Make sure your disaster plans include the recovery phase
Address lack of staff, power, and other resources
(Editor's note: This is the first of a two-part series that looks at accreditation standards that pose compliance problems for home health agencies. This month, we look at emergency preparedness and what components are necessary to satisfy a surveyor. Next month, we will examine do-not-use abbreviation lists, written orders, and competency assessments.)
Emergency preparedness is on the minds of home health managers, as they look at the devastation and extensive recovery efforts following hurricanes Katrina and Rita. Additionally, it is the No. 1 standards compliance issues for agencies accredited by the Joint Commission on the Accreditation of Healthcare Organizations.
Seventeen percent of home care agencies surveyed by Joint Commission did not comply with the standard that requires the organization to address emergency management (EC.4.10), says Maryanne L. Popovich, RN, MPH, executive director of home care accreditation for the Joint Commission. Agency managers are inclined to plan for natural disasters, but they don't always plan for disasters that might be due to mechanical or technological problems and that might result in an extended power outages, Popovich points out.
Even with natural disasters, it is important to plan for the recovery period following the disaster when you may lack power, water, gasoline, or even staff, for a period of time, she suggests.
The 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City is the reason that Oklahoma health care organizations are well prepared for emergencies, says Sue Gibson, director of Midwest Home Health in Del City. That tragedy, as well as subsequent devastating tornadoes and the ever-present high risk of terrorism due to military bases in the area, spawned a network of health organizations that are linked together by computer so that resources quickly can be identified, she reports.
Gibson's agency disaster plan has several components, she says. "We have a plan when the disaster affects our agency and our patients, when the disaster affects the hospital but not our patients, and when the disaster affects the community to a point that our assistance is needed."
They also have assigned a priority code to their patients so that if they are short-staffed following a disaster, if resources such as gasoline are limited, or if travel to certain areas is difficult, they know who can wait, says Gibson. If a patient cannot be seen as frequently or as soon as he or she is normally scheduled, an agency nurse will talk with the patient by telephone, she explains. "Our nurses are trained to assess and counsel patients by phone so that we can focus efforts following an emergency on patients who must be seen."
The agency also assigns a disaster classification that enables the agency to notify police if there is a patient who does live alone and cannot be contacted, she says. "We are able to make sure that someone checks on the patient," Gibson says. The disaster classification is assigned at start of care and reviewed at recertification periods.
Looking beyond your own agency is a key component of a good emergency preparedness plan, says Popovich. "We want to see agencies define the role that they will play in a communitywide disaster," she adds.
Gibson's agency participates in the community's terrorism emergency planning. "We not only participate in the drills, but our home health nurses have been designated as nurses who will administer the smallpox vaccine in the event it is needed," she says.
Dealing with rising gasoline prices is one aftereffect of Gulf Coast hurricanes this season, but the staff at Marion (KY) Home Health Services just schedules patient visits as efficiently as possible to keep costs down, says Sharon Darnall, RN, director of the agency. "We are a small agency with only three nurses, so we group patient visits on a daily basis. All of the patients are comfortable not seeing the same nurse each visit because with only three nurses, there is still continuity," she explains.
Because they group patients geographically, a nurse may see more patients on one day than the next, Darnall admits. This arrangement gives them a day to complete paperwork and take care of things in the office, she points out.
At Castle Home Care in Kaneohe, HI, "way out here in the ocean," mileage is not an issue. "Traffic and road delays are our problems, so we always try to schedule patients close together," says director Judith McGuire, BSN, MHA. "We pay a mileage allowance according to the Internal Revenue Service limits, so we just simply increased it," she adds.
Popovich is seeing agencies in all areas of the country talking about reviewing their plans in light of the tragedy in Louisiana and Alabama. "People realize that there may be long-term issues following a disaster that can affect their ability to provide care for their patients," she says.
A plan must address the time after the disaster and spell out how you will find your employees and patients following an evacuation, Popovich says. "You also need to be prepared to find another building from which to run your agency and be able to establish backup communications."
An emergency preparedness plan needs to include the recovery period and the needs of other organizations in the community, says Gibson. Keeping a plan updated and reviewing it regularly is important, she says. "You have to plan what needs to be done before and after a disaster so that you can make sure you are providing services when they are needed." Gibson says.
Sources
For more information about emergency preparedness plans, contact:
- Sharon Darnall, RN, Director, Marion Home Health Services, Crittendon Health Systems, P.O. Box 386, Marion, KY 42064. Telephone: (270) 965-2550. E-mail: sdarnall@crittendon_health.org.
- Sue Gibson, RN, Director, Midwest Home Health, 3921 S.E. 29th St., Del City, OK 73115. Telephone: (405) 677-7911. E-mail: [email protected].
- Maryanne L. Popovich, RN, MPH, Executive Director, Home Care Accreditation Program, Joint Commission on the Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Telephone: (630) 792-5742. Fax: (630) 792-5005. E-mail: [email protected].
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