ENVIRONMENTAL HEALTH & ENGINEERING THE JOINT COMMISSION EMERGENCY OPERATIONS PLAN: 7 COMMON VULNERABILITIES

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1 ENVIRONMENTAL HEALTH & ENGINEERING THE JOINT COMMISSION EMERGENCY OPERATIONS PLAN: 7 COMMON VULNERABILITIES

2 THE JOINT COMMISSION EMERGENCY OPERATIONS PLAN: 7 COMMON VULNERABILITIES Environmental Health & Engineering Inc. (EH&E) performs many Emergency Management audits each year for hospitals and has identified a number of common deficiencies pertaining to the Emergency Operations Plan. These deficiencies are outlined below by standard area along with our recommendations for how hospitals can better prepare for their next Joint Commission survey Hour Sustainability Plan This standard is often misinterpreted. It does not require hospitals to be selfsustaining for 96 hours, but it does require that you assess your hospital s capabilities to sustain operations for 96-hours. If the assessment determines that your hospital cannot be self-sustaining for 96 hours, then you must have contingencies in place. These contingencies must be detailed in a written plan and you must also have an effective evaluation tool in place and an accurate 96- hour resource inventory. The written contingency plans we encounter often lack the background information and details to support the hospital s sustainability. For example, it is not acceptable to simply state, Yes, the hospital has enough water, fuel, and staff to sustain for 96 hours. You must be specific, such as how many gallons of water, how much water per person per day will you supply, does this include all the staff who are staying at the facility overnight, etc.? Other important data to include are how many gallons of fuel a facility has in their storage tanks and the consumption rate. Is there enough fuel to run the whole facility or only one or two buildings using the fuel on hand? How many hours can you last on that amount of fuel? This is important because your hospital will need to decide whether you would need to close a building, curtail services or potentially evacuate. 1

3 2. Clinical Interventions During Utility Failures Ensure that your hospital has written plans for clinical intervention during utility failures. There should be clear lines of communication between the facilities / engineering department and clinical staff. Most hospitals state that these procedures are in the Nursing Procedure Manual, however, we find that often they are not. 3. Alternate Care Site Plan Hospitals must identify alternative care sites (ACS) and who is in charge of and authorizes set up of the ACS. We find that many of the details are missing from the ACS planning documentation. The hospital must detail plans for supplies and transportation. Additionally, they must describe the features of the facility and what kind of care can be provided. For example, does the facility have handicap access, doors wide enough for wheelchairs or gurneys, water for cooking or showering? What kind of communication infrastructure is available (e.g. phone, FAX, internet access). Is there an emergency generator, heating, cooling, how many bathrooms, etc? These are all critical questions that must be answered and documented in the ACS plan. There must also be a supply list for the items necessary to set up the ACS including: staff medical supplies (IV poles, fluids, biomedical equipment, etc.) pharmacy food and water, trays, cups, utensils radios, batteries, phones, computer laptops gloves, masks cots, linens, privacy screens, tables, chairs 2

4 Document where these items are stored and whether expiration dates are checked. Finally, who has authority to terminate the ACS operation and how will it be disassembled, how will items be transported back to the main hospital? How will patients be discharged, the facility be cleaned up and restocked, etc.? All of these critical elements must be included in the ACS plan. 4. Volunteer Management Plan The Joint Commission written requirements for volunteers who are not licensed practitioners are often overlooked. You must have a plan for ensuring that volunteers have the proper credentials for the tasks they will perform during an emergency. The plan must lay out who the volunteer will be assigned to for supervision, the degree of training the volunteer will receive (e.g., medical equipment, responding to fire alarms, etc.), who evaluates how they are performing and if they can continue after 72 hours. Frequently we find hospitals don t have a plan for checking credentials in the event that the internet and telephones are down. 5. Decontamination Plan Update your decontamination plan and properly train staff when new equipment or technology is purchased. We find that while most hospitals have a decontamination plan, the plan only addresses one or two of the hazardous agent categories. The plan must address biological, radiological and chemical agents. The plan should also: Establish procedures for all those donning personal protective equipment (PPE) and how it will be decontaminated and removed. Identify the various zones (red, yellow, green). Specify how waste will be collected. Outline communication during decontamination and the relationship with the fire department. Detail the set-up of the decontamination unit and supplies. 3

5 6. Disaster Staffing and Family Support Plan Make sure your Emergency Operations Plan (EOP) details the logistics and resources your hospital will have in place for staff that stay at the hospital during an emergency. This should address assistance the hospital will provide with transportation of staff to the hospital during an emergency, and overnight accommodations including food, water and sleeping space. Also childcare, eldercare and pet care are all items that must be addressed, even though the hospital is not required to set up a childcare center. 7. Surge Plan State-wide and region-wide surge planning has come a long way in recent years, but most hospitals haven t had the time or resources to update their EOP with the critical details of Surge Planning. Similar to alternative care site planning, you must document and assess both your assumptions and capabilities regarding: supplies equipment and pharmaceuticals communication transportation alternative care sites employee availability (employee shortage planning, etc.) patient / victim management and tracking memorandums of understanding (MOUs) and mutual aid agreements 4

6 ENVIRONMENTAL HEALTH & ENGINEERING 117 Fourth Avenue Tel: Needham, MA Web: Fax:

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