Do your disaster drills use a CQI approach?

JCAHO says there are missed opportunities’

After your disaster drills, do you identify areas that need improvement, and do you take steps to address these? That’s what JCAHO surveyors will want to know, with a revised standard effective July 1, 2006, requiring health care organizations to improve the planning and evaluation of emergency management drills.

"This change is being made to help ensure that the field is conducting emergency management drills rigorously and thoroughly," states a JCAHO announcement. "It is believed that there have been missed opportunities during drills to identify and improve weaknesses."

The new standard calls for a continuous quality improvement approach to planning, conducting, and evaluating emergency management drills. Although disaster drills and hazards vulnerability analysis have been required for years, quality improvement often was lacking, says Jonathan Weisul, MD, vice president of medical affairs for Alexandria, LA-based Christus St. Frances Cabrini Hospital. Weisul is responsible for JCAHO compliance for Christus Health’s Central Louisiana region.

"Our biggest weakness is failing to learn and implement from disaster drills. The JCAHO standard emphasizes the quality improvement approach — not only that you did the drill and conducted an analysis, but what did you learn from it and what did you do to close the loop," he says. "It will also be crucial to prove to the JCAHO that the drill to be done simulates a real situation."

In general, once areas for improvement are identified, the JCAHO wants to see evidence of compliance and measures of success, Weisul notes. "The same kind of thinking should be used for disaster drills — what improvements have been made and how will you continue to sustain these gains?"

In health care, the sense of urgency around disaster preparedness has increased after the 2005 hurricanes, says Weisul. "The planning is now in regard to not if but when," he says.

During an after-action debriefing following Hurricane Rita, areas needing improvement were identified and specific individuals assigned to take actions, reconvening at a later date to make sure that the improvements were put into place, says Weisul. For example, the organization found that it had relied on cell phones to communicate and that this broke down in some cases. As a result, two-way radios were obtained.

That specific aspect of communication will be tested during the organization’s next disaster drill, Weisul says. "We do a monthly check of our disaster preparedness to make sure equipment is available and in working order," he adds.

In the past, most organizations geared disaster drills toward multicasualty events such as bus crashes or bomb explosions, but future drills need to incorporate scenarios such as power outages and evacuations, Weisul stresses. These are things that typical hospitals hadn’t thought of in the past, he explains.

"In the past, we weren’t as cognizant of that —until we experienced results and failures in those key areas," says Weisul. After 2005’s Hurricane Rita, the hospital lost water pressure in a short time frame, and also lost air-conditioning. "We had to consider the effect on lab equipment and dialysis, and to try to do that in real time of less than an hour is a challenge. If we had drilled on that aspect, it would have been a very eye-opening experience."

The health care system has developed a plan to activate resources when facilities are damaged by storms, Weisul says. "What we found during Katrina is that resources are scarce. You may find you are not in line to obtain transportation and outside help."

Newly revised JCAHO standards address the verification of volunteers who are not licensed independent practitioners, including credentials and assignment of responsibilities during disasters.

The new standard, effective July 1, 2006, allows for a more streamlined process for volunteers if two conditions are met: The emergency management plan is activated and there are patient needs that the organization is unable to meet. "The new standard will not have the same level of scrutiny and state-specific licensure when volunteers cross state lines post-disaster," says Weisul.

At Christus, during an after-action review of Hurricane Katrina, quality leaders found that the process for doing emergency credentialing was too time-consuming, says Weisul. "The key is being able to develop a process that is streamlined and achieves the JCAHO standards but is not burdensome, because during times of crisis there is a lot going on for everybody. We need to make sure the processes we put in place during our times of leisure will work when we are overwhelmed during a disaster," says Weisul.

[For more information, contact:

Jonathan Weisul, MD, Vice President of Medical Affairs, Christus St. Frances Cabrini Hospital, 3300 Masonic Drive, Alexandria, LA 71301. Telephone: (318) 561-4135. E-mail: weisul@maui.net.]