Quality Improvement Project

Emergency Preparedness & Response Project: Kidney Centers, Inc.

Project Summary

Purpose: To help ESRD Providers develop and implement Emergency Preparedness & Response Plans.

Objectives: To complete the three important elements of emergency preparedness & response: Facility readiness, staff education, and patient education.

Methods: During the summer 2007 the Network partnered with a small group of facilities (Kidney Centers, Inc) to conduct a rapid-cycle improvement project (RCIP) utilizing materials developed by the National Coalition (The Kidney Community Emergency Response Coalition) and local resources. The kick-off meeting took place on June 28, 2007, and initial planning began. 9 (nine) facilities participated in this project. The QI Director provided Emergency Preparedness & Response Training to the facility managers during their monthly clinical coordinator’s meeting.

Timeline:

q June 28, 2007 – Kick-off meeting, introduction to the project q June 29 – July 16, 2007 – assessment of facility readiness q July 16, 2006 – Conference Call #1 q July 17- July 30, 2007 - Employee training q July 30, 2007 – Conference Call #2 q August 1- 12, 2007 – Patient Education q August 13, 2007 – Conference Call #3 q October 2, 2007 – Conference call #4 – summarize the project and lessons learned. q November 7, 2007 – QID presented the project summary and lessons learned during the KCI Annual Symposium “Clinical Issues in Nephrology”.

Summary:

This project was based on the “Four Keys To Being Prepared For A Disaster” developed by the Facility Operations Committee National Disaster Planning Coalition. The 4 (four) elements are:

1. Determine what kind of disaster you may expect 2. Evaluate the readiness of your dialysis facility 3. Prepare your staff 4. Prepare your patients

The project started with the facilities completing an initial checklist of action items recommended that dialysis facilities take in order to prepare a comprehensive disaster plan. The checklist used was the “Mitigation and Preparation Before An Emergency”. Through this process facilities learned what elements of preparedness were already in place at their facilities and what elements needed to be incorporated. Each facility was then given a specific time frame to hold in-services for their staff on their organization’s emergency policies and individual staff responsibilities during an emergency. Specific key elements highlighted were communication plans, back-up facility agreements, and local emergency contact names & numbers as well as relevant organizations. Lastly, the facilities were instructed to hold patient educational programs/“fairs”. During these patient programs/fairs, patient objectives were to learn the facility’s evacuation procedures, know and/or have easily available the 3-Day Emergency Diet, and have a list of emergency contact information as well as their personal medical information. Each facility was encouraged to order the CMS manual “Preparing For Emergencies: A Guide for People on Dialysis” and ensure that their patients had this booklet as reference. The project ended in November 2007, with the completion of all preparedness components of the project (facility readiness, employee educations, and patient education). During the last conference call the group reviewed the project and discussed lessons learned during this time. As a completion to the project, all facility managers completed the facility preparedness checklist again to compare where they were 3 months ago to where they are now in regards to emergency preparedness. All participants agreed that after conducting this RCIP their facilities are better prepared today to handle any type of emergency.

Lessons learned: (Quotes/comments made by facility managers/representatives) · It was a very interesting experience and helped me and my unit learn many things and helped us feel confident and more prepared for an emergency. · “Knowing that the facility is prepared gave the employees and patients a sense of security”. · “The experience gave us a different perspective, we found out many things that would have otherwise been overlooked; i.e.: shelters in area are not announced in advance; which channels to tune to in case of an emergency; hotline for national disaster; etc.” · “Learned about various resources available; i.e.: KCER resource list was helpful and I feel all the dialysis facilities can benefit from it if Network distributes the list”. · “Gave us the opportunity to update and customize the disaster plan for each unit”. · “Realized that patients need to be educated more often with involvement of management or else a lot of them do not take this seriously”. When handing out emergency preparedness materials/packets to them, need to go over the information so they are aware of content. · “Patient awareness package really helped to convey to the patient how important it is to be prepared for emergencies.” · “Patient assessment questionnaires gave us an insight on what is deficient and what additional education patient’s need”. · “It is also very important to reinforce the emergency plan periodically with employees because some of them had forgotten what was told to them about the emergency plan when they were hired. This led to discussions about who are DNR patients; which patients can assist themselves versus which patients need help; designate roles during emergency; etc. which is very important information during an emergency”. · “We learned that while executing our phone tree, we only had two people follow through”. Constant reiteration is necessary. People tend to forget what to do when an emergency actually happens. · “Got to realize importance of doing regular mock drills with employees and debriefing after the drill”. · All the tips that we were given were great. We had several patients make comments such as they were even scared to think of an instance that their unit was not available. With the resources and suggestions we received from the Network we were able to make them face that fear and assure them that they can help themselves. The patients felt more comfortable understanding that if emergencies occur and dialysis services are not available they should be able to help themselves. Not only has this information benefited our current patients but it will also benefit our future patients. · We were also successful in educating not only our patients but also our staff and their families. · “Overall it was a good learning experience to be applied at work and at home”. · “Network’s involvement was excellent as it validates some of the internal protocols and brings in new ideas”. · Always take time to talk about the event even after the crisis has passed. That is where you find ideas for improvement”. · ID bracelets – great idea for allergies and for informing people they are dialysis patients. · Talk to patients about the “Clamp and Disconnect” process often and keep a list of patients that need help in the emergency binder. Use role-playing to make things fun. · Give every patient an informational packet, continue to keep re-enforcing it by talking about it. · Remember to complete the emergency patient questionnaire – a tool is only valuable if you use it. · “Talking with transportation companies and community service personnel helped me to realize the first step might be overcoming pre-conceived ideas of the needs of the dialysis patients (examples: shelters not announced in advance, not having an access to TV channels and radio stations, Spanish speaking only patients and families, illiterate patients, special diets, culture and belief system of patient and family members, hew to get information to patients, families, and communities?”

Recommendations: (Suggestions from facilities) · Very aggressive timeline – too many things to be done in too little time. Maybe having a longer timeline will help to achieve more things and we can give more attention to detail. · Being from central coast, the closest facility with generators is 2 ½ to 3 hrs away. Maybe Network can think about helping facilities obtain generators on site so that at least 1 facility in a 60 mile radius has a generator. · Instead of “out of state” emergency contact, we should ask for “out of area, preferably out of state” contact number so that patients and staff are more encouraged to give the number. A lot of our patients threw the form away that we had asked them to fill with “out of state” number because they didn’t have any relatives “outside the state”. · Patients need more hands-on experience but due to the busy schedule it is difficult to do actual hands-on training. Instead of an emergency day, have an emergency week so that one shift is covered per day.

Patient’s concerns: (Frequently asked questions that need to be answered by the staff.) · How do we know the emergency will occur when patients are at home? · What happens if the emergency occurs during dialysis treatment time? · Does the facility need to have food for patients to support a 72-hours diet?