Managing acute responsive behaviours or mental health-related behaviours during a pandemic is a challenge faced by many inpatient units across care settings. Due to behavioural factors that limit these patients’ ability to maintain isolation precautions and physical distancing these patients are a significantly high-risk group for the spread of COVID-19, making testing a crucial prevention strategy. However, testing itself presents risks for patients with impulsive or compulsive behaviours, such as swallowing test swabs, and risks for healthcare providers, such as injuries caused by patient reactions to the discomfort of the test. These operational realities have resulted in significant variation in service delivery and testing success rates across sectors. 

In response to this need, Baycrest developed a surveillance testing protocol for patients with acute responsive or mental health related behaviours. This protocol is used on two inpatient mental health units (behavioural neurology and inpatient psychiatry) with patient populations that are characterized by destabilized mood disorders and responsive behaviours. The protocol consists of the following key elements: (1) selection of swab and test method based on the patient’s behavioural profile; (2) use of bite blocks to prevent injury to clients; (3) pre-sedation and early timing of tests; and (4) engagement of interdisciplinary team members to inform the testing approach. Through the application of this protocol, Baycrest has achieved a 100% testing rate for patients on our inpatient psychiatry and behavioural neurology units. Baycrest has created two tools – a process flow and specimen collection guide – to support teams in applying this protocol. 

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