Patient Safety Quarterly

Home care poses special challenge in emergencies

Handling the worst Mother Nature has to offer

Most health care providers have an emergency preparedness plan that covers all aspects of how to run the hospital in a disaster, but there may be one glaring omission. Did you include how to care for patients in your health program?

Some home health agencies have contingency plans for providing care in an emergency, especially in severe weather. For some agencies, severe weather is a fact of life. Take New England Lifecare in Westbrook, ME, as one example. Snowstorms and rough winters are routine and require that staff and patients always be prepared for times of limited or difficult travel.

Antoinnette Pierce, RN, New England Lifecare’s director of nursing, notes that she had to implement her agency’s disaster plan in January when an ice storm ripped through the Northeast.

"There were people without power for up to two weeks," she says. "But we didn’t have any situations that jeopardized IV patients. The storm started while we were in the office, so we called the priority patients who were going to be in a bind and gave them instructions."

It’s not always the looming snowstorm or hurricane that will affect your operations, as Kathleen Daoust, RN, infusion coordinator for the Lee (MA) Visiting Nurses Association (VNA), can attest.

"We had a tornado, and the key is to pre-plan and have systems in place to deal with catastrophic events," she says.

Here are five steps that Pierce and Daoust recommend you take to create your own or fine-tune your existing disaster management plan:

1. Educate and plan ahead.

Every initial visit by a Lee VNA or New England Lifecare nurse requires disaster training for the patient. "When we take a patient on service, we do a lot of ancillary teaching because a lot of our patients are in very rural areas," says Pierce, noting that rurally situated patients heighten the risk of a missed or delayed visit during storms.

For Lee VNA, Daoust says the nurse conducting the initial visit takes the following steps as part of the agency’s disaster management plan.

"We teach the patient to manage any problems with their therapy, identify an emergent situation, or troubleshoot a minor problem," notes Daoust. "We leave written information on how to activate assistance if they need it."

The preprinted packet contains information on the patient’s specific therapy, as well as information on how to access assistance should the patient require it. The packet provides the patient with the following emergency phone numbers:

— 24 hour pharmacy support;

— home care IV nurse;

— local hospital;

— EMS;

— the patient’s doctor.

Lee VNA also uses this as a marketing opportunity. The patient is given a wipe-off board and marker, on which the above emergency phone numbers are listed.

"We leave it with them so the phone numbers are immediately available to them," says Daoust. "It’s a marketing tool with our logo, name, and number. It’s quite convenient, and patients can write something they want to ask the nurse about so they don’t forget. Also, if they have a problem in the future, our name and number is right there, and they can call and come back into our system if they need to."

The nurse asks the patient and/or caregiver to identify any available support services in the patient’s environment.

"It may be someone who lives in their home or even a neighbor or relative with a medical background," says Daoust.

The patient is also taught what to do in case of an environmental emergency, such as how to store materials and care for equipment.

Combined with similar patient education provided during the initial visit, Pierce notes that during the winter, every home infusion patient has an extra day’s worth of supplies at all times. Should disaster strike where it would be impossible to visit the patients, they or their caregiver could still administer the infusion.

2. Prioritize.

For some patients, not receiving a visit for a day or two isn’t a problem. But for others, the question isn’t whether they need to visit but how you’ll get to the patient’s home. The first step in any disaster plan is to separate the patients who must be seen from those who can wait — not a task you’ll want to make as Mother Nature is wreaking havoc outside. "We keep a running board of all our patients," says Pierce. "Even though we use nursing agencies, we’re able to keep up to date on what each patient’s condition is. We talk to our patients every week, and our agencies also keep us informed. It’s according to diagnosis which patients we’ll have to get to first."

Lee VNA has a similar system. "We update the IV nurses on a daily basis with a written patient roster," says Daoust, who notes that the roster includes the patient’s name, vendor/referral source, current therapy and drugs, as well as any special issues or problems regarding the patient that staff should be aware of. "The roster is updated daily as needed, and we also have weekly team meetings where we discuss and update all personnel on home infusion clients."

By always having patients prioritized, there’s no scrambling to review patient charts when the weather takes a serious turn for the worse. Instead, it’s a simple matter of getting on the phone.

"We contact the patients who would be jeopardized should they miss a dose or if their care is interrupted," says Pierce. "We make sure they have an alternative in place or enough supplies to get them through until we can get to them." Informa-tion provided in the phone call includes:

  • Giving patients options. In particular, Pierce makes sure patients can contact the rescue squad or a local hospital.
  • Pump education. Patients are instructed on how to calculate drip rates, in case they lose power and the pumps run out of batteries.

Pierce notes that the above serves as a reminder to the patient education provided during the initial visit.

3. Plant a phone tree.

By having a phone tree in place, the burden of contacting all the required staff doesn’t fall on the shoulders of just one or two individuals.

"Our calling tree starts with the general manager," says Pierce. "It notes who each person is responsible for contacting by phone or car phone so staff know what’s going on, if there are any immediate needs patient-wise, to let the answering service know the beeper system is down, and who to contact and how to contact them," says Pierce.

4. Back up your backup plan.

The snowstorm hits, so you settle behind your desk and prepare to start the phone tree process and call patients. But when you pick up the phone, the line is dead, and your cell phones don’t work. That was just the situation Pierce was faced with during the ice storm. "Our biggest hassle was when the ice brought some towers down, and our beeper system went down with it," she says.

Fortunately, the disaster plan accounted for just such a situation. "Should all communication go down, we have an assigned radio station for our staff to listen to," says Pierce. "Our general manager will contact the radio station and have an announcement made should we not be able to contact people by phone or beeper. "All we want is for them to say that they have an announcement from the GM of New England Lifecare that people who are able to go into the office should do so."

5. Be prepared to tough it out.

Pierce says that her staff are well aware of the nature of Maine winters and are thus well-prepared. "Most of our nurses have their own cell phones and drive Jeeps," she says. "When winter comes, they’ve got the studded tires on."

Daoust notes that you’ll likely have patients who have to be seen, regardless of the patients. Then, it’s up to your imagination how to get there.

"We’ve had nurses park a half mile away from a patient’s home and walk there, and other nurses have used snowshoes," she says. "If it’s a bad day and you’re advised to stay at home, you can bet that any cars that go by are probably visiting nurses."