Environment of CareEmergency Management

Life Safety

“Courtemanche & Associates Healthcare Synergists is an Approved Provider of continuing nursing education by the North Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.”

Continuing Education Contact Hours will be awarded upon full attendance of the program and receipt of the participant course evaluations.

There are no influencing financial relationships or commercial support relating to this activity.

Participation in an accredited activity does not imply endorsement by the provider or NCNA of any commercial products displayed in conjunction with this activity.

Courtemanche & Associates does not discuss any products for use for a purpose other than that for which they were approved by the Food and Drug Association.

Disclosure Slide

www.courtemanche-assocs.com 2

Why Perform?

Improve Patient and Staff Safety Improve Efficiency Identify Training Issues Evaluate when answers unclear Justify a Need

TJC Risk Assessments

Safety Hazardous materials and Waste Security Hazard Vulnerability Analysis (HVA) Statement of Conditions and ILSM Medical Equipment Utility Proactive Infection Control (PICRA)

Risk Assessment Cycle

Document

No particular form required by TJCSpreadsheetsPRO/CON listingRating System

Organizations will be held to the documentation requirements that are in their own policies.

Internal and External Data

Data can be used as part of the Risk Assessment:

PI Data Staff, Patient and Family Feedback Environmental Tracers Root Cause Analysis JC publications

Simplifying ProActive Risk Assessment Identify Issues Develop arguments that support a process Develop arguments that disagree with a

process Evaluate both arguments Reach a Conclusion Document the process Monitor and Reassess

How to Conduct a Risk AssessmentCreate a Multidisciplinary Team to include:

Subject Matter Experts

Departments Directly Effected

An Administrative representative

Individual critical to implementation

Environment of Care Risk Assessments

Safety Risk Assessments

Review Data:Incident ReportsIC DataPI DataPatient SatisfactionComplaints LiteraturePrevious Assessments

Targeted Attention

New Construction

Renovations

Environmental Tours

Worker Safety – Job Hazard Analysis

Environmental Tours

Ongoing Environmental Tours Identify hazardous conditions Observe Safety Practices Observe Behavior Eliminate potential hazards Monitor Staff Knowledge

Formalize Tour Process

Establish a schedule Conduct annually in non-patient areas and

semiannually in patient care areas Create a form or checklist Respond to information Collected Train others in departments to conduct their

own mini-tours

Job Hazards Analysis

Assessments that examine the safety risks associated with specific job tasks.

NOT required by TJC but required by the Occupational Safety and Health Administration (OSHA).

Conducting a JHA

Review history of accidents, workers comp, work loss days occupational illnesses

Conduct job reviews/observations Correct any immediate danger situations Rank jobs: risks posed, likelihood of

occurrence and severity of consequences

Suicide Safety Risk Assessment

Environment plays a key role in prevention of suicide.

Deficiencies in the Evironment can contribute to suicide events.

Identification of Suicide Risks

Conduct Walk throughs Create Behavioral Checklist:

Hanging RisksSuffocating RisksWeapon RisksElopement/Jumping Risks

Behavioral Tours Ideas

Wall protrusions such as fire sprinkler heads, air vent grills – cover with small holed screens

Secure lay-in ceiling tiles Removed exposed wires, blind cords,

telephone cords, tubings and lines Install anti-suicide doors Remove plastic trash can liners

Behavioral Tours Ideas

Cont.

Use flushed cloth shower curtains attached to above threshold or breakaway rods

Use heavy furniture that cannot be easily liftedInstall shatterproof glass in windowsRemove hangers and closet rodsUse sloping hardwareUse convex mirrors to prevent blindspots

Smoking Risk Assessments

Although many Organizations and their campuses are smoke free, there are conditions where smoking is allowed.Define clearly exceptions to the no smoking

policyInsure that practice and policy are the sameMonitor policyDevelop and implemented strategies to eliminate

smoking violations

Hazardous Materials and Waste Risks

Assessments

What are Hazardous Materials?

Materials whose handling, use and storage are guided or regulated by local, state or federal directives.

Examples: radioactive waste, hazardous vapors, bloodborne pathogens

Conducting the Hazardous Risk Assessment Easy! Easy! Easy!

Annual inventory hazardous chemicals○ Identifiy those used○ How stored○ Monitoring○ Disposal

Conducting the Inventory

Department managers should conduct their own inventory

Define for Department Managers what materials should be included

Create a standardized Form Key Department to spearhead project:

Material Department Create a database

Using the Inventory to Lower Future Risk Identify safer alternatives to hazardous

chemicals where possible. Identify better storage practices for

chemicals Identify additional security methods when

needed. Facilitate the elimination of unneeded or

outdated chemicals.

Using Inventory

Verify appropriate MSDS. Monitor hazardous gases and vapors

associated with dangerous chemicals. Submit the organization’s inventory to the

appropriate local, state and federal government agencies.

Security Risk AssessmentsSecurity Risk Assessments

Why perform a Security Risk Assessment? Improve patient and staff safety Improve Health Improve Satisfaction

Data for Security Assessment

Number and severity of security incidents in an area or department

Level of access to area Security hardware present in the area Degree of public traffic through and in an

area Potential degree of loss associated with a

security issue taking place (i.e. abduction of baby, loss goods)

Data for Security Assessment

Cont.

Risks present in the community Security needs of particular patient population Risks associated with times of day. Risks associated with security sensitive

departments

Involve managers, various departments, local police when gather information about the environment.

Workplace Violence Considerations Likelihood of Community members to carry a

weapon Presence of gangs and gang activity Presence of drugs and money in Facility Facility Shift changes and the times of day Lighting of campus Landscaping of campus Accessibility of panic/alert systems

Special Patient Population Considerations Infant and Pediatrics Behavioral Health Alzheimer patients Forensic Patients

Emergency ManagementEmergency Management

What does an EM plan do for an organization The Plan defines for the Organization a

comprehensive approach to identifying risks in order to mobilize an effective response within the organization as well as in collaboration and coordination with essential response partners in the community.

Defining Emergencies

Human made Terrorist made Mother Nature made Events that escalate

Assessing risks allows the Organization to plan and act during emergencies. The best way is through the Hazard Vulnerability Assessment.

Emergency Management Hazard Vulnerability Analysis Planned Structured Flexible Scalable

The HVA is a method for evaluating the Organization’s vulnerability to specific hazards.

A Big Difference

Community Planning and Involvement!

This assessment requires community involvement for coordination and

prioritization within the HVA. Match perspectives of the Organization with the

perspectives of the Community.

All Hazards Approach

List possible disasters List possible emergencies List pandemics List terrorist event

Categorize Hazards

Natural hazards Technical hazards Human events Hazardous materials

Assess Impact

Determine Probability of event occurring Evaluate extent of the impact

Rank the event

Assess current ability to respond

Remember: Events never experienced does not mean zero potential for the event. Be objective in evaluation.

Considerations during Prioritization Short Term Effects Long Term Effects Influx of Patients/Community Changing/ Shifting Probability of Events

Responding to the Threats Identified Design activities to reduce the risk of

potential damage due to the emergency Plan activities to mobilize essential

resources and organize efforts Test plans Develop recovery strategies

HVA Uses

Effective HVA’s are linked to the Emergency Operations Plan (EOP).Focuses preparedness efforts

Drive the Emergency Drills and Tabletop Exercises

Identify Vulnerable populations (dialysis, nursing home, etc.)

Accurately understand self-sustainability

Fire Safety RisksFire Safety RisksThe Life Safety (LS) The Life Safety (LS)

AssessmentAssessment

Statement of Conditions

What is it?

A proactive tool helping the Organization perform a critical self-assessment of its fire safety risks and current level of compliance with the Life Safety Codes.

SOC Value

Identifies areas for fire safety focus efforts Assist in developing Plans for Improvement

(PFI) Creates timelines and focus for activities Educate staff on the Life Safety Code

requirements

Remember: All Organizations are required to complete an electronic SOC and BBI.

Conducting a Life Safety Assessment Lead by Competent Individual(s)

Knowledgeable about the building, fire protection features occupancy types and construction type of the building

Start at the top of the building and work down

Verify each feature of fire protectionExamine fire and smoke barrier above the ceiling

Conducting a LSA

Include inspection process as part of hazard surveillance rounds

Through engineers and maintenance staff who are making repairs and rounds

Construction/Renovation sites daily inspections

Follow-up on Contractor’s jobs Findings during fire drills and/or fire events

Medical EquipmentMedical Equipment

53

Medical Equipment

Assessing and Managing Medical Equipment Risks

What is Medical Equipment?

Life Support: anesthesia machines, ventilators

Monitoring: bedside monitors, telemetry momitors

Diagnostic: laboratory analyzers, radiology equipment

Patient Support: hospital beds, specialty beds, lifts

Where are the risks for Equipment? Selection Use Maintenance

Equipment Selection

Establish a process for selection and acquisitionIdentify a review process for each request, to

include clinical engineeringIdentify space and special utilities req’dUser training

Create a Risk Based Inventory

Criteria to use:What is the function of the equipment?What are the physical risks associated with

equipment use?What are the maintenance requirements?What is the incident history?

Maintenance is Risk Based

No longer requires PM inspections of all equipment.

PM inspections should be based on proactive risk assessment, sound professional

judgement, and organizational experience.

Multidisciplinary Approach

Joint Effort between clinical care, clinical engineers and clinical staff

Include all departments and vendors as necessary

Equipment treated the same without regard to ownership

Utility Systems

Creating a Risk-Based inventory, consider utilities impact on:Life Support SystemsInfection Control SystemsEnvironmental Support SystemsEquipment Support SystemsCommunication Systems

Utility System Examples

Electrical Emergency power Elevators and Escalators Heating, Ventilating and airconditioning (HVAC) Plumbing Boiler and steam Piped gases Communication

Addressing Risk

Assessing and monitoring the operational reliability

Identify/Rate the potential of failure Create Contingency Plans Test Contingency Plans Include Utilities in Emergency Management

Exercise

Infection ControlInfection ControlProactive Risk AssessmentProactive Risk Assessment

PICRAPICRA

PICRA

Manages Safety during construction process by conducting proactive risk assessments as part of the planning phase of building construction and renovation.

Identifies hazards that may compromise patient care

Determines the extent and nature of the risk

PICRA Criteria for Consideration Air Quality Infection Control Utility requirements or interruptions Noise Vibration Emergency procedures

Construction Issues to Assess

Disruption to essential services Relocation of patients Barriers to control airborne contaminants,

reduce noise and vibrations Debris cleanup and removal Traffic Flow

CDC Suggested Considerations

Design and Function of the new area Risk of Airborne disease transmission Preventive measures to contain dust and

moisture

Performing PICRA

Individual or Team depending on the scope, size and complexity of project

Identify type of construction Conduct regular meetings till project

completed

Summary of Concerns

Nature of Project Patients affected Risks Involved Mold Fungi Hazard Material Noise and Vibration Emergency procedures Utility Disruption Hygiene Storage

Objectives

Identify Risks Mitigate Risks Recover/Respond to Risks

Other Risk Assessments

Construction Risks Building Projects Risks

Conclusion

Nothing is an exact science. Conduct risk assessments to prevent or reduce dangers to patients, family and staff. Design the process and form to work for you and always follow your own policies.

Info@courtemanche-assocs.com(704) 573-4535