Prepare for the worst with repetition

What The Joint Commission expects from your emergency exercises

There’s a good reason why The Joint Commission expects hospitals to regularly conduct emergency drills or exercises, says Joseph L. Cappiello, MA, BSN.

“We do best what we do often,” says Cappiello, chair of Cappiello & Associates in Elmhurst, IL.

“Why do we do drills? We’re trying to ingrain in our staff an automatic response,” he says. In an emergency—a hurricane, an ice storm that wipes out power, or a terrorist attack—you want your staff prepared to operate in a crisis.

Cappiello compares emergency preparation to the five weeks of airborne training he once went through. In two or three hours, instructors can train soldiers to jump out of an airplane and land safely on the ground. But repeating this training for five weeks means if soldiers have to jump from a plane in a stressful combat situation, they’ll be able to do so without hesitation.

Exercises build competence and confidence in staff when they have to do things they don’t ordinarily do, Cappiello says. Staff need to develop skills and be exposed to experiences that are uncommon in their work routines, he told the audience at the 4th annual Hospital Safety Center Symposium in Las Vegas in May.

Joint Commission requirements

Exercises are also important to The Joint Commission, says Cappiello, the former vice president for accreditation field operations at the organization. Cappiello helped develop The Joint Commission’s emergency management (EM) standards.

In 2008, The Joint Commission moved the EM standards into their own chapter within the Comprehensive Accreditation Manual for Hospitals. “That was a shot across the bow,” Cappiello says. “The Joint Commission was saying to leadership, ‘The emergency management standards are important. We’re putting you on notice that you better be doing these things.’ ”

The EM standards require that hospitals have an emergency operations plan (EOP) that outlines how the facility will deal with a disaster, whether it’s a sewer line backup or a flood. The standards also require hospitals to activate the EOP at least twice each year, Cappiello says.

If you activate the plan in response to an actual emergency, that counts as one of your required exercises. If you are in doubt whether a particular event counts, call The Joint Commission and describe the event; officials will give you a ruling, Cappiello says.

The standards also require that at least one of the two exercises includes:

• An escalating event in which the community is unable to support the hospital
• An influx of patients
• Participation in a communitywide exercise