room
WASHROOM FOR PATIENT USE
2.8 All contact points in the washroom will be cleaned and disinfected after every use. The washroom has been equipped with a touchless soap dispenser, touchless paper towel dispenser and foot pedal trash can.
2.9 Patients will use a paper towel or tissue to open the door after using washroom.
2.11 Hand washing protocols are posted in washroom.
3.0 Hand Hygiene
RECEPTION / ENTRY
3.1 Patient washes hands upon entry with soap and water for at least 20 seconds, followed by thorough drying – must be done on arrival into and departure from the clinic, and before touching door/s.
3.2 RMT will wash hands often and when required, using soap and water for a minimum of 20 seconds each time.
3.3 Hand-washing protocols are posted visibly in reception area and at sinks.
3.4 A wireless point of sale system with tap feature will be used for payment, or patient may e-transfer before arriving at clinic. Receipt is emailed to patient. Cash is not accepted at this time.
IN THE TREATMENT ROOM
3.5 The RMT will open/close the door before, during, and after the treatment as required, as needed, using a tissue barrier, and washing hands as appropriate.
3.6 Patients will open the treatment room door after treatment, doing so with a clean tissue. If they feel unsafe doing this, they will call to the RMT and the RMT will open door for them.
3.7 Hand sanitizer and tissues will be made available in the treatment room for RMT and patient use.
3.8 At any time, the patient may ask the therapist to sanitize her hands, any object or surface.
3.9 Therapist and patient must wash hands before and after the treatment.
4.0 Face Touching Avoidance – e.g., avoid touching eyes, mouth, nose
4.1 The reason for ‘no face touching’ is that coronavirus can be spread by touch if a person has used their hand/s to cover a cough or sneeze.
4.2 Tissues will be available in reception, treatment room and washroom. Please use these tissues if you have an itch that needs to be addressed. RMT will do the same.
4.3 During treatment, the therapist will wear a cloth mask that will be changed between treatments. Hands will be sanitized before and after touching a mask.
4.4 Patients will have the choice of wearing a mask. It is recommended but not mandatory. Options are: bringing their own unworn, unused mask, or being provided a clean laundered cloth mask (no charge), or ay purchase a paper mask upon arrival. ($1/mask to cover cost). If you wear a mask, you must sanitize your hands before and after touching a mask.
4.5 Inter-oral and external TMJ treatments will not be practiced at this time.
4.6 The musculature of the face will not be treated at this time.
5.0 Enhanced Cleaning
5.1 Visibly soiled surfaces will be cleaned, followed by disinfection.
5.2 All high-touch surfaces will be cleaned and disinfected in between patients, regardless of appearance. This includes tablet, chairs, patient clothing and personal item bin, stool, massage table, surface below face cradle, oil bottle, treatment tools, handles, door handles, faucets, electronic device keyboards and mice, phones, point of sale device, desk and shelf surfaces.
5.3 Cleaning and disinfecting with be done with approved hard-surface disinfectants listed and approved here: https://www.canada.ca/en/health-canada/services/drugs-health-products/disinfectants/covid-19.html
5.4 All clutter, decorations and items that cannot be washed, wiped, or sanitized will be removed from reception, washroom, and treatment spaces.
5.5 All pillows, linens and items that are not being used for the treatment, will not be in the treatment room, or will be in cleanable storage bins.
5.6 Linens (including blankets) are single use only and are then laundered in hot soapy water.
5.7 At any time, the patient may ask the therapist to sanitize her hands, any object or surface
5.8 Thermophores, usually used as heater for on top, will not be used at this time as they cannot be sanitized. The bottom table warmer will still be used, as requested, as it will be below a sanitized vinyl table cover.
5.9 A Cleaning and Disinfectants for Clinic Settings poster from the BC Centre for Disease Control will be posted in reception area, washroom, and, treatment room.
5.10 A disinfected plastic bin has been placed in the treatment room. The patient will be asked to keep all their personal belongings in this bin during their treatment.
6.0 Personal Protective Equipment (PPE)
6.1 During treatment, the therapist will wear a cloth mask that will be changed between treatments.
6.2 Gloves will be worn in the case that the therapist or patient has open injuries or cuts. The patient may also request the RMT wears gloves during their treatment.
6.3 Patients will have the choice of: bringing their own unworn, unused mask, or being provided a clean laundered cloth mask (no charge), or ay purchase a paper mask upon arrival. ($1/mask to cover cost). Patients are required to wear the mask at all times, except when laying face down on table (laying prone).
6.4 When donning and doffing a mask these protocols will be used: wash hands with soap and water or sanitize using an alcohol-based hand rub, prior to putting on a mask, prior to taking off a mask, and after disposing of a mask in the garbage.
6.5 Patients may request the RMT enhance either the patients’ PPE or the therapists’ PPE, at any time. Stock on hand will be: gloves, face masks, safety goggles, and scrubs for therapist. Proper donning and doffing will be used for all requested items.
7.0 Professional Obligations
7.1 Crystal Stauch, RMT carries professional liability insurance through Wilson M. Beck as provided through the Registered Massage Therapist Association of BC.
(a) Crystal Stauch, RMT is following the health and safety guidelines outlined by the College of Massage Therapists of British Columbia and the Provincial Health Officer and the Registered Massage Therapists Association of BC. She is taking all reasonable precautions to clean and disinfect the clinic and all the surfaces within the treatment room.
(b) No guarantees have been made by the therapist, that the patient may not come in contact with COVID-19 virus at or during an appointment.
7.2 There is NO duty or obligation for Crystal Stauch, RMT to return to practice:
(a) A return to practice protocol does not require RMTs to engage in practice if they individually assess the risk of practice as one they are not prepared to take.
(b) The decision to return to practice is a matter of individual judgment and requires following the guidance of CMTBC and governmental authorities
7.3 In the Event That a Patient Tests Positive for Covid-19 Having Been to a Massage Therapy Appointment within the 14-days Prior to Onset of Symptoms
(a) The patient will contact the therapist and inform her of positive test results and possible transmission of the virus immediately.
(b) The therapist will immediately self-isolate.
(c) The therapist will call public health at 8-1-1 to report the possible transmission and act on direction of Provincial Health.
7.4 In the event that a patient alleges they caught COVID-19 from the RMT:
(a) The RMT must immediately call public health at 8-1-1 and report the alleged transmission, providing both the RMT’s name and the name and contact information of the patient. The patient must agree to the release of this information to receive treatment.
(b) The RMT must not provide any further massage therapy treatment to anyone until public health has investigated and has provided direction.
(c) The RMT must immediately self-isolate until the matter has been investigated and public health direction has been provided.
7.5 In the event that Crystal Stauch, RMT catches COVID-19 or displays symptoms of COVID-19 and/or exhibits signs of respiratory illness, including cough, runny nose or fever:
(a) The RMT must immediately call public health at 8-1-1 and get tested for COVID-19
(b) The RMT will not provide any further massage therapy treatment to anyone until public health has provided direction.
(c) The RMT must immediately self-isolate until public health direction has been provided.
(d) If the testing is positive, patients will be informed and the RMT will not return to practice until cleared by a public health official AND the fever is gone without medication AND she is feeling better AND not before 10 days beyond the onset of symptoms
7.6 In the event that Crystal Stauch comes into close contact with someone becomes ill
(a) If her spouse, housemate, or any other close contact becomes ill, she will cancel appointments and only return to practice once negative testing results come back or being cleared from a public health official.
7.7 What about asymptomatic spreaders?
(a) This is an unavoidable risk of practice/treatment until there is either an effective treatment or an effective vaccine against COVID-19.
7.8 RMTs have a professional obligation to obtain informed consent to treatment, consistent with CMTBC’s Consent Standard of Practice.
(a) In the current environment of COVID-19 risk, informed consent requires that the patient be informed that:
1. any massage therapy treatment involves some risk of COVID-19 transmission;
2. the RMT is following a protocol to reduce or mitigate risk, but that risk cannot be reduced to zero;
3. the patient consents to treatment despite some risk; and
4. the RMT documents the patient’s consent.