PREPARING FOR DISASTER: PREPARING FOR DISASTER THE IN-PATIENT DIALYSIS UNIT Barbara Richter, RN, BSN, MA Clinical Nurse Manager Mount Sinai Medical Center Renal Treatment Center


Slide2: BEFORE A DISASTER STRIKES: Outpatient Staff are prepared They know their collaborating units and contact numbers. They know their disaster plan and how to implement it. They have a disaster plan for their family members and know how to reach them. They know the patient disaster hotline number.


BEFORE A DISASTER HITS:: BEFORE A DISASTER HITS: Patients are prepared: They have a “TO GO “ bag with: a 3 day supply of medications their dialysis prescription current medication list 1 – 2 doses of kayexelate with sorbitol bottled water some canned food one change of clothing They have been in-serviced They know what will happen if they are in the dialysis unit They know where to call, if at home. (Hotline)


ASSUMPTIONS:: ASSUMPTIONS: The hospital is functioning. The Command Center is up and running. There is communication with the satellite units that are down.


REALITY:: REALITY: The hospital is full and needs to discharge patients using established criteria. The dialysis unit is functioning at full capacity: A handful of chronic adult outpatients Chronic pediatric outpatients Chronic in-patients Acute in-patients ICU patients (10-16 off center treatments/day)


The Plan:: The Plan: The Renal Treatment Center: 12 stations will be adapted by Y-connectors to accommodate 2 dialysis machines each 2 additional stations will be created using the R/O hook-up from the technical/equipment room Dialysate flows will be reduced to 500cc/minute, if necessary Patient treatments may be reduced to 2 hours Dialysis unit will run 24 hours 4 bedded area converted to dialysis unit, using 4 off-center R/O’s and dialysis machines


The Plan:: The Plan: Staff: Nurse and technical staff that are present will be mandated to stay Plans are made to stay open 24 hours Nurse and technical staff at home will be told not to report to work until 1st shift goes home Medical Director will assure physician coverage 24 hours Staff from other institutions: Need to bring some disposable supplies May need to bring machines May work with our dialysis staff to take care of their patients (the logistics of this still needs to be worked out)


REALITY (Cont’d):: REALITY (Cont’d): Patients are told to go to the nearest ER. The ER is dealing with a large influx of “injuries”. The Renal MDs will need to assess every patient that needs dialysis.


REALITY (Cont’d):: REALITY (Cont’d): The command center is not focusing on dialysis: The Emergency Room is busy with injuries The Emergency Triage Area is sorting levels of injury The Operation Rooms are busy with emergency surgery


THE PLAN:: THE PLAN: The renal department needs to handle the dialysis patients: Set up triage for ESRD patients in or near the dialysis unit Injuries go to Emergency Room ESRD patients are placed on schedule


THE PLAN:: THE PLAN: The Clinical Nurse Manager, the Charge Nurse, the Medical Director, the Administrator and the Technical Manager will meet, confer and activate the plan. Set up a triage room in the unit. Decide which patients’ treatments can be cut. Arrange to open the area designated to put 4 portable dialysis machines and chairs/stretchers.


THE PLAN:: THE PLAN: The staff is notified of the initial plan and updated often. 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. Home Dialysis Unit Name Date of Birth Social Security Number Insurance Information Weights and Heights Actual Billing Will Come Later


THE PLAN:: THE PLAN: Treatment prescriptions will be individualized but basically will be: 2 hours treatment The dialysate flow may be decreased Regularly prescribed blood flows No routine IV meds, i.e. Epogen, Aranesp, Zemplar, etc In-patients will be dialyzed in their room


REPONSIBILITIES:: REPONSIBILITIES: At the satellite: The Nurse Manager or Charge Nurse will notify: Medical Director of Dialysis Administrator Nurse Manager or Charge Nurse at the hospital Medical Director or his/her designee will notify: Chief Operating Office Chief Medical Office Vice President for facilities


RESPONSIBILITIES: (Cont’d): RESPONSIBILITIES: (Cont’d) The administrator will make arrangement : To transport: Dialysis machines Disposable supplies Work with Social Worker & Nutritionist to contact transportation companies to aid in patient transport Contact the network Call patients at home to give their new pickup schedule


RESPONSIBILITIES: (Cont’d): RESPONSIBILITIES: (Cont’d) Nurse Manager at the hospital unit Staff all areas appropriately Staff for 24 hours operation Along with the Medical Director and Administrator, stay in touch with the hospital command center and satellite units.


POST DISASTER:: POST DISASTER: All players need to meet to discuss: What went well Problem Areas Changes to be made