Through the Eyes of the Surveyor. There are gaps! Emergency Preparedness is now a focus!
-
Upload
juliana-stevenson -
Category
Documents
-
view
212 -
download
0
Transcript of Through the Eyes of the Surveyor. There are gaps! Emergency Preparedness is now a focus!
Preparing for the Survey
Through the Eyes of the Surveyor
Open Mind
There are gaps!
Emergency Preparedness is now a focus!
What We Know
2004/05 Hurricanes 2006 OIG report
94% emergency plans met Federal regulations 80% met training requirements
Reality: Many lacked information recommended by experts Were not followed during actual incidents Lack of Emergency Management coordination
History of the Survey
2007 CMS publishes emergency preparedness checklists as “recommended tools “for Healthcare Facilities , State LTC Ombudsman, and State SA.
Where it Began
transportation contracts were not always honored
evacuation travel took longer than expected medication needs complicated travel
host facilities were unavailable or inadequately prepared
What the Report Found
facilities could not maintain adequate staff
food and water shortages occurred
prompt return of residents was difficult.
Findings (continued)
CMS should consider strengthening Federal certification standards for nursing home emergency plans by including requirements for specific elements of emergency planning.
Recommendation
210 facilities effected in 7 states with hurricanes, floods, and wildfires.
Review of 24 facilities whose residents were sheltered in place or evacuated . (2010)
2007- 2010 Round 2
Floods 2009 Red River Flooding 7 facilities evacuated
Hurricanes 2008 (Gustav and Ike ) 92 facilities in Louisiana and 84 in Texas.
Facts
Department of Health and Human Services OFFICE OF INSPECTOR GENERAL
◦ GAPS CONTINUE TO EXIST IN NURSING HOME EMERGENCY
PREPAREDNESS AND RESPONSE DURING DISASTERS: 2007–2010
Daniel R. Levinson Inspector General April 2012
Inadequate staff training Surveyors not trained to review nursing
home emergency plans Procedures for finding missing residents Most administrators did not use CMS
checklist (13/24 aware and 7/13 used it)
Findings: The Nitty Gritty
Staffing backup plan Resident care Resident identification, information, tracking Sheltering in Place Evacuation Communication and collaboration
Six Areas of Concern in Plans
Staffing Tasks (during a disaster) Did not ensure sufficient staffing levels for care 22/24 have backup for staff unable to report to work
Resident Care tasks illness or death with evacuation disaster counseling to residents info on specific needs (oxygen, vents, feeding tubes)
and characteristics (dementia)
Specific Gaps in Plans
Resident Identification, information, and tracking
How to identify (wristband , tags) What information must accompany resident Identify next of kin/ power of attorney
Sheltering in Place Amount of potable water Extra medical supplies
Continued
Evacuation How to transport and protect medical records Evacuation routes and alternates Transport adequate food and water
◦ Communication and Collaboration No plan to communicate with ombudsmen and
authorities Did not include collaboration with EM to develop plan or
determine whether to evacuate or shelter in place
Still More
◦ February 2012 Looked at 4 hurricane (Katrina, Rita, Gustav, and Ike)
and 36,389 residents to compare SIP vs evacuation◦
◦ Conclusion Evacuation significantly exacerbated subsequent
morbidity/mortality. Universal evacuation policies require reconsideration.
Address safeguarding human resources, ensuring business continuity, and protecting physical resources.
Federal Register (proposed 12/27/2013)
§483.75(m) Disaster and Emergency Preparedness
§483.75(m)(1) The facility must have detailed written plans and procedures to meet all potential emergencies and disasters, such as fire, severe weather, and missing residents.
F517
§483.75(m)(2) The facilities must train all employees in emergency procedures when they begin to work in the facility, periodically review the procedures with existing staff, and carry out unannounced staff drills using those procedures.
F518
Subsistence (§ 483.73(b)(1))
Training and Testing (§ 483.73(d))
Generator Testing (§ 483.73(e))
Emergency Preparedness Long Term Care (LTC) Facilities
subsistence needs for staff and residents, whether they evacuate or shelter in place, including◦ food, water, and medical supplies alternate
sources of energy
Subsistence (§ 483.73(b)(1))
facilities must participate in or conduct a mock disaster drill and a tabletop exercise bi-annually.
facilities review their procedures with staff, conduct unannounced drills
Training and Testing (§ 483.73(d))
a minimum of 4 continuous hours at least once every 12 months
Generator Testing (§ 483.73(e))
Essentials needed to provide health care is available:
◦ safeguarding human resources◦ ensuring business continuity◦ and protecting physical resources.
Essentials for Survival
(1) risk assessment and planning ( All Hazards and HVA)
(2) policies and procedures (based on the emergency plan and risk assessment)
Core Elements for Success
(3) communication (develop and maintain an emergency preparedness plan)
(4) training and testing. (staff know and exercise the plan)
Core Elements (continued)
State Has to Address Changes
Michigan Deficiencies in Emergency Planning 2009 -2010 *
Number of Nursing Homes Surveyed…431* Total of Tags F517 and K48…86 (20%)…National
Average 7.6%* Total of Tags F518 and K50…164 (38.1%)…National
Average 27.9%*
Motivation for Change
Helpful Hints for the Provider
Be Prepared! Practice
Know your plan!
Know your staff!
Know the CMS Survey!
Game plan
Questions
Onward to the Survey
Emergency Management collaboration
Description of amounts and types of food supply
Extra pharmacy stock, medical supplies and equipment
Most Common Surveyor Checklist Gaps in Plan
Planning for emergency financial needs and security
Transporting adequate food and water to relocation
Transported items with each resident
Michigan Gaps (continued)
Assure assistive devices are transported
Resident becomes ill or dies in route
Training for all transport vendors and volunteers
How will residents be identified and info secured
Gaps
Communication with LTC Ombudsman
Conducting exercises and drills
Loss of resident’s personal effects
Re-entry
Gaps
Digging Even Deeper