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Survey monitor: Past tabletop efforts rewarded during emergency session


April 1, 2010

Survey monitor

Past tabletop efforts rewarded during emergency session

Bucking what anecdotally appears to be a trend, Skaggs Regional Medical Center (SRMC) in Branson, MO, actually conducted a tabletop exercise for surveyors during the hospital’s Joint Commission visit.

Many facilities Briefings on Hospital Safety has talked to in the past year have noted there were no tabletop drills requested during the emergency management session. SRMC was prepared for its tabletop, however, because it frequently uses such methods to educate emergency management committee members about disaster response.

“I have done tabletops with [our employees] several times a year,” says Lou Smith, RN, CHSP, CPHRM, safety and risk manager at SRMC. Smith is in charge of emergency planning.

She’ll bring committee members, hospital directors, and managers into a conference room with little cards in front of each person—for example, one card will ask someone to assume responsibility for logistics, and another will be to take the role of incident commander. From there, Smith explains the scenario, the expected amount of victims, and resulting problems in the community.

“I [also] put surprises … in there,” she says. For example, in a scenario, “I cut off the phones. How are you going to talk now?”

That type of training paid off when surveyors conducted their own tabletop during the July 2009 visit (the hospital’s official reaccreditation was posted in October). 

During the session, Smith kept quiet and let the emergency management team do the talking. Surveyors often look at committee member participation, rather than the lead emergency management planner taking the lead, as a way to test how many people are familiar with the emergency operations plan.

The surveyor’s scenario for the tabletop was a tornado that hit the hospital. That setup was no problem for SRMC, given that staff had previously drilled on that scenario. Tornadoes and ice storms top the hospital’s identified risks from its hazard vulnerability analysis, which is required under EM.01.01.01, element of performance 2.

Smith makes sure that disaster readiness figures into mundane events, too. She recalls activating the emergency operations center when a water main broke outside the hospital.

“That gives people a familiarity of doing it so they get into that mode,” she says.


City has millions of visitors

Branson has more than 50 live performance theaters, bringing tourists from around the country and bolstering the summer population of the city up to 2 or 3 million (the city has about 7,000 actual residents).

SRMC is licensed for 175 beds, but the average daily census is 76 beds, Smith says. Annual ER visits total about 36,000.

“That’s a big ER for a facility of this size,” she says. “So we have to be ready to take care of an emergency should it happen.”

Community cooperation is key in such cases, and Smith’s experience at the hospital helps in this regard. She’s been employed at the facility for 35 years and was formerly the ER director for two decades, so she is able to tap into years’ worth of contacts with fire officials, police, utility providers, ambulance companies, and officials at the nearby College of the Ozarks.


Documenting individual device tests

The EC review was generally painless, Smith says. However, one slipup—which didn’t end up as a citation but could have under EC.02.03.05 (inspection and testing of fire protection equipment)—involved the documentation of various life safety device tests. The hospital presented surveyors with a sheet that stated that the facility’s fire safety systems and features had all been checked.

“They did not like that,” Smith said. “They wanted documentation that each individual device was tested and was good.”

This is an important point that many safety and facility managers misunderstand. The idea reflects a common saying among Joint Commission officials: “If it’s not documented, it didn’t happen.”

Fortunately, SRMC was able to produce the records of the individual tests, which staved off any findings. 


Surveyors like evacuation preparation

Surveyors were impressed with SRMC’s staff training for Med Sleds®, which are portable rescue sleds that allow clinicians to quickly evacuate patients out of units and down stairs by dragging them along the ground.

SRMC has instructed 105 people on Med Sled evacuation techniques by using three-person training teams, in which each participant takes turns manning the head and rear of the sled and acting as a mock patient strapped to the device. The teams practice negotiating stairwells with the sleds, Smith says.

About 10% of the hospital’s 1,049 employees are now familiar with Med Sled use, and each of the facility’s eight units has a regular-size and bariatric sled available.

ER employees wondered why they had to train on the sled use given that they are on the ground floor, but Smith’s reasoning is that those workers may be called to the upper levels to assist in evacuations during a fire or other emergency.

One survey readiness tactic that Smith employs on environmental rounds is to ask nurses to find the location of the nearest portable fire extinguisher.

“I give them a minute to find it and I time them,” she says. “And they’re hustling if they can’t find it.”

If a minute expires and a nurse has been unable to point out the extinguisher’s location, Smith shows him or her, and then requests that the nurse tell everyone else on the unit about the extinguisher’s location, too. That way, many staff members can benefit from the education.


Seek out fans of emergency training to help you

Lou Smith, RN, CHSP, CPHRM, likes emergency management.

“I’m passionate about it, and I engage people who feel that passion and get them excited about it,” says Smith, safety and risk manager at Skaggs Regional Medical Center in Branson, MO.

Her successful endeavors proved fruitful during a recent Joint Commission survey. Smith seeks out employees from the ER to help with emergency management since those folks by nature are ardent about disaster readiness and trauma response. Staff in the OR and surgical units are also good candidates for emergency management work, she says.

The hospital also benefits from supportive administrators, who have allowed Smith to send hospital emergency management committee members to the Center for Domestic Preparedness in Anniston, AL, for hands-on training.

The federal government picks up the tab for attendees’ coursework, air travel, lodging, and meals, which means the hospital only has to worry about paying for a workers’ time away from the facility, Smith says.

For more information about the Center for Domestic Preparedness, go to http://cdp.dhs.gov.


Survey at a glance

  • Emergency management highlights: Surveyors conducted a tabletop exercise using a tornado scenario, which the hospital successfully completed
  • Life safety highlights: Questions arose about documentation for inspections and testing of individual fire safety devices
  • Standards focused on: EC.02.03.05 (inspection, testing, and maintenance of fire protection equipment) and EM.01.01.01 (emergency operations planning activities)

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