Transcript PREPARING FOR A DISASTER - Kidney & Urology Foundation of

PREPARING FOR DISASTER
THE IN-PATIENT DIALYSIS UNIT
Barbara Richter, RN, BSN, MA
Clinical Nurse Manager
Mount Sinai Medical Center
Renal Treatment Center
BEFORE A DISASTER STRIKES:

Outpatient Staff are prepared
 They know their collaborating units and contact numbers.
 They know their disaster plan and how to implement it.
 They have a disaster plan for their family members and
know how to reach them.
 They know the patient disaster hotline number.
BEFORE A DISASTER HITS:

Patients are prepared:

They have a “TO GO “ bag with:








a 3 day supply of medications
their dialysis prescription
current medication list
1 – 2 doses of kayexelate with sorbitol
bottled water
some canned food
one change of clothing
They have been in-serviced

They know what will happen if they are in the dialysis unit
 They know where to call, if at home. (Hotline)
ASSUMPTIONS:



The hospital is functioning.
The Command Center is up and running.
There is communication with the satellite units
that are down.
REALITY:

The hospital is full and needs to discharge
patients using established criteria.

The dialysis unit is functioning at full capacity:





A handful of chronic adult outpatients
Chronic pediatric outpatients
Chronic in-patients
Acute in-patients
ICU patients (10-16 off center treatments/day)
The Plan:

The Renal Treatment Center:
12 stations will be adapted by Y-connectors to
accommodate 2 dialysis machines each
 2 additional stations will be created using the R/O
hook-up from the technical/equipment room
 Dialysate flows will be reduced to 500cc/minute, if
necessary
 Patient treatments may be reduced to 2 hours
 Dialysis unit will run 24 hours
 4 bedded area converted to dialysis unit, using 4
off-center R/O’s and dialysis machines

The Plan:

Staff:





Nurse and technical staff that are present will be
mandated to stay
Plans are made to stay open 24 hours
Nurse and technical staff at home will be told not to report
to work until 1st shift goes home
Medical Director will assure physician coverage 24 hours
Staff from other institutions:

Need to bring some disposable supplies
 May need to bring machines
 May work with our dialysis staff to take care of their patients
(the logistics of this still needs to be worked out)
REALITY (Cont’d):



Patients are told to go to the nearest ER.
The ER is dealing with a large influx of
“injuries”.
The Renal MDs will need to assess every
patient that needs dialysis.
REALITY (Cont’d):

The command center is not focusing on
dialysis:
 The
Emergency Room is busy with injuries
 The Emergency Triage Area is sorting
levels of injury
 The Operation Rooms are busy with
emergency surgery
THE PLAN:

The renal department needs to handle the
dialysis patients:
 Set
up triage for ESRD patients in or near
the dialysis unit
 Injuries
go to Emergency Room
 ESRD patients are placed on schedule
THE PLAN:

The Clinical Nurse Manager, the Charge
Nurse, the Medical Director, the
Administrator and the Technical Manager
will meet, confer and activate the plan.
Set up a triage room in the unit.
 Decide which patients’ treatments can be cut.
 Arrange to open the area designated to put 4
portable dialysis machines and
chairs/stretchers.

THE PLAN:

The staff is notified of the initial plan and
updated often.

The administrator arranges for the paper work and
clerical staff is set up to get all demographic
information, from patients not associated with the
hospital.







Home Dialysis Unit
Name
Date of Birth
Social Security Number
Insurance Information
Weights and Heights
Actual Billing Will Come Later
THE PLAN:

Treatment prescriptions will be
individualized but basically will be:





2 hours treatment
The dialysate flow may be decreased
Regularly prescribed blood flows
No routine IV meds, i.e. Epogen, Aranesp, Zemplar,
etc
In-patients will be dialyzed in their room
REPONSIBILITIES:

At the satellite:
 The
Nurse Manager or Charge Nurse will
notify:
Medical Director of Dialysis
 Administrator
 Nurse Manager or Charge Nurse at the hospital

 Medical
Director or his/her designee will
notify:
Chief Operating Office
 Chief Medical Office
 Vice President for facilities

RESPONSIBILITIES: (Cont’d)

The administrator will make arrangement :
 To
transport:
Dialysis machines
 Disposable supplies

 Work
with Social Worker & Nutritionist to
contact transportation companies to aid in
patient transport
Contact the network
 Call patients at home to give their new pickup
schedule

RESPONSIBILITIES: (Cont’d)

Nurse Manager at the hospital unit



Staff all areas appropriately
Staff for 24 hours operation
Along with the Medical Director and Administrator,
stay in touch with the hospital command center and
satellite units.
POST DISASTER:

All players need to meet to discuss:
 What
went well
 Problem Areas
 Changes to be made