Ask the Experts, News, Preparation, Regulations, Skilled Nursing Facility

Emergency preparedness: Planning for an evacuation

Surveys begin November 15, 2017 for the Centers for Medicare & Medicaid Services’ (CMS) recent updates to emergency preparedness (EP) requirements for long-term care.

Industry expert and long-term care consultant Bonnie Foster, RN, BSN, Med says her biggest concern is always planning for a potential resident evacuation. She offers several strategies for planning a potential evacuation that providers can use when creating their EP plans:

  • Accounting for residents. Foster recommends that facilities create a laminated tag that can be clipped to the back of residents’ clothing, similar to a luggage tag, in preparation for an evacuation or other emergency. This identifier should include a photo of the resident, social security number, Medicaid number, and pertinent care information. The tags can also be color coded to identify which residents belong to each facility in cases that require multi-facility evacuation to the same area. If tagging residents is not an option, Foster suggests providers keep residents’ identifying information in their physical file. This should include a face sheet with the resident’s photo and name, a copy of the physician’s orders, a copy of all medication, and other vital information to ensure continuity of appropriate care. “These files should be updated monthly so it’s an easy grab,” she says. “Even though we say we’re paperless [in healthcare], we’re never going to be. We just can’t be.”
  • Evacuating residents with dementia during a drill. “I think the biggest challenge is we have a lot of residents with dementia and psychosocial issues and are they going to be OK when you say to them, you have to leave because we have an emergency?” says Foster. To avoid unnecessary upset, she recommends assigning a staff member to stay in the room with a particular resident who might not be able to understand a fire drill. Having food and drink readily available after or during a drill can also help keep residents calm. Knowing what will make a resident feel safe comes from the care plan, says Foster. “You can’t really predict how they’re going to do,” she says. “The big thing to me is making sure residents are calmed down as much as possible. Not getting them to understand, necessarily, but keeping them calm.”
  • Making sure staff are taken care of if they can’t leave the facility during a state of emergency. “Facilities must take care of their own. They have to take care of the staff. It has to be a family,” says Foster. During extreme flooding in her hometown of South Carolina this past year, Foster says long-term care staff weren’t able to leave their facilities for a week. During that time, the facility provided staff with clothing, laundry services, and mattresses for sleeping. “It was really a team effort,” says Foster. “Nobody left.” Staff also practiced an “on 8 off 8” regimen, where they would care for residents for 8 hours and then find a quiet room to sleep for 8 hours, switching off with other staff members. While planning for resident care in the case of an emergency is vital, it’s just as important that facilities have a plan in place to keep staff healthy and well.