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Nursing Homes in Public Health Emergencies

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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Appendix B: Model Long-term Care Preparedness Needs Assessment (continued)

Section F. Bioterrorism Readiness and Training

Question No. Question Answer
F1 Does the facility have a system in place for early recognition of patients exposed to (check all that apply):
__ Biological agents
__ Chemical agents
__ Radiological agents
__ Nuclear agents
__ None of these
F2 Does the facility have a system in place for training staff in the care of contaminated patients (check all that apply): __ Biological
__ Chemical
__ Radiological
__ Nuclear
__ None of these
F3 Does the facility have annual safety education that includes training to facility employees on (check all that apply): __ Bioterrorism
__ Weapons of Mass Destruction
__ Chemical Contamination
__ Infectious Disease Outbreak
__ Radiological Disaster
__ Nuclear Disaster
__ None of these
F4 Does the facility have general orientation that includes training to new facility employees on (check all that apply): __ Bioterrorism
__ Weapons of Mass Destruction
__ Chemical Contamination
__ Infectious Disease Outbreak
__ Radiological Disaster
__ Nuclear Disaster
__ None of these
Continue to Section G.

Return to Appendix B Contents

Section G. Exercises and Drills

Which of the following exercises or drills (actual or staged), whether held at the facility or elsewhere, have staff participated in some or all over the past 12 months? (check all that apply)

Definitions:
Table Top = Simulations or Classroom exercises
Facility Drills = Actual exercises at your facility
Community Drills = Exercises run by area hospitals or community organizations
Real Event = An actual real life occurrence

Question No. Question A
Table Top (or Class Room) Exercises
B
Facility Drills
C
Community Wide Drill
D
Real Wide Drill Event
G1 Mass Casualty __ __ __ __
G2 Chemical __ __ __ __
G3 Biological __ __ __ __
G4 Radiological __ __ __ __
G5 Nuclear __ __ __ __
G6 Bomb Threat or Terrorist Threat __ __ __ __
G7 Evacuation Drills __ __ __ __
G8 Utility Failures: telephone, water, electric, computer, sewer, HVAC, etc. __ __ __ __
G9 Hostage/Barricade __ __ __ __
G10 Extreme Weather (Hurricane, etc.) __ __ __ __

 

Question No. Question Answer
G12 Has the facility conducted drills during the following times or under the following circumstances? (check all that apply) __ Day shift (7AM-3PM)
__ Evening Shift (3PM-11PM)
__ Night Shift (11PM-7AM)
__ Weekend (Saturday, Sunday)
G13 Within the last 3 years, has the facility performed a staff recall to determine the number of staff who could report to work in the event of an emergency? __ Yes
__ No
Continue to Section H.

Return to Appendix B Contents

Section H. Pharmaceutical Stockpile

Question No. Question Answer
H1 Does your facility keep stocks of antibiotics on site for emergency use? __ Yes
__ No
__ Don't Know
H2 Does your facility keep Intravenous (IV) fluids on site for emergency use? __ Yes
__ No
__ Don't Know
H3 Does your facility maintain oxygen on site for emergency use? __ Yes
__ No
__ Don't Know
H4 Does your facility maintain respiratory bronchodilators (albuterol nebulizers) on site for emergency use? __ Yes
__ No
__ Don't Know
Continue to Section I.

Return to Appendix B Contents

Section I. Logistics, Facilities, and Security

Question No. Question Answer
I1 Does your facility require all staff to wear ID badges? __ Yes
__ No
I2 Are the facility's security staff (check all that apply): __ Facility-Employed
__ Contracted
__ Facility does not have security staff (If so, skip to Section K)
I3 Is the facility's Security Department staffed 24/7? __ Yes
__ No
I4 Does the facility have a procedure in place to lock down all exterior doors within 30 minutes, without requiring "outside" personnel?
(If no, skip to Section K)
__ Yes
__ No
I5 The lock down procedure includes notification of (check all that apply): __ Personnel in the building
__ Fire, Police, and EMS
__ Area hospitals
__ Medical Director/Administration
Continue to Section J.

Return to Appendix B Contents

Section J. Distributed Learning Capability

Question No. Question Answer
J1 Does your facility have a computer with Internet access? __ Yes
__ No
J2 If yes, please estimate the number of computers with Internet access Number _____________
J3 How are the facility's PCs connected to the Internet? (check all that apply) __ Dial Up
__ High Speed (DSL/Cable)
__ Dedicated T1/ISDN
__ Combination of above
J4 Which of the following people have access to computers with internet access (check all that apply) __ Administrator
__ Medical Director
__ Billing Staff
__ Nursing Director
__ Staff RNs
__ Staff LPNs
__ Physicians
__ Patients
__ Other (Please list) _________________
J5 Does your facility provide employees with E-mail access? __ Yes
__ No
J6 Does the facility have video-conferencing capability? __ Yes
__ No
J7 Does the facility have a fax machine? __ Yes
__ No
J8 Does the facility have a "Power safe" emergency phone?
(i.e. a phone that does not require electrical power)
__ Yes
__ No
J9 Facility computers can be used for which of the following? (check all that apply) __ E-mail
__ Web Access
__ Care Plan Access
__ Looking up labs reports
__ Looking up radiology reports
__ Documentation (H & Ps)
__ MDS Entry
__ Electronic Order Entry
__ MAR (medication) use
Continue to Section K.

Return to Appendix B Contents

Section K. Priority Checklist

Indicate the facility's priorities in getting financial or other training/education or technical assistance for emergency preparedness using a 5-point scale where 1 indicates highest priority and 5 indicates lowest priority. It is important to distinguish higher priority from lower priority and not mark all items "Highest Priority."

Question No. Preparedness Category Financial Technical or Training/Education
Highest Priority
1
2 3 4 Lowest Priority
5
Highest Priority
1
2 3 4 Lowest Priority
5
K1 Implementing an Emergency Incident Command System __ __ __ __ __ __ __ __ __ __
K2 Conducting or Participating in Emergency Exercises __ __ __ __ __ __ __ __ __ __
K3 Training Staff in Emergency Procedures __ __ __ __ __ __ __ __ __ __
K4 Diagnosis and Treatment of Victims of Chemical Agents __ __ __ __ __ __ __ __ __ __
K5 Diagnosis and Treatment of Victims of Biological Agents __ __ __ __ __ __ __ __ __ __
K6 Diagnosis and Treatment of Victims of Radiological Agents __ __ __ __ __ __ __ __ __ __
K7 Evacuation Planning (during storms, etc.) __ __ __ __ __ __ __ __ __ __
K8 Staff/Family Protection (vaccination, logistical arrangements, etc.) __ __ __ __ __ __ __ __ __ __
K9 Regional Planning with Other Institutions, such as Red Cross, EMAs, or Other Government Agencies __ __ __ __ __ __ __ __ __ __
K10 Formalizing Mutual Aid Agreements __ __ __ __ __ __ __ __ __ __
K11 Enhancing Patient Care Surge Capacity __ __ __ __ __ __ __ __ __ __
K12 Selecting and Purchasing Personal Protective Equipment (PPE) __ __ __ __ __ __ __ __ __ __
K13 Upgrading Respiratory Isolation Capacity __ __ __ __ __ __ __ __ __ __
K14 Upgrading Emergency Power Capability __ __ __ __ __ __ __ __ __ __
K15 Other Physical Plant Improvements (list below and rate):                    
K15A (user input—other physical plant improvements) __ __ __ __ __ __ __ __ __ __
K15B (user input—other physical plant improvements) __ __ __ __ __ __ __ __ __ __
K15C (user input—other physical plant improvements) __ __ __ __ __ __ __ __ __ __
K16 Increasing Emergency Stockpiles of Medications and Other Supplies __ __ __ __ __ __ __ __ __ __
K17 Upgrading Communications Equipment __ __ __ __ __ __ __ __ __ __
K18 Upgrading Security Arrangements __ __ __ __ __ __ __ __ __ __

Comments:

 

 

 

Thank you for participating in the Long-term Care Emergency Preparedness Needs Assessment.

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