Plan for the worst to get best results
Disaster plan should encompass even flu epidemic
(Editor’s note: This is the second of a two-part series examining disaster preparedness. For more on disaster plans put to the test by real emergencies, see the November 1996 issue of Hospital Home Health.)
It seems logical enough: Put your disaster plan on paper. Yet many hospital-based home care agencies rely on plans designed for the hospital, not home care. How can you devise a plan that suits your agency and your patients?
Cathy Therell, RN, MSN, administrator of St. Francis Xavier Home Care in Charleston, SC, developed her policy from scratch. Her plan was actually put to the test late this summer as three hurricanes brushed the Atlantic coast near Charleston.
Therell advises those without a disaster plan to find a "mentor" who has experience with emergencies and ask to see a copy of his or her plan. Most home care administrators are more than willing to share such information, she says.
Disaster preparedness plans should start with the basics, says Robin Will, RN, BSHA, director of information management at Shands Home Care in Gainesville, FL, and should focus on these four areas:
1. Communications.
"You have to have clear lines of communication," Will recommends. "You have to know the chain of command." It is vital for all staff to know who will implement the disaster plan, and in that person’s absence, who else has the power to call the rest of the staff to action. "You can’t build yourself into a corner," Will says. "You have to have a plan of action if the person in charge is not available, is out of town, or if he or she cannot be reached."
Therell has a special section on emergency communications in her plan. (See sample, inserted in this issue.) It outlines exactly what the disaster coordinator is responsible for doing.
When Carla Abel-Vacula, MSW, LCSW, supervisor of social work and psychiatric home care at Christ Hospital Home Health in Jersey City, NJ, worked on her disaster plan, she outlined a phone tree for relaying information. Christ Hospital updates its phone list semiannually, but problems still arise.
Last winter, when snowstorms paralyzed the East Coast, Christ Hospital put its plan into action. When Abel-Vacula heard nothing from her staff, she called her voice mail at work and found a message from her administrator that she could not be reached at home. "It turned out they had the wrong phone number for me," Abel-Vacula recalls. "You have to have a back-up system like voice mail."
2. Prioritizing patients.
The second step in any plan is a method for prioritizing patients. "You have to know which patients need life-sustaining treatment and who can have deferred visits," Abel-Vacula says. When the phone chain reaches the nurses, they are asked by supervisors which patients have to be seen no matter what.
Therell’s plan requires her staff to carry with them on visits an up-to-date patient census that outlines client needs. The plan also lists who can be deemed a "priority patient." The list includes:
• ventilator-dependent patients;
• enteral/parenteral patients;
• IV patients;
• insulin-dependent patients for whom a nurse must administer the drug;
• those who need daily dressing changes;
• patients who live alone;
• oxygen-dependent patients;
• tracheotomy patients;
• patients living in trailers.
Once you have a method of classifying patients, make sure your plan outlines who will contact them to reschedule appointments that are deferred, says Abel-Vacula.
3. Emergency situations.
Rather than cover every potential emergency that may arise, Abel-Vacula says it is important to cover the situations that can develop because of an emergency. Christ Hospital outlines five in its plan:
• Weather-related emergencies that occur at night.
These require staff to call in and let a supervisor know if they can make it to work.
• Weather-related emergencies that preclude all staff from making it to work.
Such emergencies require messages to clients to call 911 if needed or get to the hospital.
• Emergencies in which the agency and hospital communication systems fail.
This puts into action television and radio announcements, using beepers and cellular phones to contact staff, and relocating the office on a temporary basis.
• Situations in which the home health communication system fails.
This requires making use of the hospital systems.
• Fire in the building, which requires evacuation and alternate communication systems.
Therell’s plan lists steps to follow in natural disasters, communications system failures, loss of personnel, damage to organizational sites, and industrial disasters. While many of the plan’s elements are the same, Therell says each emergency has its own particular requirements. For example, a natural disaster has implications for patients first, while damage to facilities puts the emphasis on employee safety.
When disaster is mentioned, most people think of hurricanes and earthquakes. But Will says it’s important to get staff to think "outside the box" and started her plan with an atypical example of a disaster: a flu epidemic that hits both staff and patients. "We can have a disaster which does not involve the building falling down but which is a true staffing emergency," she says.
Will also recommends having a computer-related disaster policy in place. "If the system goes down for three days, who will enter the information back into the system? If you use temporary staff, do you have them sign a confidentiality agreement? Do you plan for such a disaster by spending the $80,000 to have a risk box off site? Or do you just do regular back-ups which are removed to a director’s home off site?"
4. Post-emergency plans.
The disaster doesn’t always end when the emergency does. Abel-Vacula says you have to plan for the immediate aftermath of an emergency. For example, once the storms abated and cars were allowed back on the road, Abel-Vacula started trying to get her nurses to patients. But not everyone had a four-wheel drive, and snow drifts blocked virtually all parking in Jersey City. She solved the problem by having two nurses travel together. This allowed one to see a patient and the other to drive around until the visit was over.
• Practice makes perfect
Test if your plan is effective by holding a mock disaster drill, Therell says. "Then sit down with your team and evaluate your response." Therell validates her plan by holding a yearly inservice on emergency preparedness for all staff. The staff are tested on key elements of the policy at the end of the inservice. "It keeps everyone sharp," she says.
Humor can help staff remember elements of the plan, says Abel-Vacula. During Christ Hospital’s annual drill, a 15-question multiple choice quiz on the plan was included. "We had two of the four answers seem ridiculous or funny," she explains. "It helps them remember the right answers."
Most important, says Therell, is to realize that an emergency preparedness plan is not a static document. "We continually evaluate the plan," she says.
• Network, network, network
In the absence of a template disaster plan, Therell says the American Red Cross has pamphlets on the physical preparations for disasters such as hurricanes. But hospital- based agencies also have internal resources that can be helpful. Have the director of nursing and the person in charge of admissions at the hospital look it over, Therell says. "That way, you have clear criteria about admitting your clients and what the hospital needs from you and the physician." Abel-Vacula says the medical advisory committee of your hospital is another good resource.
State home care associations also can be of assistance, says Will. "Use each other’s knowledge. Even freestanding agencies are willing to share their experiences."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content