Crisis averted: 6 tips for effective emergency preparedness

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Winter is here, bringing with it a wide array of concerns for ambulatory surgery centers. Are we in for another brutal winter? What weather-related problems will ASCs face over the coming months? While we don't have answers to these questions as yet, past years have shown that ASCs would do well to prepare for the worst.

And it isn't just natural disasters that ASCs need to prepare for. The types of emergencies that centers could face are varied.Jan Allison Photo

"There are multiple types of emergencies that have a possibility of happening, both external and internal," says Jan Allison, director, accreditation and survey readiness at Surgical Care Affiliates. "When mentioning an emergency, what typically jumps to the forefront of people's minds are the external disasters involving well-known forces that come from nature, for example, severe weather, wildfires and earthquakes. These are the emergencies that make the news because they impact the safety of multiple people and result in the widespread damage and destruction of property. But emergencies can also derive from technological events and human events as well. A more common emergency to an ASC is the loss of a utility or system."

photoAnother typical concern at surgery centers is the possibility of a fire, according to Amiee Mingus, RN, CPAN, director of clinical operations at Regent Surgical Health. "Fire is huge concern, especially in operating rooms where surgeries are being performed," she says. "Electrocautery equipment can sometimes cause sparks and since there are high levels of oxygen present in ORs, starting a fire is a definite concern."

According to Ms. Allison, the definition of what constitutes an emergency at an ASC can be widened even further to include unexpected loss of water, suction, power, medical gases and even communication failures.

Thus, it is in their best interest that ASCs adopt the old Boy Scout motto and be prepared of any type of emergency. "Both CMS and The Joint Commission suggest using a four-stage readiness plan for disaster management — mitigation, preparedness, response and recovery," says Ms. Mingus. "You just have to do the best you can do."

Here are six emergency preparedness tips for ASCs:

1. Conduct risk assessments. Conduct risk assessments to develop an emergency response and management plan, says Ms. Allison. Since surgery centers aren't able to plan for all potential emergencies, ASCs need to identify how best to use their time and resources.

"Conduct a risk assessment [regarding] which emergencies have the highest probability of occurring," she says. "To identify where they are best served in spending time and resources in emergency preparation, they need to identify and prioritize the likely hazards their facility and community could directly or indirectly face."

By focusing their drills on the emergencies most likely to occur, ASCs can ensure they are mitigating the disasters with a potentially high level of impact.

"I recommend including an emergency drill each year related to the loss of a critical utility for the facility to see how prepared they are to manage the situation and if their contingency plan is adequate," adds Ms. Allison.

2. Make drills realistic and flexible, and practice thoroughly. "No matter how much time and effort a facility puts into emergency preparedness, the emergency itself could be something facility staff hadn't considered," says Ms. Mingus.

It is important that ASCs try and make sure their drills are as realistic as possible by basing the drill on a real scenario. Avoid doing only table-top drills, suggests Ms. Mingus. While it is important to discuss emergency preparedness, physical practice is equally, if not more, important.

"I am a big believer in 'practice makes perfect.' The more you practice it, the more your staff will be able to remain calm during an actual emergency. Also, you don't want to find out that some aspect of the plan won't work as the building is falling down around you, so to speak," she says. "ASCs should also ensure their emergency preparedness plans are flexible as well. Success in the disaster situations comes with being able to flex when the situation changes."

3. Test equipment. Testing equipment regularly and making sure it is functioning properly is key for emergency preparedness, says Ms. Mingus. Additionally, ASCs could buy new equipment specifically for emergency situations, such as emergency batteries for generators to help mitigate power failures.  

4. Consider the possibility of shutting down for a few days. Last year's severe winter saw several ASCs snowed in and having to shut down for a few days. According to Ms. Allison, since healthcare facilities in this country have the technology that allows them to know in advance the type of weather front approaching, timing and severity, they should conduct a risk assessment to determine the impact of the weather.

"Because procedures are elective, decisions can be made in advance that prioritize the safety of the patients, visitors and staff," she says. "States and communities are very diverse in their ability to manage the extremes of a winter season and this can have an impact on the facility's decision to continue business as usual or to close operations for a particularly brutal storm."

The facility's size, location, available staff and type of operations are all important factors to consider before deciding whether to shut down. The impact that the weather could have on critical utilities and the ability to access resources such as water, supplies and drugs during disruptions are key factors when strategizing, says Ms. Allison.

"This is why it's important that an emergency management plan also contains operational details to guide the response to an incident or event," she adds.

5. Consider unusual emergency situations. Ms. Mingus says that several Regent Surgical Health ASCs have incorporated an active shooter policy. The issue of shooters in healthcare facilities is a sad but not uncommon situation. Hence, surgery centers need to prepare for the possibility.

"In our active shooter policy we included details such as the importance of identifying areas within a center where people can hide as well as developing codes that can be used to let people know that there is shooter on the premises," she says. "We also included advice on how to protect patients who cannot be moved from recovery rooms and how to barricade doors that can't be locked."

6. Evaluate continually. Evaluation is key to the success of any plan, especially emergency preparedness plans, which must be tweaked in accordance with every emergency. "Conduct an evaluation of how the response to an emergency went and determine what did and didn't go well," says Ms. Allison. "Promptly update the emergency management plan from the lessons learned."

It's important that facility leaders and staff are involved in the evaluation of the response to the emergency, since the entire organization was affected, adds Ms. Allison, and then share lessons learned with fellow ASCs.

"Preparedness is key for ASCs to care for the community they serve and networking with each other is vital to that preparedness," she says.

More articles on accreditation:

Joint Commission revised pain management standard to go into effect 2015
4 benefits of risk management programs
AAAHC compliance report: 5 things to know

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