Lessons learned improve preparedness

Needed: Generators, extra oxygen, walkie-talkies

There is nothing like a real emergency to test and evaluate your hospice emergency preparedness plan. Although hospices and home care agency managers interviewed by Hospice Management Advisor came through hurricanes Gustav and Ike in remarkably good shape, they all identified additions that will enhance their plans.

  • Keep communications systems operating.

Although most of her staff members stayed in the area, even after evacuating their own families, communications is difficult, says Wyona Freysteinson, RN, MS, director of the home health and hospice at Memorial Hermann Hospital in Houston. "Many staff members and our office were without power, so we could not rely upon e-mail communications, because we didn't know if employees could keep their laptops charged or find a wireless connection," she says.

Cell phones were not reliable due to the number of cell phone towers damaged, she says. "We will rent Nextel walkie-talkie phones prior to the next storm," she says. Although there always is the possibility that they won't cover all areas, they seemed to be a more reliable form of communication during Ike, she adds.

  • Make sure staff members know their role in an emergency.

Staff members at Memorial Hermann Home Health and Hospice did not evacuate, even when they made sure their families left the areas targeted by Hurricane Ike and even if they couldn't contact the office, says Freysteinson. They knew their role as first responders, she adds.

"We told everyone that if you can safely get to your patients' homes, do so," she says. Staff members knew which patients were evacuating and which ones were not. As soon as it was safe to travel, they visited patients, Freysteinson says. "Our nurses took water and ice or other supplies to patients' homes without being told to do so," she says. With no electricity and flooding threatening water supplies, both items were needed by families to ensure clean drinking water, Freysteinson says. "Reimbursement of these items had not been planned in the emergency plan, but it is now included."

  • Have backup oxygen tanks for patients.

"Many of our patients have switched from oxygen tanks to oxygen concentrators because they are easier to use and you don't have to worry about replacing tanks," says Dorean Levenberg, RN, administrator of Deaconess Home Care in Cincin-nati. The problem with concentrators occurs when there is a power outage. "The concentrators require electricity, and although they have battery backup, if the power outage lasts as long as some of ours did, the battery runs out and the concentrator does not work," she says. "We will now start to make sure that patients have a portable oxygen tank in their home just in case of a power outage."

  • Identify partnerships for emergency use.

Although staff members never found themselves stranded without gasoline, there was time spent finding gasoline and sitting in long lines when clinicians found themselves in the midst of a gasoline shortage following Ike, says Mary Zagajeski, RN, MS, COS-C, vice president of home health operations for Visiting Nurse Health System (VNHS) in Atlanta. By calling corporate offices of gasoline distributors, checking Atlanta-based web sites that identified location of stations with gas, and by talking with staff members, VNHS office staff were able to e-mail field clinicians with information, she says. While there is no need for the agency to install their own gasoline tank, she does say they are going to talk to different suppliers to see if they can develop a plan that will make it easier for VNHS staff members to obtain gasoline during a crisis.

  • Stay involved in county/city emergency management teams.

The meetings throughout the year might seem to be a waste of time but Paula Moore, volunteer coordinator at Lakes Area Hospice in Jasper, TX, says that her involvement and attendance at local emergency management meetings gave her an opportunity to prepare ahead of time for the hurricane. Because her area was evacuated, hospice staff needed passes and identification badges to enter areas in which their homes were not located.

"Prior to the storm, I was able to obtain passes that enabled all of staff — clinical, clerical, and durable medical equipment — to cross barriers to get to patients or to get to the office to coordinate clinicians," she says. There was no delay in seeing patients because Moore knew what type of identification was needed and how to get it from the appropriate departments before the emergency occurred, she adds.