Recent power outage puts spotlight on problem areas

Fix potential problems before a disaster occurs

When a patient in a wheelchair needs to get from an upper floor to street level after dialysis, the elevators are inoperable.

A "bucket brigade" is the only way to get water to the upper floors of your hospital, since water pumping is no longer functional.

There is no air-conditioning almost everywhere in your city on a hot summer day, which leads to a huge influx of patients with respiratory illnesses.

If one of these scenarios occurred at your facility, it would be a major headache and potentially dangerous. But quality managers faced an unprecedented situation when all of these problems occurred on a single day as a result of the power outage on Aug. 14, 2003, which posed a major threat to the ability to deliver quality patient care. The blackout plunged dozens of cities in the eastern United States and Canada into darkness.

An array of complex problems had to be dealt with immediately, including providing electrical power to life-support equipment for inpatients in surgery or intensive care, providing power to outpatients dependent on battery-powered devices, and loss of vital data due to computer systems being down. To make matters worse, the power outage affected phone service and caused traffic jams, which hindered the ability of staff to communicate and report to work, says Dale Woodin, CHFM, deputy executive director of advocacy for the Chicago-based American Society for Healthcare Engineering. "The massive scale of the blackout caused problems with basic communication and traffic issues."

Normal operations were disrupted and many nonessential procedures delayed, he says. "An extended outage makes for more delays and greater disruption to normal business operations."

To ensure your facility is prepared for a power outage, consider the following situations that occurred during the blackout:

• Fuel supplies for generators were limited.

Very few facilities reported problems with back-up generator systems, Woodin notes. "For the most part, the systems performed as designed. The most common problem was delays in getting fuel shipments to replenish tanks."

Not knowing the duration of the blackout was a major concern, with different hospitals having different amounts of fuel supplies for their generators, says Richard Botney, MD, assistant professor in the department of anesthesiology and perioperative medicine at Oregon Health and Science University in Portland. "If the outage were sustained, some facilities were positioned to continue their work, while others were not, due in large part to loss of fuel supplies," he explains.

• The duration of generators was a concern.

Ensuring that generators continued to work also was an issue, as shown by a number of failures when the generators continued to be used over a prolonged period, he says.

The generators are supposed to be tested regularly and maintained as per Joint Commission on Accreditation of Healthcare Organizations requirements, he notes. Maintenance and testing of this vital equipment is essential, he emphasizes.

"Things happen during prolonged use that don’t appear to be a problem during short-term use," Botney points out. Should your facility face a sustained loss of power with loss of backup generator power, that would be an extremely dire situation because patients dependent on life-sustaining equipment would be threatened, he explains, although certain vital pieces of equipment are designed to operate by hand, such as cardiac bypass machines and mechanical ventilation.

For the most part, emergency power is meant for just that situation — an emergency, Woodin says. "It is not meant to run indefinitely or sustain normal operations." The Joint Commission has stringent requirements for the ongoing testing and maintenance of emergency power systems, he underscores. "These are referenced from the NFPA codes 101, 99, and 110."

In addition, the Joint Commission defines what systems must be supplied by emergency power and requires that organizations develop contingency plans in the event of a utility failure, Woodin adds. When surveyors come to your facility, they will inquire as to the inspection and maintenance of the generators and related devices of the emergency power system, he says.

"JCAHO prescribes that generators should test run monthly with actual hospital loads," he says, adding that the automatic transfer switches connecting the generator to the building loads also must be tested monthly. "This drill is very effective in testing the entire system, from generators to end outlets and lights."