This toolkit grew out of work with and was designed based on the UNM/UNMH experience of developing a pandemic influenza plan. This work was made possible through the United States Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA), National Bioterrorism Hospital Preparedness Program (BHPP) funding provided to the New Mexico Department of Health, Office of Health Emergency Management (OHEM). This toolkit is intended and provided to assist all New Mexico hospitals in pandemic influenza response planning. For more information about this toolkit, please contact Carol Pierce at cpierce@salud.unm.edu or (505) 469-4559.
1. Complete Hospital-Specific Pandemic Influenza Awareness Exercise
2. Structure to Develop a Pandemic Influenza Plan
3. Process to Develop a Pandemic Influenza Plan
5. Evaluation and Preparedness Maintenance
1. Complete Hospital-Specific Pandemic Influenza Awareness Exercise
The discussions during a scenario-driven hospital-specific tabletop exercise provide essential awareness information about hospital strengths and gaps related to pandemic influenza response planning. This exercise is intended to focus on internal hospital capacities activities and general readiness, especially as it relates to medical surge of infectious patients. Participation in the tabletop will: raise awareness about the impact of pandemic influenza on a specific hospital; provide a baseline from which to begin planning and will increase understanding regarding the responsibilities of hospitals in pandemic influenza response.
2. Structure to Develop a Pandemic Influenza Plan
The structure to develop a pandemic influenza plan is based on the planning elements identified by U.S. Department Health and Human Services, November 2005, Healthcare Planning Supplement 3 and the New Mexico Modular Emergency Medical System (NM-MEMS) conceptual framework. Based on this information, an Executive Committee comprised of key hospital administration and leadership and the Hospital Emergency Response Coordinator (HERC) is identified to guide the planning process. The Executive Committee along with fourteen subcommittees is organized to complete essential elements of the plan. Before assigning subcommittee leads, fully read the subcommittee deliverables. Some subcommittees have a broader range of topics than the name of the subcommittee indicates. The subcommittees are:
- Executive Committee
- Logistics
- Communications
- Security
- Surge Capacity
- Triage and Admissions
- Infectious Disease and Surveillance
- Alternate Care Sites
- Pharmacy
- Human Resources
- Education and Training
- Occupational Health
- Ancillary Services
- Legal
- Ethics
Deliverables for each subcommittee were developed based on information in the U.S. Department Health and Human Services, November 2005, Healthcare Planning Supplement 3 . The deliverables for each subcommittee are identified in a separate deliverables chart . Each deliverable is an essential element, which needs to be addressed in the pandemic influenza plan. The legal deliverables on the deliverables chart were developed by UNMH Legal Counsel. These legal deliverables were developed as appropriate for a public institution and may or may not be applicable to a community hospital.
To begin the development of the plan, organize a meeting with your Executive Committee and Subcommittee Leads to discuss the process and to provide core information needed for plan development. (Note: Please feel free to contact any of the Subcommittee Leads with further questions.)
3. Process to Develop a Pandemic Influenza Plan
The process to develop the plan content includes two parts: assessment and implementation with a feedback loop as a part of each phase. Feedback is essential to provide guidance on the direction, to discuss additional resources and to discuss the interconnections between the committee deliverables.
A. Assessment: Each committee completes an assessment of every deliverable for their committee. The assessment is documented using the deliverables chart and a single report form completed for every deliverable. Every deliverable was assessed to determine:
1. How much (percent) of the deliverable is currently met?
2. How much (percent) of the deliverable can be met by optimizing existing resources?
3. Identification of additional resources necessary to achieve 100% of the deliverable?
4. Feedback on the deliverable assessment to achieve 100%.
Presentation of Assessment: Organize a meeting with all subcommittees to report on their assessments. Provide the completed assessments from each subcommittee to all participants.
Feedback on Assessment: Each subcommittee meets with the Executive Committee to discuss their assessment. At this meeting each deliverable is reviewed, discussed and feedback is provided. The discussions may include the need for additional resources to be able to fully address the deliverables. Following that meeting written feedback is provided for each deliverable. (See column #4 on the deliverables chart.)
Timeframe: The assessment phase can take 1 month-6 weeks.
B. Implementation: After receiving the assessment feedback each subcommittee implements their deliverables. This includes: writing plans and procedures, addressing details cited during the assessment and submitting the written plan to the Executive Committee.
Feedback on Implementation: Midway through the implementation phase, all subcommittees will meet to discuss progress and questions. During this meeting, key decisions are discussed such as: treatment locations such as people presenting with flu symptoms, chronically ill patients, patients on ventilators and children; processes for patients/employees to enter and exit; and processes to reassign staff to address surge.
Timeframe: The implementation phase can take 1 month-6 weeks.
The Process for Development of a Pandemic Plan is a handout for this process. Examples of a completed deliverables chart and the single report form may be useful for participants as a visual to help with the process.
The implemented deliverables are inserted into the Pandemic Influenza Plan Table of Contents . The Pandemic Influenza Plan should be viewed as an annex to your hospital’s All Hazards Plan.
- Draft Pandemic Influenza Plan Table of Contents (under development)
- A Fact Sheet with Pandemic Flu Information (Example: UNM Center for Disaster Medicine Fact Sheet)
- Flu Surge Model with estimated patient load (used in your hospital’s table top)
- HHS Pandemic Influenza Plan Executive Summary and Supplement 3 Healthcare Planning
- NM DOH Emergency Operations Plan- Pandemic Influenza Emergency Response, Appendix 2, March 10, 2006 (draft)
- Original Pandemic Influenza Briefing and Resource Book
- NM Public Health Emergency Response Act
- NM Volunteer Responder Act
- HHS State and Local Pandemic Influenza Planning Checklist
- NM MEMS PowerPoint
- EMTALA PowerPoint
- Overview of Pandemic Influenza - Susan M. Kellie, MD, MPH
- New Mexico Modular Emergency Medical System (NM-MEMS)
- Healthcare Response to Pan Flu
- Bartlett, Planning for Avian Influenza
- Starr, Influenza in 1918
5. Evaluation and Preparedness Maintenance
Ongoing evaluation is important to strengthen the plan. The most important way to evaluate the plan is to conduct exercises to test the plan in whole or part. The evaluation process includes: educating staff to their specific roles, scheduling exercises to test the plan; debriefs and after action reporting to understand plan strengths and weaknesses; and making plan modifications as identified during the exercise. Plans are alive and will only remain so if they are subject to this preparedness maintenance process.