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

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

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 Communication processes are adequate and available Supply management Surge capacity Maintaining essential services Security Release of information is uniform, coordinated and adequate

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

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

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. www.hhs.gov.pandemicflu/plan 2. SCTTF planning resources

Ephrata Community Hospital Plan as of 3/10/07 (still in development) I. Inter-pandemic and Pandemic Alert Periods 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 b. facility access c. occupational health d. use and administration of vaccines and antiviral drugs e. surge capacity f. supply chain and access to critical inventory needs g. mortuary issues c. Participation in pandemic influenza response exercises

Plan cont’d: 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. 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.

Plan cont’d: 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.

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, healthcare and community partners c. Implement a system of early detection and treatment of healthcare personnel who might be infected d. reinforce infection control procedures e. accelerate staff training in accordance with the pandemic influenza education and training

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

Plan cont’d: 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 accordance with the “Hospital Pandemic Influenza Triggers” b. Implement activities to increase capacity, supplement staff and provide supplies and equipment c. Post respiratory/cough etiquette signs d. Maintain high index of suspicion that patients presenting with flu-like symptoms have the pandemic strain

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

Plan cont’d: 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 control, occupational health, antiviral drug use and clinical management, vaccination and medical surge capacity. b. Provide states with materials from the Strategic National Stockpile for further distribution to healthcare facilities.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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)

Role of Laboratorian during a pandemic 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 information to infection control coordinator

QUESTIONS? Contact Information: beverlymcallister@ephratahospital.org Phone: 717-738-6527