" From the Inside Looking Out by Barbara Richter, RN, BSN, MA


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" From the Inside Looking Out by Barbara Richter, RN, BSN, MA

  1. 1. PREPARING FOR DISASTER THE IN-PATIENT DIALYSIS UNIT Barbara Richter, RN, BSN, MA Clinical Nurse Manager Mount Sinai Medical Center Renal Treatment Center
  2. 2. BEFORE A DISASTER STRIKES: <ul><li>Outpatient Staff are prepared </li></ul><ul><ul><ul><li>They know their collaborating units and contact numbers. </li></ul></ul></ul><ul><ul><ul><li>They know their disaster plan and how to implement it. </li></ul></ul></ul><ul><ul><ul><li>They have a disaster plan for their family members and know how to reach them. </li></ul></ul></ul><ul><ul><ul><li>They know the patient disaster hotline number. </li></ul></ul></ul>
  3. 3. BEFORE A DISASTER HITS: <ul><li>Patients are prepared: </li></ul><ul><ul><ul><li>They have a “TO GO “ bag with: </li></ul></ul></ul><ul><ul><ul><ul><li>a 3 day supply of medications </li></ul></ul></ul></ul><ul><ul><ul><ul><li>their dialysis prescription </li></ul></ul></ul></ul><ul><ul><ul><ul><li>current medication list </li></ul></ul></ul></ul><ul><ul><ul><ul><li>1 – 2 doses of kayexelate with sorbitol </li></ul></ul></ul></ul><ul><ul><ul><ul><li>bottled water </li></ul></ul></ul></ul><ul><ul><ul><ul><li>some canned food </li></ul></ul></ul></ul><ul><ul><ul><ul><li>one change of clothing </li></ul></ul></ul></ul><ul><ul><ul><li>They have been in-serviced </li></ul></ul></ul><ul><ul><ul><ul><li>They know what will happen if they are in the dialysis unit </li></ul></ul></ul></ul><ul><ul><ul><ul><li>They know where to call, if at home. (Hotline) </li></ul></ul></ul></ul>
  4. 4. ASSUMPTIONS: <ul><li>The hospital is functioning. </li></ul><ul><li>The Command Center is up and running. </li></ul><ul><li>There is communication with the satellite units that are down. </li></ul>
  5. 5. REALITY: <ul><li>The hospital is full and needs to discharge patients using established criteria. </li></ul><ul><li>The dialysis unit is functioning at full capacity: </li></ul><ul><ul><ul><li>A handful of chronic adult outpatients </li></ul></ul></ul><ul><ul><ul><li>Chronic pediatric outpatients </li></ul></ul></ul><ul><ul><ul><li>Chronic in-patients </li></ul></ul></ul><ul><ul><ul><li>Acute in-patients </li></ul></ul></ul><ul><ul><ul><li>ICU patients (10-16 off center treatments/day) </li></ul></ul></ul>
  6. 6. The Plan: <ul><li>The Renal Treatment Center: </li></ul><ul><ul><ul><li>12 stations will be adapted by Y-connectors to accommodate 2 dialysis machines each </li></ul></ul></ul><ul><ul><ul><li>2 additional stations will be created using the R/O hook-up from the technical/equipment room </li></ul></ul></ul><ul><ul><ul><li>Dialysate flows will be reduced to 500cc/minute, if necessary </li></ul></ul></ul><ul><ul><ul><li>Patient treatments may be reduced to 2 hours </li></ul></ul></ul><ul><ul><ul><li>Dialysis unit will run 24 hours </li></ul></ul></ul><ul><ul><ul><li>4 bedded area converted to dialysis unit, using 4 </li></ul></ul></ul><ul><ul><ul><li>off-center R/O’s and dialysis machines </li></ul></ul></ul>
  7. 7. The Plan: <ul><li>Staff: </li></ul><ul><ul><ul><li>Nurse and technical staff that are present will be mandated to stay </li></ul></ul></ul><ul><ul><ul><li>Plans are made to stay open 24 hours </li></ul></ul></ul><ul><ul><ul><li>Nurse and technical staff at home will be told not to report to work until 1 st shift goes home </li></ul></ul></ul><ul><ul><ul><li>Medical Director will assure physician coverage 24 hours </li></ul></ul></ul><ul><ul><ul><li>Staff from other institutions: </li></ul></ul></ul><ul><ul><ul><ul><li>Need to bring some disposable supplies </li></ul></ul></ul></ul><ul><ul><ul><ul><li>May need to bring machines </li></ul></ul></ul></ul><ul><ul><ul><ul><li>May work with our dialysis staff to take care of their patients (the logistics of this still needs to be worked out) </li></ul></ul></ul></ul>
  8. 8. REALITY (Cont’d): <ul><li>Patients are told to go to the nearest ER. </li></ul><ul><li>The ER is dealing with a large influx of “injuries”. </li></ul><ul><li>The Renal MDs will need to assess every patient that needs dialysis. </li></ul>
  9. 9. REALITY (Cont’d): <ul><li>The command center is not focusing on dialysis: </li></ul><ul><ul><ul><li>The Emergency Room is busy with injuries </li></ul></ul></ul><ul><ul><ul><li>The Emergency Triage Area is sorting levels of injury </li></ul></ul></ul><ul><ul><ul><li>The Operation Rooms are busy with emergency surgery </li></ul></ul></ul>
  10. 10. THE PLAN: <ul><li>The renal department needs to handle the dialysis patients: </li></ul><ul><ul><ul><li>Set up triage for ESRD patients in or near the dialysis unit </li></ul></ul></ul><ul><ul><ul><ul><li>Injuries go to Emergency Room </li></ul></ul></ul></ul><ul><ul><ul><ul><li>ESRD patients are placed on schedule </li></ul></ul></ul></ul>
  11. 11. THE PLAN: <ul><li>The Clinical Nurse Manager, the Charge Nurse, the Medical Director, the Administrator and the Technical Manager will meet, confer and activate the plan. </li></ul><ul><ul><ul><li>Set up a triage room in the unit. </li></ul></ul></ul><ul><ul><ul><li>Decide which patients’ treatments can be cut. </li></ul></ul></ul><ul><ul><ul><li>Arrange to open the area designated to put 4 portable dialysis machines and chairs/stretchers. </li></ul></ul></ul>
  12. 12. THE PLAN: <ul><li>The staff is notified of the initial plan and updated often. </li></ul><ul><ul><ul><li>The administrator arranges for the paper work and clerical staff is set up to get all demographic information, from patients not associated with the hospital. </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Home Dialysis Unit </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Name </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Date of Birth </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Social Security Number </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Insurance Information </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Weights and Heights </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Actual Billing Will Come Later </li></ul></ul></ul></ul></ul>
  13. 13. THE PLAN: <ul><li>Treatment prescriptions will be individualized but basically will be: </li></ul><ul><ul><ul><li>2 hours treatment </li></ul></ul></ul><ul><ul><ul><li>The dialysate flow may be decreased </li></ul></ul></ul><ul><ul><ul><li>Regularly prescribed blood flows </li></ul></ul></ul><ul><ul><ul><li>No routine IV meds, i.e. Epogen, Aranesp, Zemplar, etc </li></ul></ul></ul><ul><li>In-patients will be dialyzed in their room </li></ul>
  14. 14. REPONSIBILITIES: <ul><li>At the satellite: </li></ul><ul><ul><ul><li>The Nurse Manager or Charge Nurse will notify: </li></ul></ul></ul><ul><ul><ul><ul><li>Medical Director of Dialysis </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Administrator </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Nurse Manager or Charge Nurse at the hospital </li></ul></ul></ul></ul><ul><ul><ul><li>Medical Director or his/her designee will notify: </li></ul></ul></ul><ul><ul><ul><ul><li>Chief Operating Office </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Chief Medical Office </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Vice President for facilities </li></ul></ul></ul></ul>
  15. 15. RESPONSIBILITIES: (Cont’d) <ul><li>The administrator will make arrangement : </li></ul><ul><ul><ul><li>To transport: </li></ul></ul></ul><ul><ul><ul><ul><li>Dialysis machines </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Disposable supplies </li></ul></ul></ul></ul><ul><ul><ul><li>Work with Social Worker & Nutritionist to contact transportation companies to aid in patient transport </li></ul></ul></ul><ul><ul><ul><ul><li>Contact the network </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Call patients at home to give their new pickup schedule </li></ul></ul></ul></ul>
  16. 16. RESPONSIBILITIES: (Cont’d) <ul><li>Nurse Manager at the hospital unit </li></ul><ul><ul><ul><li>Staff all areas appropriately </li></ul></ul></ul><ul><ul><ul><li>Staff for 24 hours operation </li></ul></ul></ul><ul><ul><ul><li>Along with the Medical Director and Administrator, stay in touch with the hospital command center and satellite units. </li></ul></ul></ul>
  17. 17. POST DISASTER: <ul><li>All players need to meet to discuss: </li></ul><ul><ul><ul><li>What went well </li></ul></ul></ul><ul><ul><ul><li>Problem Areas </li></ul></ul></ul><ul><ul><ul><li>Changes to be made </li></ul></ul></ul>