Hspital Preparedness Checklist http://pandemicflu.gv Preparedness Subject 1. Structure fr planning and decisin making An internal, multidisciplinary planning cmmittee fr influenza preparedness has been created. Actins Needed A persn has been designated as the influenza preparedness crdinatr. (Insert name) Members f the planning cmmittee include the fllwing hspital staff members (insert names) Administratin Legal cunsel Infectin cntrl Hspital disaster crdinatr Risk management Facility engineering Nursing administratin Medical staff Intensive care Emergency Department Labratry services Respiratry therapy Psychiatry Envirnmental services Public relatins Security Materials management Staff develpment Occupatinal health Diagnstic imaging Pharmacy Infrmatin technlgy Other members Other members A state r lcal health department persn has been identified as a cmmittee liaisn. (Insert name) A linkage with lcal r reginal emergency preparedness grups has been established (Planning rganizatin) 2. Develpment f a written pandemic influenza plan A written plan has been cmpleted r is in prgress that includes the elements listed in #3 belw. The plan specifies the circumstances under which the plan will be activated. The plan describes the rganizatin structure that will be used t peratinalize the plan.
Respnsibilities f key persnnel related t executing the plan have been described. A simulatin exercise has been develped t test the effectiveness f the plan. A simulatin exercise has been perfrmed. (Date perfrmed ) 3. Elements f an influenza pandemic plan A surveillance plan has been develped. Syndrmic surveillance has been established in the emergency rm. Criteria fr distinguishing pandemic influenza is part f the syndrmic surveillance plan. Respnsibility has been assigned fr reviewing glbal, natinal, reginal, and lcal influenza activity trends and infrming the pandemic influenza crdinatr f evidence f an emerging prblem. (Name ) Threshlds fr heightened lcal surveillance fr pandemic influenza have been established. A system has been created fr internal review f pandemic influenza activity in patients presenting t the emergency department. A system fr mnitring fr nscmial transmissin f pandemic has been implemented and tested by mnitring fr nn-pandemic influenza. A cmmunicatin plan has been develped. Respnsibility fr external cmmunicatin has been assigned. Persn respnsible fr updating public health reprting Clinical spkespersn fr the facility Media spkespersn fr the facility Key pints f cntact utside the facility have been identified. State health department cntact Lcal health department cntact Newspaper cntact(s) Radi cntact(s) Public fficial(s) A list f ther healthcare facilities with whm it will be necessary t maintain cmmunicatin has been established. A meeting with lcal healthcare facilities has been held t discuss a cmmunicatin strategy. A plan fr updating key facility persnnel n a daily basis has been established. The persn(s) respnsible fr prviding these updates are: A system t track pandemic influenza admissins and discharges has been develped and tested by mnitring nn-pandemic influenza admissins and discharges in the cmmunity.
A strategy fr regularly updating clinical, ED, and utpatient staff n the status f pandemic influenza, nce detected, has been established. (Respnsible persn ) A plan fr infrming patients and visitrs abut the level f pandemic influenza activity has been established. An educatin and training plan n pandemic influenza has been develped. Language and reading level-apprpriate materials fr educating all persnnel abut pandemic influenza and the facility s pandemic influenza plan, have been identified. Current and ptential sites fr lng-distance and lcal educatin f clinicians n pandemic influenza have been identified. Means fr accessing state and federal web-based influenza training prgrams have been identified. A system fr tracking which persnnel have cmpleted pandemic influenza training is in place. A plan is in place fr rapidly training nn-facility staff brught in t prvide patient care when the hspital reaches surge capacity. The fllwing grups f healthcare persnnel have received training n the facility s influenza plan: Attending physicians Huse staff Nursing staff Labratry staff Emergency Department persnnel Outpatient persnnel Envirnmental Services persnnel Engineering and maintenance persnnel Security persnnel Nutritin persnnel A triage and admissin plan has been develped. A specific lcatin has been identified fr triage f patients with pssible pandemic influenza. The plan includes use f signage t direct and instruct patients with pssible pandemic influenza n the triage prcess. Patients with pssible pandemic influenza will be physically separated frm ther patients seeking medical attentin. A system fr phne triage f patients fr purpses f priritizing patients wh require a medical evaluatin has been develped. Criteria fr determining which patients need a medical evaluatin are in place. A methd fr tracking the admissin and discharge f patients with pandemic influenza has been develped. The tracking methd has been tested with nn-pandemic influenza patients. A facility access plan has been develped. Criteria and prtcls fr clsing the facility t new admissins are in place. Criteria and prtcls fr limiting visitrs have been established. Hspital Security has had input int prcedures fr enfrcing facility access cntrls. An ccupatinal health plan has been develped. A system fr rapidly delivering vaccine r antiviral prphylaxis t healthcare persnnel has been develped.
The system has been tested during a nn-pandemic influenza seasn. A methd fr priritizing healthcare persnnel fr receipt f vaccine r antiviral prphylaxis based n level f patient cntact and persnal risk fr influenza cmplicatins has been established. A system fr detecting symptmatic persnnel befre they reprt fr duty has been develped. This system has been tested during a nn-pandemic influenza perid. A plicy fr managing healthcare persnnel with symptms f r dcumented pandemic influenza has been established. The plicy cnsiders: When persnnel may return t wrk after having pandemic influenza When persnnel wh are symptmatic but well enugh t wrk, will be permitted t cntinue wrking A methd fr furlughing r altering the wrk lcatins f persnnel wh are at high risk fr influenza cmplicatins (e.g., pregnant wmen, immuncmprmised healthcare wrkers) has been develped. Mental health and faith-based resurces wh will prvide cunseling t persnnel during a pandemic have been identified. A strategy fr husing healthcare persnnel wh may be needed n-site fr prlnged perids f time is in place. A strategy fr accmmdating and supprting persnnel wh have child r elder care respnsibilities has been develped. A vaccine and antiviral use plan has been develped. A cntact fr btaining influenza vaccine has been identified. (Name) A cntact fr btaining antiviral prphylaxis has been identified. (Name) A pririty list (based n HHS guidance fr use f vaccines and antivirals in a pandemic when in shrt supply) and estimated number f patients and healthcare persnnel wh wuld be targeted fr influenza vaccinatin r antiviral prphylaxis has been develped. Number f first pririty persnnel Number f secnd pririty persnnel Number f remaining persnnel Number f first pririty patients Number f secnd pririty patients A system fr rapidly distributing vaccine and antivirals t patients has been develped. Issues related t surge capacity have been addressed. A plan is in place t address unmet staffing needs in the hspital. The minimum number and categries f persnnel needed t care fr a grup f patients with pandemic influenza has been determined. Respnsibility fr assessing day-t-day clinical staffing needs during an influenza pandemic has been assigned. Persns respnsible are: (names and/r titles) Legal cunsel has reviewed emergency laws fr using healthcare persnnel with ut-f-state licenses. Legal cunsel has made sure that any insurance and ther liability cncerns have been reslved. Criteria fr declaring a staffing crisis that wuld enable the use f emergency
staffing alternatives have been defined. The plan includes linking t lcal and reginal planning and respnse grups t cllabrate n addressing widespread healthcare staffing shrtages during a crisis. A pririty list fr reassignment and recruitment f persnnel has been develped. A methd fr rapidly credentialing newly recruited persnnel has been develped. Mutual AID Agreements (MAAs) and Memranda f Understanding/Agreement (MOU/As) have been signed with ther facilities that have agreed t share their staff, as needed. Strategies t increase bed capacity have been identified A threshld has been established fr canceling elective admissins and surgeries MOAs have been signed with facilities that wuld accept nn-influenza patients in rder t free-up bed space Areas f the facility that culd be utilized fr expanded bed space have been identified The estimated patient capacity fr this facility is Plans fr expanded bed capacity have been discussed with lcal and reginal planning grups Anticipated durable and cnsumable resurce needs have been determined A primary plan and cntingency plan t address supply shrtages has been develped Plans fr btaining limited resurces have been discussed with lcal and reginal planning and respnse grups. A strategy fr handling increased numbers f deceased persns has been develped. Plans fr expanding mrgue capacity have been discussed with lcal and reginal planning grups. Lcal mrticians have been invlved in planning discussins. Mrtality estimates have been used t estimate the number f bdy bags and shruds. Supply surces fr pstmrtem materials have been identified.