Thursday, February 8, 2018

DME Owners in Florida, Are you compliant to the Emergency Management Plan?

FLORIDA REGULATIONS FOR DME PROVIDERS MANDATE THAT THE EMERGENCY MANAGEMENT PLAN BE WRITTEN OUT IN A PARTICULAR WAY TO NOTIFY THE COUNTIES IN THE STATE THAT YOU ARE AVAILABLE FOR CERTAIN EMERGENCIES.  BELOW IS THE LETTER THEY WANT YOU TO MAIL OUT TO THE COUNTIES WITHIN THE STATE OF FLORIDA:

____________________________________________________________________

COMPREHENSIVE EMERGENCY MANAGEMENT PLAN FORMAT
FOR HOME MEDICAL EQUIPMENT PROVIDERS


Developed by __________________________________________________________
(Name of Licensed Home Medical Equipment Provider, license #)

In compliance with sections 400.934(20)-(22) and 400.935(11), Florida Statutes;
and 59A-25.006, Florida Administrative Code

Basic Home Medical Equipment (HME) Provider Information

Street Address:
City, Zip Code:
Phone Number: Fax Number:
Emergency Service Phone Number (outside normal business hours):
General Manager’s Name:
Geographic Service Area:
ο All counties in Florida are served by this provider
ο Only the following counties are served 

Person in Charge during Emergency

Name/Title:
Home Address:
Phone Numbers - Home: Work:
Pager: Cell:
Email:

Alternate - If the above person is not available during emergency/evacuation, who would be in charge?

Name/Title:
Home Address:
Phone Numbers - Home: Work:
Pager: Cell:
Email:
Insert additional names as appropriate

HME Owner (   check if same as ‘Person in Charge during Emergency’ listed above)

Name: 
Home Address:
Phone Numbers - Home: Work:
Pager: Cell:
Email:
Insert additional owners as appropriate
Table of Contents
Page

I. EQUIPMENT AND SERVICES _____
A.  Summary of Types of Equipment and Services Provided _____
B.  Life-Supporting or Life-Sustaining Equipment _____
C.  Other Equipment and Equipment Services _____
D.  Equipment and Equipment Services to Be Provided in Emergencies  _____

II. OPERATIONS BEFORE, DURING AND AFTER AN EMERGENCY AND/OR EVACUATION
A.  Personnel Responsibilities in Emergency Situations _____
B.  Planning and Information for Consumers before an Emergency _____
C.  Notification of a Possible Emergency _____
D.  During an Emergency _____
E.  Evacuation _____
F.  After the Emergency and/or upon Re-entry to Affected Area _____

III. TRAINING FOR HME STAFF, PROVIDER PERSONNEL AND CONTRACTORS _____

IV. APPENDICES
A.  Agreements and Understandings _____
B.  Information for HME Consumers _____
C.  Support Materials _____


Instructions:  This form is designed so that the requested information may be typed directly below each topic heading, allowing as much space as necessary to capture the needed details.  This will also permit the plan to be easily transmitted by e-mail to the local reviewer (see below).

Section 381.0303(7), F.S., states, “The submission of emergency management plans to county health departments by … home medical equipment providers is conditional upon receipt of an appropriation by the department to establish disaster coordinator positions in county health departments unless the secretary of the department and a local county commission jointly determine to require that such plans be submitted based on a determination that there is a special need to protect public health in the local area during an emergency.”  It is the home medical equipment provider’s responsibility to contact the county health department of each of the counties listed on the provider’s license to determine and document whether the Comprehensive Emergency Management Plan (CEMP) should be submitted to that county and, if submission is required, whether the county health department will be reviewing the plan for compliance with Florida Statutes and rules.  If the plan is to be submitted, e-mail with ‘read receipt requested’ or certified mail with return-receipt requested is recommended in order to document proof of submission.

A CEMP must be prepared by every licensed home medical equipment provider regardless of whether it will be reviewed by the local county health department.


The CEMP must be updated on an annual basis or as needed per s. 400.934(20)(a), F.S., and 59A-25.006(2).
I. EQUIPMENT AND SERVICES

A. Summary of Types of Equipment and Services Provided

In the chart below, check () each type of equipment that the HME sells and/or rents and then check the HME services provided for each type checked.



HME SERVICES

EQUIPMENT TYPES*
Intake
Equipment selection
Delivery
Setup and installation
Patient training
Ongoing service and maintenance
Retrieval

Respiratory modalities








Ambulation aids









Mobility aids









Sickroom setup









Disposable supplies








Other
(list below)








*Equipment types might include:
Respiratory modalities - airway pressure machines, apnea monitors, oxygen & ventilator equipment
Ambulation aids - walkers, canes, crutches
Mobility aids - motorized scooters, wheelchairs, passive motion devices, electrostimulation equipment
Sickroom setup – hospital beds, lifts, suction machines, enteral feeding pumps, dialysis equipment
Disposable supplies – diabetic, ostomy, urological and wound care


B. Life-Supporting or Life-Sustaining Equipment

As defined in Florida Statute (law) 400.925(13), “’Life-supporting or life-sustaining equipment’ means a device that is essential to, or that yields information that is essential to, the restoration or continuation of a bodily function important to the continuation of human life. Life-supporting or life-sustaining equipment includes apnea monitors, enteral feeding pumps, infusion pumps, portable home dialysis equipment, and ventilator equipment and supplies for all related equipment, including oxygen equipment and related respiratory equipment.”

Does the HME sell and/or rent such equipment? YES       NO  

If yes, please note s. 400.934(20)(a), F.S., requires HME provider’s CEMP “shall provide for continuing home medical equipment services for life-supporting or life-sustaining equipment, as defined in s. 400.925, during an emergency that interrupts home medical equipment services in a patient’s home.”  The continuation of these services should be included in each section of the plan as outlined below.

C. Other Equipment and Equipment Services
The types of equipment, services and consumers of each HME provider will determine the detail required in that provider’s CEMP; thus, some of the sections in the CEMP may not apply to all providers and may be marked ‘N/A’.  Please check the correct response for this HME provider under each item below:

1. HME services to consumers:
a. HME provider services equipment or delivers supplies to consumers
YES       NO  

b. HME provider does not service equipment or deliver supplies to consumers
YES       NO  

If an HME provider does not service equipment or deliver supplies to a consumer, then the provider would not be expected to offer continuing services to that consumer during an emergency.


2. HME provider only sells/rents and services equipment for consumers in a licensed health care facility YES       NO  

If an HME provider only sells to and services equipment in a licensed health care facility such as a skilled nursing facility or assisted living facility, then the HME provider would not be responsible for continuing services to the individual patients during an emergency situation; however, the HME provider would be responsible for maintaining equipment and equipment services as was being done prior to the emergency.


3. HME provider only sells/rents and services equipment to consumers for use by home health agency or hospice with patient YES       NO  

Maintenance of the equipment would be expected and provision of related supplies as was being done prior to the emergency would be expected.


4. Other unique equipment/services situation:  (Describe)



D. List and describe the equipment and equipment services that the HME would provide should there be a natural disaster or other emergency situation in the area the provider is licensed to serve:  (List and describe)


II. OPERATIONS BEFORE, DURING AND AFTER AN EMERGENCY AND/OR EVACUATION
(Insert any appropriate introductory or overview remarks.)


A. Personnel Responsibilities in Emergency Situations

1. Provide a chain of command to ensure continued leadership and authority.


2. Describe how the HME provider will timely activate the CEMP and staffing of the HME during an emergency.  (This would include a listing of the potential hazards that the provider is vulnerable to such as hurricanes, tornados, flooding, fires, hazardous materials, transportation accidents, proximity to a nuclear power plant, power outages during severe weather, etc.  The provider should have a pre-determined time of activation such as wind speed, flood water level, the proximity of wildfire, etc. as well as a plan when no warning is given.)


3. Identify the personnel that will manage equipment services for consumers who will continue to receive services in their residence or at the special needs shelter by the HME’s staff or contractors during an emergency.



B. Planning and Information for Consumers before an Emergency - describe how the HME provider will:

1. Assist local emergency management agencies with special needs registration
a. Inform special needs clients about registration and provide information


b. Collect registration information from special needs clients for the special needs registry, in accordance with the established procedures of the local emergency management agency


NOTE:  This must be done prior to an emergency and not when an emergency is approaching or occurring. If the consumer is already receiving services from a home health agency, a hospice, the Agency for Persons with Disabilities, Medicaid Waiver, Community Care for the Elderly, Older Americans Act or other state and federal funded programs, check to determine whether the other provider has offered assistance to the client with special needs registration. Home medical equipment providers are not required to assist patients residing in skilled nursing facilities assisted living facilities or adult family care homes with special needs registration as those licensed facilities are responsible for evacuation and alternative sheltering of their patients. If the local emergency management agency does not permit providers to collect the registration information, please note that here.


2. If the consumer is registered for the special needs registry by the HME provider:
a. Describe who will provide the information to the consumer and caregiver, e.g. family members, friends, etc., regarding the guidelines provided in Appendix B when there is mandatory evacuation underway due to the emergency


b. Establish and update an equipment and supply list, in accordance with Appendix B, in the consumer’s place of residence that can accompany them if they are relocated


3. For those consumers that receive HME services that are not registered with the special needs registry, find out if the consumer will need continued services in their residence prior to, during and immediately following an emergency.



C. Notification of a Possible Emergency – describe how the HME provider will:

1. Receive warnings and alert staff in charge of the CEMP implementation of impending emergency situations including during off hours, weekends and holidays


2. Alert staff and contractors of impending emergency situations including during off hours, weekends and holidays


3. Provide information to provider personnel regarding reporting to work when the HME remains operational


4. Provide alternate means of notification should the primary system fail (may include cell phones, satellite phones, contact with a community-based ham radio group, public announcements through radio or television stations, face-to-face contact and, in medical emergency situations, contact with police or emergency rescue services)


5. Alert consumers of the precautionary measures that will be taken including, delivering additional oxygen or supplies to those that are in areas not likely to be evacuating, and confirm plans of those that will be relocating with family members and friends


6. Maintain a prioritized list of consumers who need continued services during an emergency, including those who relocate to special needs shelters, which complies with the requirements of s. 400.934(21), F.S., and the procedures for furnishing this list to the county health department and local emergency management agency when requested  (the list shall indicate the means by which services shall be continued for each consumer, whether the consumer is to be transported to a special needs shelter and whether the consumer has life-supporting or life-sustaining equipment, including the specific type of equipment and related supplies)
D. During an Emergency – describe how the HME provider will:

1. Provide every reasonable attempt to assure that all consumers (including those residing in a skilled nursing facility, assisted living facility or adult family care home) needing continuing equipment/service for life-sustaining or life-supporting equipment will receive it, either from the HME or through arrangements made by the consumer, the consumer’s family or caregiver, when there is not a mandatory evacuation and the consumer decides to stay in their residence


2. Provide equipment and related supplies necessary to perform the same type and quantity of services to its consumers who evacuate to special needs shelters, which were being provided prior to evacuation per s. 400.934(20)(a)1, F.S.


3. Establish links to the local emergency operations center to determine a mechanism by which to approach specific areas within a disaster area in order to reach its consumers per s. 400.934(22), F.S.



E. Evacuation – describe how the HME provider will:

1. Provide updated equipment and supply list, in accordance with Appendix B, to be kept in consumer’s residence for consumers that will be transported from their homes if evacuation is ordered


2. Deliver essential equipment, services and/or referrals to other organizations subject to written agreement including how the HME will continue to provide services to consumers who relocate within or outside the geographic service area  (If consumers residing in a skilled nursing facility, assisted living facility or adult family care home relocate to another skilled nursing facility, assisted living facility or adult family care home in the geographic area served by the home medical equipment provider, the provider will continue to provide equipment services to those consumers. If those consumers are relocated outside the area served by the home medical equipment provider, the provider will assist the skilled nursing facility, assisted living facility or adult family care home in obtaining the equipment services of another home medical equipment provider already licensed for that area until the consumer returns to their original location.)



F. After the Emergency and/or upon Re-entry to Affected Area – describe how the HME provider will:

1. Re-establish contact with and services to consumers, as prioritized, after their return to their residence


2. Re-establish contact with contractors in order to resume services


3. Prioritize services should the emergency result in fewer provider personnel or contractors being available immediately following the disaster



III. TRAINING FOR HME STAFF, PROVIDER PERSONNEL AND CONTRACTORS
(Insert any appropriate introductory or overview remarks.)

In each of the sections below, describe how the HME will:

A. Inform administrative staff, provider personnel and contractors prior to an emergency of their roles and responsibilities during times of emergency (This could be accomplished during new employee orientation and should include the expectation of each key employee’s personal emergency preparation plan that would allow the employee to remain at work.)


B. Train provider personnel on emergency preparedness procedures (This should include the training content, such as a definition of what constitutes an emergency, when the CEMP will go into effect, the roles and responsibilities of essential and non-essential staff, etc.)


C. Train new employees and contractors regarding their disaster-related responsibilities


D. Train assigned staff on what is a special needs client and special needs registration procedures in the county(ies) they are assigned to cover, including Appendix B


E. Identify when the CEMP will be reviewed with staff and on an annual basis



IV. APPENDICES

The appendices that follow are provided in support of the HME’s CEMP:


APPENDIX A - AGREEMENTS AND UNDERSTANDINGS

(List any mutual agreements between the HME and any local, state or county entities or any other health care or service providers having responsibility during a disaster and attach a copy of each.  This is to include agreements needed to ensure the operational integrity of the CEMP.  These agreements should be updated annually along with the plan.)



APPENDIX B - INFORMATION FOR HME CONSUMERS

(Insert copy of information provided to educate consumers about the procedures that may be necessary for safety during disasters.  The information listed on ATTACHMENT 1, SPECIAL NEEDS SHELTERS, should be included for consumers on the special needs registry in preparation for a possible evacuation to a special needs shelter.)




APPENDIX C - SUPPORT MATERIALS

(List any materials necessary to support this CEMP and attach a copy of each.)



SPECIAL NEEDS SHELTERS

Please note:  The special needs shelter should be used as a place of last refuge.  The evacuee may not receive the same level of care received in the home and the conditions in a shelter may be stressful.

(1)  It is the expectation of the special needs shelter that a caregiver accompany and remain with the consumer throughout the stay.


(2)  The following is a suggested list of what consumers need to bring to the special needs shelter during an evacuation; the consumer should check with the assigned shelter to confirm the necessary items and/or those items which may not be accommodated:

Identification and current address
A copy of the consumer’s plan of care, if applicable
Medication listing including directions for the dose, frequency, route, time of day and any special considerations for administration; equipment and supplies list including the phone, beeper and emergency numbers for the consumer’s physician, pharmacy and, if applicable, oxygen supplier; necessary medical equipment and supplies; Do Not Resuscitate Order (DNRO), if applicable
Bed sheets, blankets, pillow, folding lawn chair, air mattress
Prescription and non-prescription medications needed for at least 5 to 7 days; oxygen for 5 to 7 days, if needed and shelter space allows
Special diet items, non-perishable food for 5 to 7 days and 1 gallon of water per person per day 
Glasses, hearing aids and batteries, prosthetics and any other assistive devices
Personal hygiene items for 5 to 7 days (including adult diapers, colostomy supplies, etc.)
Extra clothing for 5 to 7 days
Flashlight and batteries
Self-entertainment and recreation items such as books, magazines, quiet games
Labeled shoe box or other small closed container to hold the majority of the smaller items listed above to facilitate storage and ease of use


(3)  All persons using the special needs shelters need to know the following:

Space allotted for the consumer includes space for the caregiver.  A special needs shelter can accommodate only one caregiver at a time; any other family members, friends, etc. should go to a regular shelter.
The caregiver must provide his or her own bedding.
Caregivers who regularly assist the consumer in the home are expected to continue to provide the same care in the shelter.
Service dogs are allowed in the shelter.  Check with the local Emergency Management office to see if other pets are permitted.
Bring food items as listed above.  It is possible only sparse meals will be provided.
Smoking is not allowed in the shelter.

Sunday, February 4, 2018

Temperature and Humidity in the OR

Successful surgery depends on optimizing working conditions for medical professionals and patients. Temperatures in operating rooms are often colder than many indoor locations, but people may not know why. However, the temperature range can have a significant effect on patient health and safety.
The American Society of Heating, Refrigeration, and Air-Conditioning Engineers recommends that operating room temperatures be kept between 66 to 68 degrees Fahrenheit, with a humidity percentage of 70. While this may seem a bit chilly for a room that usually requires patients to wear a thin paper gown, health and safety take precedence over their comfort in such a case.
'Raining' in the operating room
One reason to maintain such a temperature range is to prevent the buildup of humidity in the operating room. When the space is kept too warm, condensation can collect on surfaces, including the room's ceiling and various operating equipment. In addition to making the room uncomfortable, this condensation buildup can pose serious risks to patient health.
If this moisture is left to collect and not prevented through temperature monitoring, it can build up to the point that it falls from these surfaces. It is possible, and dangerous, for this condensation to fall onto sterilized surfaces, operating tools or possibly into an open wound. As moisture moves along these surfaces, it can pick up additional bacteria that can seriously infect a patient. In order to prevent the buildup of these droplets, the operating room should be equipped with a temperature sensor and monitoring system for maintaining the recommended range.
Hospital personnel comfort
Operating rooms are also kept cool to ensure that the doctors and nurses working on the patient do not sweat. Although anesthesiologist resource Great Z's stated that many hospital personnel would not reveal this reason to patients, the source does point out that operating requires a lot of heat producing equipment. This includes large overhead lights that allow doctors to clearly see their activities. Because these systems can produce a lot of excess warmth in addition to the heat already being produced by the human body, they can cause a surgeon to sweat. This can also cause a serious health risk to the patient. Therefore, in order to prevent this and keep hospital personnel comfortable in the operating room, it is important to have a temperature monitoring system in place to ensure the space is cool.
Preventing bacteria growth while ensuring AC functionality
Similar to the case of cold temperatures for food safety, operating rooms are also kept cool to slow the rate of bacteria growth, stated Great Z's. Experts have proven that bacteria, viruses and other organisms reproduce and grow more slowly when subjected to lower temperature environments. Therefore, to fight off any infections, hospitals keep their operating rooms cooler.
Additionally, these facilities also employ temperature monitoring as a means to oversee the functionality of their AC systems. Many AC units, especially within older buildings, were not designed to consistently maintain such low temperatures. For this reason, hospitals count on their temperature monitoring systems and high temperature alarms as a means of notification if their AC fails.

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