Same Mission..New Rules

Transcription

1 Same Mission..New Rules

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3 TORNADO: MOORE, OKLAHOMA May 2013

4 West, Texas- April 2013

5 FLOODS: COLORADO September 2013

6 FLOODS: PHOENIX AREA 2012 and 2014

7 YARNELL HILL FIRE: ARIZONA June 2013

8 MASS SHOOTINGS: WASHINGTON, D.C. September 16, 2013

9 CHEMICAL SPILL: WEST VIRGINIA January 2014 Newsweek Tom Hindman/Getty

10 DROUGHT: ARIZONA AND 9 OTHER STATES

11 OIG REPORT: April 13, 2012

12 GAPS CONTINUE TO EXIST IN NURSING HOME EMERGENCY PREPAREDNESS RESPONSE DURING DISASTERS Staffing shortages Resident Care especially feeding tubes and ventilators Resident ID and tracking Shelter in Place supplies Communication 92% of all nursing homes in the country met federal requirements for emergency plans

13 Revised February 28, 2014

14 New Requirements CMS Proposed Rule Emergency plan Based on risk assessment Collaboration Communication plan Training and testing of the plan Emergency power Management of volunteers Sewage and waste disposal Temperature control during power outage

15 COMMENT TO CMS Disaster Planning Takes $$$!!!!

16 Part (a) Emergency Plan Based on and include facility and community-based RISK ASSESSMENT: Address facility population including person s at risk because of their unique needs Types of service can be provided in emergency, Continuity of operations, Delegation of authority, Succession plan

17 New Requirement RISK ASSESSMENT The hazard vulnerability assessment OR HVA asks the questions: 1. What are you biggest risks or hazards? 2. How prepared are you?

18 WHAT DOES IT LOOK LIKE? Normally a spreadsheet with number ratings Examples

19 WHAT ARE YOUR BIGGEST HAZARDS?

20 WHAT ARE YOUR UNIQUE POPULATION S NEEDS?

21 New Requirement UNIQUE NEEDS

22 TOOLS AVAILABLE TO HELP YOU ASSESS YOUR RESIDENTS UNIQUE NEEDS

23 STRATEGIES TO ADDRESS IDENTIFIED RISKS Specific policies and procedures based on risk assessment

24 Emergency Operations Plan Templates

25 HAZARD SPECIFIC PROCEDURES

26 NEW REQUIREMENT All HAZARD PLANNING How prepared are you to provide care during evacuation? How prepared are you to sustain through 3-5 days? How prepared are you to communicate during events?

27 STRATEGIES FOR EVACUATION AND SHELTER IN PLACE

28 EVACUATION ALWAYS THE BEST CHOICE? preliminary data suggests that evacuation has unintended consequences in terms of mortality, hospitalization, and functional decline. Vincent Mor, PhD - Center for Gerontology and Healthcare Research, Brown University, Providence, RI, USA

29 EXPANDED REQUIREMENT PLANS TO EVACUATE INCLUDE: Care and treatment of evacuees Staff responsibilities Transportation Identify suitable site(s) for evacuees Primary and alternate means of communication with external sources of assistance Resident Tracking

30 MEDICAL DOCUMENTATION THAT PRESERVES RESIDENT INFORMATION, AND ENSURES INFORMATION IS PROTECTED AND READILY AVAILABLE

31 NEW REQUIREMENT: SYSTEMS TO TRACK RESIDENTS AND STAFF

32 SUITABLE RE-LOCATION SITES

33 EXPANDED REQUIREMENT PLANS TO SHELTER IN PLACE FOR RESIDENTS, STAFF AND VOLUNTEERS Hardened to withstand hazard Secure building against damage Collaboration with local authorities Sufficient resources for 3-5 days Assigning of staff Means of Resupply Security Strategies Emergency financial needs

34 FOOD, WATER, MEDICAL SUPPLIES In-House Stock SUPPLIES EQUIPMENT Collaboration with vendors for resupply

35 PROVISION OF SUBSISTENCE NEEDS FOR STAFF AND RESIDENTS, WHETHER EVACUATION OR SHELTER IN PLACE

36 EXPANDED REQUIREMENT ALTERNATE SOURCES OF POWER Temps to protect resident health and safety and safe storage of provisions Emergency lighting Fire detection, extinguishing, and alarms systems Sewage and waste systems

37 EXPANDED REQUIREMENT GENERATORS Located in safe area Inspected and maintained Tested in accordance with NFPA 99 & 110, 101-LSC New testing requirement ($$ and environmental impact) o Annual test for a minimum of 4 continuous hours on full load

38 NEW REQUIREMENT COMMUNICATION PLAN UPDATED ANNUALLY INCLUDING: State and federally-compliant systems Names and contact info for staff Entities providing services Resident s physicians Other LTC facilities Volunteers

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40 FACEBOOK DURING DISASTER???

41 AND DON T FORGET TO TELL YOUR RESIDENTS AND FAMILIES ABOUT YOUR PLAN!

42 So, when. an entire neighborhood erupts in flames..

43 How do they Manage?

44 NIMS and the Incident Command System (ICS) One of the most important 'best practices' that has been incorporated into the NIMS is the Incident Command System (ICS), a standard, on-scene, all-hazards incident management system already in use by firefighters, hazardous materials teams, rescuers and emergency medical teams. The ICS has been established by the NIMS as the standardized incident organizational structure for the management of all incidents.

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46 FIVE MAJOR INCIDENT COMMAND SYSTEM FUNCTIONS Activate what you need! Incident Command ONLY POSITION that is ALWAYS ACTIVATED Operations Section Planning Section Logistics Section Finance/ Administration Section THE DOERS RESIDENT CARE RESCUE SECURITY REPAIR THE THINKERS Forecasts Intelligence Monitoring changes Preparing reports Documenting THE GETTERS People Equipment Stuff needed to support the response THE PAYERS Tracks costs and procurement Screens volunteers Handles claims ACTIVATE ONLY THOSE POSITIONS THAT ARE NEEDED

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49 TRAINING AND TESTING

50 TRAINING Training program must do all the following: Initial training in emergency prep to all new and existing staff, on hire Individuals providing services under arrangement, And volunteers consistent with their role Provide at least annually Maintain documentation Ensure that staff can demonstrate knowledge

51 NEW REQUIREMENT DRILLS Participate in a community mock drill at least annually If not available, conduct a facility-based mock drill Conduct a paper-based table top at least annually Analyze response to drill and table top

52 DEBRIEF FROM EXERCISES AND DRILLS After Action Reviews: Lead with questions, not answers Engage in dialogue and debate Conduct autopsies without blame Revise your plan accordingly Jim Collins

53 FULL SCALE DRILLS (COMMUNITY)

54 DISCUSSION-BASED EXERCISES (DBE)

55 Collaboration The last thing you want to do is meet for the first time in a disaster Build relationships now Rescue and evacuation require outside resources Contact list for key response partners: OES/EMS/Fire/Law Enforcement State licensing agency Transportation Vendors Trade Association/Red Cross

56 Local Level

57 Provider Level

58 Next Steps COALITIONS

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62 Recovery and Restoration

63 NEW REQUIRMENT PLANNING FOR RECOVERY

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65 Skilled Nursing Facilities Emergency and Safety Standards- R Assisted Living Facilities Emergency and Safety Standards- R Disaster Plan Developed, documented and maintained in an accessible location to caregivers Illustrates When, how and where residents will be relocated States how resident s medical record will be available to individuals providing services during disaster Plan to ensure medication availability for each resident during a disaster Plan for food and water Reviewed annually- documentation of review

66 Your Solution

67 Skilled Nursing Facilities Emergency and Safety Standards- R Assisted Living Facilities Emergency and Safety Standards- R Disaster Drills for Employees On each shift at least once every three (3) months Evacuation Drills Employees and residents Every six (6) months Include all individuals on premises except Resident w/ medical record containing documentation that participation will cause harm Sufficient caregivers provided in the facility for residents not participating

68 Skilled Nursing Facilities Emergency and Safety Standards- R Assisted Living Facilities Emergency and Safety Standards- R Evacuation Drills Documentation Created and maintained for at least 12 months after the date of the drill Date / time of the drill Records the amount of time taken to evacuate both residents and employees Identification of residents needing assistance for evacuation Identification of residents not evacuated Problems identified during drill Recommendation for improvement (if applicable)

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70 Skilled Nursing Facilities Emergency and Safety Standards- R Assisted Living Facilities Emergency and Safety Standards- R Evacuation Path Signage is conspicuously posted in each hallway of each floor depicting the evacuation path Resident receives orientation to exits and exit routes within 24 hours of acceptance Orientation is documented

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72 Operationalizing Med Pass Emergency Preparedness Resource Manual Stan Szpytek, AzHCA Consultant Sylvia Balistreri, Director of Quality & Regulatory Services

73 Emergency Preparedness Planning and Resource Manual FEATURES AND BENEFITS All Hazards Emergency Operations Plan (EOP) Utilizes Concepts Promoted by the National Incident Management System (NIMS) Integrates the Incident Command System (ICS) Meets Existing CMS Requirements Meets Proposed CMS Requirements

74 Emergency Preparedness Planning and Resource Manual ROLL-OUT

75 Emergency Preparedness Planning and Resource Manual OPERATIONALIZE Options Enhance Your Existing Plan Utilize the Med Pass Template as Your EOP FILL-IN THE BLANKS!!

76 Emergency Preparedness Planning and Resource Manual FORMAT Printed Copy (manual) Writeable Disk Word PDF Formatting Instructions Included

77 Emergency Preparedness Planning and Resource Manual TABLE OF CONTENTS Very Comprehensive Sections Sub-sections Page Numbers

78 Emergency Preparedness Planning and Resource Manual TABLE OF CONTENTS I. Introduction II. Hazard and Security Vulnerability Assessment III. Emergency Preparedness Collaboration IV. Emergency Preparedness and Planning V. Emergency Response VI. After Incident Recovery VII. Emergency Plan Maintenance VIII. Resources

79 Section V: Emergency Response A. Evacuation B. Shelter-in-Place C. Fire Emergency D. Missing Resident E. Severe Weather / Natural Disaster F. Utility Outage G. Haz-Mat Incident H. Workplace Aggression I. Active Shooter / Armed Intruder J. Deadly Weapons Considerations K. Facility Lockdown L. Nuclear Power Plant M. Suspicious Package N. Medical Emergency O. Epidemic/Pandemic P. Terrorist Attack

80 A. CMS Emergency Prep Checklist B. Generator Information C. Floor Plan of the Facility D. Agreements E. Staff Action Cards F. Incident Action Plan G. Emergency Provisions Form H. Employee Emergency Prep I. Family Disaster Plan J. Sample Disaster Menu K. Morgue Log Sheet L. Evac Route & Directions M. Sample Letter to Family- Evac N. Resident Evac ID Guidance O. Resident Evac Tracking Log P. NIMS Course Fact Sheets Q. Business Interruption Planning R. COOP Template S. Resident Acuity- Evacuation T. Resident Evacuation Checklist U. Resident Emergency Packets V. Transfer Techniques W. Emergency Shutdown Proc. X. Severe Weather Info Sheets Y. Workplace Aggression / Violence Z. Active Shooter Task Checklist AA. LTC Pandemic Flue Checklist BB. CDC Hurricane & Flood Recovery CC. Infection Control Checklist DD. Glossary EE. Sources

81 Additional Resources

82 Additional Resources

83 The Big One

84 Facilities in AZ will be

85 Operationalizing Med Pass Emergency Preparedness Resource Manual Stan Szpytek, AzHCA Consultant Mobile Number: Sylvia Balistreri, Director of Quality & Regulatory Services Office Number: