Are You Ready? Emergency Preparedness for Dialysis Facilities

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  • The focus on emergency preparedness has increased significantly since 9/11/2001, and most recently, Hurricane Katrina in August 2005. What did the dialysis community learn from Hurricane Katrina? Almost all of the 2500 PD and HD patients dialyzing in 43 units in New Orleans were displaced to other U.S. cities, including Baton Rouge, Houston, and Atlanta. Some even ended up in Network 5 (about 8 patients)
  • Many of the patients who were displaced had been without dialysis for 1 week or longer before restarting. In all, 94 facilities closed for at least 1 week (in Louisiana, Mississippi, and Alabama). As of June 2007, 17 facilities remained closed (16 in Louisiana, 1 in Mississippi). The majority of dialysis facilities had detailed patient evacuation plans , including dietary recommendations, medication supplies, and contact numbers. Additional info: USRDS data report that Louisiana and the surrounding region have the highest incidence of CKD and ESRD in the nation . A quarter of the population had household incomes below the federal poverty level . In Louisiana, the number of patients who had ESRD and were receiving dialysis fell from 7557 patients on July 31, 2005 (before the storm), to 6213 on August 31, 2005, immediately after the storm (an 18% reduction). By December 31, 2005, the Louisiana ESRD population had grown to 6731 (89% of the pre-hurricane census). Of the 5849 Gulf Coast dialysis patients who were affected by Hurricane Katrina (including those in Louisiana, Mississippi, Alabama, and northern Florida), 148 deaths occurred in the first month after the storm (mortality rate 2.5%; CMS claims data, provided by ESRD Network 13, 2005). However, morbidity and mortality related to Hurricane Katrina are difficult to establish for two reasons. First, patients with ESRD have high rates of morbidity and mortality, particularly from cardiovascular disease, for which mortality rates are 10- to 30-fold higher for dialysis patients compared with similarly aged patients from the general US population. Under these circumstances, identifying “storm-related” deaths may be difficult. Second, many patients remain permanently displaced after the hurricane and securing information on their health remains a challenge.
  • DCI – Tulane reopened on November 17, 2006 in a new location.
  • Most patients were displaced to Baton Rouge … All Baton Rouge facilities had generators. Water was available thanks to Baton Rouge Water Company’s planning efforts after Hurricane Betsy in 1965. Louisiana Dept. of Public Health set up surge hospital/triage center in athletic facilities at Louisiana State University. Treatment was provided by US Public Health Services officers, medical emergency response teams from various states, and many volunteers. In the 1 st week post-Katrina, 700 ESRD patients who were evacuated from the New Orleans area received dialysis. This was in addition to the 1000 patients who concurrently received their regular treatments in the Baton Rouge area.
  • Limited early evacuation for vulnerable individuals, including dialysis and transplant and those with limited mobility. Both landline and cell phone networks overwhelmed and functioned poorly. Some patients delivered to out of area hospitals for dialysis, overwhelming the capacity of facilities to handle all patients, not set up to take dialysis patients . Not enough medical staff. Some needed PD supplies but did not have contracts with suppliers. No designated shelter for dialysis patients, making them transient. Made tracking and transportation difficult. Dialysis staff didn’t know where patients were and couldn’t contact them . No easily accessible dialysis patient database available (no way to estimate number of patients coming). Difficulty obtaining supplies because of transportation.
  • The purpose of this slide, aside from humor, is to drive home the point that emergencies are local . We cannot depend on the federal or state government to take care of us in an emergency. Patients must take personal responsibility for their care through education and planning. Facility staff bear some responsibility for assisting patients in acquiring this education and planning for emergency events. The goal of this training is to get participants thinking about what they can do in the facility and their home lives and that of their patients to prepare for and respond to emergency events. The key to a successful response is proper planning and preparation ahead of time!
  • Most of the emergencies impacting patients and providers will be natural disasters (hurricanes, flooding) but your facility’s disaster plan should be broad enough to address most types of internal and external events
  • Assist facilities in developing disaster plans. MARC has a template available to assist facilities in developing a plan webpages for emergency prep and pandemic flu facility and patient emergency preparedness guides (English and Spanish) presentations throughout Network 5 region (Back to School, American Kidney Fund, annual Council meetings) 2. Coordinate with providers, emergency workers, and other essential persons to ensure that the needs of individuals are being met and that patients have access to dialysis. The Network has participated on all KCER Coalition calls as required, and the Director of Operations remains active with the Coalition’s Patient and Provider Tracking Workgroup . In April 2006, a letter was sent to state and federal emergency management and health departments highlighting the needs of dialysis patients and requesting their inclusion (as well as that of dialysis facility workers) in the “high risk” priority group for vaccinations and/or anti-virals in the event of a pandemic flu. Have worked closely with the Hampton Roads (Virginia) Planning District Commission to educate them on the special needs of dialysis patients . 3. Assist providers and patients in determining status of dialysis facilities. MARC requires that facilities report their open/closed status to MARC ASAP, and then twice weekly post event. “ OPEN” = potable water, power from any source, and sufficient staff and supplies to provide dialysis; “CLOSED” = anything else MARC will post facility status info to https://dialysisunits.com and MARC website if possible If MARC is impacted by emergency event, patients and providers can call Kidney Community Emergency Response (KCER) Coalition toll-free Hotline 866 -901-ESRD (866-901-3773) to get contact information for the designated alternate Network which can assist them 4. Provide information to family members and treating facilities on where a patient previously/currently is receiving services to assist in the location of individuals and the exchange of critical medical information. KCER Coalition has developed a Disaster Patient Activity Report (DPAR) to be used by facilities to report on the status of current and transient patients twice weekly post-event. The KCER Coalition also developed a standardized emergency dataset (which has been approved by FMC, DaVita, and NRAA) with the recommendation that providers produce paper copies of the dataset in any form from their databases at least quarterly for each patient. Patients should be instructed to carry the dataset with them in the event of evacuation.
  • Minimum requirements for dialysis facilities, More commonly know as “v-tags”, can be cited by State Survey Agency for non-compliance There is an established written plan for dealing with fire and other emergencies Should be developed in cooperation with fire and other expert personnel Should have 4 components – prevention (when possible), preparation, response, and recovery Should address emergency equipment, transportation, staffing, communications, evacuation, health records, and continuity of patient care 2. All personnel are trained as part of their orientation. The written emergency preparedness plan provides for orientation, regular training, and periodic drills in all procedures; each person is able to promptly and correctly carry out his or her role in an emergency 3. There is fully equipped emergency tray available at all times. To include emergency drugs, medical supplies, equipment Staff should be trained on use 4. Staff are familiar with the use of all dialysis equipment and procedures to handle medical emergencies 5. Patients are trained to handle medical and non-medical emergencies (how to get off dialysis machine if they need to evacuate, etc.) Should assist patients in developing individual emergency plans and review the plan regularly Patients should know what to do, where to go, and whom to contact if an emergency occurs
  • Requires a written agreement or arrangement between facility and center (hospital) for provision of services. Can also be between dialysis facilities Preferably between facilities not located in the same geographic reason where both would not be simultaneously impacted by same event b. Agreement provides that patients will be accepted and treated by the hospital/alternate facility in emergencies Both facilities/facility and hospital should have documentation on file to the effect that patients will be accepted and treated in emergencies *Agreement may also include a provision for sharing staff (e.g., in pandemic flu or post-disaster, could have staff shortages)
  • Even in an emergency situation , facilities are responsible for the safeguarding of medical record information! Medical records are secured onsite with policies regarding storage, access, and retention Where are records stored? How will you protect records from water damage? Fire? Who is responsible for ensuring that records are not destroyed in emergency? Designate more than 1 person Theft can constitute an emergency : Who has access to records? What security measures are in place to protect confidential information?
  • Preparedness is more than knowing whether you are located in a hurricane zone
  • 2. How ready is your facility? To minimize damage: a. Secure facility to prevent injuries during disaster: Ceiling TVs secured Machines and chair wheels locked Oxygen tanks secured Water treatment components secured Storeroom shelves secure, heavy items are on bottom shelves Emergency exits well marked and pathways clear Label utility shutoff valves Keep trees trimmed and away from power lines b. Keep patient and business records secure Keep data backed up with copies in a secure location Make paper copies of your patients’ orders and medication lists on a periodic basis (at least quarterly or if changed) Distribute copies to your patients All facilities should maintain off-site copies of -comprehensive list of all pts - 2728 forms - dialysis prescription - care plan for each pt - DNR or Advance Directives Should also keep copies onsite in secure water and/or fire proof box ; keep in secure location and where it is easily accessible in event of evacuation; update regularly Facility medical and financial records should be backed up regularly and stored in secure off-site location c. Have a back up utility plan Power : If you do not have an onsite generator you should have a written contract with someone who will agree to provide one if needed. Have a known supply of fuel Water : Make a back up plan. You may need to have an adapter made. Phone: Telephone networks are generally designed to provide 15% capacity , assuming that most subscribers will not be using their phones at the same time. In emergency, phone lines likely to be overwhelmed Consider redundant methods of communication : satellite phone, landline, Blackberry, even amateur radio
  • 3. Prepare staff a. Identify the disaster organizational structure you will use in the event of a disaster. Who is the person in charge ? Who will account for all patients and staff ? Who will contact your patients ? Who will grab the emergency evacuation box ? Who will call the utilities ? b. Develop a communications plan : How will you keep in contact with each other, patients and local disaster response teams? Give patients a number to contact you with ( designate at least 2 “disaster contacts” and the Network requires 2 disaster contacts with a work phone number and 2 alternate means of communication ) Run PSAs on tv, radio; update website if possible Have an “out of area” contact number (facility you have agreement with?) c. Educate key personnel in their roles during a disaster. Hold periodic disaster drills (at least quarterly) Include your patients in the drills Evaluate and modify your plans based on how the drill goes
  • d. Have a back up facility agreement with a facility that can take your patients Nearby facility because this simplifies transportation issues, but if event is regional should have back-up in a noncontiguous geographical area as it is less likely to be affected. e. Know in advance whom to contact for assistance and information Your ESRD Network (Required to report open/closed status to Network "Open" facilities are defined as facilities that have potable water, electricity from any source, and supplies and staff sufficient to provide dialysis, and that are performing dialysis. Anything less than this is considered "closed." Required to submit DPAR 5 days post event and then semiweekly until return to normal operations) City, County and State Emergency Response Teams American Red Cross Chapter Security Company
  • 4. Prepare Your Patients a. Educate your patients on Evacuation procedures – how to clamp and cut blood lines to disconnect; how to clamp and cap catheter ports (frequent drills) 3-Day Emergency Diet Personal needs assessment – handout; facility staff encouraged to use this tool to assess each patient’s level of knowledge and preparation for an emergency and then use as starting place for education and assistance Shelter information Who to contact for transportation and a back-up plan for transportation Consider patient’s individual ability to participate in emergency preparedness activities—do they have special requirements ? Perform regular drills and assess and modify plan as necessary b. Survey your patients regularly to assure that they: Update local and remote emergency contact information Produce dataset spoken about earlier—at least quarterly or when patient’s orders change . At minimum, should include: - Hepatitis B status -dialysis orders -recent labs -meds -facility and nephrologist contact info *The KCER has developed a standardized emergency dataset for HD and one for PD and they are available on the MARC website. Have a supply of their medications Have an emergency kit at home have backpack to take with them that includes: -insurance info -ID -list of meds/allergies -emergency contacts in and out of area -list of dialysis facilities in state/region Know how to get off the dialysis machine (do they know the facility’s emergency policies and procedures?) Know where to go if the have to evacuate (know region’s evacuation plan) Know where to get information during a disaster (facility staff, corporate office, Network, etc.)
  • A/C unit fell through ceiling PVC pipes for distribution loop snapped Pre-treatment tanks fell Fortunately, because of the time of the earthquake the building was unoccupied
  • Facilities shared staff, supplies, equipment Functioning facilities in the area took displaced patients Used cell phones where available Used fire hydrants for water connections Obstacle was not finding facilities but the time and travel routes to get there were. Some traveled 50 miles to dialysis (time from 2 hours to 7)
  • Back-up facility 15 miles away; provided patient treatments for duration of closure
  • 4 steps for patients in preparing for an emergency situation 1. Gather and carry important medical information. If a patient is displaced because of an event, it is crucial that he/she have his/her medical information. If the patient must go to a different dialysis facility or hospital for treatment or if the patient needs urgent medical care, this will insure that he/she receives the right treatment For dialysis patients, information should include: Name Address Phone Emergency contact and relationship (local and outside geographic area), address, phone Dialysis center, address, phone Nephrologist, address, phone Insurance info (Medicare #) Medical conditions/ allergies/complications (Hep B status, diabetes, hypertension, cardiovascular disease) Dialysis treatment type (in-center hemo, home hemo, CAPD, CCPD, IPD) Nephrologist’s orders for treatment Medications and dosage and frequency REMINDER: The KCER has developed one for HD and one for PD and they are available on the MARC website.
  • 2. Make alternate arrangements for treatment ahead of time. In-center HD -provide facility with current address and phone in case they need to contact patient -arrange backup transportation to facility -find out about other dialysis facilities in the area . Make sure they can provide the treatment patient needs and ask if they would be able to treat if regular facility cannot Home HD -contact local water and power companies ahead of time to register for special priority to have services restored. -Contact dialysis supply vendor to arrange for supply acquisition during disaster (and before when there is advance warning). Keep their info up-to-date and easy to find -keep flashlight and batteries near home dialysis machine
  • check expiration dates and replace as needed or every 6 months
  • check expiration dates and replace as needed or every 6 months
  • 3. Prepare an emergency kit For meds: -If patient uses a mail service pharmacy , have pharmacy send meds a week before patient will run out (allowing extra time for processing and delivery) -Keep supply of meds at work or any place patient spends a lot of time (like family member’s house)
  • *If patient uses a mail service pharmacy, have pharmacy send meds a week before patient will run out (allowing extra time for processing and delivery) *Keep supply of meds at work or any place patient spends a lot of time (like family member’s house)
  • Check and restock every 6 months
  • Partial list from the guide, which provides a full list of canned foods and water to last 6 days
  • Patients should know what emergency diet to follow if dialysis treatments might be delayed Since dialysis cleans waste from the blood, going without treatments means wastes and fluid build up in the patient’s system and this can cause problems. Patient’s life depends on limiting these wastes To keep the build-up of protein wastes (BUN), potassium, and fluid to a minimum, patients should follow a special strict diet 3-day emergency diet limits protein (from meat, fish, poultry, and eggs), potassium (fruits and vegetables), salt, and fluid intake more strictly than regular diet Patient should review with dietitian to see if it will work for them or to see if modifications can be made to fit their special health needs
  • Are You Ready? Emergency Preparedness for Dialysis Facilities

    1. 1. 5 Diamond Patient Safety Program Emergency Preparedness for Dialysis Facilities 2008 * This presentation was collaboratively developed by the Mid-Atlantic Renal Coalition (MARC) and the ESRD Network of New England for the 5-Diamond Patient Safety Program . The 5-Diamond Patient Safety Program is endorsed by the Renal Physicians Association (RPA) and American Nephrology Nurses’ Association (ANNA).
    2. 2. Questions… <ul><li>Does your dialysis facility have an emergency preparedness and response plan? </li></ul><ul><li>If so, are you familiar with the contents of your facility’s plan? </li></ul><ul><li>3. How many of your patients are familiar with the contents of your facility’s plan? Are you sure? </li></ul>
    3. 3. Session Objectives <ul><li>Define an “emergency event.” </li></ul><ul><li>Understand and discuss role of dialysis facility in preparing for emergencies. </li></ul><ul><li>Understand and discuss role of dialysis patient in preparing for emergencies. </li></ul><ul><li>Identify what patient needs in order to dialyze at an alternate facility. </li></ul>
    4. 4. Hurricane Katrina (2005) <ul><li>200,000 with chronic medical conditions displaced. </li></ul><ul><li>Only 3 hospitals out of 26 remained open. </li></ul><ul><li>No power + no reliable water = no dialysis. </li></ul><ul><li>Almost 2,500 dialysis patients from 43 units displaced. </li></ul>Source: Clinical Journal of the ASN , June 2007.
    5. 5. Hurricane Katrina (2005) <ul><li>Most without dialysis ≥ 1 week . </li></ul><ul><li>94 dialysis facilities closed for at least 1 week. </li></ul><ul><li>As of June 2007 – 17 facilities remained closed . </li></ul>Source: Clinical Journal of the ASN , June 2007.
    6. 6. DCI-Tulane Dialysis Facility (3 weeks post-hurricane) Photos courtesy of DCI-Tulane dialysis facility, as published in the Clinical Journal of the American Society of Nephrology
    7. 7. What Went Right… <ul><li>All 17 Baton Rouge outpatient facilities had generators . </li></ul><ul><li>Water was available . </li></ul><ul><li>Set up surge hospital/triage center at LSU. </li></ul><ul><li>Sufficient medical staff (in some locations) to provide treatment. </li></ul><ul><li>700 ESRD patients received dialysis. </li></ul>Source: Clinical Journal of the ASN , June 2007.
    8. 8. What Went Wrong… <ul><li>Limited early evacuation for vulnerable individuals. </li></ul><ul><li>Phone networks overwhelmed. </li></ul><ul><li>Hospitals overwhelmed . </li></ul><ul><li>No designated shelter for dialysis patients. </li></ul><ul><li>Staff couldn’t locate or contact patients. </li></ul><ul><li>No easily accessible dialysis patient database . </li></ul><ul><li>Difficulty obtaining supplies because of transportation. </li></ul>Source: Clinical Journal of the ASN , June 2007.
    9. 9. What is an “emergency?” <ul><li>CMS defines an emergency as “a situation requiring help or relief, usually created by an unexpected event.” </li></ul>
    10. 11. What is an “emergency?” <ul><li>External emergencies </li></ul><ul><li>Hurricanes </li></ul><ul><li>Earthquakes </li></ul><ul><li>Tornadoes </li></ul><ul><li>Floods </li></ul><ul><li>Severe snow/ice/blizzard </li></ul><ul><li>Terrorist attacks (large scale) </li></ul><ul><li>Hazardous materials spill/leak </li></ul><ul><li>Contagious illness (e.g., pandemic flu) </li></ul>
    11. 12. What is an “emergency?” <ul><li>Internal emergencies </li></ul><ul><li>Fire </li></ul><ul><li>Utility disruption (power/water/gas) </li></ul><ul><li>Contaminated water supply </li></ul><ul><li>Violent patient, family member, or staff member </li></ul><ul><li>Bomb threat </li></ul><ul><li>Theft/burglary/security breach </li></ul>
    12. 13. MARC’s Role <ul><li>Assist facilities in developing disaster plans </li></ul><ul><li>Coordinate with providers, emergency workers, and other essential persons </li></ul><ul><li>Assist providers and patients in determining status of dialysis facilities </li></ul><ul><li>Provide information to family members and treating facilities </li></ul>
    13. 14. The Dialysis Facility’s Role
    14. 15. ESRD Conditions for Coverage (Revised 2008) <ul><li>Section 494.60 (d) Emergency Preparedness </li></ul><ul><li>Implement emergency plan </li></ul><ul><li>Provide appropriate training to staff at least annually </li></ul><ul><li>Provide appropriate training to patients at least annually </li></ul><ul><li>Provide emergency equipment at all times </li></ul><ul><li>Have a plan to obtain emergency medical assistance when needed; review annually and coordinate with local disaster management agency annually </li></ul><ul><li>Comply with applicable provisions of Life Safety Code of the National Fire Protection Association (2000) </li></ul>
    15. 16. ESRD Conditions for Coverage (Revised 2008) <ul><li>Section 494.180 (g) Emergency Coverage </li></ul><ul><li>Provide patients and staff with written instructions </li></ul><ul><li>Have available roster with emergency physician information </li></ul><ul><li>Establish agreement with hospital inpatient, routine, and emergency services </li></ul>
    16. 17. ESRD Conditions for Coverage (Revised 2008) <ul><li>Section 494.170 (a) Protection of the Patient’s Record </li></ul><ul><li>Facility safeguards medical record information against loss, destruction, or unauthorized use. </li></ul>
    17. 18. ESRD Conditions for Coverage (Revised 2008) <ul><li>The Regulations: </li></ul><ul><li>Learn them. Know them. Live them. </li></ul>
    18. 19. 4 Keys to Emergency Preparedness & Response <ul><li>Higher risk of disruption </li></ul><ul><li>Railway or major interstate highway </li></ul><ul><li>Nuclear power plant or chemical facility </li></ul><ul><li>Military base </li></ul><ul><li>Airport </li></ul><ul><li>Flood zone </li></ul><ul><li>Lower risk of disruption </li></ul><ul><li>Onsite generator </li></ul><ul><li>Uninterrupted power supply for critical equipment </li></ul><ul><li>Independent water supply </li></ul>Source: National KCER Coalition 1. Determine types of disasters you might expect.
    19. 20. <ul><li>2. Evaluate your facility’s readiness. </li></ul><ul><ul><li>Secure facility </li></ul></ul><ul><ul><ul><li>Ceiling TVs, machine and chair wheels locked, well-marked emergency exits, etc. </li></ul></ul></ul><ul><ul><li>Secure patient and business records </li></ul></ul><ul><ul><ul><li>Back-up data and keep in secure location; distribute patient orders and medication lists periodically to patients </li></ul></ul></ul><ul><ul><li>Have back-up utility plan </li></ul></ul><ul><ul><ul><li>Power, water, phone, etc. </li></ul></ul></ul>4 Keys to Emergency Preparedness & Response Source: National KCER Coalition
    20. 21. <ul><li>3. Prepare staff. </li></ul><ul><ul><li>Identify disaster organizational structure </li></ul></ul><ul><ul><ul><li>Staff roles </li></ul></ul></ul><ul><ul><li>Develop communications plan </li></ul></ul><ul><ul><ul><li>Disaster contacts, facility and Network contact info </li></ul></ul></ul><ul><ul><li>Educate key personnel on roles </li></ul></ul><ul><ul><ul><li>Periodic drills </li></ul></ul></ul>4 Keys to Emergency Preparedness & Response Source: National KCER Coalition
    21. 22. <ul><li>3. Prepare staff. (con’t) </li></ul><ul><ul><li>Establish back-up facility agreement </li></ul></ul><ul><ul><ul><li>Local and regional </li></ul></ul></ul><ul><ul><li>Know whom to contact </li></ul></ul><ul><ul><ul><li>Network, city/county/state emergency response, American Red Cross, etc. </li></ul></ul></ul><ul><ul><ul><li>Report open/closed status of facility </li></ul></ul></ul>4 Keys to Emergency Preparedness & Response Source: National KCER Coalition
    22. 23. <ul><li>4. Prepare patients. </li></ul><ul><ul><li>Educate them </li></ul></ul><ul><ul><ul><li>Evacuation procedures, clamp and cut/cap, emergency diet, provider and shelter info, etc. </li></ul></ul></ul><ul><ul><ul><li>Include them in drills! </li></ul></ul></ul><ul><ul><li>Survey them regularly </li></ul></ul><ul><ul><ul><li>Contact info, treatments/meds, emergency kit, etc. </li></ul></ul></ul>4 Keys to Emergency Preparedness & Response Source: National KCER Coalition
    23. 24. Facility Case Study <ul><li>ESRD Network 17 (northern California Network) </li></ul><ul><li>1994 earthquake in Northridge, CA (southern CA) </li></ul><ul><li>FMC unit categorized as uninhabitable </li></ul><ul><li>Staff tried to get to unit but freeways were blocked </li></ul><ul><li>FMC set up tents; triage performed in parking lot </li></ul><ul><li>11 FMC facilities affected; cooperated to provide treatments to patients </li></ul><ul><li>Obstacle was time and travel </li></ul>Source: National KCER Coalition
    24. 25. Facility Case Study <ul><li>ESRD Network 17 (northern California Network) </li></ul><ul><li>Lessons learned: </li></ul><ul><li>Collaboration is the key to success in an emergency. </li></ul><ul><li>FMC is providing laminated cards to patients with their basic medical information. </li></ul>Source: National KCER Coalition
    25. 26. Facility Case Study <ul><li>ESRD Network 17 (northern California Network) </li></ul><ul><li>Arson/bomb scare - Satellite Dialysis, Watsonville, CA </li></ul><ul><li>¼ of facility damaged by fire; facility forced to close </li></ul><ul><li>Had emergency affiliation agreement with another facility </li></ul><ul><li>Transportation agencies willingly transported patients to other facility; equipment and supplies transported by volunteers </li></ul>Source: National KCER Coalition
    26. 27. Facility Case Study <ul><li>ESRD Network 17 (northern California Network) </li></ul><ul><li>Lessons learned: </li></ul><ul><li>It is important to foster good relationships and partner with other facilities and agencies to develop a simple but rapid response plan. </li></ul><ul><li>Look beyond your immediate neighborhood for alternate facilities to which you can send patients. </li></ul><ul><li>Develop a staffing plan that allows your staff to assist either “at home” or at the alternate facility. </li></ul>Source: National KCER Coalition
    27. 28. Medical Information <ul><li>1. Gather and carry important medical information. </li></ul><ul><ul><li>Patient name, address, phone (and ID) </li></ul></ul><ul><ul><li>Emergency name, address, phone (local and out of area) </li></ul></ul><ul><ul><li>Facility and physician name and contact information </li></ul></ul><ul><ul><li>Insurance information </li></ul></ul><ul><ul><li>Medical conditions/allergies (including Hep B status) </li></ul></ul><ul><ul><li>Type of dialysis treatment (HD, PD) and orders </li></ul></ul><ul><ul><li>Current meds, dosage, frequency </li></ul></ul>PATIENTS SHOULD CARRY THIS INFORMATION WITH THEM AT ALL TIMES! Source: Centers for Medicare & Medicaid Services’ Preparing for Emergencies: A Guide for People on Dialysis
    28. 29. Treatments <ul><li>2. Make alternate arrangements for your treatment ahead of time. </li></ul><ul><li>In-center hemodialysis </li></ul><ul><ul><li>Provide current contact info </li></ul></ul><ul><ul><li>Arrange back-up transportation </li></ul></ul><ul><ul><li>Determine alternate facilities </li></ul></ul>Source: Centers for Medicare & Medicaid Services’ Preparing for Emergencies: A Guide for People on Dialysis <ul><li>Home hemodialysis </li></ul><ul><ul><li>Contact local utility companies </li></ul></ul><ul><ul><li>Contact supply vendor </li></ul></ul><ul><ul><li>Keep flashlight and batteries handy </li></ul></ul>
    29. 30. Treatments <ul><li>Peritoneal Dialysis </li></ul><ul><li>CAPD (“manual”) </li></ul><ul><ul><li>Keep 5-7 days’ worth of supplies, including some way to sterilize equipment and wash hands (hand sanitizer) </li></ul></ul>Source: Centers for Medicare & Medicaid Services’ Preparing for Emergencies: A Guide for People on Dialysis
    30. 31. Treatments Source: Centers for Medicare & Medicaid Services’ Preparing for Emergencies: A Guide for People on Dialysis <ul><li>Peritoneal Dialysis </li></ul><ul><li>CCPD (“automated”) </li></ul><ul><ul><li>Contact water and power companies in advance </li></ul></ul><ul><ul><li>Keep 5-7 days’ worth of supplies, including some way to sterilize equipment and wash hands (hand sanitizer) </li></ul></ul><ul><ul><li>Consider purchasing gas-powered generator </li></ul></ul><ul><ul><li>Review procedure for manual CAPD (no power required) </li></ul></ul>
    31. 32. Emergency Kit <ul><li>3. Prepare an emergency kit </li></ul><ul><ul><li>Medication/medical supplies </li></ul></ul><ul><ul><ul><li>First aid kit </li></ul></ul></ul><ul><ul><ul><li>Hand sanitizer </li></ul></ul></ul><ul><ul><ul><li>5-7 day supply of meds </li></ul></ul></ul><ul><ul><ul><li>5-day supply antibiotics (if PD) </li></ul></ul></ul><ul><ul><ul><li>Diuretics, sorbitol, Kayexalate for potassium control (if recommended by physician) </li></ul></ul></ul>Source: Centers for Medicare & Medicaid Services’ Preparing for Emergencies: A Guide for People on Dialysis
    32. 33. Emergency Kit <ul><li>Medication/medical supplies (con’t.) </li></ul><ul><ul><ul><li>Diabetics : 5-7 day supply of syringes, insulin, glucose monitoring supplies, batteries, test strips </li></ul></ul></ul><ul><ul><ul><li>Heart disease : 5-7 day supply blood pressure, heart, or anti-clotting meds </li></ul></ul></ul>Source: Centers for Medicare & Medicaid Services’ Preparing for Emergencies: A Guide for People on Dialysis
    33. 34. Emergency Kit <ul><ul><ul><li>Eating utensils </li></ul></ul></ul><ul><ul><ul><li>Dropper </li></ul></ul></ul><ul><ul><ul><li>Paper products </li></ul></ul></ul><ul><ul><ul><li>Candles </li></ul></ul></ul><ul><ul><ul><li>Waterproof matches </li></ul></ul></ul><ul><ul><ul><li>Manual can opener </li></ul></ul></ul><ul><ul><ul><li>Baby wipes/hand sanitizer </li></ul></ul></ul><ul><ul><ul><li>Sharp knife </li></ul></ul></ul><ul><ul><ul><li>Flashlight & batteries </li></ul></ul></ul><ul><li>Radio & batteries </li></ul><ul><li>Plastic jug for storing water </li></ul><ul><li>Bottle of bleach </li></ul><ul><li>Scissors </li></ul><ul><li>Garbage bags </li></ul><ul><li>Piece of cloth or handkerchief </li></ul><ul><li>Strainer </li></ul><ul><li>Extra pair of eyeglasses </li></ul>Household supplies Source: Centers for Medicare & Medicaid Services’ Preparing for Emergencies: A Guide for People on Dialysis
    34. 35. Emergency Kit <ul><ul><li>Use fresh foods as long as possible </li></ul></ul><ul><ul><li>Dry or evaporated milk </li></ul></ul><ul><ul><li>1-2 gallons distilled or bottled water </li></ul></ul><ul><ul><li>Single-serving cereal </li></ul></ul><ul><ul><li>Fruit bowls (peaches, apple sauce, NO raisins) </li></ul></ul><ul><ul><li>Canned low-sodium veggies </li></ul></ul><ul><ul><li>Canned low-sodium meat (tuna, chicken, salmon) </li></ul></ul><ul><ul><li>Peanut butter & jelly </li></ul></ul><ul><ul><li>Bread (can be frozen for 3 months) </li></ul></ul><ul><ul><li>Hard candy or jelly beans </li></ul></ul><ul><ul><li>Food for pets </li></ul></ul>Source: Centers for Medicare & Medicaid Services’ Preparing for Emergencies: A Guide for People on Dialysis Food
    35. 36. Emergency Diet <ul><li>4. 3-day Emergency Diet </li></ul><ul><ul><li>Keeps protein wastes, potassium, and fluid to a minimum until patient can get treatment </li></ul></ul><ul><ul><li>Review regularly and before an event (if possible) with the renal dietitian </li></ul></ul><ul><ul><li>May be continued until patient can get treatment, but only in extreme situations </li></ul></ul>Source: Centers for Medicare & Medicaid Services’ Preparing for Emergencies: A Guide for People on Dialysis
    36. 37. Water Treatment <ul><li>How to disinfect water: </li></ul><ul><li>Rapidly boil water for 10 minutes. </li></ul><ul><li>OR </li></ul><ul><li>2. Mix household chlorine bleach (5.25% sodium hypochlorite solution ONLY) with water following procedure in CMS patient guide. </li></ul>Source: Centers for Medicare & Medicaid Services’ Preparing for Emergencies: A Guide for People on Dialysis
    37. 38. Getting off Dialysis Machine <ul><li>Facility staff should show patient how to disconnect from machine and locate his/her emergency pack. </li></ul><ul><li>Emergency pack </li></ul><ul><ul><li>Scissors, tape, clamps </li></ul></ul><ul><ul><li>Should be kept within patient’s reach </li></ul></ul><ul><li>Patient should stay calm and await instructions. </li></ul><ul><li>Patient should disconnect self ONLY in emergency evacuation situations when no staff person is available. </li></ul>Source: Centers for Medicare & Medicaid Services’ Preparing for Emergencies: A Guide for People on Dialysis
    38. 39. Caring for Your Access <ul><li>After disconnecting, patient should go to the designated safe area . </li></ul><ul><li>They should wait for directions from someone in charge – facility staff, emergency personnel (paramedic, police officer, firefighter). </li></ul><ul><li>Should not remove access needles until he/she has been checked by medical personnel or until patient is certain he/she is in an area out of immediate danger. </li></ul><ul><li>Should never allow any medical personnel unfamiliar with patient’s dialysis status to put anything into his/her vascular access. </li></ul>Source: Centers for Medicare & Medicaid Services’ Preparing for Emergencies: A Guide for People on Dialysis
    39. 40. The KCER Coalition <ul><li>The goals of the national Kidney Community Emergency Response Coalition are to… </li></ul><ul><ul><li>Test and refine the national response strategy </li></ul></ul><ul><ul><li>Raise public awareness of the critical needs of individuals with CKD </li></ul></ul><ul><ul><li>Promote and disseminate tools and resources </li></ul></ul><ul><ul><li>Plan for a possible flu pandemic </li></ul></ul>
    40. 42. Resources <ul><li>MARC website @ www.esrdnet5.org </li></ul><ul><li>National Kidney Community Emergency Response (KCER) Coalition @ www.kcercoalition.com </li></ul><ul><li>The Nephron Information Center’s Disaster site @ www.kidneydisasters.org </li></ul><ul><li>Dialysis Facility Compare @ </li></ul><ul><li>www.medicare.gov – select “Dialysis Facility Compare” </li></ul>
    41. 43. Resources <ul><li>Kopp, J.B., Ball, L.K., Cohen, A., Kenney,R.J., Lempert, K.D., Miller, P.E., Muntner, P., Qureshi, N., and Yelton, S.A. (June 20, 2007). “Kidney patient care in disasters: Emergency planning for patients and dialysis facilities.” Clinical Journal of the American Society of Nephrology 2: 825–838, 2007. doi: 10.2215/CJN.01220307. </li></ul><ul><li>Kopp, J.B., Ball, L.K., Cohen, A., Kenney,R.J., Lempert, K.D., Miller, P.E., Muntner, P., Qureshi, N., and Yelton, S.A. (June 20, 2007). “Kidney patient care in disasters: Lessons from the hurricanes and earthquake of 2005.” Clinical Journal of the American Society of Nephrology 2: 814–824, 2007. doi: 10.2215/CJN.03481006. </li></ul>

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