Business Continuity Plan for Obstetrics/Gynaecology/Sexual Health Directorate INITIATED BY: APPROVED BY: To be completed can be approved locally and does not need to go to a formal board or committee Chris Moulds/Rachel Fielding Senior Management Team DATE APPROVED: June 2016 VERSION: Two OPERATIONAL DATE: June 1 st 2016 DATE FOR REVIEW: 3 years from date of approval or if any legislative or operational changes require DISTRIBUTION: To be placed on Sharepoint and File share Maternity folder. Distributed to all doctors via the weekly rota. Distributed to Midwives/ Nurses via global E Mail. To be completed to include Civil Contingencies for addition to SharePoint FREEDOM OF INFORMATION STATUS: Open
Definition of a Business Continuity Plan (BCP) A BCP sets out the business impact risks for a particular area and then sets out the detailed step-by-step instructions that describe the appropriate method for carrying out tasks or activities to maintain the core function of that area and its service delivery until normal operating can resume. These actions are contained in action cards i
CONTENTS Definition of a Business Continuity Plan (BCP)... i Minor Amendments... i 1. Purpose... 1 2. Training, testing & exercising... 1 3. Business impact analysis... 1 ACTION CARD 1 - WATER SUPPLY FAILURE... 6 ACTION CARD 2 - ELECTRICITY FAILURE... 9 ACTION CARD 3 - HEATING... 13 ACTION CARD 4 - PIPED MEDICAL GASES FAILURE... 15 ACTION CARD 5 - BLEEP SYSTEM FAILURE... 18 ACTION CARD 6 - TELEPHONE SYSTEM FAILURE... 20 ACTION CARD 7 - CLINICAL SYSTEM / ESSENTIAL MEDICAL DEVICES FAILURE... 22 ACTION CARD 8 - IT DESKTOP SYSTEMS FAILURE... 24 ACTION CARD 9 SPECIAIST IT SYSTEMS... 25 ACTION CARD 10 STAFF AVAILABILITY... 28 ACTION CARD 11 SPECIALIST STAFF AVAILABILITY... 29 ACTION CARD 12 SITE ACCESS DENIAL... 30 ACTION CARD 13 ADVERSE WEATHER 31 ACTIONCARD 14 - FIRE 32 ii
1. Purpose This plan meets the requirements of the Health Boards Civil Contingencies Strategy and Business Continuity Policy. The purpose of this plan is to set out the risks to the normal operating of the Obstetrics, Gynaecology & Sexual Health Directorate and includes both inpatient and outpatient services. This includes Acute and Community Obstetric services and Community Gynaecology and Sexual Health services. In the event that the risks are realised, the action cards set out what staff are expected to do in order to maintain service delivery until normal service is resumed. Departments within the organisation have responsibility for disaster recovery e.g. Estates refurbishing a ward after a fire. These plans are held by those Departments. 2. Training, testing & exercising This plan will be communicated to staff via local meetings e.g. Directorate Quality & Safety Meetings, Management meetings, Ward Managers / Team meetings, Ward meetings, Labour ward forum and a copy will be given to staff in the annual mandatory training programme. A copy will be given to all ward managers / team leaders and the plan will be stored on Sharepoint with the Health Board Business Continuity Plan file, in the Maternity guidelines folder on Sharepoint and will also be filed in the Maternity file share folder for all staff to access. Training will be provided via established training forums within the mandatory training days with support from the Contingency Planning Department. Testing and exercising of the Action cards will take place during the training sessions through the use of scenarios. Action cards will be tested annually by the use of scenarios at ward level i.e. the staff on the ward will be asked to respond to a potential scenario using the action cards. 3. Business impact analysis Below is a schedule of the potential risks to the normal delivery of services and a list of the action cards that will be used in the event of those risks being realised. 1
Risk Brief description of impact Mitigation Utilities failure Water Unable to provide planned and emergency surgical procedures due to lack of hand washing facilities. Action number 1 card Dehydration risk to patients and staff. Risk of infection prevention and control. Electricity Risks to patients and staff safety / clinical risks to patients which include: Action number 2 card 1. lack of a security system increasing the risk of baby abduction 2. Lack of continued electronic cardiotograph monitoring (CTG) for the high risk pregnancies (e.g. diabetes or high blood pressure) or a condition that might affect the health or development of the baby 3. Lack of diagnostic tests e.g. Ultrasound scans 4. Unable to maintain essential services such as baby heat pads/ theatre equipment. 2
Risk Brief description of impact Mitigation Heating Hypothermia risk to patients and babies (seasonal). Action number 3 card Risk of staff welfare and wellbeing which may impact on sickness / stress rates. Piped Medical gasses Lack of medical gases will be a clinical risk to women / patients which include: 1. Use of entenox in labour. 2. Use of oxygen / air for resuscitation procedures. 3. Use in theatre procedures e.g. anaesthetics. Action number 4 card Bleep system Clinical risk to patients. Risks include: Action number 5 card 1. Unable to activate the emergency 2222 / 3333 calls. 2. Unable to summon Obstetric / paediatric assistance in emergency situations. 3. Lack of Obstetric advice to be given to other departments within the Health Board e.g. A&E department. 3
Risk Brief description of impact Mitigation Telephone System Clinical risk to patients. 1. Inability to communicate incidents and action e.g. fire, plan of care. Action number 6 card 2. Unable to contact Community Midwifery services for home birth / emergency community events. Clinical systems/essential medical devices Clinical risk to patients which include: Action number 7 card 1 Use of medical devices for high risk pregnancies e.g. Diabetic women / administration of antibiotics and other medication requiring specific infusion rate. IT desktop systems (e.g. Citrix) Clinical risk to patients as this would cause disruption to normal business. Action number 8 card 1. Unable to respond to patient concerns/ Datix. 2. Communication within the Directorate is predominately via E mail. Specialist IT systems: Welsh Clinical Portal, RADIS, Maternity Information System (MITS) Sexual Health (Lillie) Clinical risk to patients as this would cause disruption to normal business.1. Unable to access the Welsh Clinical Portal system to view patient results and plan care. 2. Unable to upload vital information relating to the woman / patient so all staff can access the process in Action number 9 card 4
Risk Brief description of impact Mitigation Specialist IT systems: Welsh Clinical Portal, RADIS, Maternity Information System (MITS) Sexual Health (Lillie) Clinical risk to patients as this would cause disruption to normal business.1. Unable to access the Welsh Clinical Portal system to view patient results and plan care. 2. Unable to upload vital information relating to the woman / patient so all staff can access the process in order to provide safe and effective care. Action number 9 card Staff Availability Staff unable to attend work because of illness (pandemic) or other issues (adverse weather / snow). Clinical risk to women/ patients if: Inadequate numbers or skill mix of staff are available. Action card number 10 Specialist staff Site access denied Adverse weather Normal services would not be able to be maintained producing a clinical risk to patients if: inadequate numbers of appropriately trained staff Inadequate skill mix of staff are available. This would provide a clinical risk to patients as normal services would not be able to be provided Staff unable to attend work because of adverse weather conditions (snow) Action card number 11 Action card number 12 Action card Number 13 Fire Disruption to patient care and patient and staff wellbeing Action 14 card 5
ACTION CARD 1 - WATER SUPPLY FAILURE In the event of an interruption of water supply to a single ward or department, the fault will need to be reported immediately to the Estates Department. Action Plan: The nurse/midwife in charge to undertake or delegate the following duties to staff: Report: Report the fault to the Estates Helpdesk (WHTN 01854) ext 8888 or, out of hours, the on call Estates Officer via Switchboard. Ensure that the Estates Department is aware of the time of water supply failure, precise location, effect, impact and risks and any urgent requirements. Try to ascertain an estimated time period for the disruption/ resolution. Infection Prevention & Control/Personal Hygiene: Provide patients with hand "wet wipes" as necessary. Advise new mothers to use wet wipes to clean their babies Utilise spray foam cleansers for sanitizing skin when changing soiled patients. Nursing / midwifery staff should maintain hand hygiene using hand wipes and alcohol rub. Use disinfectant wipes to cleanse surfaces as necessary. Carry out only essential procedures on community/out patients reschedule complex procedures. Waste Disposal: Inform patients that the toilets will not flush. Determine which waste may be discarded in the sluice hopper, and which receptacles can be cleaned manually using appropriate detergents (Chlorclean or detergent and Sodium Hypochlorite solution). This process CAN be used for waste from infected patients, such as those with Clostridium Difficile. Alternatively, use disposable bedpans/urinals and discard used items and products in clinical waste bags. 6
Staff must be reminded of their responsibilities regarding Infection Prevention & Control and Health and Safety, and must wear personal protective equipment (PPE) such as aprons, gloves and masks/goggles as necessary, and must comply with COSHH regulations when handling detergents. The sluice hopper will not flush, and it may be necessary to store receptacles such as bed pans containing waste in a designated area in the dirty utility/sluice room, pending the return of the water supply. Standard infection prevention & control measures must be adhered to i.e. keeping items covered, hand cleansing etc. If in doubt, seek advice from the Infection Prevention & Control Team. Hydration and Nutrition: If the loss of water supply is noted on a single ward, obtain a water supply from the nearest ward or department. In the event of a significant or prolonged disruption to the water supply, bottled drinking water will be distributed to the wards via the Catering Department. A limited number of large dispensing flasks may be obtained from Catering Department to enable hot and cold water for drinks to be transported to the ward from an area unaffected by water supply failure. Disposable cups etc may need to be used when the regular supply of crockery has been used. Risks assess patients' safety/ability to use disposable cups. Provide assistance where necessary. Communication: Inform the Duty Bed Manager/Senior Nurse/midwife, who will escalate the information to the Directorate/Senior Manager on call. If no contact can be made with the Duty Bed Manager/Senior Nurse/midwife contact a Senior Nurse/midwife via Switchboard. Use discretion with regard to informing patients and visitors do not cause undue concern. Security: There may be engineers etc. coming and going. Please ensure that ID is shown. Ensure the woman, patient and visitors within the areas are all kept informed of the problem and the actions put into place. Do not cause undue concern. Signs should be displayed to ensure everyone is aware of the ongoing problem. REMAIN IN COMMUNICATION WITH THE DUTY BED MANAGER/ SENIOR NURSE/MIDWIFE 7
YOU WILL RECEIVE ADVICE FROM THE ABOVE CONTACT REGARDING ANY FURTHER ACTION TO BE TAKEN Return to Normal Working: On resumption of the water supply, the Estates Department will give instructions regarding any water quality checks/ running of water/flushing of outlets that need to be performed before resumption of water use. Liaise with the Duty Bed Manager/Senior Nurse/midwife regarding any additional staffing requirements to assist with the service/ activity recovery process e.g. catching up on bed baths, washes etc. 8
ACTION CARD 2 - ELECTRICITY FAILURE In the event of a major interruption to the electricity supply to wards, in most cases, the emergency generators will automatically activate, to provide power to the emergency (red) E sockets and emergency lighting. In the event of a local power failure to a single ward or department, the emergency generator may not activate automatically and the fault will need to be reported immediately to the Estates Department. Action Plan: The nurse/midwife in charge to undertake or delegate the following duties to staff: Report: Report the fault to the Estates Helpdesk (WHTN 01854) ext. 8888 or, out of hours, the on call Estates Officer via Switchboard. Ensure that the Estates Department is aware of the time of electricity supply failure, precise location, effect, impact and risks and any urgent requirements. Try to ascertain an estimated time period for the disruption/ resolution. Communication: Contact Clinical Engineering on (WHTN 01751) ext 3628 (RGH) or (WHTN 01854) ext 8200 (PCH) or, out of hours, the on call technologist via Switchboard. Inform the Duty Bed Manager/Senior Nurse/midwife, who will escalate the information to the Directorate/Senior Manager on call. If no contact can be made with the Duty Bed Manager/Senior Nurse/midwife contact a Senior Nurse/midwife via Switchboard. Use discretion with regard to informing patients do not cause undue concern. Community clinics/out Patient clients to be informed accordingly, ensuring safe exit from premises, if in darkness Lighting: Get out the emergency torches and lanterns which are located within the theatre. Sockets: Check the emergency/red E sockets have power. 9
Switch off and unplug any non essential electrical items from emergency sockets as it is important not to overload the system. Medical Devices (Clinical Engineering): Contact Clinical Engineering on ( WHTN 01751) ext. 3628 (RGH) or (WHTN 01751) ext. 8200 (PCH) or, out of hours, the on call technologist via Switchboard. Check all medical devices in situ to ensure battery back up power is working. Check the emergency equipment i.e. ventilators, defibrillators, patient monitoring etc. are working on battery back up power or UPS. Try to locate an alternative device from another area if necessary. If battery power fails take the following steps; 1) Replace with alternative medical device if available, if not try to locate an alternative device from another area. 2) If no alternative immediately available, contact the Duty Bed Manager/Senior Nurse/midwife/Clinical Engineering equipment library. Note the time of the power failure to help to estimate the period of back up power available on equipment in use. Some newer devices may be able to indicate how much battery back up power is available. Identify any patients being nursed on inflatable mattresses. Risk assess the situation and plan for potential transfers to alternative beds/mattresses depending on anticipated timescales for return of power(do not task staff/patients with unnecessary moves if, by the time the moves have been done, power is restored). In some circumstances it may be necessary to use the beds of more ambulant patients as a short term measure. Locate the wards supply of manual sphygmomanometers and deploy for use in physiological monitoring. Meals: In the absence of facilities for producing hot drinks, cold alternatives should be offered. A limited number of large dispensing flasks may be obtained from the Catering Department to enable hot water for drinks to be transported to the ward from an area unaffected by the power disruption. Preparations should be made in conjunction with the Catering Manager, for the provision of sandwiches and cold meals in the absence of hot meal trolleys. Fridge temperatures should be monitored, and fridge contents 1
disposed of as necessary. In liaison with Catering Services, once power supply has been restored, replacement foods should be obtained. Waste Disposal: In the absence of a working sluice machine, bedpans and urinals may need to be emptied in the sluice hopper, and cleaned manually using appropriate detergents (Chlorclean or detergent and Sodium hypochlorite solution). This process CAN be used for waste from infected patients, such as those with Clostridium Difficile. Alternatively, use disposable bedpans/urinals and discard used items and products in clinical waste bags. Staff must be reminded of their responsibilities regarding Infection Prevention & Control and Health and Safety, and must wear personal protective equipment (PPE) such as aprons, gloves and masks/goggles as necessary, and must comply with COSHH regulations when handling detergents. IT: Manual requests for tests and investigations may need to be made. You may need to use a runner for this. Paper records of all patient movement i.e. transfers and discharges must be maintained, for inputting once power and computer access returns. Ventilation: If the air conditioning fails (seasonal), windows should be opened where possible to maintain a comfortable temperature. Safety: Patients will need to be given a means of attracting a nurse/midwife's attention in the absence of buzzers. If bells are available, these should be given to patients. In the absence of bells, make-shift systems such as a spoon to be rattled against a cup could be used. Security: Be vigilant regarding access and exit to the ward, clinical areas, check all visitors before allowing entry and ensure they sign the Register. Advise women not to leave their babies unattended at any time without informing a member of staff. Follow guideline for the security of newborn babies and children in hospital. Be extra vigilant during this period. If possible request security guards to man the maternity entrance to monitor babies leaving the Maternity unit. Every baby who is discharged home / leaves the unit to be accompanied by an appropriate healthcare professional. There may be engineers etc. coming and going. Please ensure ID is visible and checked as required Ensure the woman, patient and visitors within the areas are all kept informed of the problem and the actions put into place. Do not cause undue concern. Signs should be displayed to ensure everyone is aware of the ongoing problem. 1
REMAIN IN COMMUNICATION WITH THE DUTY BED MANAGER/SENIOR NURSE/MIDWIFE. YOU WILL RECEIVE ADVICE FROM THE ABOVE CONTACT REGARDING ANY FURTHER ACTION TO BE TAKEN. 1
ACTION CARD 3 - HEATING In the event of a local failure of the heating system to a single ward or department, the fault will need to be reported immediately to the Estates Department. Action Plan The nurse/midwife in charge to undertake or delegate the following duties to staff: Report: Report the fault to the Estates Helpdesk (WHTN 01854) ext. 8888 or, out of hours, the on call Estates Officer via Switchboard. Ensure that the Estates Department is aware of the time of heating failure, precise location, effect, impact and risks and any urgent requirements. Try to ascertain an estimated time period for the disruption/ resolution. Communication: Safety Inform the Duty Bed Manager/Senior Nurse/midwife, who will escalate the information to the Directorate/Senior Manager on call. If no contact can be made with the Duty Bed Manager/Senior Nurse/midwife contact a Senior Nurse/midwife via Switchboard. Use discretion with regard to informing patients do not cause undue concern. Community clients/out patients that have to wait/undress in cold areas, should be assessed, and where possible asked to return to an alternate clinic Following risk assessment encourage mothers to perform skin to skin contact for babies. Provide extra blankets Ask mothers to place additional clothing to new born babies eg hats, mitts. If necessary provide over head heaters or nurse on heated pads Refer to effective discharge planning guideline and where possible support early discharge home. Security: There may be engineers etc. coming and going. Please ensure that ID is 13
visible and checked as required Ensure the woman, patient and visitors within the areas are all kept informed of the problem and the actions put into place. Do not cause undue concern. Signs should be displayed to ensure everyone is aware of the ongoing problem. REMAIN IN COMMUNICATION WITH THE DUTY BED MANAGER/ SENIOR NURSE/MIDWIFE YOU WILL RECEIVE ADVICE FROM THE ABOVE CONTACT REGARDING ANY FURTHER ACTION TO BE TAKEN 14
ACTION CARD 4 - PIPED MEDICAL GASES FAILURE In the event of an interruption of piped medical gases supply to a single ward or department, the fault will need to be reported immediately to the Estates Department. Action Plan: The nurse/midwife in charge should undertake or delegate the following duties to staff: Report: Report the fault to the Estates Helpdesk (WHTN 01854) ext. 8888 or, out of hours, the on call Estates Officer via Switchboard. Ensure that the Estates Department is aware of the time of piped medical gases supply failure, precise location, effect, impact and risks. Contact Clinical Engineering on ( WHTN 01751) ext. 3628 (RGH) or (WHTN 01751) ext. 8200 (PCH) or, out of hours, the on call technologist via Switchboard for regulators and flow meters etc. Try to ascertain an estimated time period for the disruption / resolution. Oxygen: Switch off all piped oxygen flow meters and Nitrous Oxide. Risk assess which patients / babies must continue to receive oxygen therapy and entenox. Locate the ward or department's supply of portable oxygen and Nitrous Oxide cylinders. Ensure that there are sufficient supplies of flow meters, keys, connectors and cylinder holders when converting from piped oxygen to portable oxygen and Nitrous Oxide cylinder supply. Seek assistance with locating the required equipment and sufficient oxygen and Nitrous Oxide cylinder supplies from the Duty Bed Manager/Senior Nurse/midwife Contact Clinical Engineering on ( WHTN 01751) ext. 3628 (RGH) or (WHTN 01751) ext. 8200 (PCH) or, out of hours, the on call technologist via Switchboard. Medical Air: Switch off all piped medical air appliances 15
Locate the ward or department's supply of portable medical air cylinders. Ensure that there are sufficient supplies of flow meters, keys, connectors and cylinder holders. Seek assistance with locating the required equipment and sufficient oxygen cylinder supplies from the Duty Bed Manager/Senior Nurse/midwife. Nitrous Oxide: Switch off all piped Nitrous Oxide flow meters. Locate the ward or department's supply of portable Nitrous Oxide cylinders. Ensure that there are sufficient supplies of flow meters, keys, connectors and cylinder holders. Seek assistance with locating the required equipment and sufficient Nitrous Oxide cylinder supplies from the Duty Bed Manager/Senior Nurse/midwife. Suction: Switch off all suction flow meters that are delivered via wall units. Risk assess which patients must continue to receive suction. Locate the ward or department's supply of portable suction equipment (these should be checked daily). Seek assistance with locating the required equipment from the Duty Bed Manager/Senior Nurse/midwife. Waste Anaesthetic Gas Scavenging: Gas scavenging machines have built in resilience, however in the unlikely event that they fail completely a risk assessment must be undertaken and either Manually ventilate the room by opening windows, using fans etc. Relocate to an area where the gas can be scavenged. If possible stop undertaking procedures where gas scavenging is required until a repair can be undertaken. Communication: Inform the Duty Bed Manager/Senior Nurse/midwife, who will escalate the information to the Directorate/Senior Manager on call. 16
If no contact can be made with the Duty Bed Manager/Senior Nurse/midwife contact a Senior Nurse/midwife via Switchboard. Contact Clinical Engineering on ( WHTN 01751) ext. 3628 (RGH) or (WHTN 01751) ext. 8200 (PCH) or, out of hours, the on call technologist via Switchboard for regulators and flow meters etc. Use discretion with regard to informing patients do not cause undue concern. Safety: Identify patients requiring close supervision/regular physiological monitoring and ensure they receive appropriate care. Ensure patients, relatives and staff are aware of the presence of portable cylinders and other equipment that may increase the risk of tripping/falling. Staff should be vigilant regarding the storage and security of medical gas cylinders. All cylinders to be stored in nominated areas. Any discrepancies in stock or any unauthorised movement of medical gas cylinders should be immediately reported to Pharmacy Department, and if necessary, to Security. Security: There may be engineers etc. coming and going. Please ensure that ID is visible and checked as required REMAIN IN COMMUNICATION WITH THE DUTY BED MANAGER/ SENIOR NURSE/MIDWIFE YOU WILL RECEIVE ADVICE FROM THE ABOVE CONTACT REGARDING ANY FURTHER ACTION TO BE TAKEN 17
ACTION CARD 5 - BLEEP SYSTEM FAILURE The Hospital Bleep System is independent of the telephone system. While the failure of the telephone system would result in an inability to access and activate the bleep system, a fault to the bleep system could result in loss of bleep services, yet telephone services may remain unaffected. In order to maintain communications, the nurse/midwife in charge should do, or delegate the following duties to staff: Check that the telephones are working. Even if the majority of telephones are not working, there will be a single telephone connected to a separate central 'Switch' which should still work. This may be situated in a non clinical area in the ward. If no telephones are working, refer to the 'Telephone System Failure on Ward Action Card.' Action Plan: In the event of an interruption of the bleep system supply to the wards, the fault will need reporting immediately to Switchboard staff. Report: Report the fault to Switchboard staff. Ensure that Switchboard staff are aware of the time of bleep system failure, precise location, effect and impact. Try to ascertain the estimated timescales for disruption/ resolution. Switchboard may be able to supply mobile telephones for temporary use. If not, use own personal mobile telephone - priorities will need to be identified. Relevant staff should be informed of the mobile telephone numbers being used. Communication: Inform the Duty Bed Manager/Senior Nurse/midwife/ Senior Midwife, who will escalate the information to the Directorate/Senior Manager on call. If no contact can be made with the Duty Bed Manager/Senior Nurse/midwife/ Senior Midwife contact a Senior Nurse/midwife/ Senior Midwife via Switchboard. Use discretion with regard to informing patients do not cause undue concern. 18
EMERGENCY CALLS All 2222 / 3333 emergency calls i.e. Cardiac arrest, fire alert, Obstetric emergency and Security alert should still be made to Switchboard staff, who will contact the relevant team/service via numbers isolated for emergency calls or via mobile telephone. Safety: If staff are being deployed as 'runners' to relay messages, the nurse/midwife in charge must be made aware of the runner's intended destination, anticipated time of arrival and/or return back to the ward area. Personal alarms or deploying runners in pairs may prove necessary, particularly if the journey or destination is remote, or if the message is to be relayed outside of daylight hours. Security: There may be engineers etc. coming and going. Please ensure ID is visible and checked as required REMAIN IN COMMUNICATION WITH THE DUTY BED MANAGER/ SENIOR NURSE/MIDWIFE YOU WILL RECEIVE ADVICE FROM THE ABOVE CONTACT REGARDING ANY ADDITIONAL ACTION TO BE TAKEN. 19
ACTION CARD 6 - TELEPHONE SYSTEM FAILURE In order to maintain communications, the nurse/midwife in charge should do, or delegate the following duties to staff: Check the other telephones. Even if the majority of telephones are not working, there will be a single telephone connected to a separate central 'Switch' which should still work. This may be situated in a non clinical area in the ward. Action Plan: In the event of an interruption of telephone system supply to a single ward or department, the fault will need to be reported immediately to Switchboard staff. Report: Report the fault to Switchboard staff. Ensure that Switchboard staff are aware of the time of telephone system supply failure, precise location, effect and impact. Try to ascertain an estimated time period for the disruption/ resolution. RGH Cordless phones will not work but fixed phones are the fallback for a telephony failure PCH If no telephones are working, a member of staff will need to be sent to inform Switchboard staff. Switchboard may be able to supply mobile telephones for temporary use. If not, use own personal mobile telephone - priorities will need to be identified. Relevant staff should be informed of the mobile telephone numbers being used. Community/Out patient service staff have access to mobile phones for use in this situation The Community teams should be made aware the problem at the earliest time so local actions / arrangements can be put into place e.g home birth arrangements. Communication: Inform the Duty Bed Manager/Senior Nurse/midwife of the situation, by going to the nearest working telephone - this may not be in your ward or department. Identify any immediate risks or 20
concerns. If no contact can be made with the Duty Bed Manager contact another Senior Nurse/midwife via Switchboard. Instruct staff to only use the available telephone for urgent calls/bleeps. Inform relevant medical and all key staff e.g. pharmacy, physiotherapy, blood results reporting, of the available ward contact number (limit this cascade for urgent contacts only). Use discretion with regard to informing patients do not cause undue concern. Assess the need for faxing and implement an alternative system in the absence of faxing capability. Safety: If staff are being deployed as 'runners' to relay messages, the nurse/midwife in charge must be made aware of the runner's intended destination, anticipated time of arrival and/or return back to the ward area. Personal alarms or deploying runners in pairs may prove necessary, particularly if the journey or destination is remote, or if the message is to be relayed outside of daylight hours. Security: There may be engineers etc. coming and going. Please ensure ID is visible and checked as required REMAIN IN COMMUNICATION WITH THE DUTY BED MANAGER/ SENIOR NURSE/MIDWIFE YOU WILL RECEIVE ADVICE FROM THE ABOVE CONTACT REGARDING ANY FURTHER ACTION TO BE TAKEN 21
ACTION CARD 7 - CLINICAL SYSTEM / ESSENTIAL MEDICAL DEVICE FAILURE In the event of a failure of a clinical system or essential medical device within a single ward or department, the fault will need to be reported immediately to the Clinical Engineering Department. Clinical Systems are defined as any system carrying real time patient data relating to the patient s physiology, failure of a clinical system that could result in life threatening events going undetected. Medical devices are defined as patient connected equipment used for monitoring, diagnostics or therapy with a patient. Action Plan The nurse/midwife in charge should undertake or delegate the following duties to staff: Report Contact Clinical Engineering on ( WHTN 01751) ext. 3628 (RGH) or (WHTN 01751) ext. 8200 (PCH) or, out of hours, the on call technologist via Switchboard. Ensure that the technologist is aware of the time of the failure, location, effect, impact and risks. When monitoring patients on other wards, inform the wards immediately of the system outage. Where therapy is being delivered consider alternative means to continue therapy. Seek advice from senior obstetrician and band 7 midwife. Try to ascertain an estimated time period for the disruption/resolution and data that may need to be recovered. Processes Manual observations of patients may need to be made; additional staffing may be required to accomplish this. Paper records of all observations and alarms will need to be retained. Alternative technology might need to be employed to provide diagnostic information, all results to be manually recorded. Communication Inform the Duty Bed Manager/Senior Nurse// Senior Midwife, who will escalate the information to the Directorate/Senior Manager on call. If no contact can be made with the Duty Bed 22
Manager/Senior Nurse/Senior Midwife to contact a Senior Manager via Switchboard. Security: There may be technologists, engineers etc. coming and going. Please ensure that ID is visible and checked as required REMAIN IN CONTACT WITH YOUR DUTY BED MANAGER/SENIOR NURSE/MIDWIFE YOU WILL RECEIVE ADVICE FROM THE ABOVE CONTACT REGARDING ANY FURTHER ACTION TO BE TAKEN 20 3
ACTION CARD 8 - I T DESKTOP SYSTEMS FAILURE In the event of a failure of an IT system to a single ward or department, the fault will need to be reported immediately to the IT Department. Action Plan: The nurse/midwife in charge should undertake or delegate the following duties to staff: Report: Report the fault to the IT Helpdesk or, out of hours, the on call I T technician via Switchboard. Ensure that the technician is aware of the time of the failure, location, effect, impact and risks. Try to ascertain an estimated time period for the disruption / resolution. Processes: Manual requests for tests and investigations may need to be made. You may need to use a runner for this. Paper records of all patient movement i.e. transfers and discharges must be maintained, for inputting once computer access returns. Communication: Inform the Duty Bed Manager/Senior Nurse/Senior midwife, who will escalate the information to the Directorate/Senior Manager on call. If no contact can be made with the Duty Bed Manager/Senior Nurse/midwife contact a Senior Nurse/midwife via Switchboard. Use discretion with regard to informing patients do not cause undue concern. Security: There may be engineers etc. coming and going. Please ensure that ID is visible and checked as required REMAIN IN CONTACT WITH YOUR DUTY BED MANAGER/SENIOR NURSE/MIDWIFE YOU WILL RECEIVE ADVICE FROM THE ABOVE CONTACT REGARDING ANY FURTHER ACTION TO BE TAKEN 21 3
ACTION CARD 9 SPECIAIST IT SYSTEMS SPECIALIST IT SYSTEMS (RADIS, Welsh Clinical Portal, Lilie, MITS} In the event of a failure of a Specialist IT system to a single ward or department, the fault will need to be reported immediately to the IT Department. Action Plan: The nurse in charge should undertake or delegate the following duties to staff: Report: Report the fault to the IT Helpdesk (MITS: IT Team) or, out of hours, the on call I T technician via Switchboard. Ensure that the technician is aware of the time of the failure, location, effect, impact and risks. Try to ascertain an estimated time period for the disruption / resolution. Processes: Welsh Clinical Portal: Manual requests for tests and investigations results may need to be made. This may require a member of staff and a telephone to be highlighted for this purpose. Myrddin: Paper records of all patient movement i.e. transfers and discharges must be maintained, for inputting once computer access returns. MITS: paper records must be maintained for summary of labour, birth notifications and postnatal summary. Close communication between midwife in charge and MITS IT team with regard to allocating NHS numbers for newborn babies. MITS to be updated as soon as system is available to ensure all MITS generated documents: births, post natal discharges are filed appropriately in the client s maternity records and are available to inform Maternity Statistics. Communication: Inform the Duty Bed Manager/Senior Nurse, who will escalate the information to the Directorate/Senior Manager on call. If no contact can be made with the Duty Bed Manager/Senior Nurse contact a Senior Nurse via Switchboard. Inform the Consultant On- Call (out of hours) and all Consultants (inhours) so that they can inform and direct their team accordingly. Use discretion with regard to informing patients - do not cause undue concern. MITS: close communication between MITS IT team and midwife in charge of maternity unit. Security: There may be engineers etc. coming and going. Please ensure that ID is 22 3
visible and checked as required. REMAIN IN CONTACT WITH YOUR DUTY BED MANAGER/SENIOR NURSE OR IF NOT AVAILABLE, ANOTHER SENIOR NURSE. YOU WILL RECEIVE ADVICE FROM THE ABOVE CONTACT REGARDING ANY FURTHER ACTION TO BE TAKEN 23 3
ACTION CARD 10 STAFF AVAILABILITY In the event of a disruption to normal levels of skill-mix of nursing staff, it will be ensured that at least 1 member of staff on duty will be Specialist staff. Please refer to limiting services guideline Limiting Services Guideline Please refer to adverse weather policy. REMAIN IN CONTACT WITH YOUR DUTY BED MANAGER/SENIOR NURSE OR IF NOT AVAILABLE, ANOTHER SENIOR NURSE. YOU WILL RECEIVE ADVICE FROM THE ABOVE CONTACT REGARDING ANY FURTHER ACTION TO BE TAKEN 24 3
ACTION CARD 11 SPECIALIST STAFF AVAILABILITY In the event of a disruption to normal levels of skill-mix of nursing staff, it will be ensured that at least 1 member of staff on duty will be Specialist staff. Please refer to limiting services guideline Limiting Services Guideline Please refer to adverse weather policy. REMAIN IN CONTACT WITH YOUR DUTY BED MANAGER/SENIOR NURSE OR IF NOT AVAILABLE, ANOTHER SENIOR NURSE. YOU WILL RECEIVE ADVICE FROM THE ABOVE CONTACT REGARDING ANY FURTHER ACTION TO BE TAKEN 25 3
ACTION CARD 12 SITE ACCESS DENIAL In the event of staff and patients being unable to access a clinic in the community, the fault will need to be reported immediately to the Duty Bed Manager/Senior Nurse/Senior midwife, who will escalate the information to the Directorate/Senior Manager on call. If no contact can be made with the Duty Bed Manager/Senior Nurse/midwife contact a Senior Nurse/midwife via Switchboard. Action Plan: The nurse/midwife in charge should undertake or delegate the following duties to staff: Report: Report the incident to the Duty Bed Manager/Senior Nurse/Senior midwife, Try to ascertain an estimated time period for the disruption / resolution. Processes: Ensure patients are redirected to another service, e.g. arrange another appointment or if urgent arrange to be seen on another site. Communication: Inform clients of venues for alternate service provision/verbally or by displaying information notices, in prominent places. Inform the Duty Bed Manager/Senior Nurse/midwife/ Senior midwife, who will escalate the information to the Directorate/Senior Manager on call. If no contact can be made with the Duty Bed Nurse/midwife contact a Senior Nurse/midwife via Switchboard. Use discretion with regard to informing patients do not cause undue concern. Security: There may be engineers etc. coming and going. Please ensure that ID is shown. REMAIN IN CONTACT WITH YOUR DUTY BED MANAGER/SENIOR NURSE/MIDWIFE YOU WILL RECEIVE ADVICE FROM THE ABOVE CONTACT REGARDING ANY FURTHER ACTION TO BE TAKEN 26 3
Action card 13 Adverse weather Please refer to adverse weather policy. REMAIN IN CONTACT WITH YOUR DUTY BED MANAGER/SENIOR NURSE OR IF NOT AVAILABLE, ANOTHER SENIOR NURSE. YOU WILL RECEIVE ADVICE FROM THE ABOVE CONTACT REGARDING ANY FURTHER ACTION TO BE TAKEN 27 3
Action card 14 - Fire Please refer to the Fire Safety Site Specific Information Guidance. The documents and associated plans are provided to satisfy the requirements of FIRECODE and the Regulatory Reform Fire Safety Order 2005. The hard copies provided on site are for Fire Service use should they require. 28 3