Three-level plan for Y2K helps break problem down into critical subsystems’
"Plan for Y2K on the following three levels," recommends Dallas Peak, MD, FACEP, clinical assistant professor at Indiana University School of Medicine:
Your ED and all of its critical subsystems. "Look at all of the devices in your department that are crucial to delivery of patient care," advises Peak. "This may include monitors, defibrillators, medication storage devices, computerized ADT [admissions/discharge/ transfer] and tracking systems. Use whatever means available to test and assure that these functions are Y2K compliant."
However, if a system is critical to your departmental function, you must assure that an adequate back-up system is in place in case of unforeseen failures, says Peak. "The reason for this is simple. No-one will be able to guarantee’ full Y2K compliance until January 1, 2000 rolls around," he notes.
There are too many imbedded chips and systems are too interdependent, he explains. "One non-compliant device going down may take many others down with it. I would recommend planning for failure and devising a work-around ahead of time," says Peak. "In many cases, this will mean a paper-based or greaseboard solution."
Test this backup system in the same way you would conduct a disaster drill, Peak recommends. "Focus on the most important things first: for example, can you get medications out of the Pyxis machine if it goes down? Is the machine plugged into a circuit with back-up power in case of a failure of the electrical grid?" he says. "If you are unsure, have pharmacy prepare a special package of meds to have available on an emergency basis (many departments do this as part of general disaster preparedness)."
Have plenty of photocopiers available, advises Peak. "If your registration computer system goes down, make copies of driver’s licenses, insurance cards, and paper forms," he says. "Keep one set with the chart and another set stored in a separate place.
The subsystems relied on by the hospital. "This includes power, lights, ventilation, phones, water, suction, oxygen, and the like," says Peak. "Ensure that the proper testing has been done on these systems. If not, a back-up plan would be critically important."
Communication systems are key, Peak stresses. "I remember the disruption caused by the failure of the Galaxy 4 satellite last year," he says. "We were unable to contact consultants for hours. Patients started backing up in the ED waiting on consultations and admission. I am very skeptical that the communications industry as a whole is prepared."
Have a secondary means of contacting the on-call surgeon, cardiologist, neurosurgeon, orthopedic surgeon, and internist, recommends Peak. "Preferably, have them in-house where overhead paging will be available," he says. "Do not rely on pagers or cell phones. Time after time, it has been shown in disaster situations, cell phones are overloaded in a matter of minutes."
It is quite possible that some digital phone (PBX) systems within hospitals will fail, Peak predicts. "These are very complicated systems and it is difficult to foresee all potential problems," he says. "Plan to have radio communications available for talking to lab, x-ray, OR, and bed control."
It is also important to have "runners" available to move specimens, reports, medications, and patients back and forth, Peak advises. "A hospital without electrical power is a scary thought. Most would turn into darkened tombs," he says. "It would be impossible to provide patient care in a semi-dark environment where elevators, ORs, ventilators, and monitors were lifeless."
The key to ensuring readiness for Y2K in your hospital should be the internal "grid," says Peak. "If the community’s electrical grid goes down, your hospital should have adequate back-up generators immediately on-line," he recommends. "According to JCAHO, these generators should undergo at least a monthly test under load.’ If not tested under an actual load, many generators will fail when placed into actual use."
Fuel stores should be available to carry the facility at least 72 hours, Peak advises. "Ensure that your critical devices are plugged into circuits that will receive power from the back-up generators," he says.
Your community and the relationship to your ED and hospital. One of the last steps in preparation is to look at your relationship with the community, Peak emphasizes. "If you are an EMS control hospital, don’t rely on the newer, trunked’ radio systems many large communities have in place," he says. "Dust off your old VHF radio and make sure that it works properly!"
If you are an inner-city hospital, plan for contingencies with your local law enforcement, Peak advises. "Aside from Y2K concerns, everyone else is going to be planning for the party of the century.’ There is a possibility that things will get out of control," he says. "Many communities have already canceled all vacation requests for fire, EMS, and law enforcement during the holiday weekend.
This could be a very high volume time for many urban EDs, Peak predicts. "Consider extra physician and nurse coverage, or, at least, have personnel on call’ from home or within the hospital," he says.
One additional threat is the increased risk of terrorism during this time period which has been speculated on by FEMA and other government agencies, Peak reports. "If your community is at risk, consider your plans for dealing with NBC [nuclear/biological/chemical] casualties," he says.
Finally, make sure that your family and the families of your staff are safe, Peak says. "Encourage them to follow the recommendations made by state and local agencies with regard to Y2K preparation," he suggests. "For instance, the State of Florida recommends citizens to prepare food, water, and supplies as if a storm-related loss of services were to occur."
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