Services continue despite losing building in hurricane

Staff overcome communications and travel problems

(Editor’s note: The devastation that Florida has experienced this hurricane season is unlike any the state has seen before. Following are the lessons learned from one agency caught in the middle of Ivan, one of the more powerful storms.)

Charley, Frances, Ivan, and Jeanne might be the names of friends you invite to your house for dinner. But for people living in Florida, these names represent a trying, traumatic series of hurricanes that kept Floridians and the home health agencies that serve them in a constant state of evacuation, preparation for storm damage, and clean-up.

Many houses and offices are still standing in Florida, albeit with damage. Some others, such as the facilities of Sacred Heart Home Care in Pensacola, must be rebuilt because the original structure was destroyed.

Rolodex file lost in storm

Ivan’s wind, rain, and storm surge collapsed the part of the building that housed Sacred Heart’s administration, nursing, clinical, and pharmacy departments, says Connie Hetterich, RN, administrator of the agency. "Luckily, a fire wall in the building protected our durable medical equipment offices," she adds.

Records for all active patients were packed up and moved to a safe space at the hospital before the hurricane arrived. Records for inactive patients were left in the office and were moved to higher locations in case of flooding and covered with plastic. "The actual medical records are computerized, but we kept paper records of consent forms and supporting documentation," Hetterich explains. "Unfortunately, we no longer have those records, or many of the items we had in our desks," she says.

Little things like Hetterich’s Rolodex file of important phone numbers and names are missing because no one imagined that the entire office would disappear, she adds.

"We focused on active patient information and employee contact information so that we could resume care as soon as possible and so we could check on patients and employees," Hetterich points out.

The announcement that Ivan would make landfall at Pensacola came over a weekend, so Sacred Heart employees started emergency preparations on Monday, says Nona Wainwright, RN, director of nurses for the agency. Nurses spent the day contacting patients to see which patients were leaving the area with family members, which ones were going to a shelter, and which ones were planning to stay, she explains.

"We had a good idea of patients’ plans before we made these calls because, during admission of new patients, we always ask what they will do if there is an evacuation or a threat of a hurricane," Wainwright says.

"All of our supervisors also made sure they talked with each of their employees to find out what their plans were as well," she adds.

Extra meds and oxygen delivered early

"Our pharmacy compounded enough drugs to carry our patients through 72 hours or a week, depending on the medication," Hetterich notes. Employees then spent Monday and Tuesday making extra deliveries, she adds. "[We] also spent time delivering extra oxygen tanks to patients.

"We were very glad to see that our patients had no problems with oxygen in the aftermath of the storm and that we had correctly planned for their needs," Hetterich continues. "What we didn’t anticipate were the number of calls from clients of other vendors who needed oxygen tanks but could not reach their vendors."

While Hetterich’s agency helped other vendors’ clients as they could, the unexpected calls point out a need for agencies in the area to work together to develop a plan to address patients’ needs before, during, and after an emergency, she stresses.

Ivan hit Pensacola at 1:50 a.m. Wednesday. "We were unable to see patients until Saturday because entire areas were flooded, roads were closed, and it was dangerous for anyone to travel," Wainwright says. "On Saturday, nurses started seeing priority patients as they could, such as wound-care patients," she explains.

Although access to many areas was restricted to prevent looting, home health workers with an identification badge could go into any area to check on patients, Wainwright notes. "Our employee badge became a very important accessory in the aftermath of Ivan," she says.

While the agency requires employees to wear identification when seeing patients, all employees were reminded to keep their badges with them starting on Monday, rather than leaving them in their desks, she points out. This was a good idea because, after Ivan came through, many of those desk items were missing, Wainwright explains.

Home health employees were able to continue working during and after the storm at Sacred Heart Hospital, where they helped move patients to safer locations within the building, deliver meals, supervise children in the "Hurricane Kid Camp" set up for 200 children of hospital and home care employees during and after the storm, and sit with patients to calm them.

"I was surprised to see the number of pregnant women who were at least 36 weeks pregnant, some due in one or two days, who came to the hospital as their shelter," Hetterich says. "We provided mattresses that the home care agency keeps so the women would not have to sleep on the hard hospital cots," she adds.

Following the storm, many physicians in the area were unable to provide intravenous therapy in their offices, so their patients came to the hospital for their IV therapy. "Our home health nurses with IV training were able to supplement the hospital staff so these patients [could receive] their therapy," Hetterich notes.

"Our staff really pitched in to help during the storm; then the hospital employees helped us after the storm," she says.

Gasoline becomes precious commodity

Hospital support for the home care agency included space, help from information systems, maintenance, and administrative departments, as well as supplies such as water, ice, and gasoline.

"We did not have to stand in line for water and ice; the hospital provided it," Wainwright explains. "Our sister hospitals in Mobile and Jacksonville brought cans full of gasoline so our field staff could make visits, and they also provided employees to help us get back into business."

The gasoline was critical because there was no electricity in the area, and gasoline pumps at service stations don’t work without electricity, she points out. "We did tell employees to make sure their gas tanks were full Tuesday evening, but power wasn’t restored for many days in some areas."

In the two days prior to the storm, all field staff made sure records from OASIS (Organization for the Advancement of Structured Information Standards) forms and any information on their laptops were dumped to the server, Hetterich says. "We made sure we had backups of the information, and we also exported information to our state CMS [Centers for Medicare & Medicaid Services] intermediary before we took the server off-line," she says. Even with those precautions, the server did suffer some damage, requiring the agency to work with paper records for three days. For some time, they were unable to submit claims electronically, she adds.

Hetterich says she is working with her CMS intermediary to make sure claims are processed properly, and she also is notifying other organizations that OASIS records, medical records, and claims information may appear out of sync due to storm damage and losses.

Wainwright plans to incorporate before-and-after pictures of the agency’s office into her employee education on emergency preparation. "When you live in Florida, you develop a tendency to become complacent when a hurricane is predicted, because we often prepare for a storm that doesn’t come. I want to make sure that we don’t forget what happens when it does hit, to make sure we all take emergency preparations seriously," she adds.

"I just never imagined that we would literally lose our building," Hetterich adds. If she had anticipated the loss, she would have taken items such as her Rolodex file with her.

"My staff have always said that if anything happened to me, they would be fine, because they would have my Rolodex file," Hetterich points out. When asked if her staff are more protective of her now that the Rolodex file is gone, she laughs and says, "Actually, the thing that concerns me is that they are still looking for the Rolodex file."