Emergency Planning for Home Therapies

The 2017 hurricane season brought many storms, including Harvey, Irma, and Maria, to name a few. These hurricanes devastated areas across the nation and U.S. territories. Texas, Louisiana, Florida, and Puerto Rico know all too well about the reality of a hurricane’s aftermath. What lessons have we learned as nephrology nurses who provide care and case manage home patients on peritoneal dialysis or home hemodialysis (HHD)? Below are some key points for planning before, during, and following a hurricane.

Before a Hurricane/Disaster

• Prepare a disaster plan that includes home patients and center staff.
• Perform drills and table top exercises and be sure to include patients.
• Update contact information for all patients and staff. Be sure to have more than one contact.
• Train patients/care partners for CAPD before CCPD.
• Train patients to use bagged dialysate as a backup if they are on Pure-flow for HHD.
• Indicate on home assessment checklist if the patient has access to a generator.
• Establish a command center and command leader and have a staff phone tree.
• Charge all technology and fill any vehicles with gas.
• Check inventory of supplies and pick up any from center. Be sure to have enough for at least 1 week manual backup therapy
• Fill prescriptions to keep from running out.
• Stock up on bottled water and non-perishable foods.
  

During a Hurricane/Disaster

• Command center keeps in contact with staff.
• Establish a patient list by individual nurse to stay in contact with patients.
• Establish a text group with staff to keep in communication with team.
• Keep track of hospitalized patients, patients relocating to a relative or shelter.
• Account for all staff and patients on a daily basis.
• Contact suppliers with any urgent needs as supplies could have been damaged or gotten wet.
• Adhere to evacuation instructions and established curfews.
• Do not risk driving in flood waters.
• Keep up to date with alerts and bulletins from Office of Emergency Management, Renal Networks, Department of Health in your state, Kidney Community Emergency Response (KCER) Coalition, Centers for Medicaid & Medicare Services (CMS), and your local county.
  

Post Hurricane/Disaster

• Leader, technical team, building management assesses damage to center if able to safely access building.
• Leader establishes conference call huddles with staff.
• Staff follow safety instructions by leader if unable to access building or center is closed due to damage.
• If need arises to work remotely, assign staff laptops and necessary technology to work in the field and schedule home visits.
• Staff will need to meet at a designated location to update daily plan and gather supplies needed.
• Contact all supply vendors, including lab, to obtain supplies to bring to home visits, including medication.
• Home nurses will need to visit homes if no physical place to meet due to damage or closure.
• Obtain additional resources as needed to manage the challenges of home visits to patients over a broad geography.
• Work with local and provider support to manage day-to-day operations.
• Continue to notify state department of health if damage prohibits use of the facility for patient training or interdisciplinary team (IDT) visits.
• Schedule patient visits at patients’ homes or where patients are staying if relocation was necessary.
• Continue to report and coordinate care with the nephrologist and IDT.
• Patients may have relocated out of state with family or friends, so it is important to track all patients post disaster.
• Staff also may be dealing with post disaster challenges. such as flooding, power outages, or relocation.
• Work with local communities and relief organizations.

Once the initial acute rescue phase of a disaster is over, recovery can take days, months, or years. Dialysis providers need to continue to support the center staff and attend to patient needs. This may result in patient transfer to another dialysis home center or involve use of telehealth and frequent home visits. Home dialysis patients will sometimes need to be hospitalized during or after a disaster. If we develop a plan, practice the plan, and teach patients and staff to be prepared, we can limit the use of emergency rooms and hospital admissions.

We also need to encourage adherence to evacuation instructions and curfews to prevent rescue by emergency medical care personnel. The Home Therapies SPN urges all nephrology nurses to complete your provider’s emergency training, know your plan, and participate in any drills. Please take this seriously as many of us either experienced the hurricanes, know someone who did, or volunteered as first responders to assist our patients, staff, and community. Stay safe!

Reprinted with permission from the ANNA Specialty Practice Networks Update newsletter.