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PANDEMIC PLANNING AT EPHRATA COMMUNITY HOSPITAL By: Beverly McAllister, MS, MT(ASCP) SC Laboratory Operations Manager.

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Presentation on theme: "PANDEMIC PLANNING AT EPHRATA COMMUNITY HOSPITAL By: Beverly McAllister, MS, MT(ASCP) SC Laboratory Operations Manager."— Presentation transcript:

1 PANDEMIC PLANNING AT EPHRATA COMMUNITY HOSPITAL By: Beverly McAllister, MS, MT(ASCP) SC Laboratory Operations Manager

2 OBJECTIVES: Identify the components of a well-defined Pandemic Plan Identify the components of a well-defined Pandemic Plan Describe the role your facility plays in response to a pandemic Describe the role your facility plays in response to a pandemic Describe your role as a laboratorian in response to a pandemic Describe your role as a laboratorian in response to a pandemic

3 Components of a well-defined Pandemic Plan Pandemic Planning Committee focused on defining a process for the following: Facility Surveillance for and detection of influenza Facility Surveillance for and detection of influenza Communication processes are adequate and available Communication processes are adequate and available Supply management Supply management Surge capacity Surge capacity Maintaining essential services Maintaining essential services Security Security Release of information is uniform, coordinated and adequate Release of information is uniform, coordinated and adequate

4 Pandemic Plan Committee Direct initiative of Emergency Management Committee Direct initiative of Emergency Management Committee Goal: Develop a Pandemic Influenza Plan Goal: Develop a Pandemic Influenza Plan Formed in July 2006 Formed in July 2006 Meet on a monthly basis Meet on a monthly basis Consists of the following members: Consists of the following members: COO COO VP of Medical Affairs VP of Medical Affairs VP of Physician Practices VP of Physician Practices Director of Emergency Management Services Director of Emergency Management Services Director of Facilities Management Director of Facilities Management Director of Public Relations Director of Public Relations Director of Purchasing Services Director of Purchasing Services Director of Home Care Director of Home Care Director of Pharmacy Director of Pharmacy Director of Ephrata Medical Equipment Director of Ephrata Medical Equipment

5 Pandemic Plan Committee members contd Infection Control Coordinator Infection Control Coordinator Laboratory Operations Manager Laboratory Operations Manager Employee Health Nurse Employee Health Nurse Nursing Education Nursing Education Chaplaincy Chaplaincy Director of Emergency Services Director of Emergency Services Advanced Life Support Unit Manager Advanced Life Support Unit Manager Physician Practice Representation Physician Practice Representation

6 What resources have we used to develop the Pandemic Plan? 1. United States Department of Health and Human Services Pandemic Influenza Plan was used as a blueprint for pandemic influenza preparation and response. 1. United States Department of Health and Human Services Pandemic Influenza Plan was used as a blueprint for pandemic influenza preparation and response SCTTF planning resources 2. SCTTF planning resources

7 Ephrata Community Hospital Plan as of 3/10/07 (still in development) I. Inter-pandemic and Pandemic Alert Periods 1. ECH facility responsibilities 1. ECH facility responsibilities a. ECH will respond to alerts and pandemic related issues through utilization of the EMC, Pandemic Planning Committee and the Hospital Incident Command Structure (HICS) b. Written Plan includes: a. disease surveillance a. disease surveillance b. facility access b. facility access c. occupational health c. occupational health d. use and administration of vaccines and antiviral drugs d. use and administration of vaccines and antiviral drugs e. surge capacity e. surge capacity f. supply chain and access to critical inventory needs f. supply chain and access to critical inventory needs g. mortuary issues g. mortuary issues c. Participation in pandemic influenza response exercises

8 Plan contd: Inter-pandemic and Pandemic Alert Periods B. State and local responsibilities: 1. ECH works within the framework of the SCTTF and through the Hospital Medical Sub-Committee a Regional Hospital Response Plan has been developed. 2. Exercises with local emergency management, local first responders and receivers, regional assets including hospitals and state agencies. 2. Exercises with local emergency management, local first responders and receivers, regional assets including hospitals and state agencies. 3. Open lines of communication through the use of faxes, direct lines, FREDS, HAN, NEDSS and RODS. 3. Open lines of communication through the use of faxes, direct lines, FREDS, HAN, NEDSS and RODS. 4. Human Relations Department and Employee Health have developed guidelines for any legal issues affecting staff and patient care. 4. Human Relations Department and Employee Health have developed guidelines for any legal issues affecting staff and patient care.

9 Plan contd: Inter-pandemic and Pandemic Alert Periods C. HHS responsibilities 1. ECH response plan is adopted under the guidelines of the US Department oh Health and Human Services and the PA Department of Health (DOH) Pandemic Response Plan 2. ECH will utilize the Department of Homeland Security model protocols for early detection and treatment of influenza among patients and staff; knowing that these protocols can be practiced during routine influenza seasons.

10 II. Pandemic Period A. If an influenza pandemic begins in another country: 1. ECH facility responsibilities a. heighten institutional surveillance b. communicate with key public health, b. communicate with key public health, healthcare and community partners healthcare and community partners c. Implement a system of early detection c. Implement a system of early detection and treatment of healthcare personnel and treatment of healthcare personnel who might be infected who might be infected d. reinforce infection control procedures d. reinforce infection control procedures e. accelerate staff training in accordance with the e. accelerate staff training in accordance with the pandemic influenza education and training pandemic influenza education and training

11 Plan contd: Pandemic Period- begins in another country 2. State and local responsibilities a. Working with HHS to provide local a. Working with HHS to provide local physicians and hospital administrators physicians and hospital administrators with updated information and with updated information and guidance as the situation unfolds. guidance as the situation unfolds.

12 Plan contd: Pandemic Period- begins in or enters the US B. If an influenza epidemic begins in or enters the United States 1. ECH facility responsibilities a. Activate facility pandemic response plan in a. Activate facility pandemic response plan in accordance with the Hospital Pandemic Influenza accordance with the Hospital Pandemic Influenza Triggers Triggers b. Implement activities to increase capacity, b. Implement activities to increase capacity, supplement staff and provide supplies and supplement staff and provide supplies and equipment equipment c. Post respiratory/cough etiquette signs c. Post respiratory/cough etiquette signs d. Maintain high index of suspicion that patients d. Maintain high index of suspicion that patients presenting with flu-like symptoms have the presenting with flu-like symptoms have the pandemic strain pandemic strain

13 Plan contd: Pandemic Period- begins in or enters the US e. Implement infection control practices e. Implement infection control practices f. Rapid communication within and between f. Rapid communication within and between healthcare facilities and DOH healthcare facilities and DOH g. Implement surge-capacity plans g. Implement surge-capacity plans h. If pandemic strain is detected in local or h. If pandemic strain is detected in local or community, transmission can be assumed and community, transmission can be assumed and hospital would move to the next level of response hospital would move to the next level of response 2. State and Local Health Responsibilities a. Provide healthcare facilities with information on a. Provide healthcare facilities with information on the global, national and local situation the global, national and local situation b. Work with HHS to provide guidance on infection b. Work with HHS to provide guidance on infection control measures for healthcare and non- control measures for healthcare and non- healthcare facilities healthcare facilities c. work with healthcare facilities to address surge c. work with healthcare facilities to address surge capacity needs capacity needs

14 Plan contd: Pandemic Period- begins in or enters the US 3. HHS Responsibilities a. Assist state and local healthcare and public health partners on issues related to hospital infection partners on issues related to hospital infection control, occupational health, antiviral drug use control, occupational health, antiviral drug use and clinical management, vaccination and medical and clinical management, vaccination and medical surge capacity. surge capacity. b. Provide states with materials from the Strategic b. Provide states with materials from the Strategic National Stockpile for further distribution to National Stockpile for further distribution to healthcare facilities. healthcare facilities.

15 III. Pandemic Response A. Planning for provision of care in the facility 1. Detecting the introduction of Pandemic 1. Detecting the introduction of Pandemic Influenza Influenza 2. Preventing the spread of Pandemic 2. Preventing the spread of Pandemic Influenza Influenza 3. Managing the impact on facility and staff 3. Managing the impact on facility and staff 4. Expansion of preparedness and response 4. Expansion of preparedness and response plans for bioterrorism, SARS and other plans for bioterrorism, SARS and other infectious diseases to include influenza infectious diseases to include influenza

16 Pandemic Response contd 5. Identify criteria and methods for measuring: a. Infection control practices a. Infection control practices b. Case reporting b. Case reporting c. Patient placement c. Patient placement d. Healthcare workers illness surveillance d. Healthcare workers illness surveillance 6. Review and update inventories of supplies that will be in high demand during the pandemic will be in high demand during the pandemic 7. Review procedures for receipt, storage, and distribution of assets received from federal distribution of assets received from federal stockpiles stockpiles 8. Approach to planning will be consistent with an All-Hazards response All-Hazards response

17 Pandemic Response contd B. Planning Process 1. Committee Structure- Define members 1. Committee Structure- Define members 2. Planning Resources 2. Planning Resources a. Pandemic Response Plan DHS a. Pandemic Response Plan DHS b. SCTTF-Hospital Regional Response b. SCTTF-Hospital Regional Response Plan Plan c. Inter-facility multi-disciplines c. Inter-facility multi-disciplines d. Outside resources as identified d. Outside resources as identified

18 Pandemic Response contd C. Planning Elements 1. Hospital Surveillance 1. Hospital Surveillance a. Laboratory testing will be consistent a. Laboratory testing will be consistent and monitored closely and monitored closely b. Absenteeism rates will monitored weekly b. Absenteeism rates will monitored weekly c. ED visits will be monitored through RODS c. ED visits will be monitored through RODS and laboratory testing through NEDSS and laboratory testing through NEDSS d. Data to be evaluated includes: d. Data to be evaluated includes: 1. admissions 1. admissions 2. discharges/deaths 2. discharges/deaths 3. Patient characteristics such as: 3. Patient characteristics such as: age, underlying disease, secondary age, underlying disease, secondary complications, illness in healthcare personnel complications, illness in healthcare personnel

19 Pandemic Response contd e. Guidelines for distinguishing between influenza and other respiratory disease influenza and other respiratory disease f. Symptoms of Influenza f. Symptoms of Influenza 1. fever 1. fever 2. headache 2. headache 3. myalgia 3. myalgia 4. prostration 4. prostration 5. coryza 5. coryza 6. sore throat 6. sore throat 7. cough 7. cough

20 Pandemic Response contd 2. Hospital Communications a. External communications outside the facility a. External communications outside the facility will occur through the following contact will occur through the following contact individuals: Infection Control Coordinator, individuals: Infection Control Coordinator, VP of Medical Affairs, Public Relations VP of Medical Affairs, Public Relations b. Internal Communications will occur b. Internal Communications will occur through Incident Command through Incident Command 3. Education and Training a. Hospital Plan and response education a. Hospital Plan and response education b. Hospital staff guide to the Pandemic b. Hospital staff guide to the Pandemic c. Unit specific education c. Unit specific education d. Internet Plans d. Internet Plans

21 Pandemic Response contd D. Triage/Clinical Evaluation/Admission Process 1. Identification of patients w/pandemic flu 1. Identification of patients w/pandemic flu 2. Separation of pandemic patients 2. Separation of pandemic patients 3. Identify type of care needed 3. Identify type of care needed 4. Identify triage coordinator for patient 4. Identify triage coordinator for patient management management 5. Define ED/OP clinical evaluation disposition 5. Define ED/OP clinical evaluation disposition procedures procedures 6. Review/streamline admission process 6. Review/streamline admission process 7. Entry Trigger points switch from passive 7. Entry Trigger points switch from passive (signs) to active (direct questioning) (signs) to active (direct questioning)

22 Pandemic Response contd E. Facility Access The following criteria and procedures will The following criteria and procedures will be used to limit access if pandemic occurs: be used to limit access if pandemic occurs: 1. Definition of essential visitors 1. Definition of essential visitors 2. Protocols for limiting non-essential visitors 2. Protocols for limiting non-essential visitors 3. Criteria or triggers for temporary closing 3. Criteria or triggers for temporary closing hospital to new admissions/transfers hospital to new admissions/transfers a. staffing ratios, isolation capacity, risks a. staffing ratios, isolation capacity, risks to non-influenza patients to non-influenza patients b. who makes decision regarding closing/ b. who makes decision regarding closing/ communication of information communication of information c. consult with state and local health departments on c. consult with state and local health departments on their role in determining what assistance they offer their role in determining what assistance they offer

23 Pandemic Response contd F. Occupational Health 1. Managing ill workers 1. Managing ill workers a. plan for detecting signs and symptoms a. plan for detecting signs and symptoms of influenza in healthcare personnel of influenza in healthcare personnel before reporting to duty before reporting to duty b. policies for managing healthcare workers b. policies for managing healthcare workers with respiratory symptoms with respiratory symptoms c. Consider assigning staff recovering from c. Consider assigning staff recovering from influenza to care for influenza patients influenza to care for influenza patients 2. Time-off Policies 2. Time-off Policies 3. Reassignment of High-Risk Personnel 3. Reassignment of High-Risk Personnel

24 Pandemic Response contd 4. Psychosocial health services 5. Influenza vaccination and use of anti-viral drugs a. Employee annual vaccination program a. Employee annual vaccination program b. Increased vaccination coverage during b. Increased vaccination coverage during Inter-pandemic period Inter-pandemic period c. Documentation of vaccination of employees c. Documentation of vaccination of employees d. Program established for rapidly vaccinating d. Program established for rapidly vaccinating or providing antiviral prophylaxis or or providing antiviral prophylaxis or treatment to healthcare personnel as treatment to healthcare personnel as recommended by HHS and PADOH recommended by HHS and PADOH

25 Pandemic Response contd G. Use and Administration of vaccines and antiviral drugs antiviral drugs 1. Pandemic influenza vaccine and 1. Pandemic influenza vaccine and pre-pandemic influenza vaccine pre-pandemic influenza vaccine a. Interim recommendations a. Interim recommendations 1. Monitor updated HHS information and 1. Monitor updated HHS information and recommendations on the development, recommendations on the development, distribution, and use of vaccine distribution, and use of vaccine 2. Work with local and state health depts. 2. Work with local and state health depts. on vaccine distribution plans on vaccine distribution plans 3. Have estimated quantities of vaccine needed 3. Have estimated quantities of vaccine needed 4. Develop vaccination prioritization plan 4. Develop vaccination prioritization plan 5. Develop Pandemic Influenza Plan 5. Develop Pandemic Influenza Plan

26 Pandemic Response contd H. Surge Capacity 1. Plans to include addressing emergency staffing needs 1. Plans to include addressing emergency staffing needs and increase demand for isolation wards, ICUs, and increase demand for isolation wards, ICUs, assisted ventilation services and consumable and assisted ventilation services and consumable and durable supplies durable supplies 2. FluSurge software 2. FluSurge software 3. Staffing 3. Staffing a. Assign responsibility for assessment and a. Assign responsibility for assessment and coordination of staffing during an emergency coordination of staffing during an emergency through Hospital Incident Command System through Hospital Incident Command System b. Estimate minimum number and categories of b. Estimate minimum number and categories of personnel needed to care for a single patient or a personnel needed to care for a single patient or a small group of patients with influenza on a given small group of patients with influenza on a given day day

27 Pandemic Response contd c. Determine how the hospital will meet staffing needs as c. Determine how the hospital will meet staffing needs as number of patients with pandemic influenza increases number of patients with pandemic influenza increases or staff become ill or staff become ill 1. consider patient-care responsibilities to clinical 1. consider patient-care responsibilities to clinical administrators administrators 2. recruiting retired healthcare personnel 2. recruiting retired healthcare personnel 3. Using trainees 3. Using trainees 4. Using patients family members in ancillary 4. Using patients family members in ancillary healthcare capacity healthcare capacity d. Collaborate regionally under the regional hospital d. Collaborate regionally under the regional hospital response plan response plan

28 Pandemic Response contd e. Increase cross-training of personnel e. Increase cross-training of personnel f. List essential support staff personnel titles f. List essential support staff personnel titles g. PADOH-emergency staffing crisis g. PADOH-emergency staffing crisis credentialing credentialing h. Identify insurance and liability issues related h. Identify insurance and liability issues related to non-facility staff to non-facility staff i. Use of healthcare providers from other i. Use of healthcare providers from other systems systems

29 Pandemic Response contd 4. Bed Capacity a. Review and revise admission criteria for times when a. Review and revise admission criteria for times when bed capacity is limited bed capacity is limited b. Polices and procedures for expediting discharge of b. Polices and procedures for expediting discharge of patients who do not require on-going care patients who do not require on-going care c. Plan with homecare agencies for follow-up on early c. Plan with homecare agencies for follow-up on early discharges discharges d. Triggers for canceling elective surgical procedures d. Triggers for canceling elective surgical procedures e. Disposition of those patients requiring emergency e. Disposition of those patients requiring emergency procedures procedures

30 Pandemic Response contd f. Bed tracking through DOH Facility Resource f. Bed tracking through DOH Facility Resource Emergency Data Systems (FREDS) Emergency Data Systems (FREDS) g. Hospital licensed bed expansion during the g. Hospital licensed bed expansion during the Pandemic Pandemic h. Discussion regarding Altered Standards of h. Discussion regarding Altered Standards of Care in Mass Casualty Events Care in Mass Casualty Events i. Polices and Procedures for shifting patients i. Polices and Procedures for shifting patients between nursing units to free up bed space in between nursing units to free up bed space in critical care areas and cohorting of patients critical care areas and cohorting of patients j. MOUs with other healthcare facilities j. MOUs with other healthcare facilities k. Identification of areas to be vacated for cohorting of k. Identification of areas to be vacated for cohorting of pandemic patients pandemic patients

31 Pandemic Response contd 5. Consumable and durable supplies a. Evaluation of existing system for tracking medical a. Evaluation of existing system for tracking medical supplies to detect rapid consumption supplies to detect rapid consumption b. Consider stockpiling enough consumable resources b. Consider stockpiling enough consumable resources such as masks for duration of pandemic event such as masks for duration of pandemic event c. Assess anticipated needs for consumable and c. Assess anticipated needs for consumable and durable resources, and determine trigger point for durable resources, and determine trigger point for ordering extra supplies ordering extra supplies d. Anticipate need for antibiotics to treat bacterial d. Anticipate need for antibiotics to treat bacterial complications of influenza complications of influenza e. Establish contingency plans for situations in which e. Establish contingency plans for situations in which primary sources of medical supplies become limited primary sources of medical supplies become limited

32 Pandemic Response contd I. Security 1. Healthcare facility plan for additional 1. Healthcare facility plan for additional security security J. Mortuary Issues 1. Assess current capacity for refrigeration of 1. Assess current capacity for refrigeration of deceased persons deceased persons 2. Discuss mass fatality plans with local and 2. Discuss mass fatality plans with local and state health officials and medical examiners state health officials and medical examiners 3. Identification of temporary morgue sites 3. Identification of temporary morgue sites 4. Determine scope and volume of supplies 4. Determine scope and volume of supplies needed to handle the dead. needed to handle the dead.

33 Planning for provision of care in the non-hospital setting 1. Effective Management a. plan to establish and staff telephone a. plan to establish and staff telephone hotlines hotlines b. develop training modules, protocols, b. develop training modules, protocols, and algorithms for hotline staff and algorithms for hotline staff c. Provide public education materials c. Provide public education materials d. clinics and offices should have plans that include: d. clinics and offices should have plans that include: education, staffing, triage, infection control in education, staffing, triage, infection control in waiting rooms, communication with healthcare waiting rooms, communication with healthcare partners and public health authorities partners and public health authorities

34 Planning for provision of care in the non-hospital setting- contd e. communication plan e. communication plan f. plan for procuring supplies f. plan for procuring supplies g. participation in community plan for g. participation in community plan for distribution of vaccine and antivirals distribution of vaccine and antivirals

35 Planning for provision of care in the non-hospital setting- contd 2. Planning a. create planning committee a. create planning committee b. decision making and coordinating b. decision making and coordinating structure structure c. How to conduct surveillance for c. How to conduct surveillance for pandemic influenza in healthcare pandemic influenza in healthcare personnel and for residential facilities personnel and for residential facilities in population served in population served d. staff education d. staff education

36 Planning for provision of care in the non-hospital setting- contd 3. Alternative care sites a. bed capacity and spatial separation of a. bed capacity and spatial separation of patients patients b. facilities and supplies for hand hygiene b. facilities and supplies for hand hygiene c. lavatory and shower capacity for large c. lavatory and shower capacity for large number of patients number of patients d. food service d. food service e. medical service e. medical service

37 Planning for provision of care in the non-hospital setting- contd f. staffing for patient care and support f. staffing for patient care and support services services g. cleaning and disinfection supplies g. cleaning and disinfection supplies h. environmental services h. environmental services i. safety and security i. safety and security

38 RELEASE OF SUPPLIES FROM STRATEGIC NATIONAL STOCKPILE EPHRATA COMMUNITY HOSPITAL (EMERGENCY MANAGEMENT COMMITTEE) COUNTY (LEMA) PENNSYLVANIA STATE DEPT. OF HEALTH (PEMA) Governor informs PEMA to submit request Federal and State hold conference call and decide to deploy SNS FEDERAL DEPARTMENT OF HEALTH AND HUMAN SERVICES (FEMA)

39 Role of Laboratorian during a pandemic Perform necessary tests to determine presence or absence of influenza virus in a patient Perform necessary tests to determine presence or absence of influenza virus in a patient Report positive influenza results to Pennsylvania Department of Health via PA-NEDSS reporting system Report positive influenza results to Pennsylvania Department of Health via PA-NEDSS reporting system Report information to infection control coordinator Report information to infection control coordinator

40 QUESTIONS? Contact Information: Phone:


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