Emergency Management for Dialysis Facilities Aaron Battle - Patient Services Director ESRD Network of New York (NW2) Laurene Jones - Community Outreach Coordinator ESRD Network of New England (NW1) July 17, 2013
What are ESRD Networks? In 1972, the U.S. Congress voted to provide funds through the Centers for Medicare & Medicaid Services (CMS) for the treatment of patients with End Stage Renal Disease (ESRD). The development of Network organizations were authorized by Congress in 1978 to monitor and improve the quality of care provided by dialysis facilities and kidney transplant programs. 2
What are ESRD Networks? There are 18 Networks providing oversight of patient centered quality of care for dialysis and transplant centers in the U.S. and it s territories. ESRD Networks: Quality Improvement Community Outreach and Education Data Management Networks are an effective bridge between patients, ESRD providers, stakeholders and CMS. 3
ESRD Network 1 & 2 Network 1 oversees six New England States (CT, MA, ME, NH, RI, VT) with 181 dialysis and 15 transplant facilities serving over 13,000 patients Network 2 oversees New York State with 250 dialysis and 14 transplant facilities serving over 26,000 patients 4
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ESRD Networks, Patients, Providers and Stakeholders Effective emergency preparedness and planning requires close working relationships between Networks, providers, patients and Offices of Emergency Management and other stakeholders. Due to recent emergencies and predicted future events, the Network, CMS, emergency planners and stakeholders recognize the need for collaborative planning and preparedness for this special needs population. To ensure operational support and continuity of care in the event of a emergency, Networks are assisting providers, with the assistance of offices of emergency management and other stakeholders, in the improvement of their emergency preparedness plans. 6
Conditions for Coverage * The CMS Conditions for Coverage (CfC) for ESRD Facilities States: The dialysis facility must implement processes and procedures to manage medical and non medical emergencies that are likely to threaten the health or safety of the patients, the staff, or the public. Evaluate at least annually the effectiveness of emergency and disaster plans and update as necessary. In order to ensure life saving dialysis services will be available in the event of an emergency or disaster, facilities should collaborate with their ESRD Network, suppliers, utility service providers, and their State agencies for survey and for emergency preparedness as well as with other dialysis facilities 7
Conditions for Coverage* Emergency preparedness of staff and patients: The dialysis facility must provide appropriate training and orientation in emergency preparedness to the staff and patients. Emergency equipment: Emergency equipment must be on the premises at all times and immediately available. (including, but not limited to, oxygen, defibrillator or automated external defibrillator, artificial resuscitator, and emergency drug) Contact their local emergency management agency at least annually. * CMC CfC Interpretive Guidance Vtags 408-416 8
Objectives / Key Points During recent emergencies and moving forward: What have we learned? How can we develop better communication, collaboration/relationships? How can we assist one another in meeting the needs of this special population? 9
Emergency Management and Planning Mission: Providers/Network To promote safe access to care for the dialysis population, with the ability to effectively and efficiently cope with and manage emergencies and disasters. 10
Emergency Management and Planning Vision: Providers/Network Work collaboratively with, providers, patients, the Network, Office of Emergency Management (OEM), departments of health, other emergency planners and stakeholders to build, sustain and improve mitigation, preparedness, response and recovery in the event of an emergency and/or disaster. 11
Need for Emergency Management Research and data from natural and social scientists indicates that disasters are becoming more frequent, intense, dynamic, and complex. The number of federally declared disasters has risen dramatically over recent decades. Emergency managers create and sustain broad and sincere relationships among individuals and organizations to encourage trust, advocate a team atmosphere, build consensus, and facilitate communication.* * National Oceanic and Atmospheric Administration (NOAA) 12
Phases of Emergency Management Recovery Mitigation Response Preparedness 13
Phases of Emergency Management Recovery Mitigation Response Preparedness 14
Mitigation Develop, implement and demonstrate the effectiveness of emergency preparedness plans to reduce interruptions in life saving services, loss of life and property. In addition, lessen the impact and severity of the emergency/disaster before during and after. Efficient and effective response Decrease the incidence of repeated damage and long-term sustained effect. 15
Mitigation Prioritize disaster planning to respond to the most significant threats first. Planning should take into consideration an all hazards approach. Prepare mitigation strategy for emergencies/ disasters that may affect your dialysis facility/region. 16
Phases of Emergency Management Recovery Mitigation Response Preparedness 17
Preparedness Preparedness measures are actions taken prior to an event that prepare the dialysis staff for response. Measures include planning, policy development, equipment stockpiling, training, and exercises. Each ESRD dialysis facility shall have a plan to implement during an emergency incident. The plan, called a Facility Emergency Operations Plan (FEOP), shall be prepared by the ESRD dialysis facility management or emergency management coordinator, and updated annually. 18
Preparedness: Facility Emergency Operations Plan (FEOP) Facility Emergency Operations Plans should protect both dialysis patients and staff. Facility Emergency Operations Plans should be widely distributed and understood by dialysis patients and staff to reduce reaction times, improve coordination, and minimize confusion. Emergency planning save lives and protects property through coordination of emergency response operations. 19
Preparedness: Facility Emergency Operations Plan (FEOP) A plan provides the facility with a tool to establish formal coordination with other entities that it may need to assist dialysis patients and staff in time of crisis. A well distributed and practiced plan helps educate and prepare dialysis patients and staff for emergencies. A plan provides a framework for responding in any emergency situation whether anticipated or not. The needs of home patients must be addressed separately by the facility during disaster planning. All home patients will need basic emergency information. 20
Preparedness: Facility Emergency Operations Plan (FEOP) At a minimum, each FEOP should include the following: Facility mission during emergency activation Emergency roles for facility personnel Process for reporting status to the Network Notification process for facility staff (phone tree) Identification of backup facility/services Process for terminating and reactivating facility operations 21
Preparedness: Responsibilities Facility leadership shall ensure that all personnel within their facilities are current on emergency procedures and equipment, and familiar with their personal roles, as well as the Network s plan for managing emergencies. Each facility is responsible for maintaining the accuracy of its internal plan. Facilities shall develop and maintain ongoing relationships with local first responders, including Office of Emergency Management (OEM) and State Health Departments. 22
Preparedness: Suggestions & Recommendations Facility communication with first responders: Include provisions for individuals with kidney failure in all emergency plans, and involve ESRD Networks in all planning efforts. Add/include dialysis facilities as high priority locations for restoration of all services such as power, water, and phone services. Designate dialysis facilities as high priority for delivery of emergency services and supplies such as generators, fuel, water, and medication. 23
Preparedness: Suggestions & Recommendations Consider and add dialysis personnel for emergency access, for example gasoline/fuel, transportation and housing. Educate dialysis providers and patients of evacuation zones and encourage early evacuation of individuals with ESRD patients, with appropriate family members (where possible). Inform dialysis providers of possible evacuations and that some of their patients may be affected. 24
Preparedness: Network Assumptions Dialysis providers have emergency plans in place, and proactive emergency exercises are conducted on a regular basis. Dialysis providers have a formal, written agreement with a backup dialysis provider. Dialysis providers will contact the Network office if they are/will be unable to provide treatment. Dialysis providers will coordinate communications to inform dialysis patient/staff for access of care. 25
Preparedness: Network Assumptions Dialysis providers have communicated with local first responders (fire, police, and Office of Emergency Management (OEM) offices) about the unique needs of the dialysis population and to designate them as a high priority for emergency services and essential supplies. Dialysis providers have communicated with local utility companies (electrical, gas, phone and water company) about listing ESRD dialysis facilities as a high priority location for restoration of services. Dialysis providers have emergency generators or a back-up power source to sustain dialysis machines short-term. 26
Preparedness: Network Assumptions Dialysis providers have established resources for obtaining emergency supplies Dialysis providers will assist in coordinating emergency transportation for ESRD patients encountering access to care barriers during an emergency Dialysis providers offer continuous education to their patients about personal emergency preparedness and facility procedures. Dialysis providers offer continuous education and training to their dialysis staff about facility policies and procedures. Dialysis providers will notify the Network when they reopen their clinic and resume operations. 27
Preparedness: Dialysis Staff and Patient Education Emergency preparedness education and involvement is the cornerstone of any successful disaster plan. It is essential that all dialysis staff thoroughly understand their respective roles and responsibilities if disaster threatens. Initial patient education should begin on admission to the facility and be reviewed and updated on a regular basis. 28
Preparedness: Generator Unless the facility is located in a state where the ESRD licensing rules require emergency generators, the decision to purchase or rent a generator likely depends on whether an alternate dialysis facility is available. Frequent testing of a generator needs to be completed far in advance of any disaster. Other options for emergency power may include access to corporate owned generators deployed to disaster areas as needed. Generator procedures should include obtaining equipment, fuel, installation and maintenance. 29
Preparedness: Generator Facilities should have access to extra generator fuel in case they need to run it for an extended period of time. Ideally, have enough fuel for two or three days. It is important to determine fueling needs. Things to consider include the following: What is the size of the fuel tank (gallons)? What is the generator fuel consumption rate in gallons per hour (GPH)? 30
Preparedness: Annual Review Update Facility Emergency Operations Plan (FEOP) Dialysis staff and patient education and training Update patient contact information, medications and medical records Assess available supplies, equipment and staffing needs Written Memorandum of Understanding (MOU) with back-up facility, transportation services, utility companies and other vendors Evaluate, and take corrective action in an effort to ensure effective coordination during incident response Re-assess and evaluate communication procedures First responders are aware of the special needs for ESRD patients during an emergency 31
Phases of Emergency Management Recovery Mitigation Response Preparedness 32
Response Access issues and effect of an incident and how they may impact operations in the short/long term. Analyze immediate actions needed to restore or resume activities needed to meet facility and patient needs. Determine the need to instruct patients/staff to backup facilities. This should include implementation of 3-day diet, going to the emergency department or calling 911, if necessary. 33
Response: Network/Facilities Response activities are those functions carried out in response to an actual event. Assure that the Network is available at all times during major disaster situations. Serve as a channel for communications to all ESRD facilities during a disaster situation. Facilitate communications with effected ESRD facilities, Large Dialysis Corporations and appropriate local government agencies. 34
Response: Network/Facilities As appropriate, coordinate activities with providers and other emergency workers to ensure access to dialysis. Exchange critical medical information with appropriate agencies or treating facilities to care for patients. 35
Phases of Emergency Management Recovery Mitigation Response Preparedness 36
Recovery The recovery phase of a comprehensive emergency management plan follows response, and focuses upon returning dialysis facilities and the renal community to their baseline levels of functioning. Well-executed recovery activities can significantly improve the function of the recovering unit(s) as compared to its pre-incident condition. Improvements may be made in day-to-day operations of the recovered facility, or in establishing a base for longterm growth. 37
Recovery: Short- and Long-Term Although speed is essential, the safety of staff and patients is always the most important consideration. Recovery is both a short-term and potentially long-term process. Short-term recovery focuses on capability and capacity for delivering dialysis services to patients in the impacted facility, and return-to-readiness for emergency response. Long-term recovery focuses on restoring the dialysis facility and the renal community to their normal or predisaster condition, or to a new normal state. 38
Recovery: Endpoint The recovery phase can extend for very prolonged periods of time, even months in some cases. For example, a facility impacted by a massive flood may require months to recover to its pre-event status. Though the dialysis facility may have reverted to its dayto-day organizational structure, assistance from the Network may still be required for continued oversight of specific continuing recovery activities and to objectively define the endpoint of recovery. 39
Recovery: Organizational Learning and Systems Improvement Debriefing after an emergency is an important step to obtain input with regard to lessons learned. The link between recovery and organizational learning (or systems improvement) should be well explained so that important data elements are captured during recovery and used to drive, through documentation, further improvement in readiness in anticipation of the unknown but unavoidable next emergency. 40
Recovery: Organizational Learning and Systems Improvement Recovery efforts should include a thorough evaluation of how response efforts were performed under stress. Specific strengths, weaknesses, and strategies to both lessen vulnerability and improve both the Network and renal community s ability to respond to future emergencies and disasters should be captured and tracked. Network staff, dialysis administrators and key first responders should participate in the debriefing. 41
Summary of Four Phases of Emergency Management Critical Areas of Emergency Management: Through an ongoing planning and training process, specific focus has been given to six critical areas of emergency management that are frequently challenged in crisis: Communications, Resources and assets, Safety and security, Staff roles and responsibilities, Utilities management, and Patient clinical and support activities. 42
National Disaster Coalition Kidney Community Emergency Response (KCER) Coalition www.kcercoalition.com There are currently eight Response Teams which focus on a certain area for preparedness and response activities. Response Teams are tasked to meet bi-monthly, usually via teleconference. Response Teams post their activities and meeting minutes on this website. Communications Coordination of Staff and Volunteers Facility Operations Federal Response KCER Response Teams Pandemic and Infectious Disease Patient Assistance Patient/Provider Tracking Physician 43
Resources: Patient Hotlines DaVita: 800-400-8331 Fresenius: 800-626-1297 DCI: 866-424-1990 DSI: 877-374-3375 ARA: 888-880-6867 NKF: 888-33-KIDNEY (888-335-4363) AKF: 866-300-2900 44
Resources: Websites Emergency Preparedness for Dialysis Facilities (CMS Guide) www.networkofnewengland.org/emerg.htm Emergency Preparedness for Dialysis Facilities (CMS) http://www.ipro.org/index/custom-externalaction?url=http://www.fmqai.com/esrd/pdf/cmsdisasterplanninggu ide.pdf&title=emergency Preparedness for Dialysis Facilities (PDF) National Kidney Foundation: Planning for Emergencies - A Guide for People with Chronic Kidney Disease http://www.kidney.org/atoz/pdf/disasterbrochure.pdf Coordination of staff and volunteers www.annanurse.org and www.oep-ndms.dhhs.gov Weather Maps and Information www.noaa.gov 45
Be Prepared. Be Safe. Preventive action is your best defense against health and safety hazards. 46
For more information ESRD Network of New England Laurene Jones, Community Outreach Coordinator (203) 387-9332 ljones@nw1.esrd.net ESRD Network of New York Aaron Battle, Patient Service Director (516) 209-5414 abattle@nw2.esrd.net