In Case of an Emergency…

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By Kristin Persson, Business Systems Analyst, Change Healthcare and Rhonda Perrin Oakes, RN, CHPN, Regulatory Analyst, Change Healthcare
Emergency Response Vehicle

No matter where your home care or hospice organization is located, you face the possibility of natural disasters that would require moving patients under your care. The Emergency Preparedness Rule, which went into effect in November 2017, aims to ensure organizations have considered those disasters and any others (a terrorist event, for example) and planned for the worst.

Lest anyone think a half-baked plan is acceptable, remember that the worst can happen. At last year’s Change Healthcare Solutions Conference, an administrator in charge of disaster preparedness at her organization told a story related to 2016’s Hurricane Matthew. The organization had a week-long warning of the impending storm; each time she checked, the administrator was told every patient had been contacted and had a plan to evacuate the area.

On Friday afternoon, South Carolina Governor Nikki Haley announced a mandatory evacuation for Monday. All staff duly moved inland, leaving one patient whose family declined to be evacuated. Monday morning, the family posted on Facebook that the agency had left the patient there to die.

Because all emergency services were shuttered and roads into the area closed, the home care organization needed a National Guard escort to drive a rented van to the patient’s home where they met with local firefighters who could lift the patient into the vehicle. After locating a bed at an inland skilled nursing facility and driving several hours, the group had to detour to a local ED for a chest X-ray required by the nursing facility before admittance.

Following this episode, the organization changed its policy regarding mandatory evacuations. Any patient who refuses to leave must sign paperwork to that effect, followed by a call to Adult Protective Services by the agency.

A solid plan

Keep these key points in mind as your organization reviews and updates its plan, which is subject to inspection by a surveyor.

  1. The plan must take into account any type of hazard, natural or man-made. That includes storm systems, floods, wildfires, power outages, terrorist attacks and area-specific events such as a nuclear-power-plant event or coal-mine disaster.
  2. Every patient must be assigned a designation as to acuity level and level of care. They also must be assigned an evacuation severity code and an emergency preparedness zone.
  3. All staff must be trained on what to do in the event of an emergency, including conducting both a tabletop exercise and a full-scale organization-wide or community-wide exercise. Staff training on the plan must be conducted annually; new staff must be trained when they come on board.
  4. The plan must include a communication section that complies with state and federal laws and includes communicating with local/state agencies, local healthcare facilities and all relevant providers.
  5. The plan must be reviewed and updated at least annually.

Assigning evacuation codes and emergency preparedness zones

Every home care and hospice organization should develop a set of codes that describes the patient’s condition with regard to evacuation. If the patient is on a ventilator, he will require an ambulance; other patients may require a stretcher or wheelchair. At the other end of the spectrum would be a code indicating the patient’s family can transport her without assistance. These codes can be noted in our Homecare Advisor™ and Hospice Advisor™.

Organizations can populate and customize our Emergency Preparedness report to use in the event of an emergency and give to a surveyor upon request. The report contains the information needed to identify patients by risk level during an emergency. It can be filtered by location if your organization has more than one and sorted by emergency preparedness zone, county, ZIP code, or ESC code.

However, keep in mind that such a report is only as good as the data it contains. A truly useful report requires that discharges be entered in a timely manner, that a phone number format is established and followed, and that physician data and patient addresses/contact phone numbers are kept current.

Finally, consider that in the event of a mass evacuation, some of your patients may be able to travel with others in the facility where they reside. To facilitate this, gather and enter building numbers and room numbers and have a process to help ensure up-to-date phone numbers for area facilities are kept on file.

For more home care and hospice news, insights and tips, we invite you to explore our latest posts on Homecare Talk Blog.

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