tips for practical and compliant emergency...
TRANSCRIPT
8/14/2018
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Tips for Practical and Compliant Emergency Preparedness42nd Annual Hospice and Palliative Care Conference
September 12, 2018
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Options to Explore
Note: We will not cover all of the slides. They are included for reference and to address specific requests by attendees.
Emergency management structure
Planning process and types of plans
Hazard assessmentDevelopment and utilization
Emergency operations planningDocument development
Implementation
Education and exercise
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Workshop Goals
Overview
Overview healthcare emergency preparedness best practices
Provide
Provide tools and resources for practical emergency preparedness
Apply
Apply concepts to four core elements of CMS emergency preparedness rule
Outcomes
Current needs
Existing questions
Known concerns
Desired resources
Acronyms
Healthcare CoalitionsAn Overview
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What is a Healthcare Coalition?
“A collaborative network of healthcare organizations and their respective public and private sector response partners that serve as a multiagency coordinating group to assist with preparedness, response, recovery, and mitigation activities related to healthcare organization disaster operations.”
Purpose of Healthcare Coalitions
Help patients receive the care they need at the right place and at the right time
Decrease deaths, injuries, and illnesses resulting from emergencies
Promote healthcare system resilience in the aftermath of an emergency
CMS Emergency Preparedness RuleEmergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers
42 CFR Parts 403, 416, 418, 441, 460, 482, 483, 484, 485, 486, 491, and 494
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Four Core Elements of Emergency Preparedness
Risk Assessment and Emergency Plan
Policies and Procedures
Communication Plan
Training and Testing Program
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Core-EP-Rule-Elements.html
Four Core Elements of Emergency Preparedness Clarified
Risk Assessment (aka HVA)
Emergency Plan
Policies and Procedures
Communication Plan
Training
Exercise
Items to note
17 provider types
Interpretive guidance
Demonstrate capability
“CMS Emergency Preparedness”https://www.cms.gov/medicare/provider-enrollment-and-certification/surveycertemergprep/emergency-prep-rule.html
ASPR TRACIEAssistant Secretary for Preparedness and Response Technical Resources, Assistance Center, and Information Exchange
https://asprtracie.hhs.gov/
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Emergency Plan
Updated annually
Based on risk assessment
“All hazards”
Strategies to address emergency events from risk assessment
Address patient population
Continuity of operations Delegations of authority, succession plans,
essential personnel, data protection, alternate facility
Collaboration with local, regional, State, and Federal entities
Interpretive Guidance
Specify patient population (i.e. outpatient) and their vulnerability during a disaster
Specify
Address services the facility can provide
Address
Document efforts to contact preparedness partners
Document
Participate in healthcare coalition Participate
Policies and Procedures
Track staff and patients
Evacuation
Shelter-in-place
Medical documentation Protects confidentiality and information Maintains availability
Emergency staffing (give and take)
Role in alternate care site
Application to Home Care varies
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Interpretive Guidance
Incorporate in plan or part of Operating Manual
Incorporate
Centralize in order to demonstrate compliance
Centralize
Include staff and families in evacuation planning as well as patient care and treatment and appropriate transport
Expand
Patient tracking only applicable if unable to close
Customize
Communications Plan
Reviewed annually
Names and contact information for staff, service providers, patients’ physicians, volunteers
Contact information for emergency management and sources of assistance
Sharing medical documentation
Means to release patient information during evacuation
Means to provide patient status
Means to provide facility needs and ability to assist
Interpretive Guidance
Primary and alternate communication with external assistance
Means of shelter in place if unable to evacuate (Home care requirements differ)
Patient records secure and available to support continuity of care
Policy to facilitate support from volunteers
Means to contact off-duty staff
Another provider of same type
Primary and alternate communications
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Training and Testing
Training:
Based on risk assessment and plan
Updated annually
Initial training
Annual training
Documentation of training
Demonstrate knowledge of emergency procedures
Training and Testing
Testing:
One full-scale, community-based exercise
Activation of plan meets the requirement for one year
Facility-based when community-based not accessible
Small community-based with other facilities
One facility full-scale or tabletop
Analyze response exercises and events
“Facility” also means “organization” in regards to home care agencies.
Interpretive Guidance
“Operations-based” exercise
Per-diem and intermittent staff included
Facility determines level of annual training for staff
Demonstrate addressing risk assessment
Maintain documentation for at least three years
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Integrated Program
If part of a healthcare system with separately certified facilities and the system elects to have an integrated program the program must:Demonstrate each facility participatedTake into account each facility’s unique
circumstancesDemonstrate facility capability to use the
program Include unified plan
Community-based risk assessment Facility-based risk assessment
Include policies and procedures and meet training and testing requirements
Interpretive Guidance
Community-based risk assessment may be from other agencies.
Facility expected to have a copy Work with entity that prepared to ensure plan
alignment
Discuss preparedness with landlord
Planning
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Plan Types
Emergency Response Plan
• ERP• Get out, get safe
Emergency Operations Plan
• EOP• Lead
organization back to normal
Continuity of Operations Plan
• COOP• Operational
redundancy
Planning Process
Hazard assessment
Plan development
Education and review
Revision
Education
Exercise
Revision
Risk Assessment
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Overview of Risk Assessment
Definitions and terminology
Hazard Vulnerability Assessment (HVA)
Threat and Hazard Identification and Risk Assessment (THIRA)
Gap Analysis
Risk Assessment
Common utilization
Healthcare requirements
Hazard mitigation plans
Development of emergency plans
Budget justification
Components
Event or Risk
Probability
Impact
Duration
Preparedness
PLACEHOLDER FOR HVA TOOL
SEVERITY = (MAGNITUDE -
MITIGATION)
EVENT
PROBABILITY HUMAN
IMPACT
PROPERTY
IMPACT
BUSINESS
IMPACT
PREPARED-
NESS
INTERNAL
RESPONSE
EXTERNAL
RESPONSE
RISK
Likelihood this
will occur
Possibility of
death or
injury
Physical
losses and
damages
Interruption
of servicesPreplanning
Time,
effectiveness,
resources
Community/
Mutual Aid staff
and supplies
Relative threat*
SCORE
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 =
Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 =
Moderate
3 = High
0 = N/A
1 = High
2 = Moderate
3 = Low or
none
0 = N/A
1 = High
2 = Moderate
3 = Low or
none
0 = N/A
1 = High
2 = Moderate
3 = Low or
none
0 - 100%
Tornado 0%
Severe Snow
Storm0%
Structure Fire 0%
Wild Fire 0%
Violence in the
facility0%
Violence in the
community0%
Hurricane 0%
Pandemic
Influenza0%
Snow
Storm/Blizzard0%
0%
AVERAGE 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0%
*Threat increases with percentage
Table adapted from Kaiser Permanente.
0 RISK = PROBABILITY * SEVERITY
0 0.00 0.00 0.00
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INCIDENT
PROBABILITY
INCIDENT EFFECT PREPAREDNESS
RISK
HUMAN PROPERTY FACILITY WARNING DURATION PLANNING TRAINING
IMPACT IMPACT IMPACT TIME EQUIPMENT
Likelihood this
will occur
Possibility of
death or injury
Amount of
property
severely
damaged
Complete
interruption /
shutdown of
facility or
services
Incident
anticipation time
Time incident
may continue
Emergency
Management /
Operations Plan
Staff trained
and equipped
Relative
Threat
4 = Highly
Likely (probable
within this year)
4 = Multiple
deaths4 = >50% 4 = >30 days 4 = <6 hours 4 = >1 week
4 = No EMP or
EOP
4 = staff not
trained on EOP
7.00 - 7.4 =
Very High
3 = Likely
(probable within
3 years)
3 = Injuries
result in
permanent
disability
3 = 25-50% 3 = >2 weeks 3 = 6-12 hours 3 = <1 week
3 = EMP/EOP
partially
complete
3 = some staff
trained, no
equipment
5.27 - 7.00
= High
2 = Possible
(probable within
5 years)
2 = Injuries do
not result in
permanent
disability
2 = 10-25% 2 = >1 week 2 = 12-24 hours 2 = <1 day2 = EMP/EOP
complete
2 = most staff
trained, some
equipment
3.56 - 5.27
= Moderate
1 - Unlikely
(probable within
10 years)
1 = Injuries
treatable with
first aid
1 = <10% 1 = 24 hours or
less1 = 24+ hours 1 = <6 hours
1 = EMP/EOP
exercised
and/or
evaluated
1 = Anticipated
staff trained and
properly
equipped
1.85 - 3.56
= Low
Bomb Threat 0.00
Workplace
Violence0.00
Tornado 0.00
Severe
Thunderstorm0.00
Winter Storm (Ice,
Snow, Low
temperatures)
0.00
Flood 0.00
Fire 0.00
Power Outage 0.00
Info Systems
Failure0.00
HVAC Failure 0.00
Water Service
Failure0.00
Phone Service
Failure0.00
Medical Gas
Failure0.00
Medical Vacuum
Failure0.00
Disease Outbreak 0.00
Mass Casualty
Incident0.00
Hazmat Exposure 0.00
Supply Shortage 0.00
VIP Situation 0.00
Infant Abduction 0.00
Average Score #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00
Probability
The Probability column rates the incident’s likelihood of occurring over a defined time span with the highest scores being given to those incidents likely within the next year to threeyears.
Human Impact
The Human Impact column rates the incident’s possibility of injury or death to staff or community members.
Property Impact
The Property Impact column rates the incident’s possibility of severely damaging the facility. Severe damage can be considered that damage that limits or eliminates a portion of thefacility for operation, impacting the facility’s ability to provide care.
Facility Impact
The Facility Impact column rates the incident’s impact on interruption or termination of a facility’s services. Interruption of services in a facility may drastically impair the facility’s ability to provide care to patients and the community and may include the loss of equipment or personnel.
Event/Risk
Identify and prioritize hazardsReview agency hazards
Historical and current data
Define scope and magnitude of risk
Differentiate risks that create different impacts
Examine factors that influence probability of events with no history
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Impact
Personnel and clients
Facilities and resourcesBuilding and supplies
Mission critical elements Communications, expertise, utilities
Internal and external Facility and community impact
Human, business, property, infrastructure
Duration
Agreed upon scope of impact
Warning
Event time versus response time
Preparedness
Internal
External
Plans
Training
Equipment
Capability and Capacity
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Assessment Tool
Probability, risk, and mitigation assigned a value
• Chance of occurrence and magnitude of impact
• Mitigation activity scores are reversed
Scores derived from assessment of:
• Personal knowledge
• Experience and historical data
• Subject matter experts
• Group consensus
Practical HVA Development and Utilization
Tactics
Worksheet
Divide and conquer
Small portions
Root cause or justification
Gather informationScenario based discussion
Questionnaire
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Tactics
CommitteeCompetition
New faces
Recognition
Legitimize through use
After events
Utilization
Improvement planning
Mitigation strategies
Training and Exercise Plan
(TEP) Event analysis
Plan Development
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Big Picture Develop an objective
1Ensure
leadership support
• Concept
• Time
• Resources to implement
2Empower a champion
• Lead and coordinate
3
Considerations
Wheels are wheels
No “find and replace”
Small portions
A little at a time
Regular meetings
Keep the topic fresh
Test periodically
Practice manageable objectives
Plan Contents
Introduction and Purpose
Situation and Assumptions
Authority and References
Hazard Analysis/Identification
Concept of Operations
Recovery
Appendix
Annex
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Concept of Operations Considerations
Incident Management
Notification and activation
Communications plan
Information management
Recording information
Medical records management
Resources
Security and safety
Staff responsibilities
Utilities management
Resident care
Specific action (i.e. shelter-in-place, surge, evacuation, fatality management)
Appendix and Annex
Appendix
• Contacts
• Maps
• Support agreements (supply, alternate site)
• Utilities
Annexes
• Hazard specific
Exercise
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Types of Exercises
Discussion-based
• Tabletop Exercise (TTX)
Operations-based
• Functional Exercise (FE)
• Full-scale Exercise (FSE)
Exercise Considerations
Objectives before
scenarioEvaluate Document
“Community” Exercise
Emergency Management
Healthcare Coalition
Similar Agencies
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Exercise Instructions
Discuss Discuss concerns, actions, communications
Share Share from your role
Work Work as a healthcare coalition
Objectives
Examine the benefits of collaboration among
healthcare providers before, during, and
after an event.
Identify ways to improve utilization of healthcare coalition
partnerships.
Exercise Design Team
Input, perspective, expertise
Resources
Involvement in exercise play
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Exercise Objectives
Real events that occurred
Previous exercises
Hazard Vulnerability Assessment (HVA)/Risk Assessment
New procedures or
plans
Standards and requirements
Ask staff
Sample Exercise Objectives
1. Implement internal and external communications systems to coordinate an evacuation.
2. Test the knowledge and ability of departments to respond to information requests from the command center.
3. Demonstrate coordination with local health department and regional
partners.
4. Determine the time it takes to evacuate a patient.
5. Implement Situational Awareness tools to coordinate the response.
6. Ensure facility staff can contact nearby hospitals and the healthcare
coalition.
Objectives to Expected Actions
Implement internal and external communications
systems to coordinate an evacuation.
Alert executive staff.
Call the fire department.
Send an email notification to staff with instructions.
Notify our partner facility of evacuating patients.
Write a media release and post to social media.
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Exercise Scenario
Decide your scenario AFTER your objectives
2-4 sentences to lay the groundwork
Be creative – but not unrealistic
Think about the off hours or weekends
Severe storms have been plaguing [your area] for the past few days. About 12 hours ago, a severe storm system produced strong tornadoes swept through the region. The damage is widespread and is impacting communities and healthcare facilities across the region. The county EOC has been activated and shelters for community members have been opened in each county.
Evaluation Criteria
Was the task completed?
What time was it completed?
What were some of the challenges?
Who completed the task?
What resources were needed to
complete the task? Were resources
missing?
What are some suggestions to make the task
easier?
Exercise Evaluation Guide
TASK TASK COMPLETED?(CIRCLE ONE)
TIME WHO COMPLETED THE TASK?
YES NO N/AYES NO N/AYES NO N/AYES NO N/AYES NO N/AYES NO N/A
Other: YES NO N/A
Purpose: to capture
the actions/tasks completed during
the exercise.
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The Role of the Evaluator
Assign a “non participant” to document
actions, decisions, and areas for improvement
during the exercise on the exercise evaluation
guide.
Place evaluators at key areas where the
action takes place.
Participant Feedback
Purpose: to gather feedback from the exercise players on
their performance during the exercise.
Questions to ask:
What were the strengths discovered during the exercise?
What areas could be improved?
What suggestions do you have for addition resources / training?
Exercise Documentation
Purpose: to summarize the action during the exercise and outline areas for improvement.
Exercise Evaluation Forms (from the Evaluators)
Participant Feedback Form (from the Players)
After-Action Report
Objectives, scenario, and a list of participants
Summary of evaluation forms and participant feedback
List of areas for improvement
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Exercise Logistics
Exercise time? Location?
Exercise Roles:
Controller / Facilitator
Evaluators
Exercise Scope
Exercise limitations
Safety measures
Communications methods
Summary:
Exercise Design
Write Write an After Action Report
DocumentDocument the actions and areas for improvement
Conduct Conduct the exercise
Evaluation Create an Exercise Evaluation Guide
Scenario Create a scenario to drive the objectives
Objectives Develop objectives (and expected actions)
Team led by a champion
Train and Exercise
Identify participants and determine type of training
Plan exercises based on objectives
PlanCompile and enhance internal plans
Integrate external resources into plans
AssessDevelop a risk assessment
Provide justification
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Resources
https://asprtracie.hhs.gov/documents/cms-ep-rule-resources-at-your-fingertips.pdf
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/FAQ-Round-Four-Definitions.pdf
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Core-EP-Rule-Elements.html
Contact
All Clear Emergency Management Group, LLC
Will Moorhead
336-802-1800
www.AllClearEMG.com