Transcript of CAPT Holly Ann Williams Nurse Epidemiologist/Anthropologist, CDC CDR Robin Bartlett Pharmacist,...
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- CAPT Holly Ann Williams Nurse Epidemiologist/Anthropologist,
CDC CDR Robin Bartlett Pharmacist, Indian Health Service LT Josef
Otto Occupational Therapist, Department of Defense 2011 U.S. Public
Health Service Scientific and Training Symposium New Orleans, LA 23
June 2011 Strengthening Emergency Response: Development of Standard
Operating Procedures for Use in Federal Medical Stations Center for
Global Health International Emergency and Refugee Health
Branch
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- Outline Definition of a Standard Operating Procedure (SOP)
Purpose Description and elements of a SOP Template and example of
written format Federal Medical Stations Description of services
Environment during an emergency response and importance of SOPs
during deployments Development of SOPs by PHS Rapid Deployment
Force (RDF) 3 : Types of SOPs
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- Definition: Standard Operating Procedure (SOP) Set of written
instructions that document a routine or repetitive activity
followed by an organization Key concepts: Prescribed procedures To
be followed routinely Deviations should be noted Written for
specific situations Should be easily understood by those required
to use it Should be written by persons knowledgeable with the
activity and organizational structure
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- Purpose of a SOP Promotes quality: Decreases variation and
promotes quality through consistent implementation of activities
for a given situation, regardless of personnel changes Provides
officers with the information for how to function in their
particular deployment role Describes how the various sections work
together to complete necessary activities Illustrates expectations
for performance - can be used in training new officers Offers the
ideal framework against which actual response activities can be
compared: Can be used to frame lessons learned
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- Description of a SOP A living document: Should be reviewed
routinely and re-enforced by command/section/branch leadership
Concise, step-by-step and easy-to-read style: Keep it simple and
short but have sufficient detail so that someone with limited
experience could successfully understand it and perform the
activity Flow charts or diagrams should illustrate processes when
applicable Tactical in nature: How to perform in humanitarian
response situations
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- Elements of a SOP Numbering system with a unique title: Version
number with date of approval, date of last revision Implementation
date Purpose of the SOP, which should match the title: SOP Patient
Flow Purpose: The purpose of the SOP is to describe the process in
which patients move through the Federal Medical Station from
initial contact through discharge. Scope: identify those
individuals that will use the SOP or be affected by the process:
SOP Patient Flow Scope: This SOP is applicable to RDF staff,
volunteers, patients and caregivers.
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- Elements: II Responsibilities - who does what by
section/branch: You may need to add statement that additional staff
would be pulled as necessary during a surge or exacerbated
emergency situation Procedure what will be done, described in
present tense References other material to support this activity:
outside sources, other SOPs, checklists Definitions
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- Standard Operating Procedure 1.Purpose The purpose of this
Standard Operating Procedure (SOP) is to describe the process in
which 2.Scope This SOP is applicable to RDF staff, volunteers,
patients, and caregivers. 3.Responsibilities Operations Section:
Preventative Medicine Branch, Ancillary Services Branch, Patient
Transport/Labor Pool:. Logistics Section Procedures: SOP
Template
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- 5.References http://www.apic.org/Content/Navigation
Menu/EmergencyPreparedness/SurgeCapacity/Shelters_Disasters.p df 6.
Definitions RDF Rapid Deployment Force - The RDF consists of five
pre-identified teams, each comprising 105 or more multidisciplinary
staff. The teams serve on a rotating call basis, with the on-call
team capable of deploying within 12 hours of notification. RDF
teams have a built-in command structure and can provide mass care
at shelters (including FMSs), and staff Points of Distribution and
Casualty Collection Points. The RDF can also conduct community
outreach and assessments, among other functions. SOP Template:
II
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- Why are SOPs Necessary in a Humanitarian Response?
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- FMS Prior to Patient Arrivals Credit: Williams, RDF 3, LSU
Field House, Hurricane Gustav, 2008
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- FMS After Patients Arrive! Credit: Williams, RDF 3, LSU Field
House, Hurricane Gustav, 2008
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- Federal Medical Stations Designed as medical asset to offer
scalable surge capacity for all-hazards casualty care events:
Provides basic services for displaced populations Intended for
low-acuity and special needs patients BUT reality means acuity
level often much higher than anticipated Higher acuity patients
create multiple challenges: Staffing level often inadequate for
number and acuity of patients Patients tend to come in surges or
waves: Need systems for triage, registration and provision of care
by acuity level (red, yellow, green) Officers may be in their first
deployment situations Pace is fast and stressful May be co-deployed
with a Disaster Medical Assistance Team (DMAT) and/or local/state
partners
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- Development of SOPs by RDF 3 Standardized, clear and concise
guidance for staff was recognized as need: Prompted development of
SOPs Original SOPs were developed through the Preventive Medicine
Branches of all five RDFs but never approved by OFRD (2006): Animal
health emergency support, APHT/RDF Collaboration, community health
facility assessment, community outreach, community water
assessment, FMS site selection, infectious diseases and hand
washing, medical waste, solid waste, surveillance in the community,
surveillance in the FMS, vectors, waste water, and water. Later,
selected SOPs revised again in 2007 and 2009
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- Development of SOPs by RDF 3: II Current SOPs that have been
sent to OFRD: Management of death in a FMS Infection control
Patient flow and patient flow expanded (situation of disease
outbreak) Red, yellow/green clinical areas Registration Triage
Additional SOPs in development with RDF 3: Children in the FMS
Patient referral to outside facilities Rapid needs assessments of
existing health care facilities Special dietary needs Surge
capacity in the FMS Violence in the FMS
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- Standard Operating Procedure Patient Flow 1.Purpose The purpose
of this Standard Operating Procedure (SOP) is to describe the
process in which patients move through the Federal Medical Station
(FMS) from initial contact through discharge. 2.Scope This SOP is
applicable to RDF staff, volunteers, patients, and caregivers.
3.Responsibilities Ancillary Services Branch, Medical Records
Group: Complete the Patient Admission log on all new arrivals to
the FMS. Register patients in the Electronic Medical Record (EMR).
If EMR system is unavailable, plan a back-up paper system as deemed
appropriate. Give all patients an armband for identification
purposes. Preventative Medicine Branch: Assist with completing
Patient Admission log and Surveillance Assessment/Triage Form on
all new arrivals, to identify any potential infectious diseases or
conditions requiring isolation. Medical Services Branch: Triage all
new patients Determine bed availability and assign patients to beds
Evaluate and treat patients Assist with establishing discharge plan
in collaboration with staff from the Services Access Team (SAT), if
available. Rapid Deployment Force #3 SOP # Revision #0
Implementation DateTBD Page #1 of Last Reviewed/Update Date SOP
OwnerOperations SectionApproval
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- Standard Operating Procedure Patient Flow 4.Procedure The
concept of patient flow will use the RAD model Registration,
Assessment, Discharge. The flow of patients within the FMS will
move from Registration, to Assessment, and finally to Discharge.
Each of the areas will have multiple components and assignments.
Registration - Enrollment Enrollment of the patients at the FMS
will take place immediately after their arrival and be located at
an identified patient entrance. RDF staff will complete the Patient
Admission Log in written format to ensure accountability of all
patients and provide a backup in the event the EMR is unavailable.
RDF staff will enter all patients in the EMR. RDF staff will give
each patient an armband for identification purposes and direct them
to the Triage area. Rapid Deployment Force #3 SOP # Revision #0
Implementation DateTBD Page #1 of Last Reviewed/Update Date SOP
OwnerOperations SectionApproval
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- Registration Patient processed into FMS Assessment Patient
Evaluation and Treatment Discharge Return to Community or Transfer
of Medical Care Patient Flow-RAD
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- Discharge Discharge PlanDischarge Reestablish Registration
Enrollment TriageTransport Assessment Bed Assignment Evaluation
Treatment Patient Flow-RAD
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- For more information please contact Centers for Disease Control
and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone,
1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail:
cdcinfo@cdc.gov Web: www.cdc.gov The findings and conclusions in
this report are those of the authors and do not necessarily
represent the official position of the Centers for Disease Control
and Prevention. Thank you to the original five Preventive Medicine
Branches of the RDFs and the entire RDF 3 staff who have worked on
various versions of the existing SOPs. Center for Global Health
International Emergency and Refugee Health Branch