The U.S. Energy Information Administration reported that 2020 marked the highest duration of power interruptions for electricity customers since they started collecting data more than eight years ago¹.

A crisis can occur in many different forms, at varying magnitudes, and at any given point in time. The more thorough a plan is before the emergency occurs, the better the outcome for everyone. For healthcare providers, it is critical that staff is prepared and knows the process to care for patients – even when technology is not readily available.

Establish Critical Procedures

Under the 2016 Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness Rule, all healthcare providers are required to have a plan in place to react in the state of an emergency.

The CMS rule outlines four core elements:

1. Risk assessment and emergency planning
2. Communication plan
3. Policies and procedures
4. Training and testing

Even when applying this rule, many providers lack major elements from their plan, which is bound to cause even more distress during an already sensitive time. Although it can be difficult to imagine yourself in an emergency, it is important to think through every possible scenario and develop a specific plan of action. For example, in the case of an EHR system outage, here are just a few of the many protocols you will need to consider:

• How will you communicate the outage, and who will need to be notified?
• Will you implement a paper record system?
• Where will paper documents be stored?
• When systems become available, how will the paper records be integrated to the electronic records?
• Who will be responsible for ensuring records are accurate and complete?

Determine Roles & Responsibilities

An important part of your crisis plan should include clearly defined roles and responsibilities. Who will do what, and when?

When developing your plan, the organization’s administrator or director of nursing should be in the driver’s seat, determining the steps involved for each unique situation. But these individuals are not the only ones who should be involved in the planning process. Physical and digital security is also an important aspect of the plan that must not be overlooked.

When in crisis mode, the plan should clearly dictate who will be responsible for each process or department affected. Carefully consider every procedure that will need to occur during a crisis, and assign a specific individual (with the right credentials) to that task. For every individual assigned to a task, assign a backup (or two) in case someone is inaccessible or that position is not currently filled. Remember to keep your plan updated. For example, in an emergency such as a natural disaster that would necessitate moving patients/residents offsite:

• Who will initiate the evacuation plan?
• Who will keep track of the patients/residents, ensuring no one is left behind?
• Who will contact the appropriate authorities (police, fire, power company, etc.)?
• Who will make transportation arrangements? What if you have multiple facilities?
• What vendors need to be notified, and who will make contact?

Put Your Words into Action

After a solid plan is established and well documented, it’s time to put it to the test. Ideally, this should be done on an annual basis at a minimum, preferably bi-annually or even quarterly. Pay attention to the emergency testing regulations in your state, as well as your organization’s policy, as some will require more frequent testing than others. Don’t let your organization fall out of the habit of checking pertinent systems. This is your time to determine whether they are sufficient to carry you through an actual emergency.

• Test back-up generators weekly
• Practice regular fire drills with patients/residents and staff
• Conduct elopement training with your staff
• Monitor and log training attendance
• Verify your vendors are still in business, that they have a valid phone number, and an after-hours number

Evaluate Your Response

Regular practice of your plan should provide valuable insight on process improvement. What did you learn in the process? Did everything run smoothly and timely, or were there unnecessary delays or confusion? Take the time to address these inefficiencies and write a plan of correction now, while the details are still fresh and before a situation arises.

It should also be noted that plans should be evaluated especially after real emergencies, once operations have safely returned. While we can never plan or foresee every situation, we can always use our experiences and lessons learned to better future outcomes.

• Were there any critical steps you missed?
• What was your total downtime, and how can that be improved?
• Do you need more supplies, or better access to them?
• Was your staff confident in their training and actions?
• Was anyone harmed?

Engage Support Services

Natural disasters are not the only crisis long-term care facilities can face. Are you prepared for unexpected emergencies such as:

• A server issue that interrupted a nursing home’s entire east coast operation
• An EHR system outage that lasted more than 15 hours
• Emergency evacuation due to nearby unstable dynamite or fire in a chemical plant

¹ https://www.eia.gov/todayinenergy/detail.php?id=50316