Post COVID-19 Conditions Management Protocol

The Curative Service Division, DoHS has released a new guideline on Post COVID-19 conditions Management Protocol.

Scope of the document

• This document contains information for Healthcare workers who are providing care for patients previously diagnosed as COVID-19 (tested positive for SARS-CoV-2 or history suggestive of COVID-19 but not tested) or those who are at risk of developing Post COVID-19 conditions.
• This document will be updated as and when new evidence becomes available.

Objectives

1. This document provides a plan of action for a comprehensive multidisciplinary approach and coordinated care for patients with Post COVID-19 conditions.
2. It makes recommendations about Post COVID-19 care in all healthcare settings from community level health care settings to tertiary level.
3. It makes recommendations about Post COVID-19 care for adults, children, elderly and pregnant women.

Summary and Recommendations

For Healthcare providers

• Suspect Post COVID-19 conditions if patients present with new or ongoing symptoms
• Use screening questionnaire along with clinical assessment – comprehensive clinical history (physical, cognitive, psychiatric symptoms) and appropriate examinations.
• Assess functional abilities and limitations – Listen emphatically
• Use holistic, patient-centered approach
• Shared decision – Involve patients in the decision making process
• Provide support for people with disabilities, underserved and vulnerable groups
• Offer tests and investigations tailored to patient’s symptoms and signs
• Rule out other differentials and manage pre-existing comorbidities
• Provide time for follow up in person/remotely of admitted patients during discharge
• Refer if patient can’t be managed at the facility or doesn’t improve with treatment
• Refer urgently, after initial resuscitation, if – hypoxemia or severe respiratory distress, cardiac chest pain, pediatric inflammatory multisystem syndrome or organ dysfunction requiring acute care, sudden deterioration and worsening of symptoms
• Ensure effective information sharing between services – maintaining clinical records.

For Policy makers

• Special multidisciplinary Post COVID-19 clinics (‘one stop’ clinics) or special hours, dedicated patient care pathways or online support tools
• Surveillance and record keeping – using standardized questionnaires and assessment tools, as well as International Collaboration for research
• Use of telemedicine and non-profit organizations for patient support
• Funding for Post COVID-19 programs
• Educational documents, videos both for public and health care providers through national portals and trainings of healthcare personnel for Post COVID-19 care and rehabilitation.
• Feedback of Post COVID-19 care and care pathways and updates as required.

Related

• Guideline for Clinical Audit | Curative Service Division
• Curative Service Division (CSD)- Department of Health Services
• Standard Treatment Protocol (STP) For Basic Health Services (BHS) Package 2078
• Standard Treatment Protocol of Emergency Health Service Package
• Implementation Guide for Minimum Service Standards (MSS)-2077
• EYE, ENT and Oral Health Manual for Health Workers
• EYE, ENT and Oral Health Manual for School Teachers and FCHVs
• Process & Timeframe for Health Sector Budget and Programme Formulation in Nepal