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Nursing Home #2 Disaster Planning Document

DISASTER POLICY & PROCEDURE

PURPOSE:  It will be the purpose of this policy to inform facility employees of the action to take in the event of a disaster.

It will be the responsibility of the highest ranking staff person on duty to declare a situation a disaster and activate the facility’s disaster and evacuation policy and procedure.

A disaster may be classified as a fire, tornado, flood, electrical power outage, explosion, bomb threat, hazardous material spills or releases, or any other situation that would warrant evacuation of the facility in order to protect the lives and safety of residents and staff.

PROCEDURES:

  1. In the event of an emergency, the shift charge nurse shall immediately contact the Administrator, Director of Nursing, and the Maintenance Supervisor.

  2. Once the Administrator, Director of Nursing, or Maintenance Supervisor arrives and determines that the situation requires evacuation, the facility call tree shall be put into effect in order to obtain available persons to evacuate the residents to safety.

  3. A command center shall be set up in the Administrator’s and connecting Business Office to handle and coordinate all internal communications. If this area is in the line of danger a new location will be determined at that time.

    • The Administrator, or Highest Ranking person at the scene, will direct people to areas needing assistance.

  4. If temporary placement for residents is needed, the Administrator, or Highest Ranking person at the scene, shall contact the American Red Cross by calling 9-1-1 and requesting an emergency shelter through the County Department of Emergency Government Center.

  5. If permanent placement for residents is needed, the Administrator and Director of Nursing, or highest ranking person at the scene, will assess which residents need to be hospitalized or transferred to another nursing home.

  6. The Administrator, or Highest Ranking person on the scene, shall assign a person to coordinate transportation.

  7. Once a shelter is arranged, the residents will be evacuated from the building in an orderly fashion. All department personnel shall report at this time with the supplies they are assigned to gather.

  8. Medical Records personnel will be responsible for putting name tags on all residents upon evacuation. They shall also be responsible for ensuring that the residents’ medical records are transported with the resident.

  9. Nursing personnel will be assigned to specific wings, and are responsible for evacuating those residents and assisting with others when complete.

    • The Charge Nurse shall be responsible for removing the Medication Carts, the Medication Administration Record, Resident Charts and the current Resident Roster to the designated shelter.

  10. Dietary personnel will be responsible for gathering food and dietary supplies.

  11. Housekeeping and Laundry personnel will be responsible for gathering all linens and supplies for resident care.

  12. The Activities personnel shall assist wherever needed.

  13. The Administrative Assistant and the Bookkeeper shall gather all departmental employee schedules and the employee call roster, as well as other important business office supplies and records.

  14. The Social Worker will be responsible for contacting family members to notify them of the disaster and where residents are being transported.

  15. The Day Care personnel shall be responsible for accounting for all children, phone numbers of family members of the children and organizing the children for evacuation.

  16. The Apartment Residents will be evacuated the same as the residents on the east wing being evacuated. Reminder to nurses to bring the apartment files.

  17. The Administrator shall check all rooms before leaving the grounds. A "white tag" will be placed on each door handle to verify that the room is empty to ensure that no residents or staff members are left behind.

This plan will be in cooperation with the American Red Cross, the County Emergency Government Office, and the local Police and County Sheriff’s Departments.

NOTE: It is important to know that each situation is going to be different, and that a situation may not allow for the above procedure to be implemented in this specific order.

At the time of a disaster, it is imperative that the Administrator be contacted in order to give staff proper direction. This policy and procedure is written so that there are clear guidelines for providing resident and staff safety in the event of a disaster.

Sound judgment and common sense are the best practices in any emergency.

FIRE POLICY & PROCEDURE

PURPOSE:  To provide facility staff  a course of action to follow in the event of a fire.

PROCEDURE:

R -- Rescue anyone in immediate danger.

A -- Alert other staff members by pulling the fire alarm and giving the location of the fire. This is accomplished by putting a pillow outside of the door to indicate where the fire is located.

C -- Contain the fire. Close all doors and windows. Turn off all sources of air circulation: fresh air systems, fans, air conditioning exhaust fans, oxygen.

E -- Extinguish the fire if small. The extinguisher should be aimed low at the base of the fire, and move slowly upward with a sweeping motion. If you cannot extinguish the fire, evacuate the building immediately.

POINTS TO REMEMBER:

  1. Once the fire alarm goes off, the Fire System company is automatically notified by our alarm system and will call the facility to find out if this is a drill or a fire. In the event of a fire, the fire department will be notified automatically.

  2. ALL staff members report to the nurses’ station immediately for directions from the charge nurse of location of fire. (Nurses refer to the fire board for location of fire.)

  3. Once staff members are aware of the designated wing of the fire, begin to evacuate residents in immediate danger to a safer section of the building first (this may be behind fire doors); or, in the event of a disaster, remove residents from the building.

    • REMEMBER: always move away from the fire.

  4. Ambulatory residents should be instructed on where to go. Bedfast residents should be placed on blankets or bedspreads and pulled to safety.

  5. Once a resident room has been completely checked, a "white tag" will be placed on each door handle to verify that the room is empty to ensure that no residents or staff members are left behind.

  6. Each Department Head or designated person will be responsible for reporting to the nurses' station with their current employee schedule. This will enable us to account for all employees once everyone has been removed from danger.

  7. The Nurses and Administrative Personnel will be the last to leave the fire area to verify that no residents or staff members are left behind.

  8. If a complete evacuation from the building is necessary, no one will be allowed to re-enter the building until the Fire Department gives the "All Clear" signal.

  9. In the case where a complete evacuation from the building is necessary, please refer to the DISASTER POLICY & PROCEDURE.

NOTE: It is important to know that each situation is going to be different, and that a situation may not allow for the above procedure to be implemented in this specific order.

At the time of the disaster, it is imperative that the Administrator be contacted in order to give staff proper direction. The policy and procedure is written so that there are clear guidelines for providing resident and staff safety in the event of a fire.

Sound judgement and common sense are the best practices in any emergency.

SEVERE THUNDERSTORM and TORNADO POLICY & PROCEDURE

PURPOSE:  To provide facility staff a course of action to follow in the event of severe weather.

PROCEDURE:

  1. The Weather Radio is on at all times to keep staff appraised of the situation.

  2. When there is a warning on the radio or local sirens go off, this means to seek cover.

  3. During the day time hours, (5:00 a.m. – 10:00 p.m.) all residents will be directed to the long hallway. Chairs will be placed in the hallway away from doors or windows where the residents can sit down.

    • All drapes and room doors will be closed once the residents have been removed from their rooms to prevent injury from flying debris.

  4. During evening hours, (10:00 p.m. – 5:00 a.m.) beds will be moved away from all windows, and all drapes, including the privacy curtains will be pulled and room doors shut.

  5. If time allows, staff will provide each resident with a blanket to cover their heads.

  6. Once residents have been evacuated to the long hallway, the Charge Nurse will review the Resident Roster to account for all Residents.

  7. Be sure to listen to the Weather Radio and Weather Reports for current updates. Do not leave the area until the storm has passed and the warning has been lifted.

  8. In the event of a disaster, if a complete evacuation needs to take place, please refer to the DISASTER POLICY & PROCEDURE.

WATCH -- Conditions are favorable for a thunderstorm or tornado to develop.

WARNING -- A thunderstorm or tornado have been sighted. If a siren sounds, stay inside and take cover.

BOMB THREAT POLICY & PROCEDURE

PURPOSE:  To provide facility staff a course of action to follow in the event of a bomb threat.

PROCEDURE:  When a phone call is received regarding a bomb threat, please follow the following procedure.

  1. Stay Calm.

  2. Keep the caller on the phone line as long as possible, get as much information as possible.

  3. Be alert for distinguishing background noises, such as music, voices, aircraft, and church bells, etc.

  4. Note distinguishing voice characteristics.

  5. Ask where the bomb will explode, and at what time.

  6. Try keeping the caller on the phone line, and alert another staff member so they can notify key personnel:

    • Police 9-1-1

    • Administrator

  1. If the caller indicates a specific area, that area should receive immediate attention.

  2. If what appears to be a bomb is found, DO NOT TOUCH IT!  Clear residents and staff from this area and move them behind fire doors.

  3. Organize staff to evacuate residents upon police or administrative order.

WATER SHORTAGE POLICY & PROCEDURE

PURPOSE:  If the water supply is disrupted for any reason, this policy is to ensure that there is adequate water supply for the residents and staff.

PROCEDURE:

  1. Notify the Administrator and the Maintenance Supervisor immediately.

  2. The Maintenance Supervisor will try to determine the cause of water disruption and the approximate length of shut down time.

  3. If it becomes necessary, water will be brought in through contracted services to provide potable water in the event that the community water supply becomes contaminated or disrupted.

  4. The Dietary Department will use disposable dishes and utensils.

  5. If it becomes apparent that a water shortage will last a significant period of time, arrangements will be made to ensure proper care for those residents whose care has been disrupted due to lack of water supply.

HEAT & HUMIDITY POLICY & PROCEDURE

PURPOSE:  To provide staff protective measures for residents during the summer months.

PROCEDURE:

  1. Keep the air circulating

  2. Draw all the shades and curtains in the rooms that are exposed to direct sunlight.

  3. Remove the residents from areas that are exposed to direct sunlight. Relocate the residents to cooler areas in the building during the daytime hours.

  4. Discourage outside activity during the day.

  5. Dress the residents appropriately with light weight clothes, loose fitting, preferably cotton fabric. Bed confined residents shall have their sheets changed frequently. Cover the residents lightly at nap times and bedtime.

  6. Encourage and offer fluids to the residents frequently.

  7. Report any changes in the resident’s condition such as edema, shortness of breath, the skin being hot or dry.

  8. Give frequent baths.

  9. Place fans in hallways to get air circulating.

  10. Watch for signs and symptoms of heat exhaustion and heat stroke. See attached definitions.

DEFINITIONS:

HEAT STROKE -- Heat stroke, also known as sunstroke, is a profound disturbance of the body’s heat regulating mechanism, caused by prolonged exposure to excessive heat, particularly when there is little or no circulation of air.

In heat stroke, there is a disturbance in the mechanism that controls perspiration.

Symptoms: The first symptoms may be headache, dizziness and weakness. Later symptoms are an extremely high fever and absence of perspiration. Heat stroke also may cause convulsions and sudden loss of consciousness. In extreme cases it may be fatal.

Treatment: Heat stroke is considered a medical emergency and immediate steps must be taken to prevent death. The primary objective in this situation is to reduce the body’s high temperature as rapidly as possible. This can be accomplished by immersing the person in a cool water bath or sponging the person with cool water. The physician should be contacted immediately and the resident transferred to the hospital.

HEAT EXHAUSTION --  Heat exhaustion, also known as heat prostration, is a disorder resulting from overexposure to heat or to the sun.

Long exposure to extreme heat or too much activity under a hot sun causes excessive perspiration, which removes large quantities of salt and fluid from the body. When the amount of salt and fluid in the body falls too far below normal, heat exhaustion may occur.

Symptoms:  The early symptoms are headache and a feeling of weakness and dizziness, usually accompanied by nausea and vomiting. There may also be cramps in the muscles of the arms, legs or abdomen.

The person also turns pale, breathing and pulse is rapid, skin is cool and moist, and perspires profusely. Body temperature remains at a normal level or slightly below or above. The person may seem confused and may find it difficult to coordinate body movements.

Treatment:  Treatment should include removing the person to a cool environment and encouraging increased consumption of fluids. If the condition is accompanied by cramps, the pain may be relieved by gentle massage of the painful area.

The physician should be notified promptly to obtain specific directions for care.

ELECTRICAL POWER OUTAGE POLICY & PROCEDURE

PURPOSE:  To provide the facility with auxiliary power throughout designated areas of the facility, should our normal power supply fail. The facility has an emergency generator that will automatically activate in the event of disruption of power.

The generator is capable of providing the facility with a minimal supply of electricity for approximately 2 full days.

PROCEDURE:  In the event of a power outage, the facility generator operates all areas of the facility with the exception of: the new wing outlets in the resident rooms, resident room lights, the Director of Nursing Office and the Medical Records office.

  1. Anyone in the new wing that requires oxygen must be hooked up to the piped in oxygen in the new wing or if using a concentrator must be plugged in, in the hallway or use free standing tanks.

  2. Check all residents to ensure they are safe and remain calm.

REMINDER: During a power outage it should be business as usual once the residents are taken care of since the majority of our facility is hooked up to the generator, including the phone.

ELEVATOR POLICY & PROCEDURE

PURPOSE:  To provide facility staff a course of action to follow in the event the elevator should become stuck between floors.

PROCEDURE:

  1. Obtain the key to open the elevator maintenance room.

  2. Locate and shut off power to the elevator.  This will return elevator to the ground floor.

  3. Take key with a red tag, located to the left of the power shut off.

  4. Put key in hole at the top of the elevator door and turn. This opens the first door.

  5. Push the latch on the second door and push open at the same time, the person on the elevator can also help push door open.

  6. Turn on power to the elevator.

  7. If the power is not restored, push the reset button, which is in the panel on the left.

  8. If this does not work contact the Maintenance Supervisor, if not available contact the Elevator company at ------.

DAYCARE EVACUATION POLICY & PROCEDURE

PURPOSE:  To account for and evacuate all children and staff members to safety in the event of a disaster.

PROCEDURE:  In the event that it becomes necessary to evacuate the entire building, the following procedure will be followed:

  1. The Administrator or designated person will notify the daycare in the event of the need for complete evacuation.

  2. The Day Care personnel shall be responsible for accounting for all children, staff members, phone numbers of family members and organizing the children for a complete evacuation.

  3. The Day Care Manager or designated person will report to the nurse’s station for directions on the evacuation.

  4. Once it has been established where to evacuate, the children will be removed in a orderly fashion.

  5. Once evacuated to a safe area, the day care manager will notify all family members of where they are at, what is going on and where to pick their child up.

  6. The day care will be under the directive of the person in charge at all times.

In the case where a complete evacuation from the building is necessary, please refer to the DISASTER POLICY & PROCEDURE.

APARTMENT EVACUATION POLICY & PROCEDURE

PURPOSE:  To evacuate all apartment residents to safety in the event of a disaster.

PROCEDURE:  In the event it becomes necessary to evacuate the entire building, or the east wing, the following procedure will be followed:

  1. The Administrator or designated person will notify the apartment residents in the event of a disaster.

  2. For the purpose of an emergency, the apartment resident will be evacuated the same as the residents on the east wing would be evacuated.

  3. Nursing personnel will direct the C.N.A.’s or staff to evacuate these tenants with the nursing home residents.

  4. Nursing staff will knock on the apartment door and notify the tenants on what to do, if no one answers the door, go on to the next apartment and report to the Administrator anyone who was not home.

    • The Administrator will then take the master key to ensure there is no one left in the apartment.

  5. The nursing staff will be responsible for bringing the apartment residents files in the event of disaster.

  6. A designated person will notify family members what has transpired and where the apartment residents are located.

  7. In the case where a complete evacuation from the building is necessary, please refer to the DISASTER POLICY & PROCEDURE.

WANDERING RESIDENT

POLICY:  It is the facility's policy to identify residents who walk or wheel about unrestricted and are a threat to leave the facility unattended due to their confusion.

PURPOSE:  To ensure the resident’s safety utilizing the least restrictive means available.

PROCEDURE:

  1. Obtain information during pre-admission or admission conferences with the resident and family regarding any history of wandering or the potential for wandering.

  2. All instances of wandering or attempted elopement will be recorded in the medical record.

  3. A plan of care will be developed and implemented with specific approaches and goals for the wanderer.

  4. The resident’s name, picture, and physical description is placed in the wander book located at the nurses station.

  5. All staff, are responsible for knowing whose name is on the list and be able to recognize the resident and be able to intervene as necessary. Every new employee will be informed of wandering residents upon orientation.

  6. A monitoring device will be placed on the resident according to manufacture’s directions. Exit monitoring system will be kept operational 24 hours a day.

When a resident is believed to be missing, the following steps will be implemented:

  1. The charge nurse shall be alerted that the resident is missing.

  2. The charge nurse shall alert all staff. All employees are to report to the nurse’s station. The charge nurse will explain the circumstances and designate where each staff person is to search.

  3. Search the building and grounds thoroughly. Be sure to search the shower room, closets, bathrooms, and entryways.

  4. If this search is unsuccessful, surrounding streets and yards will be checked. This search should take no longer than 15 minutes.

  5. If the resident is not found within the 15 minutes, notify the local Police, Administrator and Director of Nursing.

  6. Give the police a description and a current photo of the missing resident.

  7. The Charge Nurse, Administrator or Director of Nursing shall call the family explaining the situation and what is being done to find the resident. Encourage them to assist if they desire.

  8. When the resident is located, the charge nurse will notify all previously contacted persons.

  9. Upon return of the resident to the facility, the resident will be assessed for injuries and a thorough incident report will be filled out by the charge nurse and given to the Administrator and also documented in the resident’s medical record.

Last Updated: March 18, 2011