Emergency preparedness is a vital component of maintaining safety and ensuring continuity of care in post-acute care settings. Facilities face unique challenges in emergency situations. The vulnerable people they care for, including the elderly and those recovering from surgery or a serious illness, are especially susceptible to adverse outcomes. The resident population also often includes individuals with cognitive impairments, limited or no mobility, and chronic illnesses, which complicates evacuation and emergency response efforts. Moreover, facilities may not have the infrastructure or ability to stockpile resources at the same level as hospitals, making it even more critical to plan for emergencies.
Whether dealing with natural disasters, chemical spills, violent intruders, or other unforeseen catastrophes, having a robust emergency preparedness plan is essential for protecting residents, visitors, and staff. This article will discuss some key elements of an effective emergency preparedness plan and strategies the director of nursing services (DNS) can implement to ensure the nursing department is prepared if disaster strikes.
Essential Elements of an Effective Emergency Preparedness Plan
- Risk Assessment and Danger Detection
The first step facility leadership should take when creating a comprehensive emergency preparedness plan is to conduct a thorough risk assessment. This involves recognizing potential hazards that could impact the facility, such as natural disasters (e.g., tornadoes, hurricanes, floods, or earthquakes), infectious disease outbreaks, fires, chemical spills, active shooters, and technological failures (e.g., medical equipment failures, power outages, or cybersecurity attacks that may affect electronic health records). The risk assessment should also include assessing the facility’s physical infrastructure, considering the building’s age, compliance with life safety codes, staffing adequacy, and the availability and dependability of supplies (e.g., food, water, emergency power supply, medications, and medical equipment).
The DNS’s role in the risk assessment is to identify potential risks that would affect resident and staff safety within clinical practices, such as infection prevention and control, medication management and administration, and resident care standards. The DNS should collaborate with other departments to review policies and procedures and update them, if necessary, to ensure they comply with regulatory requirements and follow evidence-based best practices.
Once the assessment identifies potential risks, facility leadership must evaluate the likelihood and severity of impact and then develop strategies to mitigate the risks to staff, residents, and visitors. The likelihood of a disaster’s occurrence generally depends on geographical location and historical data. Facilities that reside in areas prone to hurricanes will have different plans than facilities in areas where wildfires are frequent. The facility assessment is a great tool for the DNS to review alongside the risk assessment to coordinate strategies for the emergency preparedness plan. By utilizing these two tools, the DNS can identify strengths and weaknesses within the nursing department, take proactive steps to maintain compliance, and develop an informed strategic plan.
Note: DNSs can utilize AAPACN’s Facility Assessment Considerations: A DNS Guide at a Glance to collect and analyze data necessary to develop the nursing department’s portion of the facility assessment. - Communication Strategy
Efficient and effective communication is crucial during an emergency. The DNS should establish clear communication protocols to ensure the facility informs staff, residents, and their families about the situation and the steps underway. Having effective communication patterns in place will help the facility coordinate response efforts and share vital information while reducing any fears, uncertainty, and panic.
The established practices should include a clear chain of command that defines who is responsible for making decisions and the point of contact for communicating information during an emergency. This hierarchy needs to include primary and backup personnel in case any individuals are not available. The DNS must ensure assigned roles within the nursing department are specific and clearly communicate responsibilities to the staff. For example, if an emergency occurs on the weekend, the nursing supervisor needs to know he or she is the point person until administration arrives on site. The nursing supervisor should remain in contact with the designated member of administration (director of nursing, assistant director of nursing, or administrator) until relieved. - Staff Training and Practice Drills
Effective implementation of any emergency plan requires staff who are prepared and ready to act. Training should occur regularly. Whether it is during orientation, at an annual refresher, or offered monthly, training should increase staff members’ knowledge of the process. Advance understanding of the instructions and goals they will be presented helps to prepare staff for an emergency situation.
In addition to training, facilities should conduct emergency drills routinely, across all shifts, to provide hands-on experience and ensure that all staff members are familiar and comfortable with their roles and responsibilities during an emergency. The frequency of drills will vary depending on each facility’s unique needs, the type of emergency, and any local regulations. Drills emphasize emergency procedures and reinforce through repetition proper practice.
Training and drills should cover an array of scenarios, from natural disasters to active shooter situations. The DNS should assess staff competency with each scenario and work to improve where needed.
Note: DNSs can review the AAPACN Emergency Drills: Code and Elopement Toolkit for assistance setting up mock drills, evaluating staff compliance with procedural steps, and then facilitating a debrief.
The DNS should also monitor compliance with training requirements and ensure staff can attend in-services as needed. Regular opportunities to learn about and practice emergency response efforts will help foster a culture that supports safety. A DNS who emphasizes the importance of preparation and continuously improves emergency response fosters staff participation and encourages the reporting of potential hazards found in the workplace. - Evacuation and Shelter-in-Place Plans
Depending on the nature of the emergency, a facility may need to either evacuate residents or implement a shelter-in-place protocol. Both scenarios require a comprehensive, step-by-step plan. Planning for an evacuation includes identifying safe evacuation routes, establishing safe meeting locations, acquiring transportation, and ensuring that each residents’ medical needs are met during transit. On the other hand, should the situation require shelter-in-place, the facility must ensure that it has adequate supplies and resources to care for residents until the emergency is over.
The Centers for Medicare & Medicaid Services (CMS) provides detailed guidance on provisions in Appendix Z of the State Operations Manual. However, some states may mandate specific amounts or durations of provisions that exceed federal guidance, so the DNS should also review state agency requirements. In either scenario, the DNS needs to know what the facility’s plan is, meet all requirements, and ensure the staff has adequate resources available. - Partnership with Local Agencies and Health Partners
An essential step in emergency preparedness is incorporating established relationships into the facility’s plan. Local emergency management agencies, healthcare coalitions, and community partners such as local hospitals or other area long-term care facilities all can contribute to a coordinated response during a crisis. A DNS can work with emergency personnel such as the police, fire departments, and emergency medical services to facilitate safe and efficient evacuations and resident transfers to hospitals or other care facilities. The coordination of these partnerships can provide additional resources and support, such as backup generators for power supply, emergency staffing personnel, emergency transportation assistance, and alternative temporary shelter options. - Maintaining Operations
Sustaining continuity of care during an emergency is the top priority for facilities—not only for the safety of the residents, but also to maintain a sense of normalcy as much as possible. This should involve having a strategy in place to ensure that essential services, such as medication administration, wound care, and nutritional support, can continue even in the event of a disaster. The DNS should also include a contingency plan for staff shortages, supply chain interruptions, and other logistical operational challenges that may occur.
One way to plan for staff shortages is to cross-train nursing staff in multiple roles. This ensures that crucial tasks can still occur if specific staff members are not available. For example, having the wound specialist nurse also trained to perform in the restorative nursing role, or the staff development nurse cross-trained to fill in for the infection preventionist can help to ensure continuity of care. All specialty nursing roles should be able to step in as a direct care nurse in the event of an emergency.
The DNS should also maintain an adequate store of essential medical supplies, personal protective equipment, and medications by establishing inventory levels and regularly reviewing and reordering supplies before they reach critically low levels. Some items such as dressings, ointments, and antiseptics have a long shelf life. These might be items to keep a larger inventory of to ensure basic care continues, even if there are supply chain interruptions.
Conclusion
Emergency preparedness in post-acute care facilities is not just about having a plan on paper; it requires a culture of preparedness that saturates every aspect of the nursing department’s operational functions. With the right foundation in a comprehensive emergency preparedness plan—conducting a thorough risk assessment, establishing clear communication protocols, and ensuring staff are well-trained—the DNS can enhance the facility’s ability to keep residents and visitors safe while maintaining continuity of care during emergency situations.
Note: To support the DNS with training staff on what a disaster is and basic steps to take, AAPACN has developed the Emergency Preparedness In-Service Education.
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