During a recent facility visit, I was shown the locked supply closet where the emergency preparedness supplies are stored. In exploring their process for activation, I learned the person who could choose to activate and who held the key for the supply closet was the facility administrator. The administrator’s decision tree was built upon the hypotheses that business would operate as normal in an emergency, and he/she could get into the facility in a timely manner. That theory has some fundamental flaws when it comes to emergency preparedness. A well-thought-out plan holds no bias about roles or specific people. It is designed to use the skills and abilities of the people there in a moment of need.
Emergency preparedness used to mean planning for natural disasters, fires, mass casualty or other types of patient surges or care needs. The general belief was if you had plans for fire, flood and earthquake, you were sufficiently prepared. Additionally, emergency preparedness focused primarily on the acute care delivery system, as it would be the first line of impact. The threat of infectious diseases, mass casualties and large-scale events in recent years has prompted an examination of the whole healthcare delivery system and the need to be prepared and work in an organized manner.
The Centers for Medicare & Medicaid Services has finalized a rule that requires nearly 20 types of healthcare providers, including long-term care, to advance their ability to respond to local, community, regional and national needs. The deadline to meet regulatory requirements is rapidly looming. While having a plan is the first step, actively testing and refining the plan is the most important action organizations can take. To assure preparation is more than words on paper, facilities need to incorporate five key elements into their plan.
1. Build muscle memory with staff
Facilities must conduct routine exercises to test the emergency plan, including unannounced employee drills across all work shifts. This may include full-scale exercises that are facility or community based. Routine practice will build muscle memory and help staff know exactly what to do and when to do it if an emergency arises. Muscle memory through simulation is what helped Orlando Health respond to the 2016 mass shooting at Pulse Nightclub, which is located just down the street from the hospital.
2. Push your plan to the point of failure
Use the drills to expose potential points of failure. Don't be caught in the web of validating what is right in the plan. You want to know what is missing or doesn't work before you find yourself needing to trust its procedures in an emergency.
3. Assign specific roles and responsibilities
Administrators may not always be available in an emergency. Someone else always needs to be prepared to take on the emergency leadership role. How can you support communications with remote personnel? Who will assume the key roles and how well trained are they in working with emergency medical services (EMS), and local and state officials?
4. Leverage partnerships with supply vendors
Healthcare providers are under increasing pressure to reduce costs. However, facilities must be willing to invest in supplies that enhance resident care. They are required under the new regulations to have memoranda of agreements with their supply vendors. Facilities need to test the full cycle of supply chain agreements, including how to obtain needed emergency supplies from their partners. Remember, an emergency is not business as usual, and the people at the facility might not even know whom to call. Make sure communication systems and contact information are up to date and staff are trained how to access them.
5. Consider the ethics of response
In an emergency, facilities must uphold certain clinical principles, such as meeting standards of care, informed decision making and preservation of human dignity. However, when faced with an emergency, your staff may be forced to make decisions that can violate those principles. For example, crisis standards of care may require prioritizing medications, care and treatments.
Another example is the decision to evacuate. Triaging who will be taken out of the building first often raises moral questions for responders. Additionally, emergency situations often cause significant tension between agencies overseeing the activation and response and the medical professionals who are personally experiencing the emergency. Providers assume they have created plans that cover every potential scenario, but when a situation arises that there isn’t a policy in place for, someone is responsible for making ethical, moral and business judgements. Leaders need to consider the impact that disaster activation can have on themselves and those they work alongside. Ethical considerations also need to be built into drills to help the response team talk through guiding principles such as the philosophy of the greater good and its application in an emergency.
Emergencies happen at a moment’s notice. Being passionate about preparing your facility will help ensure it will be ready for any situation.
Martie Moore is chief nursing officer at Medline, where she provides nursing leadership for solution-driven clinical programs, delivers product development to enhance bedside practice and launches quality initiatives across the continuum of care. She can be reached at firstname.lastname@example.org.