You’ll need a policy before disaster strikes
After the terrorist attacks of 9/11, area hospitals all reported a deluge of volunteer clinicians. This may sound like good news when your facility is suddenly overwhelmed with patients, but it also can be dangerous.
"We have an obligation to provide safe, quality care," stresses Marianne Klass, RN, MN, accreditation and safety director at Swedish Medical Center in Seattle.
"During times of chaos, it is not unlikely that certain people may enter a system and [impersonate] someone they aren’t, such as a physician. Systems must be in place to safeguard this from happening."
When developing a policy for credentialing of volunteers, consider the following:
• Comply with new Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards.
In September 2002, the Joint Commission issued a new standard which allows a hospital to grant privileges to health care professionals who volunteer their services during an emergency, says Charlotte Jefferies, of the Pittsburgh-based health care law firm Horty, Springer & Mattern.
The JCAHO standard was created after the Joint Commission’s debriefing of health care personnel involved in the 2001 flood in Houston and in response to the terrorist attacks on 9/11, Jefferies says.
"Physicians and hospital personnel involved in those disasters identified a specific need for rapid access to clinicians to assist the hospital in meeting patient care demands in those emergency situations," she says.
JCAHO requires an emergency management plan to design, implement, and evaluate a total response and recovery system, and this includes emergency credentialing for physicians, says Klass. "It makes sense to extend this standard to any clinician," she says.
The standard encourages hospitals to develop credentialing and privileging policies or protocols that can be implemented when a hospital determines to activate its emergency management plan, says Jefferies.
The standard outlines acceptable sources of identification of volunteer licensed independent practitioners. Those sources of identification include:
— a current picture hospital ID card;
— a current license to practice and a valid picture ID issued by a state, federal, or regulatory agency;
— identification indicating that the individual is a member of a disaster medical assistance team;
— identification indicating that the individual has been granted authority to render patient care in emergency circumstances, such authority having been granted by a federal, state, or municipal entity;
— verification of the volunteer practitioner’s identity by a current hospital or medical staff member.
• Understand Good Samaritan laws.
Although specific documentation may be required in the event of a disaster, this may not be followed to the letter in the event of a mass casualty incident, in the eyes of some quality managers.
"Our policy does require documentation, but in a real 9/11-type emergency, our chances of getting all of that documentation is slim — and who knows when we will be able to do all of the verifications," says Kathy Downs, CMSC, CPCS, CPHQ, director of medical staff services at Paradise Valley Hospital in National City, CA.
"I also think that depending on the situation, some hospitals will just need all of the medical personnel available and will have to worry about the consequences later," says Downs.
When an individual truly acts in a voluntary capacity to aid another whom he or she is not required to aid, that individual is deemed to have acted as a "Good Samaritan" and is exempt from liability, says Jefferies.
Some form of Good Samaritan legislation has been enacted in all 50 states and the District of Columbia, Jefferies says. No volunteer physician who in good faith renders aid is liable for civil damages as a result of acts or omissions in rendering such aid, she says.
If federal law grants immunity to hospitals for their use of volunteers when they activate an emergency management plan, then the hospital would not be liable for the acts of the volunteer, unless it failed to follow its own identification process before granting privileges, says Jefferies.
But if the volunteer was incompetent and the hospital knew, or from information in its possession should have known, of the individual’s incompetence, then the question is whether the hospital acted in good faith, she explains.
Therefore, how you handle the credentialing of volunteers is important, Jefferies stresses. "In a real disaster, time is of the essence, and we know from experience that there is usually very little or no time to check the qualifications of persons who volunteer to provide care."
Jefferies notes that the JCAHO standard, like many state disaster plans and regulations, does not require, recommend, or suggest that the hospital conduct an evaluation of the volunteer’s education, experience, training, work history, character, ethics, or ability.
The key element addressed by the JCAHO standard and other state rules, regulations, and statutes is having a procedure to verify the identity of the volunteer, she explains.
• You need a system to verify competencies and licensure.
There is a risk to any organization choosing to accept nonprivileged or unknown staff, says Klass. "If we’re desperate for help, we certainly don’t want to turn away volunteers, but we must do so under the framework of caution for liability and for patient safety," she says.
There should be a designated role in your incident command system for collecting documents from volunteer physicians, nurses, respiratory therapists, and pharmacists, to track name, licensure, and other pertinent clinical information, says Klass. If a person shows up barehanded without any of these items, other methods of identification and tracking should be implemented, such as taking Social Security numbers or other personal facts, she says.
"If the computers are functional, then there is the ability to tap into the state licensure system for verification, but the paper-and-pencil’ method needs to be in place as a contingency," she adds.
The facility has procedures in place to assign a volunteer clinician alongside a staff person, says Klass. "This enables a buddy system to eye the competencies and skills of the volunteering person. If there are any concerns, this can be immediately addressed.
If there is any doubt as to a volunteer’s capability, he or she might not be accepted at all, says Klass. "If we aren’t desperate for help, we won’t accept their help, or obviously, we could place them in nonrisky activities, such as making sandwiches or shoveling debris," she says.
• Reduce need for volunteers.
There may be less of a need for volunteers than you expect, since during actual disasters staff typically "step up to the plate," says Klass. "Staff will come in when they are not scheduled or work extra long hours to get us through the disaster," she says.
As a result, the facility has rarely had to accept the help of volunteer clinicians, she says. To reduce the need for volunteers, Klass recommends working with staff to have solid home preparedness plans, so that if they are at work when a disaster occurs, you can count on them to stay and be focused.
At Swedish Medical Center, all staff have been asked to develop home preparedness plans for whatever is needed to survive independently for three days, such as shelter, food, water, medications, clothing, battery-operated radio, first-aid kits, battery-operated flashlights with extra batteries, candles, and portable generators.
"Those who do not have sound home plans are more likely to leave work or not come in, since their first obligation is to secure the home front," Klass says. "Hence, personal disaster plans are crucial to a successful hospital emergency management plan."
[For more information about credentialing of volunteers during disasters, contact:
• Kathy Downs, CMSC, CPCS, CPHQ, Director of Medical Staff Services, Paradise Valley Hospital, 2400 E. Fourth St., National City, CA 91950. Telephone: (619) 470-4156. Fax: (619) 472-4502. E-mail: DownsKA@PVH.AH.ORG.
• Charlotte Jefferies, Horty, Springer & Mattern, 4614 Fifth Ave., Pittsburgh, PA 15213. Telephone: (412) 687-7677. Fax: (412) 687-7692. E-mail: email@example.com. Web: www.hortyspringer.com.
• Marianne Klass, RN, MN, Accreditation and Safety Director, Swedish Medical Center, 747 Broadway, Seattle, WA 98122-4307. Telephone: (206) 386-2549. Fax: (206) 215-3071. E-mail: Marianne.Klaas@swedish.org.]