Disaster Staffing Plan Definition: The Disaster Staffing plan is implemented to provide a plan to accommodate staffing needs that exceed what can be accommodated utilizing existing hospital resources in a disaster situation. Provides Operational guidance for Accessing community and other resources Providing guidance for coordination of scheduling of existing staff A plan for training and credentialing of volunteer staff JIT training for staff assigned new roles Activation: Hospital’s Incident Commander and the personnel of the Emergency Operations Center will activate the Disaster Staffing Plan in response to the need for staff that exceeds existing resources. Immediate Actions: Follow departmental plan for Incident Management Adhere to guidelines provided in specific disaster plans 1.8 -1 Staffing Plan General Information Cancellation of Elective Services The Incident Commander and the Incident Command Center may elect to cancel all unnecessary services and surgeries scheduled. This includes any offsite facility if determined, including Primary Care and Family Medicine sites. At this time staff of these facilities should report to Highland Hospital Labor Pool. Internal Response Human Resources will keep an updated master call list and each department has their own call list of their direct employees. Each department should refer to their departmental plans for staffing during emergency situations. All available staff already at work will be tracked by the Labor Pool and the Planning Section. Employees at home may contact the Emergency hotline phone number (585) 3410188 for updated information. Once it is determined the initial amount of staff needed to attend to the influx and acuity of the patients, department managers will be notified and should initiate their call in process. This should include accessing those that are most likely to come to work in the shortest period of time (live close, have immediate transportation, etc) and calling them first. An accurate recording of staffing must be documented in the Staff Call Roster. This should be forwarded to the Command Center (Planning Section) to determine further staffing needs. Independent licensed practitioners, who do not have a specific assignment in the Emergency Management Plan, report to the Labor Pool after it is activated. o Each ILP will sign in and an assessment of competency will be conducted. o ILP is assigned to the areas most appropriate for their skill set and the current needs. Non-patient care staff and offsite staff, dependent upon the disaster and staffing needs, will report to the Labor Pool to be reassigned to units and duties as needed. o Each person will sign in and will be asked about their past patient care experience and their willingness to provide patient care. o Staff is assigned to the areas most appropriate for their skill set and current needs. External Assistance If it is deemed necessary as an outcome of the staffing that needs cannot be met then the Rochester Regional Healthcare Association Mutual Aid Plan will be implemented. Privileging In a declared emergency situation any health care worker must be given privileges before giving care to any patient. As part of the plan the Volunteer Office will begin to contact former employees in good standing, retirees or those in the community who have expressed interest in assistance during the time of disaster. The Volunteer Office, in conjunction with Human Resources, will be responsible for non-physician credentialing and verification of the needed information. See procedure, Privileging of non-licensed independent practitioners. The Chief Medical Officer or the Associate Medical Director will be responsible for managing physician credentialing and privileging. See procedure Physician Privileging. 1.8 -2 Deployment, training and assessing competency of staff Competency Assessment Upon reporting to the Labor Pool, staff/volunteers will complete the Disaster Preparedness Selfevaluation of Competencies Checklist for Professionals or the Disaster Preparedness Self-evaluation of Competencies Checklist for Unlicensed Personnel. The checklist will survey their education, patient care/work experience, and define their skill set to aid in appropriate deployment to patient care areas. The same tool will be utilized by a staff supervisor to assess and verify staff/volunteer competence on assigned unit within 72 hours. Just-in –Time Training Intake & Triage Staff Intake & Triage Staff will receive just-in-time training regarding proper screening and proper containment of chemical, biological, radiological or other hazard/disaster event. Staff & Volunteers Decisions about training and cross-training of staff & volunteers to care for patients at our facility will be made by the Incident Command staff to assure the delivery of safe patient care. Disaster Just-intime Training Pocket Guides for Nurses or Patient Care Technicians will be distributed. Staff and volunteers will be instructed to use a “buddy” in their assigned patient care area to assist them with performing a new skill or task in real time. Licensed and unlicensed care providers and volunteers complete unit-based Self-Evaluation and orientation to unit. See Self-Evaluation of Competencies for Professionals and SelfEvaluation of Competencies for Unlicensed Professionals at the end of this policy. To facilitate cross-training, staff in patient care areas will be given the Disaster “pocket-guides” for Nurses and Patient Care Technicians. Pocket guides are to be returned to command center at completion of shift. Manager/charge nurse is to complete 72 hour evaluation of competency of licensed and unlicensed care providers on assigned units. Inpatient disaster staff to receive education and updates as information becomes available (at a minimum, every 24 hours) by the ICC. Ongoing Staffing If the disaster continues for extended periods of time staff will be designated in the following groups: Working, Resting, and Recovery. o Each group will be determined to work 8-16 hours, dependant upon the surge of patients, the type of disaster and the amount of staff available. o Groups will be announced via the color established on their badge coding. o Staff will be rotated through each group ensuring rest periods, meal periods, etc. o Staff will rest in office space that is available in the North and South buildings or others areas as deemed appropriate. If the disaster continues for more than one 24-hour period staff will report to the labor pool in order to gain their assignments for the following day. 1.8 -3 Staff Support If staff require assistance getting to and from work, the hospital will provide transportation via security or the labor pool. Provisions for child care and elder care will be addressed by the Operations Sector, Staff Support. Pet care options addressed in the Influx Plan of Family, Community and Pets. The Disaster Staffing Plan will remain in effect until such circumstances arise where the Command Center has determined that the threat to the facility has ended and an All Clear is paged. Privileging Procedures During a declared emergency the Incident Command Center may determine that volunteers are needed to assist throughout the emergency. The following information has been provided, consistent with Joint Commission guidelines, to ensure the proper identification and credentialing of the volunteers. Highland Hospital may modify the usual process for determining qualifications and competencies of practitioners if necessary to meet immediate patient needs during an emergency. I. Process for Recruitment of Volunteers A. Current Volunteer Pool 1. Notify all volunteers via phone and request volunteer to report for shifts which would cover appropriate areas including dietary and patient transport. a. Scheduling and shift coverage will be completed by the Volunteer office. B. Recruitment of New Volunteers 1. If additional coverage is needed the following will take place: a. Rochester Regional Healthcare Associate Mutual Aid Plan will be implemented. b. Highland Hospital retirees and former employees in good standing would be contacted. c. Current volunteers would be requested to bring family and friends with them to work. d. Local churches and community organizations would be contacted. Physician Privileging II. Licensed Independent Practitioners A. Licensed Independent Practitioners may be needed during a declared emergency. The Chief Executive Officer, Chief of the Medical Staff, or designee, may grant “Disaster Privileges”. 1.Granting such privileges will be on a case-by-case basis at the CEO or Medical Staff President’s discretion. 2.The privileges should be effective immediately and continue through the completion of the patient care needs or until the orderly transfer of the patient's care to an appropriately credentialed member of the medical staff can be accomplished. B. Those approved for emergency credentialing privileges should be provided written verification of privileges. This verification should be kept with them for easy identification purposes. 1.Hospital identification indicating “Volunteer Practitioner” and the individual’s name, title, credentials and expiration date of ID will be provided and displayed conspicuously at all times while the practitioner is engaged in providing care and services. C. The practitioner shall take direction from the Department Chief (or designee) in their clinical 1.8 -4 specialty regarding patient care services. The practitioner’s notations in the medical record shall reflect that the physician is working under “Disaster Privileges.” 1. For quality review purposes, a list of all patient encounters should be kept, if practical. III. Procedures for eligibility to function as a volunteer licensed practitioner A. The Labor Pool Unit Leader or designee shall ensure that, as conditions warrant, appropriate identity and credentialing verification processes are followed. The Credentialing Department will be consulted as necessary in the credentialing process. B. Identification requirements for those practitioners requesting “Disaster Privileges” will include the hospital obtaining a valid government-issued photo identification and at least one of the following: 1. A current picture identification card from a health care organization that clearly identifies professional designation 2. A current license to practice 3. Primary source verification 4. Identification indicating that the individual is a member of a federal or state Disaster Medical Assistance Team (DMAT) or the Medical Reserve Corps (MRC), the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP), or other recognized state or federal organizations or groups. 5. Identification indicating that the individual has been granted authority by a government entity to provide patient care, treatment, or services in disaster circumstances. 6. Confirmation by a licensed independent practitioner currently privileged by the hospital or by a staff member with personal knowledge of the volunteer practitioner’s ability to act as a licensed independent practitioner during a disaster. C. As soon as the disaster is under control or within 72 hours from the time the volunteer licensed independent practitioner presents themselves to the hospital, whichever comes first primary source verification of the practitioner will occur. 1. If primary source verification cannot occur within 72 hours due to extraordinary circumstances the following will be documented: a. Reason primary source verification could not be performed with in the allotted 72 hours. b. Evidence that the practitioner demonstrated the ability to continue to provide adequate care, treatment and services c. Evidence that the primary source verification was attempted as soon as possible. D. Based on the oversight of the practitioner, and within 72 hours of their arrival, the practitioner will be evaluated to determine if disaster privileges should be granted. Non-Licensed Independent Practitioner Privileging IV. Non–Licensed Independent Practitioners A. Per Joint Commission requirements, volunteer practitioners are defined as those who are not licensed independent practitioners but who are required by law and regulation to have a license, certification or registration to meet these needs. B. Assigning disaster responsibilities to volunteers shall be made on a case-by case basis, taking into consideration the needs of the organization and the patient and may have tasks delegated to them by personnel in the Incident Command Center, the department manager or others dependant upon the situation. 1.8 -5 1. Oversight of the professional performance of volunteer practitioners, including direct observation, mentoring, and clinical record review will be performed by the Manager of the area assigned in conjunction with the Director of Quality Management. C. Human Resources shall maintain a list of all volunteer practitioners and the responsibilities they have been assigned. 1. Hospital identification indicating “Volunteer Practitioner” and the individual’s name, credentials, title, and expiration date of ID will be provided and displayed conspicuously at all times while the practitioner is engaged in providing care and services. V. Procedures for eligibility to function as a volunteer non-licensed practitioner: A. The Labor Pool Unit Leader or designee shall ensure that, as conditions warrant, appropriate identity and credentialing verification processes are followed. The Credentialing Department will be consulted as necessary in the credentialing process. B. Identification requirements for those practitioners requesting “Disaster Privileges” will include the hospital obtaining a valid government-issued photo identification and at least one of the following: 1. A current picture identification card from a health care organization that clearly identifies professional designation 2. A current license, certification or registration 3. Primary source verification if required by law and regulation in order to practice 4. Identification indicating that the individual is a member of a federal or state Disaster Medical Assistance Team (DMAT) or the Medical Reserve Corps (MRC), the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP), or other recognized state or federal organizations or groups. 5. Identification indicating that the individual has been granted authority by a government entity to provide patient care, treatment, or services in disaster circumstances. 6. Confirmation by hospital staff member with personal knowledge of the volunteer practitioner’s ability to act as a qualified practitioner during a disaster. C. As soon as the disaster is under control or within 72 hours from the time the volunteer licensed independent practitioner presents themselves to the hospital, whichever comes first primary source verification of the practitioner will occur. 1. If primary source verification cannot occur within 72 hours due to extraordinary circumstances the following will be documented: 2. Reason primary source verification could not be performed with in the allotted 72 hours 3. Evidence that the practitioner demonstrated the ability to continue to provide adequate care, treatment and services 4. Evidence that the primary source verification was attempted as soon as possible. D. Based on the oversight of the practitioner, and within 72 hours of their arrival, the practitioner will be evaluated to determine if disaster responsibilities should be granted. 1.8 -6 REQUEST FOR EMERGENCY PRIVILEGES IN CASE OF OFFICIALLY DECLARED DISASTER Name: ____________________________________ Today’s Date __________ Male□ Female □ Social Security #: ______________________________ Date of Birth: ________________________ Medical School: _______________________________ Graduation Year:_____________________ New York State License #:_________________Reg thru _____ DEA # ___________ Reg thru_____ Cell Phone #: __________________________________ Pager # ___________________________ Hospital Affiliations: Primary: ______________________________________________________ Phone #: ____________________________________________ Secondary: _____________________________________________________ Phone #: _____________________________________________ Photo ID attached: □ Documentation of Malpractice insurance attached: □ I hereby consent to the inspection by Highland Hospital, its Medical Staff, and its representatives, of all records and documents that may be material to an evaluation of my competence to perform those procedures allowed within the scope of my license and my current practice. ________________________________________ Signature □ National Practitioner Data Bank Query: Date ______________ □ OIG Query: Date ________________ □ Photo ID faxed for verification: Date ______________ Approval Signature: ________________________________________ Date __________________ 1.8 -7 Initial Disaster Staffing Assignment Assessment for Licensed Professional Staff Name:___________________ Currently an employee of Highland Hospital? Yes__ No__ If so, what unit/dept:_________________ Title:_______________ Other Medical Experience: ________________________________________________ Instructions: Please complete the following self-assessment regarding your skills. Skill Set Medication administration Med/surg (specify) Pediatrics: Infant Toddler School age Adolescent Ventilator Emergency Care Critical Care OR/PACU (specify) IV therapy Dysrrhythmia Wound Care Oncology Hemodialysis Labor & Delivery BLS, ACLS (specify) Trauma Burn Care N 95 fit check Other: (List) Current Within last 5 years 1.8 -8 Greater than 5 years ago Never Initial Disaster Staffing Assignment Assessment for Unlicensed Assistive Personnel Name:_________________ Currently an employee of Highland Hospital? Yes__No__ If so, what unit/dept:_____________ Position Title:____________________ Medical Work Experience:_____________________________________ _ Education:____________________________________________________________ Instructions: Please complete the following self-assessment regarding your skills. Skill Set Current Within last 5 years How to don & doff PPE How to fit check N95 mask Patient care/hygiene Patient feeding Patient transport Patient ambulation ROM Vital signs Inserting airways Suctioning Phlebotomy BLS, ACLS (specify) EKG Telemetry Monitoring Post Mortem Care Respiratory Etiquette 1.8 -9 Greater than 5 years ago Never Disaster Mode Unit-based Self-Evaluation of Competencies for Licensed Professional (i.e. PA, NP, RN, LPN, PT/OT, RT, pharmacist,) Name _____________________________ Title _____________________ Date ___________________ Medical Work Experience _____________________________________ Education ___________________________ License # ________________ Highland Employee ____Yes ____No Volunteer ____Yes ____No Directions: Before caring for the patients on the unit to which you have been deployed, please review the following checklist and document/attest to your current competencies: SKILL CURRENT COMPETENCY I. Patient Assessment & Management a. b. c. d. e. f. g. Newborn Infant Toddler School Age Adolescent Adult Older Adult II. Care of GI/GU system a. Care of pt with GI tube b. Care of pt with salem sump c. Care of pt with intestinal tube (ex. PEG, j-tube) d. Care of pt with an ostomy e. Care of pt with nephrostomy tube f. Care of pt with surgical drain III. Care of Respiratory system a. Suctioning: 1. Nasopharyngeal sxn 2. Endotracheal sxn b. Oxygen delivery c. Respiratory therapy 1. PD & C 2. Incentive Spirometer use 3. Admin. of nebulized meds c. Care of patient with tracheostomy d. Care of patient with chest tube in place f. Care of patient on ventilator 1.8 -10 NOT COMPETENT COMMENT EVALUATION (within 72 hrs) SKILL CURRENT COMPETENCY IV. Management of Surgical Patients a. Pre-op procedure b. OR experience 1. Scrub 2. Circulate 3. PACU c. Management of post-op patient V. Management of Patients with Special Needs a. Care of patient pre & post dialysis b. Care of patient receiving peritoneal dialysis c. Care of the Liver transplant patient d. Care of the acute stroke pt e. Care of patient in restraints f. Care of deceased patient g. Trauma patient VI. Medication Administration a. Oral administration b. Intramuscular administration c. Subcutaneous administration d. Intravenous administration 1. IV push 2. Continuous infusion 3. Intermittent/piggyback/ soluset e. Nasogastric administration f. Intestinal tube administration (G-tube, J-tube) g. Administration of Chemotherapeutic agents h. Administration of Vasopressor agents i. Administration of Paralytic agents VI. Specimen Collection & Testing a. Blood glucose monitoring b. Hemoccult c. UA, C&S d. Sputum e. Wound cultures f. Urine pregnancy 1.8 -11 NOT COMPETENT COMMENT EVALUATION (within 72 hrs g. Venipuncture SKILLS CURRENT COMPETENCY NOT COMPETENT COMMENT EVALUATION (within 72 hrs VII. Care of Patient receiving parenteral therapy a. Access, flushing, dressing changes of peripheral lines b. Access, flushing, dressing changes of central access devices 1. Triple lumen 2. Groshong 3. IVAD/mediport c. Administration & monitoring of patients receiving blood/blood products d. Administration & monitoring of patients receiving hyperal. e. Programming volumetric Infusion devices (ex. Alaris pump) VIII. Infection Prevention & Control a. Use of Universal/Standard precautions b. Use of PPE/N95mask c. Aseptic technique d. N95 fit testing IX. Certifications/Special Skills & Competencies (List others) a. Cardiac monitoring b. Ventilators c. Chemotherapeutic administration & monitoring d. BLS certification e. ACLS certification f. Critical Care g. Emergency Care h. Perioperative Care (describe) X. Other area of clinical expertise: Deployed to: ________ Date: __________ Authorized Signature: ___________________Title: _________ 1 copy – Planning Sector 1 copy – Unit 1 copy- Employee/Volunteer 1.8 -12 Disaster Mode Unit-based Self-Evaluation of Competencies for Unlicensed Personnel Name _____________________________ Title _____________________ Date ___________________ Medical Work Experience _____________________________________ Education ___________________________ Highland Employee ____Yes ____No Volunteer ____Yes ____No Directions: Before caring for the patients on the unit to which you have been deployed, please review the following checklist and document/attest to your current competencies: CURRENT NOT COMMENT EVALUATION SKILL COMPETENCY COMPETENT (within 72 hrs) 1. Patient Care: Hygiene Elimination Bathing 2. Measure & record Vital Signs 3. Obtain pulse oximetry 4. Feed patient Patient Feeding Administering Tube Feeding 5. Assist with ROM/Positioning 6. Assist with Patient transfers, lifting, ambulation 7. Oropharyngeal suctioning 8. Provide post mortem care 9. Set up oxygen equipment 10. Apply restraints 11. Measure & record I & O 12. Empty drains, catheters 13. Specimen collection – blood, urine sputum, stool 14. Obtain EKG 15. Apply “TED” stockings, ACE wraps 16. Apply hot/cold treatment 17. Perform simple dressing change 18. Perform aseptic technique 19. Set up for special procedures 20. Recognize& report physical, behavioral & mental status changes in patients 21. BLS certification 22. Certified in Point of Care testing: Blood glucose monitoring, Hemoccult 23. Decontamination training Deployed to: __________ Date:________ Authorized Signature:_________________Title:____________ 1 copy-Planning sector 1copy – Unit 1.8 -13 1 copy – Employee/volunteer Disaster Mode Orientation to Patient Care Unit This form is to be completed by Charge Nurse, Nurse Manager or designee on assigned unit before deployed staff person may begin their first shift of duty on the assigned unit. Name: ______________________Title:________Unit _____________ Date__________ Instructions: Place a check mark in the space provided after the staff person has been oriented to each of the following: Location of Fire Pull Station, fire equipment and floor Evacuation Plan ___________ Location of Medical Gas Shut-off valve (if applicable) ___________ Location of Emergency Equipment, medications ___________ Review of security/safety issues and emergency page codes ___________ Location of supply cart, linen supply, general equipment, supplies ___________ Operation of Call Light system, locator system ___________ Operation of wall suction and oxygen ___________ Location of Generic Standards Manual, Unit Specific Standards Manual, ___________ Infection Prevention Manual, Environment of Care Manual and other unit resources Review of charting and documentation guidelines ___________ Operation of unit-specific equipment (list): _____________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Signature of person orienting:______________________Title:__________Date:_______ 1 copy – Planning Sector 1 copy – unit 1 copy - employee/volunteer 1.8 -14