1. Training and Testing for Best Outcomes
Emergency Preparedness:
Training and Testing for Best Outcomes
UAHC UHPCOConference
August 28, 2017
Presented by:
Lois A. Sucher, RN,DON, COS-C
Jenny Nelson, PT, MSG, MCS

2. |
Of all the webinars I have attended since learning of the Medicare Requirements, this was the best to boil down the basics. I received permission to use some of their slides for this presentation. For a complete copy of this FREE WEBINAR please contact Kinnser.

3. EP Training
Training plans must specifically address each one of the agency’s identified risks
The training plan must be written and must extend to all staff members – at least one training each year
The training plan must have a means of demonstrating staff knowledge and retention
Training must be rooted in applicable policies/procedures and how they will be implemented
Training and Testing

4. The Agenda
Gaining a basic understanding of the Emergency Preparedness Rules
Performing the Risk Assessment
Developing Policies and Procedures
Implementing the Communication Plan
Training and Testing Requirements
In order to TRAIN and TEST any given scenario, it is IMPORTANT for ALL STAFF to KNOW and UNDERSTAND all the components REQUIRED. The 4 CORE items are interwoven into each other.

5. Emergencies vs. Disasters
KEY DEFINITIONS
Emergencies vs. Disasters
EMERGENCY = A hazard impact causing adverse physical, social, psychological, economic or political effects that challenges the ability to respond rapidly requiring stepped-up capacity and capability to meet the expected
outcome requiring a change from routine management to incident
command.
DISASTER = An emergency with greater magnitude, longer duration and generally lower outcomes.
In BOTH cases, our JOB is to MAXIMIZE the BEST OUTCOMES for our Agency Staff / Patients and Community

6. Policies and Procedures
E0013 – Policies and procedures based on the emergency plan, risk assessment and communication plan
Policies and procedures must be updated annually
Can be incorporated into the standard manual set, but the agency must be able to demonstrate that they are kept in a central place

7. SURVEY READINESS E-Tags to Know
HHA
Hospice
Tag Requirement
E-0001 Y
Establishment of the Emergency Program (EP)
E-0004
Develop and Maintain the EP Program
E-0006
Maintain Annual EP Updates – Risk Assmnt w/all hazards + strategies for addressing emergency events
E-0007
EP Program Patient Population – Types of emergency services, continuity of operations, delegation of authority and succession planning
E-0009
Process for Collaboration – Coordination and collaboration with local, tribal, regional, State and Federal emergency officials/offices
E-0013
Development of EP Policies and Procedures – Based on the overall plan, risk assessment and communications plans with at least annual review
E-0015
Subsistence Needs for Staff and Patients – Food, water, medical supplies, meds, alternate energy sources for maintaining temperature, lighting, fire detection systems, sewage and waste disposal
We all have the Medicare Regs, and after studying several webinars, we like the way Kinnser spelled them out in simplicity. We put the complete list of the “E-Tags to Know” in our handouts. Each E-Tag is designated if needed for HH or Hospice

8. Here is E-Tag E The GOAL is to be SURVEY Ready in Policies and Procedures. I like putting the E-TAG number right at the top of our policy page so Surveyors have ready access!
As we teach then train our policies, we need to review and update our Policies
This policy is referring to TRAINING and TESTING

9. Risk Assessment Process to assess and document hazards
KEY DEFINITIONS
Risk Assessment
Process to assess and document hazards
Those that are likely to impact the geographic region or community
Those that present gaps and capacity challenges
Hazard Vulnerability Analysis
What I think our BIGGEST Challenge is the GAP of after we process internally within our Agency—Safety of the Building, Staff, Patients—TO WHOM do we report:
Patient Status including pts we have not been able to contact, as well as Employees we have not been able to contact. (We can bring this up later so as NOT to distract)

10. HAZARD VULNERABILITY ANALYSIS
Scoring the Risks
Measure the probability – High, Moderate or Low Risk?
Measure the vulnerability and potential disruption – High, Moderate or Low Risk?
Measure your agency’s level of preparation – Poor, Fair or Good
Each level for each category has a score from 1 to 3 (Green to Red)
The total score indicates the priority that should be placed on risk assessment and planning
This is a 3 STEP process: FIRST: Measure the PROBABILITY, SECOND: Measure the VULNERABILITY to our Agency/Staff/Patients THIRD: Measure our level of the AGENCY PREPAREDNESS
Talk about the Survey Requirements and NOT overdoing up front. As we come to understand and train on the highest priority risk, then periodically add in other risks.

11. The purpose is to look at the TOTAL by SUBJECT and determine how likely the “event’ is going to take place and how “prepared” we are as an Agency to provide care to get good outcomes as best we can. The higher the numeric value—the more focus we should give preparing for that event.

12. We put this worksheet with formulas in your electronic handouts
We put this worksheet with formulas in your electronic handouts. (Formula= Probability x level of Vulnerability x Preparedness level) We put this worksheet with the formulas “built in” in our handouts.

13. Assessing Patient Risk
For home health agencies –
Needs to be done as a part of the comprehensive assessment
For both home health and hospice –
How will clinical information and patient care requirements be communicated?
Consider evacuation requirements
Limitations on patient mobility
Limitations on transport of life-saving equipment
Special needs/limitations – language barriers, diet, intellectual ability

14. PATIENT RISK LEVELS
High Risk Patients
No available caregiver or family present – patient cannot be left alone for extended periods
Bedbound or chair bound patients with physical assistance needs
Unable to administer meds – self-injections of daily meds
Wound care patients who are unable to perform dressing changes
Infusion patients – IV therapy or feedings
This would include pts who Must have Assistance to Evacuate. Include patients with mental / memory deficits

15. Moderate Risk Patients
PATIENT RISK LEVELS
Moderate Risk Patients
Patients with assistive devices or stable in the use of medical equipment – able to manage for a short period of time
Stable with administration of meds
Patients with reasonably managed chronic disease
Patients for whom a visit can be postponed for up to 3 days without jeopardizing safety

16. PATIENT RISK LEVELS
Low Risk Patients
Patients with family and/or caregiver support systems in place who can manage for longer than three days
Patients with less complicated wound care or other care needs
Patients for whom the patient or a caregiver is already managing and administering medications

17. Sharing Medical Information
COMMUNICATIONS PLAN
Sharing Medical Information
Plan for sharing medical record information to ensure continuity of care
Must include the means for sharing information about the general condition and location of patients

18. Part of Training is learning how to Communicate the High Risk Patients or Employees.

19. Put only pertinent information on this log. KEEP This Simple
Put only pertinent information on this log. KEEP This Simple. When I was the TRIAGE nurse at a Trauma Center in the Midwest, I needed the most PERTINENT INFORMATION with the HIGHEST Priority (Remember You have the medical record completed by your scribe)
In your handouts we gave you a Red and a Yellow log. No green log is needed, as you will have that list on your Agency Patient Roster. You will need to report Green numbers to the local health dept. (reduce paperwork and use your current Patient Roster.
List Special Needs—Adaptive Equipment, Oxygen, Diets, Translator Services, Mobility, Mental Capacity of the Patient. etc.
Also included in your handouts, is this Instruction page, and the PATIENT NO CONTACT Log that also must be reported.
Also in the handouts is an AGENCY Employee Contact Tracker.
Don’t forget to employ your aides and office staff to help scribe, make calls to employees, etc.

20. Insert photo of Vial of life and FEMA Flags
One MISSION of HOME HEALTH is to reduce the SURGE to Medical Facilities where we can. One of those is helping our patients and families and caregivers to be prepared. Of course we will need to send pts to the Hospitals, SNFs etc, but if we can reduce the facilities from becoming OVERWHELMED by utilizing field clinicians and educated caregivers we are a significant contributor to higher outcomes.
Insert photo of Vial of life and FEMA Flags

21. Patient Preparedness (see attached handout)
Be prepared for 96 hours—food, water, medications
Vial of Life—Code Status, Med Profile, Physicians, Emergency Contact numbers
VIAL of LIFE sticker on front window, Refrigerator
Emergency Preparedness for People Receiving Home Care
Review this pamphlet with pt / caregiver 
FEMA Communication Model: Instruct on how to use flags
Keep in closet closest to front door
 VACCINES: Flu and Pneumonia up to date. Most elderly die of pneumonia during a pandemic due to weakening of the immune system.
Emergency Supplies: See handout for more comprehensive list. Lighting in home to prevent falls during a power outage—especially important
Emphasize the IMPORTANCE of a 7 DAY Supply of MEDICATIONS
Protect your FEET—Keep a pair of sturdy shoes/socks in a zip lock bag under bed.
Secure list of FINANCIAL accounts, insurance policies, Titles, VA Info—CD, Thumb Drive, etc
Emergency Exits
Notify Power Company in advance on oxygen, vents, pumps for infusions, etc.  
OASIS—code TRIAGE for clinical risk (i.e. likelihood of clinical exacerbation)
code DISASTER for enhanced risk with outside emergencies
(i.e. assess pt. independence with meds, oxygen, competent caregivers, etc.)
Our DUTIES as Home Health and Hospice Agencies is to help EDUCATE AND PREPARE our Patients and Families to FORMULATE a DISASTER PLAN in their homes. Try to LOWER your patient’s risk and vulnerability by educating pt and caregivers.

22. Clinician Preparedness (see attached in Handouts)
Be prepared for 96 hours (changed by FEMA)
Secure Yourself First
Secure your Family
Report to Agency Command Center in your respective county via phone, text, internet or in person at the designated area.
Secure your Patients
COMMUNICATION PLAN:
Cell phone chargers, Battery Chargers or Solar Chargers
FEMA communication flag kit
GMRS 2 way radios—2-10 mile range. Have an Agency Designated Channel & back up.
Keep a copy of your clinical license on you. This will help get you across police lines.
Keep your gas tank at least ½ full AT ALL TIMES
Stay Healthy! Vaccinations—stay up to date (Flu, Tetanus, Shingles, Pneumonia)
CAR SUPPLIES: (see handout for more complete list)
Water – High Energy Bars – Shelter (Blanket/Tarp)—zip bag with clean clothes
Car stock of Basis First Aid bandages, etc. incl BIO-HAZARD BAGS
Emergency money in low denominations (no change is given in disasters)
Long Life Flashlight, back up batteries, solar charger / hazard light
First Aid Kit WITH Protective Gear—N95 masks may be expired! Alcohol Hand Sanitizer
Extra-Sticky Post-it Notes and a pencil to leave messages—Sharpie
Box of plastic gloves and pair of work gloves (Protect your hands)
Portable radio with fresh batteries, crank or solar
The more our Clinicians are Educated, Trained and Safe the better outcomes we will have with our patients and in the community at large.
Engage the clinicians/Staff in Policy development.
Important to test communications.
“THIS IS A TEST” to see how fast and who responds Text experiment.

23. EP Testing Requirements
The agency must conduct at least one full-scale exercise annually
When community-based testing is not feasible an individual full-scale test can be substituted
An additional exercise must be done and can include a table-top exercise led by a facilitator with clinically relevant emergency scenarios
Multiple agencies or groups involved
Often a mock disaster
IMPORTANT TO EVALUATE your DRILL or an ACTUAL DISASTER—see handouts for an Evaluation
Table-top exercises – TTX
Key staff and other constituents -- simulated scenarios
Utilizes informal assessment of plans, policies and procedures -- identifies gaps that should be addressed

24. It is important to Develop a BUSINESS RECOVERY PLAN—It is in the best interest of your company, employees, patients and the community that you stay in business.

25. In Closing . . .
Remember that your agency must be ready by November 15th.
Perform the risk assessment using an easy to use template.
Develop your plan based on the risk assessment results.
Make sure that your policies and procedures address the E-Tag requirements that are applicable to your agency.
Develop and document the communication plan.
Train the staff.
Make sure that the elements of the emergency plan are tested and that the testing process is documented.
Document the analysis of your Drill or Disaster