Emergencies: Non-Medical. Provided by Coverys Risk Management

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1 Provided by Coverys Risk Management

2 What s the Risk? Practices can be exposed to litigation risks by completely forgoing preparations or inadequately preparing for non-medical emergencies. For instance, electrical interruptions occur from time to time in physician practices. These interruptions can increase liability exposure. Adverse weather conditions can also present general liability exposures. Additionally, loose or frayed carpets, loose bathroom railings, wet floors and broken stairs can cause serious injuries and expose a practice to claims. When Is This Risk an Issue? One of the many lessons of both the Boston Marathon bombing and Hurricane Sandy is that we are all subject to the ravages of disasters, both natural and man-made. Natural disasters (for example, tornados, earthquakes, landslides, floods) and human-related events (for example, bombings, riots, civil disturbances, and construction) may result in disruptions of essential services to a physician practice. Taking preventive steps may help minimize the impact of these larger-than-life events. In many cases, however, disasters are outside the control of any one individual or group. To protect patients, visitors and staff members, it is essential to have a plan to address these emergencies in place. Potential Disasters The first step in any comprehensive disaster plan is for each practice to identify the kind of disasters to which it may need to respond. Need Identification Space In the event the office space is destroyed or suffers damage that will take weeks or months to repair, alternative space will be needed. For example, one practitioner, whose office was closed for over nine months due to a fire, rented space from three different colleagues. The practitioner saw patients on days when his colleagues weren t seeing patients or had lighter patient loads. Equipment Discussions (and, ideally, contracts) with vendors before the fact may enable the practice to access replacement items as soon as they are needed. The loss of computers means the loss of vital information and communication for most practices. 1

3 Emergency Action Plan According to the Occupational Safety & Health Administration (OSHA), businesses with more than 10 employees should have a written emergency action plan (EAP). 1 Businesses with 10 or fewer employees should also have an EAP, but they may communicate the plan to the employees orally. 2 The EAP must include, at the minimum, the following elements: Procedures for reporting a fire or other emergency; Procedures for emergency evacuation, including type of evacuation and exit route assignments; Procedures to be followed by employees who remain to operate critical plant operations before they evacuate; Procedures to account for all employees after evacuation; Procedures to be followed by employees performing rescue or medical duties; and The name or job title of every employee who may be contacted by employees who need more information about the plan or an explanation of their job duties under the plan. 3 In addition to the written plan, the employer must have and maintain an employee alarm system that uses a distinctive signal for each purpose. 4 Furthermore, the employer must designate and train employees to assist in a safe and orderly evacuation of other employees. 5 The employer must review the EAP with each employee covered by the plan when the plan is developed or the employee is initially assigned to a job, when the employee s responsibilities under the plan change, and when the plan is changed. 6 Patient Records Patient medical records may be the most significant loss for a practice that is ravaged by certain disasters. Storing paper records in fire-proof cabinets or backing up electronic records is imperative. More and more physicians are implementing electronic medical records (EMRs) and eliminating paper records. Once the move to EMRs is complete, a paper record is no longer readily available to bridge a multi-hour or multi-day computer blackout. 7 Some large hospitals are purchasing systems described as: high-availability disaster recovery (HADR) systems, which provide up to percent computing reliability, real-time data duplication, physically separated duplicate computing sites with independent emergency power, backup staff, and networked communications topologies to eliminate disruptions from a severed cable or microwave link. 8 Unfortunately, the cost of HADR systems is so astronomical that it is often not practical for physician practices to purchase. 9 Nevertheless, physician practices can and should create 2

4 contingency plans for EMRs. For more information on EMR contingency planning, please see the chapter titled Medical Records: Electronic. Manual Systems The loss of a computer system should not also mean the loss of the ability to treat patients. Having a manual system in place can address this. Electrical Power Outages The loss of electrical power impacts more than patient care equipment. Developing a policy to ensure the reliability of back-up electrical systems that support the patient care environment is important. Additionally, well-prepared employees should be able to answer questions such as, How much time should elapse between the time the lights go out and the emergency generator restores power? and, If the generator does not restore power within two to five minutes, how would you respond? Hurricane Sandy, which hit the Mid-Atlantic and Northeast coasts in 2012, caused flooding and the loss of electricity in healthcare facilities across the affected area. Several days and even weeks passed before businesses and people had power restored. The office practice s policy should address this type of event. Water Distribution Breakage or disruption of the main water line into a physician practice may occur, necessitating the use of an alternative or reserve water supply. The breakage of pipes inside the practice or other types of water damage can disrupt patient care activities. In addition to the obvious safety hazards, pooled water can create infection control problems. Falls Falls are the leading cause of injuries for elderly people, with one-third of elderly adults falling every year. The most common injuries are to the head and fractures of the wrist, spine and hip. 10 Falls involving elderly people are extremely expensive, mostly due to death, debilitating conditions and recovery costs. 11 Conditions within the practice may result in patient and visitor injuries. These can include loose or frayed carpets, loose bathroom railings, wet floors and broken stairs. The office or practice manager should regularly inspect the environment for fall hazards Fire and Emergency Evacuation The Joint Commission requires that hospitals conduct fire drills on each shift on a quarterly basis. Many hospital-owned and affiliated physician practices are required by their hospitals to also conduct quarterly drills. The frequency of fire drills is determined mainly by the building occupancy classification, as defined by National Fire Protection Association s (NFPA) Life Safety Code. However, one fire 3

5 drill per year per shift is typically required for a free-standing building that is classified for business occupancy, for example, a primary care clinic where only local anesthesia or no anesthesia is used. Each practice should develop a fire and emergency evacuation plan based on the requirements of the NFPA standards and the local fire department. 12 The plan should be posted at each physician practice. 13 The plan should also address training staff members, outlining their professional responsibilities to protect and rescue patients. 14 Staff members must know how to respond in the event of a fire and understand the importance of the RACE acronym, which stands for rescue, activate, confine and extinguish. Developed by fire safety experts, the RACE acronym is a training tool to help staff members remember the following: Rescue persons in immediate danger is always the number one priority. Activate the building fire alarm to warn other building occupants and summon help. Confine the fire by closing the door to the room of origin. Extinguish the fire if it is safe and you are comfortable doing so. 15 Fire Extinguishers The NFPA code requires that fire extinguishers are in working order and are only used for small fires. The code also requires that employees are trained to use portable fire extinguishers. Monthly checks of fire extinguishers should include verification that the extinguisher and operating instructions are visible. An expert should conduct an annual inspection. Tornados Tornados can produce very strong winds and wide paths of destruction. The National Weather Service issues severe weather and tornado watches and warnings via radio, television, the Internet and/or by siren alerts. When watches and warnings are issued, the office practice should heed them and take steps to protect patients, visitors and staff members on office premises. The office practice should develop a severe weather response plan and assign an individual who can initiate the plan once a tornado watch or warning has been issued. Also, be sure to identify where shelter may be taken, including nearby municipal shelters. When taking shelter in the office building, take shelter in the basement or in interior hallways or interior rooms without windows. Doors to rooms should also be closed. Personal Emergencies Personal emergencies can leave patients at risk if a practitioner is away from the office for an extended period. Patients may fall through the cracks if a plan to follow-up with at-risk patients is not in place. Covering Practitioner 4

6 It s important to prepare for personal emergencies by identifying a covering practitioner who can not only cover emergencies, but also respond to urgent matters. Following an extended absence, the covering practitioner should be prepared to give a full report to the practitioner returning from an extended absence, especially regarding patients who required extensive or ongoing care and may have died in the interim. Closing From time to time, illness or death may require the closure of a practice. Attempts should be made to minimize the chaos that could prevail in what is bound to be an emotional time. Disruptive or Violent Behavior in the Office The potential for disruptive or violent behavior in the office setting exists. Planning for such behavior should take environmental and staffing factors into account. Training staff members on de-escalating disruptive and/or violent behaviors in the office setting is also important. Depending on the patient population, specialty and geographic location, some practices have instituted measures such as installing panic buttons, enclosing the front desk area, locking the door from the waiting room, or even providing a gun box for weapons. For more information on workplace violence in the office, see the Coverys Instant titled Violence in the Physician Office: How Safe Are You? How Can I Reduce Risk? While disasters are rare events, their occurrence often brings chaos. In most instances, the best approach is preparedness. For healthcare practitioners, this will entail implementing one of the risk management recommendations and suggestions set forth in this chapter. Identify Issues Identify potential disasters Determine what disaster might occur in a practice, such as fire, flood, earthquake, tornado, hurricane, terrorism, pandemic, or other. Identify needs Recognize that in order to function in the midst of or after a disaster, certain basics such as furniture, fixtures, equipment, supplies, and staffing needs must be met. Make and keep a list of all such items currently in use, including the manufacturer name and model number, in order to know what to replace following a disaster. Identify space Determine what relocation options may be available and update the information annually. Check with colleagues to 5

7 determine if renting space in the event of an emergency is an option. Identify vendors Keep a list of all equipment and supplies in the office, so those that may be damaged or destroyed can easily be replaced. Identify computer needs Discuss with the computer vendor or manufacturer the option of leasing, renting or purchasing both hardware and software in the event that a disaster disables or destroys your existing system. Identify key records Identify key records (patient medical records, financial records, personnel records, operational records, payer records, compliance records) and their location, whether on-site or off-site. Identify staff member educational needs Incorporate a review of policy and procedures into regularly scheduled safety training programs or develop a separate educational program to ensure that all staff members are aware of the policies. Develop Contingency Plans Develop a written disaster plan Develop a written disaster plan that addresses the steps that should be taken to prepare for a disaster, the steps to take during a disaster, and the person responsible for carrying out each identified task. Develop an EAP Recognize that OSHA requires businesses to develop an EAP. Follow OSHA standards when developing the plan. For more information on the standards, visit the OSHA website at: nt?p_id=9726&p_table=standards. For help developing evacuation plans and procedures, visit the OSHA website at: Empower staff members Make arrangements to ensure that designated staff members have access to all the information and sites they 6

8 will need to keep the practice operational during and/or after a disaster. Consider a portable office Consider keeping a portable emergency kit off-site, filled with basic medical and administrative needs that would be required to keep the practice operational during and after a disaster. Necessary supplies might include basic medications, thermometers, blood pressure cuffs, otoscope/ophthalmoscope, wound care supplies, charged cell phone, laboratory request forms, prescription pads, flashlights, pen and paper, and other similar supplies. Consider manual systems Develop manual systems that permit staff members to work around a non-functioning computer system. Enter the necessary data once the system is restored. Conduct drills Schedule disaster drills at regular intervals to familiarize the staff members with their roles and responsibilities. Protect Medical Records Protect paper records Keep only the paper records of current patients on-site, to minimize the risk of losing years of medical records. Store paper records that must be kept in the office off the floor and in fireproof file cabinets. Back-up electronic records Back-up electronic records on the main server at the end of each business day and store the back-up media in an offsite location to minimize the risk of losing data when an office computer is damaged or destroyed. 7

9 Plan for Electrical Power Outages Ensure reliable alternate power source Ensure that there is a reliable and adequate source of alternate power available to provide electricity to critical areas during the curtailment of the regular power source, especially if procedures are performed in the office. Test generators Test emergency generators based on criteria such as manufacturer s recommendations, risk levels and facility experience. Document all utility system testing. Empower staff members Ensure that employees know their responsibilities when power is lost to elevators, computers, telephones, pneumatic tube systems, and heating, ventilation and cooling systems. Ensure that employees are familiar with the emergency system s operation and their role in the event of emergency system failure. Plan for Water Disruption Have a back-up plan Ensure the practice has a back-up plan in place in the case of disruption of the main water line. Evaluate document storage Consider restoration service Evaluate the storage of critical documents that may be at risk in the event of flooding or water damage. All medical records and other pertinent records should be stored off the floor. Consider identifying readily available document restoration services in your emergency response plan. Reduce Likelihood of Falls Remove ice and snow Develop written procedures for the removal of ice and snow from parking areas and walkways. Retain a log to document each time these procedures are performed. Prioritize the areas to be cleared. 8

10 Strategize for fall reduction Ensure that contracted services are completed Orient physicians and staff members to strategies for reducing slips, falls and other events that may result in a general liability claim. If maintenance services are contracted, ensure that services are addressed in a contract and properly executed. Develop a response plan Develop a response plan for parking lot injuries. Outline the procedures for calling 911. Delineate who will provide assistance for minor injuries and greet EMS if necessary. Record patient/visitor injuries on an occurrence form. Schedule regular walkthroughs Inspect the office to determine if the environment may contribute to a possible fall. Schedule regular walkthroughs, by the practice manager or physician, for the purpose of identifying and reducing risks. Prepare for Fire and Emergency Evacuations Develop and post plan Develop a fire and emergency evacuation plan and post it where it can be seen by employees and patients. Consider patient populations Consider your patients and their illnesses and injuries to facilitate their evacuation in the easiest and quickest manner. Conduct drills Conduct fire drills so that all of the staff members know what to do to ensure their own safety and the safety of patients. Verify the preferred frequency of drills with local authorities. Ensure that corrective actions take place immediately if any deficiencies are noted during a fire drill. Train staff members Train all staff members to immediately respond to fire and/or smoke and recognize the importance of RACE. Include RACE standards in core training for fire safety and practice them in fire drills. Train rescuers to never place themselves in danger when trying to rescue others at the practice. 9

11 Ensure Working Fire Extinguishers Follow NFPA 10: Standard for Portable Fire Extinguishers Ensure that fire extinguishers are in working order Follow NFPA 10: Standard for Portable Fire Extinguishers, to ensure that portable fire extinguishers work as intended to provide a first line of defense against fires of limited size. 16 Ensure that fire extinguishers are in good working order. Check necessity of employee training Educate and train employees Check with the local authority having jurisdiction to confirm whether the practice is required to train a certain percentage of employees. Educate employees that fire extinguishers are only to be used for small fires. 17 Call 911 Educate staff members so they know that whomever discovers the fire or smoke is to immediately call 911 and/or activate the closest fire alarm. Check fire extinguishers monthly Verify that the fire extinguisher and operating instructions are visible. 18 Check the safety seals to ensure they are not broken, that the container is full, and that the pressure gauge is operable. 19 Perform a monthly check. 20 Ensure that an expert performs an annual inspection. Recognize that the monthly check may be performed by the practice manager or staff member, but an annual inspection should be performed by an expert. Develop Tornado Plan Develop a plan Develop a severe weather response plan and assign an individual who can initiate the plan once a tornado watch or warning has been issued. Identify shelters Identify tornado shelters within the practice or the location of the nearest municipal shelter. Take shelter safely Take shelter in the basement, interior hallways or interior rooms without windows. Ensure that doors to rooms are closed. 10

12 Prepare for Personal Emergencies Plan for short-term absence Empower the covering professional Ensure that a plan is in place if a personal emergency requires a practitioner to be away from the office for more than a short while, so that patients with special needs do not fall through the cracks. Give covering practitioners a list of at-risk patients and those with a need for follow-up. Assign triage Ensure that a licensed professional is empowered to triage incoming calls, or if that is not possible, the receptionist, office manager, or secretary should be alerted to key phrases, words or complaints that would signal that a call to the covering professional for immediate handling is necessary. Make sure that the person in charge of triage, if calling to reschedule existing appointments, tells patients that a covering practitioner is available to see them immediately if needed. Have the licensed professional scan incoming laboratory and X-ray reports for designated abnormal results and ensure that results are telephoned (and a copy of the report sent) to the covering practitioner. Keep a log of all information told or sent to the person providing coverage. Get a report from the covering practitioner Ensure that the covering practitioner gives a full report to the returning practitioner. Understand that of particular interest are those patients who were hospitalized, those who required extensive or ongoing care, and those who have died. Create a plan for closure Ensure that the practice has a written plan addressing both the short-term and long-term management of the office. For more information on this topic, please see the chapter titled Retirement, Closing Practice, or Leaving a Group. Prepare for Disruptive or Violent Behaviors Analyze the potential for workplace violence Determine any current issues with workplace violence and identify weaknesses in defense. Consider developing a 11

13 checklist to aid in completing a workplace violence analysis. See the sample Violence Prevention Checklist. Develop a written plan Develop a written workplace violence prevention plan. Take into account both environmental and staffing issues. See the sample Violent Patient Management Plan. Seek assistance from the local police when developing your plan. Train staff members Identify staff members who can respond appropriately if a situation with a patient starts to escalate. Train staff members on the causes of violent confrontations, potential violent behaviors, and de-escalation techniques. See the sample poster titled Violence in the Workplace: Guidelines for Management. Train staff members to always be aware of their surroundings, avoid unsafe areas, and how to prevent violent behavior. Test the panic button If the office has a panic button, test it at regular intervals. Consider specific safety measures Depending on the patient population, specialty and geographic location, consider implementing specific safety measures, such as enclosing the front desk area, locking the door from the waiting room, or providing a gun box for weapons. References: 1. United States Department of Labor, Occupational Safety and Health Administration (OSHA), Emergency Action Plans, ards, 12/17/ Ibid. 3. Ibid. 4. Ibid. 5. Ibid. 6. Ibid. 12

14 7. Florence Kavaler and Raymond Alexander, Risk Management in Healthcare Institutions - Limiting Liability and Enhancing Care, Jones & Bartlett Learning, Burlington, MA, 2014, p Ibid. 9. Ibid. 10. Ibid, p Ibid. 12. ECRI Institute, Physician Office Fundamentals in Risk Management and Patient Safety, ECRI Institute, 2008, Plymouth Meeting, PA, p Ibid. 14. Ibid. 15. Tom Kiurshi, Hospital Fire Safety: RACE for the Extinguisher and Pass It On, Fire Engineering, July 1, 2008, 161/issue-7/departments/fire-prevention-bureau/hospital-fire-safety-race-for-theextinguisher-and-pass-on-it.html, 12/17/ National Fire Protection Association (NFPA), NFPA 10: Standards for Portable Fire Extinguishers, 2013 Edition, 12/17/ Ibid. 18. United States Department of Labor, Occupational Safety and Health Administration (OSHA), Extinguisher Placement and Spacing, n.d., 12/17/ Ibid. 20. Ibid. The links included in this document are being provided as a convenience and for informational purposes only; they are not intended and should not be construed as legal or medical advice. Coverys Risk Management bears no responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content. 13