Disaster Nursing Informatics: Are you ready?

Transcription

1 Disaster Nursing Informatics: Are you ready? Miami VA Healthcare System Kathryn Ginger Ward-Presson, MSN, RN Kathryn G. Sapnas, PhD, RN, CCRN, CNOR Susan Mangery, RN, M.ED., BSN, BS, C.N.A, BC Cathleen Rhoades, MS, RN 1

2 Objectives 1) The participant will be able to verbalize at least two reasons how relevant historical events contributed to the evolution and development of the technology assessment process. 2) The participant will be able to verbalize the process used to develop this Best Practice in Nursing Informatics Disaster Preparedness and Response. 3) The participant will be able to identify the potential impact disasters can create in regards to disruption of information technology, operations, and patient care. 2

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4 Disaster Timeline Miami VA Fire 9/16/04 Hurricane Ivan Katrina National Disaster Medical 9/25/04 Hurricane Jeanne Activation & Reception of Gulf Evacuees at Airport Aug-92 Mar-00 Aug-04 Sep-04 Nov-04 Aug-05 Sep-05 Sep-Oct 05 Sep-06 Oct-05 Sep-Oct 05 Apr Post 2004 Post Hurricane Hurricane Hurricane Hurricane Hurricane Evidence Hurricane Hurricane Andrew Charlie Katrina & Rita Wilma Based Season Katrina Review of National Nursing Review of Literature Disaster Literature Technology Medical Assessment Activation 4

5 Miami VA Disaster Informatics Historical Timeline DATE EVENT SITUATION/STATUS ISSUES/LESSONS LEARNED August 22-23, 1992 Hurricane Andrew Community and hospital infrastructure devastation March 2000 Miami VA Fire VA patients transferred out to other VAs Staff went with patients to work at other VAs August 13, 2004 Hurricane Charley Disaster Emergency Medical Personnel System Deployment/Internal Patient Care Related September 9, 2004 Hurricane Frances Disaster Emergency Medical Personnel System Deployment/Internal Patient Care Related September 16, 2004 Hurricane Ivan Disaster Emergency Medical Personnel System Deployment/Internal Patient Care Related September 25, 2004 Hurricane Jeanne Disaster Emergency Medical Personnel System Deployment/Internal Patient Care Related November 2004 Post Hurricane 2004 Season Initial Review of the Literature Developed processes to survive Staff needed to be prepared for role flexibility and adaptability Develop excellent open communication with staff and keep them informed The need for point of care access to Computerized Patient Record System, Bar Code Medical Administration System, and glucometer testing machines The need for point of care access to Computerized Patient Record System, Bar Code Medication Administration System, and glucometer testing machines The need for point of care access to Computerized Patient Record System, Bar Code Medication Administration System, and glucometer testing machines The need for point of care access to Computerized Patient Record System, Bar Code Medication Administration System, and glucometer testing machines After action reports and debriefing after each hurricane is absolutely necessary 5

6 Miami VA Disaster Informatics Historical Timeline (continued) DATE EVENT SITUATION/STATUS ISSUES/LESSONS LEARNED August 23, 2005 Hurricane Katrina Direct Cat 1; Miami-Dade major power loss set stage for the Disaster Informatics Technology Assessment Outpatient and Community Based Outpatient Clinic service delivery: affected logistics and information August 31, 2005 Post Hurricane Katrina Miami VA National Disaster Medication System Activation September 2-3, 2005 Post Hurricane Katrina Miami VA National Disaster Medication System Activation; Miami Air Reception of Gulf Evacuees from New Orleans: technology inventory September-October 2005 Post Hurricane Katrina Literature Search to support evidence-based practice Development of Miami VA Nursing Model for Technology Assessment-Disaster Focused Technology Assessment September 20, 2005 Hurricane Rita Preparing for second National Disaster Medication System Activation October 23, 2005 Hurricane Wilma Dade/Broward/Palm Beach County wide-spread power outage April 2006 Evidence-based Nursing Technology Submit to Nursing Executive Committee and Senior Leadership Field hospital set up at Opa Locka, impacted service delivery; affected logistics, and technology. Gap in the literature related to impact Implemented Lessons Learned from Opa Locka during Katrina Multiple systems affected; hospital, clinics, major impact to community infrastructure, employee home structure, process & outcomes assessed, service delivery, patient care was affected Complete Nursing Informatics Technical Assessment 6

7 Evolution of Disaster Technology Assessment 2004 Literature reviews began our journey to informatics disaster preparedness Identified current practices 2005 evolved best practices to support our emergency disaster plans and create process, structure and positive outcomes Emergency preparedness and response plan is consistent with our Magnet Journey 7

8 Getting Ready for the Storm 8

9 Lessons Learned from Past Hurricanes 9

10 Hurricane Season 2005 Hurricane Katrina (August 23rd, 2005) Power outages in Community Based Outpatient Clinics (CBOCs) and employees homes Katrina sets the stage for the Disaster Informatics Technology Assessment Katrina evacuees from Louisiana and Mississippi at the U.S. Miami Coast Guard airbase to Miami VA and other surrounding hospitals 1 st level technology assessment and needs documented in the field Literature search conducted on technology assessment and disasters after Katrina events Hurricane Rita (September 20, 2005) Power outages in Community Based Outpatient Clinics 10

11 Miami VA Staff Helping Post Katrina Victims 11

12 Miami VA Staff Receiving Post Katrina Evacuees at Opa Locka Airport 12

13 Receiving Patients From the Gulf in C

14 Miami VA staff. 14

15 Then came Wilma! October 24,

16 Hurricane Wilma Hits Florida Coast 16

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18 Florida: Hardest Hit in Years Hurricane Wilma (October 24, 2005) Major damage to some Community Based Outpatient Clinics Damage to Miami VA Medical Center patient care is affected Many personnel have devastating damage to homes and no electricity for weeks to months Initial Nursing Technology Assessment conducted at CBOCs and field clinics 18

19 Assessment of Damage Post Wilma Winds up to 105 knots Tornadoes Considerable rainfall and flooding Widespread extensive damage The largest disruption to electrical service ever experienced in Florida Up to 98 per cent of South Florida lost electrical service, and some areas out for a month Numerous trees, power lines and poles down Broken windows, crop losses, extensive roof damage, and destruction of homes 19

20 Miami Nursing Staff Affected Nurses at the Miami VAHCS suffered much personal loss and hardship. Many nurses came to work as their families sat at home in dark, hot homes with little food to eat and no place to buy necessary items. Gasoline was not available due to power outages at gas stations. 20

21 Outpatient Clinic Status Immediately After Hurricane Wilma County Clinic Name Days Clinic Closed Days Clinic Open with Mobile Unit on Site Mobile Unit County Community Site Broward Oakland Park 1 3 Pembroke Pines 5 Hollywood 5 Coral Springs 7 Deerfield 7 Margate - 4 Dade Homestead 2 4 Monroe Key Largo Key West 2 2 ½ 21

22 Teamwork! 22

23 How Can We Continue Care to Our Veterans? Gulf Model - Use Vans Equipped With: 1) Electricity 2) Clinic Supplies 3) Private Exam Areas 4) Satellite for Technology Connections 23

24 Miami VA Emergent IT Response to Patient Care Needs Emergency Disaster Mobile Clinics In strategic locations across Broward and Miami-Dade counties Set up for veterans and non veterans to get care Remote Satellites (2) At 2 locations to be able to use wireless connectivity to hospital system (VISTA) and computerized patient record system (CPRS) Included 6 laptop computers for use by staff and 1 network printer per satellite deployment Telecommunications Nextel phones distributed to staff as needed 24

25 Oakland Park Sets Up Mobile Clinic for Continuity of Patient Care 25

26 Patient Care Post Wilma at Oakland Park 26

27 Administrators and Staff at Work 27

28 Mobile Clinic Opens at a Broward Community Site 28

29 Miami VA Senior Leadership Visit Mobile Clinic 29

30 Planning for Contingencies! 30

31 Mobile Clinic Opens at Homestead Clinic 31

32 Laptop Use at the Homestead CBOC 32

33 State of the Art Communication! 33

34 Nursing Technology Data Collection Initial information technology needs data collection began right after Hurricane Katrina Continued data collection occurred with Hurricane Wilma Data collection organized using the VA National Nursing Information Technology Report A model for Miami VA technology assessment was developed, based on the literature to guide our assessment and findings Evidence-based literature set the tone for what to assess and document 34

35 Miami VA Nursing Technology Assessment Process Identifying and Ranking Assessment Topics Evaluation General Function Hardware/Software Access/Availability Technical Needs Assessment Training/Support Equipment Inventory/ Needs Assessment Data Synthesis Dissemination of Information Monitoring the Effectiveness Figure 1. Process of Miami VA Nursi ng Technology Assessment * adapted from FinOHTA Report 8: Technology assessment in Nursing: A systematic review of the Finnish and International Literature and the VA Annual Nursing Information Technology Assessment and Informatics Survey (draft). 35

36 Environment General Function Disaster work environment (field hospital/mobile clinic) Safety and Serviceability Weather conditions Space and Workflow of clinics HIPPA considerations Communications Technology Deployment Nextel phones/walkie talkies (two way communications) Access to VPN (Virtual Private Network) Staff Cascade call lists Patient Call Lists Patient Population Veteran/Non Veteran Special Populations children, elderly, frail 36

37 Hardware/Software Needs Assessment Hardware Satellite capabilities Storage and Set up Protection in adverse weather Laptop computers Wireless network cards Strategic placement of laptops/printers to enhance workflow Consider privacy screens Printers Determine best of breed printer equipment Printers selected 37

38 Hardware/Software Needs Assessment Software Computerized Patient Record System (CPRS) Health Summary Reports Appointment Lists Medication Profiles Access to Network Drive/Web page Disaster inventory lists Computer Contingency Plans Have downtime documents ready 38

39 Access/Availability Clinical Staff/Providers Determine numbers of staff/providers needed to maintain clinic operations Develop and define roles of each team member within disaster clinic Assure appropriate computer access 39

40 Technical Training/Support Information Resource Management (IRM) IT specialists assigned to specific clinic sites Develop and define roles of IT specialists to support clinic staff 40

41 Equipment Inventory/Needs Assessment Documented inventory equipment lists for each clinic On network drive or on web page Technical equipment Clinical equipment including medications 41

42 Learned Lessons in Technology Disaster Planning Plan, Plan, Plan! Communication Debriefing Planning Meetings with Everyone Pre & Post Disaster Staffing Assignments Current Call Back Lists Routine Maintenance Checks of Equipment Jump Bags Ready 42

43 Report Submitted MIAMI VA HEALTHCARE SYSTEM NURSING INFORMATICS TECHNOLOGY ASSESSMENT: DISASTER PREPAREDNESS AND RESPONSE Report Prepared By: Submitted: April 7, 2006 Report Commissioned by: Kathryn Ginger Ward-Presson, MSN, RN Associate Director Nursing Care Services Kathryn G. Sapnas, PhD, RN, CCRN, CNOR Susan Mangery, RN, M.Ed., BSN, BS, CAN, BC Cathleen Rhoades, MS, RN 43

44 Nursing Informatics Technology Assessment MIAMI VA NURSING ANNUAL NURSING INFORMATION TECHNOLOGY REPORT 2006 Appendix A ASSESSMENT ACTION TIMELINE RESPONSIBILITY RESOURCES PERFORMANCE INDICATOR General Function: Environment 1. Safety and serviceability 2. Weather conditions 3. Set up of clinic - space Group assessment of various clinic sites for disaster clinics considering space, patient safety and various weather conditions such as wind, heat, rain, and flooding areas January 2006 Assess again as needs arise Facilities Management IRMS Nursing Service MAS Assoc. Chief Selma Zolotas, Chief Engineering P. Gwen Findley, PhD, Chief IRMS Kathryn Ward- Presson, Associate Director of Nursing Care Steve Williamson, Chief of MAS Assessment and determination of complete environmental needs for disaster setup in 75% of clinic sites will be completed before the 2006 hurricane season (June 2006). 4. Work flow of clinic Assessment of space considering the work flow of the clinic March 2006 Outpatient Clinics (CBOCs) Susan Mangery, RN, M.ed, BSN, BS, BC, Assoc. Chief Outpt Clinics, CBOC staff Cathy Rhoades, MS, RN, Nurse Informaticist Assessment and determination of space related to workflow in 75% of clinic sites will be complete before the 2006 hurricane season (June 2006). IRMS IT Specialists 44

45 Are You Ready? 45

46 References Alexander, J.W., Kroposki, M. (2001). Using a management perspective to define and measure changes in nursing technology. Journal of Advanced Nursing, 35, 5, Braun, E. (1998). Technology in Context: Technology assessment for managers. Routledge: New York. Caper, G. R. (2005). A framework for technology assessment: Approaches for the selection of a home technology device. Clinical Nurse Specialist, 19, 4,

47 References Captain Tropic. (2002). A collection of hurricane photos taken from space. Hurricane and disaster preparedness. Retrieved on June 20, 2006 from hurricane_space_shots.html Department of Veterans Affairs Annual Nursing Information Technology Survey FinOHTA and Health Services Research Unit (1998). Technology assessment in nursing: A systematic review of the Finnish and International literature. Retrieved October 27, 2005 from Kirkley, D., Johnson, P., & Anderson, M. (2004). Technology Support of Nursing Excellence: The Magnet Connection. Nursing Economics, 22, (2),

48 References McMahon, D. (2002). Evaluating new technology to improve patient outcomes: A quality improvement approach. Journal of Infusion Nursing, 25, 4, Pillar, B., Jacox, A. (1990). Nursing & Technology: Useful Sources of Information for Technology Assessment. Nursing Economics, 8, (3), Pillar, B., Jacox, A., & Redman, B.K. (1990). Technology and its assessment and nursing. Nursing Outlook, 36, (1), Whittenburg, C. (1995). A program proposal for technology assessment. AORN Journal, 61, 2,