Clinical guidance for doctors

Guidance for medical practitioners

There is a rapidly growing evidence base underpinning clinical care for patients affected by COVID-19.

As new trustworthy educational resources are brought to our attention we will share them here.

RCPI Online Lecture Series: COVID-19

We hold regular Clinical Updates on COVID-19. Recordings are available to watch online afterwards.

Click here to get access to these clinical updates

You will be brought to Panopto, our video sharing platform. You will need to sign in with your username and password for the RCPI website.

Note, this educational material is for a medical audience only.

HSE guidance and evidence

The HSE is developing an online repository for Interim Clinical Guidance intended for the Clinical Community. This resource provides a national easily-accessible repository of clinical guidance and latest research evidence to equip the clinical community in Ireland to respond to Covid-19.

View HSE repository of guidance and evidence for the clinical community

Communication Skills for Telephone Consultations

Below you can access a free online course entitled Communication Skills for Telephone Consultations. This course has been developed by the National Healthcare Communication Programme, the Royal College of Surgeons in Ireland, the HSE National Clinical and Integrated Care Programmes, and the International Association for Communication in Healthcare. It takes one hour to complete and will guide you through key skills required for telephone consultations, including breaking bad news.

Click here to open this course

Where to find trustworthy information

Pregnancy and COVID-19

The Institute of Obstetricians and Gynaecologists has issued guidance on Covid-19 and maternity services.

This guidance document aims to:

To outline considerations for care for pregnant women and their infants during the COVD-19 pandemic
To advise maternity units around the provision of safe care to women and infants with suspected / confirmed COVID-19
To support healthcare staff working in the maternity services
To set out a framework for managing the impact on maternity services
To provide principles to help units develop their own response plans

Click here to view the guidelines (PDF)

Stillbirth, Surveillance of fetal wellbeing and SARS-CoV-2 Infection

Click here to view the guidance and evidence summary

Guidance for thromboprophylaxis and COVID-19 in pregnancy

Click here to view new guidance for thromboprophylaxis and COVID-19 in pregnancy

Click here for the Rapid Risk Assessment Tool for VTE Thromboprophylaxis in Pregnancy / Post-partum

Interim Guideline for the Management of Covid-19 Infection in Paediatric Patients

The National Clinical Programme for Children has developed a guideline for the management of SARS CoV 2 infection in children which has been approved by the Paediatric Clinical Advisory Group and CCO Clinical Advisory Group.

Click here to view the guideline (PDF)

Interim Guidance on Medically Vulnerable Children

The Faculty of Paediatrics at RCPI and the National Clinical Programme for Paediatrics and Neonatology have published interim guidance on medically vulnerable children during the COVID-19 pandemic. The guidelines are aimed at parents and healthcare professionals.

Click here to view the guideline (PDF)

Faculty of Paediatrics endorses European Academy of Paediatrics call for urgent action to mitigate the impact of COVID on children

The Faculty of Paediatrics at RCPI is among the many international organisations supporting the European Academy of Paediatrics' call for urgent action to mitigate the impact that COVID is having on the health and well-being of our children, now and for many years to come.

Click here to read more on the EAP website

Guidelines on Post-Mortem Examination Practice during the COVID-19 Pandemic

Updated December 2021
The Faculty of Pathology has issued updated guidance on Covid-19 and mortuaries/post-mortem examinations. The guidelines will be continually reviewed. The Faculty's aim at all times is to ensure that histopathologists and state pathologists can investigate all deaths fully, respectfully, and with full empathy for the families of the deceased.

The guidelines have been developed by the Histopathology Working Group and endorsed by the Board of the Faculty of Pathology.

Click here to view the guidelines (PDF)

Ethical Framework for Decision-Making in a Pandemic

The Department of Health in Ireland has published an ethical framework for decision-making in a pandemic. This document includes a number of substantive ethical principles and procedural values that can be applied to, and employed during, the decision-making process in a pandemic.

You will find the document here

Help with understanding this ethical framework - Prepared by Professor Emer Shelley, Dean of the Faculty of Public Health Medicine

The Ethical Framework for Decision Making during the COVID-19 pandemic was developed by a multidisciplinary group and published by the Department of Health on the 29th of March.

The principles apply to planning and decision making at national level as well as to managing and providing care. The introduction makes clear that this is not guidance about management or clinical decision making. The framework sets out the principles to use and the procedural values to apply when making those decisions. The weight given to different principles may vary at different stages of the pandemic.

The ethical principles to apply in decision making during a pandemic are listed and described in Table 1: minimising harm, proportionality, solidarity, fairness, duty to provide care, reciprocity and privacy.

Several of these principles are similar to those in use in everyday clinical practice. However during the pandemic they are applied from a public health perspective. For example:

Minimising harm relates to the obligation to protect the public from serious harm, including physical, psychological, social and economic harm.
Solidarity applies between individuals, health care institutions, government institutions, governments and nations.
Reciprocity requires that society supports those who face a disproportionate burden in protecting the public good and take steps to minimise the risks and burdens as far as possible. This includes healthcare workers as well as patients and families and those who who are affected economically.
Fairness is a principle of concern to many clinicians. A fair decision is one that gives people with an equal chance of benefiting from health resources an equal chance of receiving them. A fair decision is also one that might treat some people differently but for clinically sound reasons e.g. is requires those who could get the same benefit from an intervention at a later date, to wait.

Procedural values to guide ethical decision-making during a pandemic are set out in table 2: reasonableness, openness and transparency, inclusiveness, responsiveness and accountability.

Reasonableness requires that decisions are 'based on best available evidence at the time, be the result of an appropriate process (taking into account the speed and context in which a decision is made), proportionate to the threat and should have a reasonable chance of working. The decision should be made by people who are credible and accountable.'
Responsiveness requires an opportunity to revisit and revise decisions as new information becomes available, as well as mechanisms to address disputes and complaints, while inclusiveness requires that stakeholders are consulted as much as possible, their views are taken into account, and any disproportionate impact on particular groups is considered.
Accountability it is also of particular concerned to clinicians. 'Within all accountability relationships, it must be clear who is accountable to whom, what they are accountable for, how accountability will be evaluated and the consequences of failures of accountability.' As usual, appropriate records should be kept of decisions taken and the justification for them.

What about research? During the pandemic the usual protections for research participants should be upheld, as should standards for research integrity. The principles of fairness, reciprocity and privacy are most relevant in this context and the five procedural values apply.

The Framework includes consideration of the principles and the values for applying them, including:

Allocation of Scarce Resources - It is particularly important that the process by which resource allocation decisions are made is reasonable, transparent and accountable, and that the rationale underpinning those decisions is communicated to the public, especially each person and family impacted by a clinical decision. As with other decisions, the decisions to be made will differ at different stages of the outbreak. 'Once the healthcare system reaches capacity, everybody will be cared for, but may not have the same access to different levels of medical intervention. Decisions will, therefore, have to made regarding who should be prioritised to receive intervention. These decisions should be based on the underlying rationale of maximising the benefit that can be gained from the limited amount of resources available and giving due attention to the fair distribution of benefits and burdens.
Prioritisation of Medication and Critical Care - For fairness, 'decisions should be based on the underlying rationale of maximising the benefit that can be gained from the limited amount of resources available'. Decisions are principally based on health-related benefits, considering 'which patients are most likely to benefit from the intervention. Consideration of the patient’s pre-morbid health status, their will and preferences (if known), the presence of co-morbidities and their frailty status (independent of age) are all relevant in this context'. A multi-principled approach takes into account estimates or projections of: the total number of lives saved; the total number of life years saved; and long-term functional status should patients survive; these estimates or projections may be made based on empirical data if they are available, or on sound clinical rationale. Such an approach can act as a tool to facilitate fair decisions, as it seeks to balance utility and equity considerations. Decisions about access may also be required when there is evidence of effectiveness of medications or vaccines.

Do you want to recommend an educational resource for doctors?

If you would like us to share educational/clinical information regarding COVID-19 here, please contact Aoife Costello in our Communications Department.