Closed POD Planning Toolkit for Special Populations

State: MI Type: Promising Practice Year: 2014

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Mass prophylaxis in response to a bioterrorism attack.

The overall practice goal was to successfully develop closed POD plans with all 40 Long-Term Care facilities and nine Community Mental Health agencies in Oakland County.

The two primary objectives for this project were:

  • Develop an easy to use step-by-step toolkit that would result in a completed closed POD plan.
  • At least 50% of LTC and CMH agencies will have closed POD plans completed by July 2012.

 

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Oakland County Health Division
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Closed POD Planning Toolkit for Special Populations
Size of Jurisdiction: 1.2 millionWhere is the LHD Located: City of Pontiac, Oakland County MI Describe public health issue: Mass prophylaxis in response to a bioterrorism attack. Goal/s and objective/s: The overall practice goal was to successfully develop closed POD plans with all 40 Long-Term Care facilities and nine Community Mental Health agencies in Oakland County. The two primary objectives for this project were: Develop an easy to use step-by-step toolkit that would result in a completed closed POD plan. At least 50% of LTC and CMH agencies will have closed POD plans completed by July 2012. How was the practice implemented: Through the use of a community collaborative committee, a Closed POD Toolkit was created that easily walks planners through a step-by-step format that includes templates, illustrations and diagrams. Once finalized, the completed toolkit serves as the agreement between the Closed POD agency and the LHD for use during a bioterrorism incident. The toolkit format was tested in July 2012 during a SNS exercise. Results/Outcomes: The final Closed POD Toolkit was put into practice September 2012. LTC Partnership Committee members were asked for their suggestions to improve the toolkit. All members agreed that the toolkit was easy to use and made completing a Closed POD Plan less confusing and faster. Participation in monthly communications tests has risen from a total of four participating partners in the first monthly test (August, 2011) to an average of 20 (50%) participating partners in 2013. As of July 2013 at total of .9 LTC facilities (23%) and 10 CMH agencies (100%) have completed Closed POD Plans using the toolkit. In addition, a large business has also completed a Closed POD Plan. When piloting the original Toolkit, OCHD found that the information was confusing, overwhelming, and intimidating. Solutions included, clarifying what was being asked of partners, providing an acronym list for terms, and breaking the Toolkit down into smaller steps by utilizing fill in the blank charts and tables. Successful accomplishment of completing plans with LTC facilities and CMH agencies allowed Emergency Preparedness staff to expand their partnership efforts to other organizations in the county with confidence. Recently, a large private business within the community completed a Closed POD Plan and was so pleased with the process they plan to take the Toolkit to all of their other office buildings in key cities nationwide. OCHD is launching a Closed POD Partner Registry page on the County website that will allow for future partners to learn more information about the program. Were all of your objectives met? Yes What specific factors lead to the success of this practice: Partnership Building Collaboration Flexibility Communication What is the Public Health impact of the practice: This practice will alleviate the potential of affected persons to overwhelm the public health system and Open PODs during a public health emergency by establishing more Closed PODs within the community.
Brief description of the LHD: The OCHD serves 1.2 million residents of Oakland County MI. Oakland is the second most populated county in the state. It is located in the southeastern lower portion of the state, bordering the City of Detroit to the south, Macomb County to the east, Livingston County to the west, and Genesee County to the north. The population served by this practice is employees and residents of Long-Term Care (LTC) Facilities and Community Mental Health (CMH) Agencies within the County.Statement of the problem/public health issue: The national goal for dispensing prophylaxis to the public during a bioterrorism incident is 48 hours. Oakland County has a population of 1.2 million residents. In a bioterrorism incident our mass dispensing sites will be inundated with anxious people waiting for medication. Target population affected by the problem: The target populations affected are the 40 LTC facilities and 10 CMH provider agencies within the county. There are approximately 4,850 elderly and disabled residents living within the LTC facilities in Oakland County, and approximately 7,200 staff members working at the LTC facilities. Using the Head of House method which assumes there are 4.5 family members in each house, the total population reached is expected to be 32,400 people. The total amount of consumers covered through Community Mental Health is approximately 14,650 developmentally disabled people, and 6,500 staff and their family members (using the head of household method). The total population served through CMH would be roughly 21,150 people. When combined, the total population potentially to be reached through this practice is 53,550 people during a public health emergency. Of that, we are currently reaching 100% of the CMH population and 23% of the LTC population. What has been done in the past to address the problem: Previous to development of this practice, there were no good tools available to guide businesses and other community agencies in development of Closed POD plans. The terms and concepts used were foreign to this population. They lacked knowledge of Incident Command Systems, and also the role that Public Health plays during emergencies. Agencies that served some of our most vulnerable populations (the elderly, disabled and cognitively/developmentally impaired) had no connection to their Public Health Department and also lacked experience in planning for any community disaster. Without a Closed POD plan, agency personnel would need to wait at open dispensing sites along with all the other 1.2 million population. This would negatively impact continuity of operations for these agencies. In addition, the vulnerable populations these agencies serve would need to wait in long lines at open POD for medication. Likely, many might not have the physical ability or transportation to visit an open POD leaving this population unprotected. Why is the current/proposed practice better: The closed POD concept was developed by the CDC to assist public health with dispensing medication to specific businesses and organizations in a more efficient manner. In addition, businesses benefit in that they would be able to continue operations since employees and their family members would obtain medicine at the worksite. This concept can also provide a more efficient method of dispensing medications to special populations that reside in group settings. In an effort to assist our community agencies that serve vulnerable citizens in the County that are the least likely to wait in line at dispensing sites, like the aged and developmentally or cognitively impaired, the Oakland County Health Division Emergency Preparedness Unit developed a closed POD planning toolkit. We realized that a toolkit was needed to make closed POD planning easier and less overwhelming for agencies that are not accustomed to this type of planning. Is the current practice innovative? How so: The practice is inventive and differs from other approaches in that it is broader in scope, targeting not just businesses but other partners like Community Mental Health, long term care facilities, faith based organizations, schools, and other local government agencies. The Toolkit is a printed, all-in-one spiral bound book, easily accessible for partners that don’t have electronic technology available. The Toolkit is specifically designed, offering step-by-step instructions for mass dispensing and planning in an organization. Preparedness staff meets face-to-face with partners, walking them through each section and giving technical support if needed. This has allowed for a more rapid response than putting all the ownership on that partner to create the plan. It also differs from other approaches in that it addresses specific trainings and sustaining elements of Closed POD plans and resources rather than just recruitment and planning.The practice is a creative use of an existing tool or practice- When building the Closed POD Toolkit, OCHD reviewed products and tools developed by the Advanced Practice Centers in the NACCHO Toolbox and on the Department of Strategic National Stockpile (DSNS) Extranet. The search yielded several results including "Closed POD Site Handbook"-Platte County 2008, “Partnering with Public Health, Closed POD Planning Workbook”, and "Closed Dispensing Site Workbook for Businesses".
Goal/s and objective/s of the practice: The overall practice goal was to successfully develop closed POD plans with all 40 Long-Term Care facilities and nine Community Mental Health agencies in Oakland County.The two primary objectives for this project were: 1. Develop an easy to use step-by-step toolkit that would result in a completed closed POD plan. 2. At least 50% of LTC and CMH agencies will have closed POD plans completed by July 2012. Steps taken to implement the program: In March of 2011, OCHD held a one day Long Term Care conference inviting all LTC facilities within the county. Results conference surveys included the desire for more emergency planning training, infection control methods, and plan development. As a result of this conference, the Long Term Care Partnership Committee was formed in May, 2011. This committee meets monthly and allows for multi-agency partnerships between LTC facilities, Oakland County Health Division, Oakland County Homeland Security Division and Oakland County Medical Control Authority. Through this partnership committee, the topic of making Closed POD planning easier and faster for LTC facilities was discussed. Working in partnership, public health emergency preparedness staff and volunteer LTC facilities initially created a rough draft of a Closed POD plan toolkit. The steps required, questions to be answered, and information needed to develop a Closed POD plan were documented in a step-by-step format that included illustrations and diagrams. The first draft toolkit was shared with other facilities for their input and suggested revisions. More revisions were made and more input was received as CMH facilities also participated in the pilot. The pilot organizations participated in an SNS exercise in July 2012. Feedback from the exercise was used to further refine the toolkit. After adjusting the plan to fit the needs of all participating facilities, a final Closed POD Toolkit was developed in September 2012. Once an agency finalizes all of the information and has the toolkit completed, signatures are obtained on the front page of the toolkit from both the Closed POD agency and the local health department documenting agreed upon roles for both during a bioterrorism incident. What was the timeframe for the practice: Began May 2011, ended September, 2012 Were other stakeholders involved: The other stakeholders besides the OCHD were LTC facilities, Community Mental Health agencies, Homeland Security, and the County’s EMS system called the Medical Control Authority. What was their role in the planning and implementation process: The Homeland Security Division and Medical Control Authority provided technical assistance and guidance in the planning and exercise process. The role of community agency partners was to complete Closed POD plans and provide recommendations for improvement of the toolkit. In this planning, partners agreed to provide the following: • Designate essential staff to work with Local Public Health in planning for the operation of a Closed POD. Provide primary and secondary 24-hour emergency points of contact to ensure timely notification and activation of the Closed POD during a public health emergency. Identify a Closed POD location. Identify security escorts during medication transport. Provide estimated number of individuals to be served at the Closed POD (total should include head of household planning considerations). Arrange for pick-up of SNS materials at designated Distribution Node (DN). Maintain the necessary supplies and equipment needed to operate a Closed POD. Implement communication methods before, during, and after an emergency. • Submit all medical history forms as required. Dispense medications following protocols and guidance. Participate in ongoing trainings and exercises in collaboration with Local Public Health and Homeland Security. What does the LHD do to foster collaboration with community stakeholders? OCHD fosters collaboration by hosting monthly meetings focused on the topics requested by our community partners. OCHD continuously offers support such as making site visits to the agency, and by sharing information via our Internet portal and email. OCHD regularly offers training opportunities, classes, and key information on developing and maintaining simple, yet effective dispensing plans by utilizing the Closed POD Toolkit. Describe the relationships and how it furthers the practice goals: Before this collaboration took place, LTC facilities were unaware of the resources available to them through Local Public Health, Homeland Security, and the Medical Control Authority. Monthly meetings have improved communication and information sharing among peer LTC facilities. These agencies are less reluctant to seek information or ask for support from Public Health, Homeland Security and the Medical Control Authority. Implementation, start-up, and in-kind cost: The cost of developing the Closed POD Toolkit was minimal. Public health provided all meeting space as in-kind support. The main cost incurred during the project came from staff wages and mileage expenses to visit facilities and provide consultation. The final Closed POD Toolkit, printed as color, spiral bound booklets, cost $19.53 each to print. The cost of this booklet can be reduced by choosing lighter weight paper and choosing a different type of binding material. An electronic version of the toolkit using Adobe Acrobat could also be used for very little cost. The Cities Readiness Initiative Grant through CDC provided the funding for this project.
What did you find out: When initiating the development of the Closed POD Toolkit at the LTC Partnership Committee meeting, only a few facilities were interested in taking the plunge because of their inexperience in emergency planning. While all the facilities knew that developing an emergency plan was imperative for their facility, they were reluctance to a Closed POD commitment. Feedback from the first participating facilities allowed OCHD to make the toolkit more compact and user-friendly. The development of the Closed POD Toolkit expanded from a stapled packet of papers, to a three ring project folder, and finally into a spiral bound, glossy covered, full color booklet. In addition, OCHD took the opportunity to train partners in emergency planning as a whole and not solely on the medication dispensing portion. As facilities completed their plans, word spread about the simplicity of developing Closed POD plans. Through positive word-of-mouth more LTC facilities signed up to start their planning efforts. Our commitment to partners includes thorough training on how to utilize the toolkit, an opportunity to attend small, lecture-style FEMA Independent Study classes hosted by OCHD; participate in a Hazards and Vulnerability Assessment with Homeland Security; and have the option to participate in future mass trainings and exercises.To what extent were your objectives achieved: 1. Develop an easy to use step-by-step toolkit that would result in a completed closed POD plan. This objective was completely achieved. 2. At least 50% of LTC and CMH agencies will have closed POD plans completed by July 2012. As of July 2013 at total of .9 LTC facilities (23%) and 10 CMH agencies (100%) have completed Closed POD Plans using the toolkit. In addition, a large business has also completed a Closed POD Plan. List any primary data sources: A log of each Closed POD toolkit distributed A log of each Closed POD plan completed and signed Monthly communications test results Closed POD Plan exercise participation and after-action reports Survey and Exercise After Action results List any secondary data sources used: None List performance measures used:  Significant dates involving the practice. Survey of partner agencies regarding usefulness of the tool and suggested improvements. Monthly communication tests. Number of Closed POD toolkits distributed. Number of Closed POD plans completed and signed by LTC facilities and CMH agencies. Describe how results were analyzed: Survey and After Action results were compiled. The results showed that a majority of LTC and CMH agencies felt the improved toolkit was easy to use and made completing a Closed POD Plan less confusing and faster. As of July 2013 at total of .9 LTC facilities (23%) and 10 CMH agencies (100%) have completed Closed POD Plans using the toolkit. In addition, a large business has also completed a Closed POD Plan. Participation in monthly communications tests has risen from a total of four participating partners in the first monthly test (August, 2011) to an average of 20 (50%) participating partners in 2013. OCHD is launching a Closed POD Partner Registry page on the County website that will allow for future partners to learn more information about the program. Were any modifications made to the practice as a result of the data findings: When piloting the original tool, discussion with partner agencies revealed that the information was confusing and intimidating. Solutions included clarifying what was being asked of partners, providing an acronym list of terms, and breaking the Toolkit down into smaller steps by utilizing fill in the blank charts and tables. The initial tool was lengthy and wordy. To resolve this issue, OCHD was able to get the Toolkit down to 25 pages, printed front and back. The actual plan itself is seven pages long, with the rest of the pages designated as notes pages, samples of messages, training documents, and drug and fact sheets. To ensure partner staff was trained in the Closed POD process, we initially required their essential staff to take four FEMA Independent Study courses before the plan could be signed. This held up many plans from being completed. Through exercises we realized that this requirement was not necessary. Agencies were able to successfully operate a Closed POD using just the toolkit. We have now removed this requirement but still recommend FEMA trainings. Fill in the blank tables, charts, and images were added to the Toolkit and documents to clarify what was being asked of partners.
Lessons learned in relation to the practice and to partner collaboration: Partners were already overburdened with other opportunities aside from those offered by OCHD. o To ensure that information was reaching partners efficiently, OCHD kept monthly meetings concise, on track, and to the point while still allowing partners to participate and interact. o To keep all facilities informed, even those who are not able to attend the monthly meetings, OCHD prints and disseminates all LTC Partnership Committee meeting minutes, agendas, and any other pertinent information the week before an upcoming meeting. o If facilities still wanted to participate, but were unable to physically attend the monthly meetings, a call-in line was provided and any attendees were given attendance markings. OCHD also realized that it was impractical for facilities to make extra trips to the Health Division to complete the planning process. OCHD resolved this issue by completing face-to-face meetings at multiple facilities. Just because OCHD was familiar with all terminology and processes for dispensing mass prophylaxis, did not mean that partners understood the terminology and the process. o The initial Toolkit was lengthy, daunting, and wordy. To resolve this issue, OCHD was able to get the Toolkit down to 25 pages, printed front and back. The actual plan itself is seven pages long, with the rest of the pages designated as notes pages, samples of messages, training documents, and drug and fact sheets. o To help with the training and comprehension of the Closed POD process, partners were required to take four FEMA Independent Study courses to guide them in the understanding of mass dispensing management. Later we realized that this requirement was not necessary and instead made these trainings a recommendation. o Fill in the blank tables, charts, and images were added to the Toolkit and documents to clarify what was being asked of partners.Is this practice better than what has been has been done before: Compared to other available toolkits, the Closed POD Toolkit has been simplified to meet the needs of all partners from small agencies to very large businesses. Once completed, this Closed POD Toolkit booklet contains all pertinent information necessary in the case of mass medication dispensing. This Toolkit allows for easy identification of essential staff members, provides information like drug fact sheets, disease fact sheets, risk communication message templates, and staff call down lists. Also included are Just in Time training sheets, Job Action Guidelines, and activation checklists. Through the use of functional exercises in 2012 and 2013, this practice proved to be successful in reaching the intended target population. This practice is expected to continue to improve and expand in the future. OCHD will continue to maintain strong relationships with partners and will expand the use of the Closed POD Toolkit to facilities and organizations throughout the county. There continues to be a steady increase in the number of interested partners.To ensure that partners remain committed to the project, OCHD will: Continually offer facilities with completed plans the opportunity to participate in various exercises like tabletop discussions, and functional or full-scale exercises. Persist in finding new partners to collaborate with Offer refresher classes for FEMA Independent Study Courses Ensure that facilities are well equipped to operate their Closed POD. OCHD has put together Closed POD Supply Kits. These kits include clipboards, command vests in two colors to distinguish between general staff and command staff, printed signage, duct tape, caution tape, and a copy of their completed plan. The kits come in large, rolling duffel bags that are easy to store and maneuver. Facilities can include more items, if needed. Describe sustainability plans: To sustain this practice over time, OCHD is committed to bringing in more Closed POD partners. Currently, OCHD is continuing to finalize Closed POD plans with the remaining LTC facilities in the county. OCHD is also entering into a reformatting process for all school districts in the county, which already have Closed POD plans in place. During reformatting, all current plans and processes previously completed with the school districts will be updated and converted into this easier Toolkit. This is essential for guaranteeing that all Closed POD partners are following the same format and that communications and protocols will not be confused if a public health emergency were to ever occur. Aside from continuing to meet face-to-face with current and potential partners, OCHD is launching a Closed POD Partner Registry page on the county website that will allow for future partners to learn more information about the program. By becoming a Closed POD Partner, organizations will receive thorough training on how to utilize the Toolkit, an opportunity to attend small lecture style FEMA Independent Study classes hosted by OCHD, participate in a Hazards and Vulnerability Assessment with Homeland Security, and have the option to participate in future mass trainings and exercises.
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