Long Term Care Facility Emergency Dispensing Program

State: TX Type: Model Practice Year: 2010

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This program ensures the dispensing of necessary treatment to vulnerable older adults within the 48 hour timeframe mandated to disseminate materials from the Strategic National Stockpile during a bioterrorism attack. With approximately 50% of nursing home residents having some form of dementia or cognitive impairment, and with the high acuity level of resident populations at nursing homes, long-term care centers are challenged to provide continuity of care, carry out an emergency plan, and access life-saving treatment during a bioterrorism event.

Tarrant County Public Health recognized that utilizing (1) the structure and staffing of nursing centers to administer and manage medical assets, (2) the knowledge and professional networks of senior care providers, and (3) the unique access and infrastructure of local law enforcement could help overcome barriers of access and resources needed to reach special populations of long-term care residents within the mandated 48 hours. The primary goal of the Long-Term Care Facility Emergency Dispensing Program, initiated in 2007, is to meet the critical demand of a special population while expediting the dissemination of resources from the Strategic National Stockpile (SNS) during a bioterrorism event. Through collaborative efforts with senior care providers and local law enforcement, Tarrant County Public Health has recruited large nursing centers to ensure efficient coordination of emergency response for institutionalized older adults and those providing for their special needs.

This had been achieved through the following objectives: (1) identification of long-term care centers that have the necessary structure and staffing to receive, maintain and administer medical assets; (2) coordination of the efficient and expedient delivery of assets to each center through local law enforcement; and (3) testing the program for efficiency and effectiveness during an actual biological, chemical or radioactive terrorist attack. Key to the program is establishing a working relationship with nursing centers to improve planning efforts and to promote a fluid response in the event of a bioterrorism crisis.

Ongoing communication includes personal ‘goodwill’ visits to nursing centers by representatives of Tarrant County Public Health to update contact information every six months. Tarrant County Public Health also provides in-services to nursing center staff about pandemic and emergency planning and preparedness, infection control, or other public health issues pertinent to resident care. Long-term care centers were targeted during a grant-funded H1N1 education campaign to increase awareness of pandemic influenza and the availability of H1N1 vaccines for older adults and healthcare workers. Finally, email announcements of public health events are distributed to primary contacts at each center. Having a point of contact for long-term care centers allows continual communication to flow between sectors and reinforces a working relationship. Tarrant County Public Health Preparedness designated preparedness employees as points of contact for nursing centers. These employees have experience working in or with the long-term care sector and personally provide the pandemic and emergency education for nursing centers. Tarrant County Public Health employees tested the plotted route between long-term care points of dispensing to estimate the total completion time of disseminating medications and supplies. Maps and estimates were distributed to county constables who are responsible for completing the dispensing in an actual

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Tarrant County Public Health Department
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Long Term Care Facility Emergency Dispensing Program
This program ensures the dispensing of necessary treatment to vulnerable older adults within the 48 hour timeframe mandated to disseminate materials from the Strategic National Stockpile during a bioterrorism attack. With approximately 50% of nursing home residents having some form of dementia or cognitive impairment, and with the high acuity level of resident populations at nursing homes, long-term care centers are challenged to provide continuity of care, carry out an emergency plan, and access life-saving treatment during a bioterrorism event. Tarrant County Public Health recognized that utilizing (1) the structure and staffing of nursing centers to administer and manage medical assets, (2) the knowledge and professional networks of senior care providers, and (3) the unique access and infrastructure of local law enforcement could help overcome barriers of access and resources needed to reach special populations of long-term care residents within the mandated 48 hours. The primary goal of the Long-Term Care Facility Emergency Dispensing Program, initiated in 2007, is to meet the critical demand of a special population while expediting the dissemination of resources from the Strategic National Stockpile (SNS) during a bioterrorism event. Through collaborative efforts with senior care providers and local law enforcement, Tarrant County Public Health has recruited large nursing centers to ensure efficient coordination of emergency response for institutionalized older adults and those providing for their special needs. This had been achieved through the following objectives: (1) identification of long-term care centers that have the necessary structure and staffing to receive, maintain and administer medical assets; (2) coordination of the efficient and expedient delivery of assets to each center through local law enforcement; and (3) testing the program for efficiency and effectiveness during an actual biological, chemical or radioactive terrorist attack. Key to the program is establishing a working relationship with nursing centers to improve planning efforts and to promote a fluid response in the event of a bioterrorism crisis. Ongoing communication includes personal ‘goodwill’ visits to nursing centers by representatives of Tarrant County Public Health to update contact information every six months. Tarrant County Public Health also provides in-services to nursing center staff about pandemic and emergency planning and preparedness, infection control, or other public health issues pertinent to resident care. Long-term care centers were targeted during a grant-funded H1N1 education campaign to increase awareness of pandemic influenza and the availability of H1N1 vaccines for older adults and healthcare workers. Finally, email announcements of public health events are distributed to primary contacts at each center. Having a point of contact for long-term care centers allows continual communication to flow between sectors and reinforces a working relationship. Tarrant County Public Health Preparedness designated preparedness employees as points of contact for nursing centers. These employees have experience working in or with the long-term care sector and personally provide the pandemic and emergency education for nursing centers. Tarrant County Public Health employees tested the plotted route between long-term care points of dispensing to estimate the total completion time of disseminating medications and supplies. Maps and estimates were distributed to county constables who are responsible for completing the dispensing in an actual
Public health preparedness involves the expedient dispensing of life-saving treatment to the entire county within a 48 hour timeframe. One of the challenges of this task is reaching special populations having significant physical or cognitive disabilities that may prevent their timely arrival to public points of dispensing setup throughout the county. This program ensures that a special population receives the treatment and improves the efficient mass dispensing effort. By dispensing to large licensed long-term care centers, defined as those with over 75 beds, treatment is delivered to a suitable structure with secured facilities to properly store medications and supplies. Medical personnel are available 24 hours a day to properly administer the treatment. Residents receive full assistance in receiving the treatment while remaining in their care environment. Staff is available to perform assistance with the reassurance of receiving treatment for themselves and their families. By March 2010, the program included 67 large licensed nursing homes (at least 75 beds) throughout the county. In the course of dissemination during a bioterrorism event, assets are released to these centers, providing treatment to 8,800 institutionalized seniors and residents with special needs. When including the 7,000 employees providing care at these centers and employees’ families, the potential total impact includes treating 36,800 people. Research has shown that integrated efforts between service networks improve efficiency, learning opportunities and images of organizations. Tarrant County Public Health’s bioterrorism response relies largely on the combined efforts of county officials, local law enforcement, and 1500 Medical Reserve Corp (MRC) volunteers. Collaborative partnerships are instrumental in the successful and timely deployment of needed assets to 1.8 million residents. This is especially true in reaching special populations. Tarrant County’s total population is highly diverse, experiencing rapid growth in its number of older adults age 60 and over, as well as in its number of institutionalized individuals. Public health entities will be faced with providing rescue, relief and recovery efforts for an increasingly older and frailer population in institutional settings. This program identifies long-term care centers as key partners in a bioterrorism response, recognizing the unique needs of an aging population and the challenges of effective SNS distribution with limited resources. Much of this effort relies on establishing an ongoing relationship with long term care centers. Nursing homes experience generally high rates of turnover with top management staff, and challenges arise in maintaining communication and accurate information about nursing centers. While recent changes to guidelines set forth through private accrediting agencies and state regulators cite the need for ongoing emergency planning in long term care centers, long-term care management staff are pressured to update standardized emergency plans. Public health entities have the potential to bridge the gap between planning and practice. Through this program, public health preparedness efforts extend beyond planning to provide education and outreach to long-term care centers. Establishing points of distribution, site visits and professional education for long-term care staff, and emergency plan exercises go beyond the traditional level of involvement between aging and public health sectors. With combined planning efforts, Tarrant County Public Health is able to improve its disaster response. Key to the program is establishing a working relationship with nursing centers to improve planning efforts and to promote a fluid response in the event of a bioterrorism crisis. Ongoing communication includes personal ‘goodwill’ visits to nursing centers by representatives of Tarrant County Public Health to update contact information every six months. Tarrant County Public Health also pro
Agency Community RolesKey to the program is establishing a working relationship with nursing centers to improve planning efforts and to promote a fluid response in the event of a bioterrorism crisis. Ongoing communication includes personal ‘goodwill’ visits to nursing centers by representatives of Tarrant County Public Health to update contact information every six months. Tarrant County Public Health also provides inservices to nursing center staff about pandemic and emergency planning and preparedness, infection control, or other public health issues pertinent to resident care. Tarrant County Public Health targeted long-term care centers during a grant-funded H1N1 education campaign to increase awareness of pandemic influenza and the availability of H1N1 vaccines for older adults and healthcare workers. Finally, email announcements of public health events are distributed to primary contacts at each center through the public health department. Long-term care symposiums in August 2007, May 2008, and May 2009 at Tarrant County Public Health included information about the program for attendees. This annual event focused on public health preparedness and gave a general overview of long-term care centers’ role in county efforts during a bioterrorist attack. Participants were able to visit the public health department and learn about other services available through the department, as well as voice concerns related to emergency preparedness.  Practice & testing: Mansfield Nursing and Rehabilitation Center participated in a training exercise with Tarrant County Public Health on April 2008. Using the planned route of delivery, Tarrant County Constables delivered medications to the facility. Results of the exercise were shared at the May 2008 symposium. Tarrant County Public Health preparedness staff evaluated the planned route in January 2010 to pinpoint estimated route completion times and feasibility. Results were shared with county constables. Joint training and exercises minimize errors and optimize performance under a real crisis event. Maintenance: Long-term care center participants updated their contact information sheets in July 2008, July 2009, and January 2010 to ensure the accuracy of emergency information to be used during crisis. Costs and ExpendituresImplementing the Long-Term Care Facility Emergency Dispensing Program included an initial assessment of suitable centers having the organization and staffing to handle the successful distribution of assets. Public Health Emergency Preparedness and Cities Readiness Initiative grant funds were utilized to implement the program. Education is routinely offered at long-term care facilities. Site visits and peer-to-peer outreach is key to maintaining communication and receptivity with long-term care centers. Long-term care symposiums in August 2007, May 2008, and May 2009 at Tarrant County Public Health focused on public health preparedness and gave a general overview of long-term care centers’ role in county efforts during a bioterrorist attack. Joint training and exercises were held to minimize errors and optimize performance under a real crisis event. Tarrant County Public Health conducted on-site ‘goodwill’ visits to long term care center participants to update their contact information and to ensure the accuracy of emergency information used during crisis. Point of contract information was obtained on all qualifying centers and entered into the Public Health Information Network to allow for rapid notification to centers during a bio-emergency. This system of notification has been tested and evaluated over the past two years. Based on staff attrition at the centers it was determined that fax numbers would be the most effective method of notification. In addition, all centers were GIS mapped and placed on routes within four quadrants of the county. Staff then drove the routes in order to determine timely distribution to centers with the county of life-saving prophylaxis drugs. Specific dispensing instructions were developed to accompany the medications along with contact information should the facility need assistance during the event. Funding sources for this program include: Public Health Emergency Preparedness/Pandemic Flu (PHEP), Cities Readiness Initiative (CRI), Public Health Emergency Response (PHER) ImplementationIn the event of a major terrorist attack, Tarrant County Public Health is responsible for deploying federal assets from the SNS to 1.8 million people within 48 hours. Successful deployment relies on strategically-positioned points of distribution. Establishing points of distribution at long-term care centers ensures access to a particularly frail and vulnerable subpopulation. The following steps were involved in implementing the program: Development: Implementing the Long-Term Care Facility Emergency Dispensing Program included an initial assessment of suitable centers having the organization and staffing to handle the successful distribution of assets. A geospatial information systems analysis plotted the efficient route of delivery to minimize travel time between centers. Tarrant County constables agreed to deliver the assets for the program due to their ability to control traffic and navigate the county in emergency situations. Communication: Health educators from Tarrant County Public Health first introduced the program to participants when providing pandemic influenza education at long-term care centers in July 2007. Long term care center participants completed contact information sheets that specified key contacts at the facility, the number of resident beds and staff, and drop-off points for asset delivery. Education is routinely offered at long-term care facilities. More recently, a team of health educators that included senior care professionals provided H1N1 education and emergency preparedness planning for long-term care centers and senior care professional organizations. Site visits and peer-to-peer outreach are key to maintaining communication and receptivity with long-term care centers. They are efforts at establishing the department as a resource and partner concerned with that centers’ ongoing success. Long-term care symposiums in August 2007, May 2008, and May 2009 at Tarrant County Public Health included information about the program for attendees. This annual event focused on public health preparedness and gave a general overview of long-term care centers’ role in county efforts during a bioterrorist attack. Participants were able to visit the public health department and learn about other services available through the department, as well as voice concerns related to emergency preparedness. Practice & testing: Mansfield Nursing and Rehabilitation Center participated in a training exercise with Tarrant County Public Health on April 2008. Using the planned route of delivery, Tarrant County Constables delivered medications to the facility. Results of the exercise were shared at the May 2008 symposium. Tarrant County Public Health preparedness staff evaluated the planned route in January 2010 to pinpoint estimated route completion times and feasibility. Results were shared with county constables. Joint training and exercises minimize errors and optimize performance under a real crisis event. Maintenance: Long-term care center participants updated their contact information sheets in July 2008, July 2009, and January 2010 to ensure the accuracy of emergency information to be used during crisis. Program is ongoing
To meet the critical demand of a special population while expediting the dissemination of resources from the Strategic National Stockpile (SNS) during a bioterrorism event. (1) Identification of long-term care centers that have the necessary structure and staffing to receive, maintain and administer medical assets; To include large long-term care centers, defined as nursing centers with over 75 licensed beds. Public health preparedness staff conducted on-site visits to each center to gather information on key staff members, contact information, number of beds, number of employees, and delivery site. Data is updated annually Data is reported to local SNS coordinator. Modifications to the nursing home center contact list included eliminating any center that was not a licensed nursing center. Contact list requires annual or biannual updates to maintain accuracy of contact information Short-term outcome, with improved access and an increase in the number of county residents with special needs receiving SNS assets during a bioterrorism attack. (2) Coordination of the efficient and expedient delivery of assets to each center through local law enforcement Performance measure; coordinate the route of asset delivery to expedite completion time within the required 48 hour timeframe using local law enforcement. Geospatial information systems analysis plotted each center on a route. Route was tested by public health preparedness staff to estimate delivery completion time and to optimize delivery performance. Route is updated as nursing home center list changes. Data is reported to local SNS coordinator and to county constables who are responsible for actual delivery of assets. Short-term outcome, with the expedited delivery of SNS assets within the required timeframe. ( 3) Testing the program for efficiency and effectiveness during an actual biological, chemical or radioactive terrorist attack. Practice the delivery of an asset and estimate route completion Mansfield Nursing and Rehabilitation Center participated in a training exercise with Tarrant County Public Health in April 2008. Using the planned route of delivery, Tarrant County Constables delivered medications to the facility. Results of the exercise were shared at the May 2008 symposium. Tarrant County Public Health preparedness staff evaluated the planned route in January 2010 to pinpoint estimated route completion times and feasibility. Results were shared with county constables. Exercise was completed April 2008 and route testing in January 2010. Data is reported to local SNS coordinator and to county constables who are responsible for actual delivery of assets. Long term outcome, with improved performance of delivery during an actual bioterrorism attack.
Program participation overcomes barriers of accessing life-saving treatment during a terrorist attack. Additionally, because private accrediting agencies and state regulators require ongoing emergency planning in long,term care centers, centers look to public health authorities for their expertise in disaster preparedness. Public health preparedness permanent staff is designated as the contact person coordinating continuing events and correspondence with long,term care centers to maintain effective communication and receptivity to county planning efforts. SNS coordinator at public health department incorporates long-term care centers in point-of-distribution plotting for all hazards planning and to meet 48 hour distribution timeframe.
 
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