Overview:
Over the past several years, The Joint Commission has issued standard changes to the Emergency Management Chapters in each of its accreditation programs. These changes resulted in a realignment of the standards with each of the programs affiliated CMS requirements. Although the work on the EM chapters had begun prior to the pandemic, the resulting new and revised standards put forth are reflective of many of the issues, barriers and questions that arose during the Covid-19 pandemic.
The end result of the chapter revisions is designed to provide a meaningful framework for the emergency management program. But all our readers are aware of that. This month’s article is really about taking that framework to create your foundation, but also taking that framework and using it to drive knowledge and training into each department within your organizations so that when disaster strikes, care continues in a seamless manner delivering high quality , safe care without missing a step. There are certainly standards and elements of performance that speak to staff training and knowledge that focus on the operational framework.
With the continuous cybersecurity concerns, ransomware and even the most recent CrowdStrike event, we need to be significantly concerned about how our organizations will function absent of the information technology systems.
Observations from the field:
Recently, during a mock survey, our consultant asked the staff on a patient care unit about the care delivery process in the event of an electronic medical record system failure. The staff did a great job verbalizing the process: the overhead announcement, accessing the downtime documentation box and so on. But when the consultant asked to see the downtime care documents, they were outdated. Absent were the suicide screening tools, social determinants of health assessment tool and other essential documents that would permit us to continue to provide seamless, high-quality, safe care. When the bedside staff were asked about medication administration, care planning and order management, many of the newer staff members admitted they were not familiar with the use of those documents.
Emergency Operations Drill questions to ask within your organization:
- During your Emergency Drills, is practicing the use of downtime documents a part of your drills?
- Does your organization have a hard-wired process to ensure that paper documents are created for each computerized document?
- Who is responsible for updating the downtime documentation files? Who is responsible for periodically validating they are up to date?
- Is downtime care delivery and documentation part of your on-boarding process?
- Is there a downtime plan in every department from the bedside to the boiler room? Does every department review the plan and exercise the plan with their team members?
- When your organization conducts their Emergency Operations drills, are the front-line care team members engaged to drill their component? For instance, if the unit needed to be evacuated, have the staff actually drilled using the evacuation slide devices for non-ambulatory patients?
Workplace Violence and Active Shooter Drill Opportunities:
Sadly, current events in recent years have focused many of our efforts on Workplace Violence and Active Shooter types of events. Regulatory and Accreditation organizations have implemented requirements that require our healthcare organizations to develop organized approaches to the identification of events, collection of data about events and trending of the data collected and establishment of actions to mitigate the identified risks.
Ensuring that this work includes educating and training front-line staff how to personally react/respond if confronted with such an event is essential. Conducting a risk assessment to determine the various degrees of training needed in each department will initially be a significant body of work, ultimately, it will lead to the provision of tailored meaningful education and training to staff. For instance, is full de-escalation training including escape training essential for all staff or a subset of staff? Perhaps the provision of verbal de-escalation skills is sufficient in some locations.
Workplace Violence/Active Shooter Drill questions to ask within your organization:
- How does your organization drill for workplace violence events and active shooter events?
- Does your organization take the event to individual care locations and individual staff members? For instance, have you selected a care location that will be asked to demonstrate actions to be taken and then execute those actions?
- What type of skills have you provided to your staff that will help them as an individual stay safe? Have you provided basic de-escalation training to staff? Have you taught them how to create a diversion or distraction should they be in a situation where they feel they need to escape?
- Can front-line staff identify locations that would be best to seek shelter within or behind?
In summary:
Ensuring our organizations have the proper framework and our staff are trained in safety strategies and how to be able to continue to provide care, treatment and services is essential to both the operational wellness of our organizations and the overall wellness of those working within our organizations.
For questions or to learn more contact the C&A team at 704-573-4535 or email us at info@courtemanche-assocs.com.
