"Emergencies are not limited to inpatient-only [facilities]."
So said Laurie Deihs, RN, assistant director of education for the Accreditation Association for Ambulatory Health Care during a June 17 webinar hosted by AAAHC. Ms. Deihs, along with Kris Kilgore, RN, administrative director of Surgical Care Center of Michigan in Grand Rapids, shared the five elements of emergency management to help ASCs ensure preparedness for any emergency situation:
1. Internal emergency and disaster plan. When creating the plan, it is important to know federal, state and local regulations. Ms. Kilgore said reaching out to local agencies can be effective — the fire department in her community is willing to help her ASC conduct fire drills and provide tips on compliance, she said. ASCs should also perform risk assessments, considering the ASC's specific patient demographics, facility issues and the rates of inclement weather. "Think about what is in the news today, and could that happen at your facility," she said. In addition, this risk assessment should include a set chain of command, to ensure everything will run smoothly during a crisis.
All these plans should be reviewed for feasibility — "Actually try to get a patient down a stairwell, for example," said Ms. Kilgore. ASCs should perform drills regularly and track participants to ensure everyone's knowledge of the emergency plans are up-to-date.
2. Staff and physician training and education. "Training and education is different than drills," said Ms. Deihs. Drills are hands-on, but it's equally important for physicians and other staff members to understand the theory behind them as well as any fire safety, first aid or other government-required knowledge. This training includes anesthesiologists, residents and anyone else in the ASC. "Anyone in your facility needs to know your emergency plan and especially your evacuation plan," said Ms. Kilgore.
3. Emergency medications and equipment. ASCs should check state requirements to ensure they have all needed emergency medications and equipment. This includes the crash cart, said Ms. Deihs. "Often, emergency care is delayed because of the crash cart, people don't know the location, can't find the key, don't know the contents of the crash cart," she said, or find the wrong or expired items within the cart.
4. Simulation-based drills and debriefing. To prepare for adverse events and practice response plans, Ms. Deihs and Ms. Kilgore recommend using simulation-based emergency training. "Simulation-based training increases emergency preparedness through deliberate practice using clinically-based scenarios to represent 'real world' situations," said Ms. Deihs. Doing simulation-based training allows an ASC to assess its internal emergency disaster plan and the readiness of the clinical team, allows the ASC's team to develop and use clinical and critical thinking skills, promote collaboration and communication within the team and allows the ASC to discover and fix any flaws in its emergency plan.
To conduct an effective drill, ASCs need to base the drill off a 'real-world' scenario — "make sure the scenario you're carrying out is something that could happen at your facility, or something that could happen at your facility," said Ms. Kilgore. ASCs should then identify the roles needed, develop a plan to execute the drill, evaluate the drill results, debrief staff and create a corrective action plan or modify the emergency response plan as needed.
Additionally, it's important to have fun but to also communicate with staff that the drill should be taken seriously, she said. Teddy bears of staff members may play the role of patients or other figures in an emergency, but it is important everyone treat the drill as a real emergency in order to realize the benefits of having the drill.
5. Evaluation and corrective action plans. After drafting an emergency response plan and testing it through drills, it is important to evaluate the effectiveness of the plan and take any action necessary to make the emergency plan effective. Any changes to the plan should be communicated to staff to inform everyone of new procedures. Good corrective action plans will also have timeframes — be it a week or a month, the dates to have the emergency plan updated should be realistic but firm, said Ms. Kilgore.
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