Emergency Preparedness: New Regulations For …

1 More legal Information for nurses is available at Legal Eagle Eye Newsletter for the Nursing Profession Home Page. Emergency preparedness : New Regulations For Healthcare Facilities Proposed By CMS. T he US Centers for Medicare & Medi- caid Services (CMS) has announced an intention to set nationwide Emergency - The US Centers for Medi- Sec. Condition of participation: Emergency preparedness . The hospital must comply with all appli- care & Medicaid Services preparedness requirements for Medicare cable Federal and State Emergency prepar- and Medicaid participating providers. (CMS) has issued proposed edness requirements. The hospital must CMS's proposed new Regulations are new Emergency prepared- develop and maintain a comprehensive not mandatory at this time. ness Regulations for health- Emergency preparedness program that CMS, being a US Federal agency, care facilities including meets the requirements of this section, must first publish new Regulations as pro- utilizing an all-hazards approach.

2 The hospitals, long term care posed Regulations and accept and consider Emergency preparedness program must public comments before issuing new regu- facilities, hospices, home include, but not be limited to: lations in mandatory final form. health agencies, ambula- (a) Emergency plan. The hospital must CMS is accepting public comments tory surgical centers and develop and maintain an Emergency pre- until February 25, 2014. critical access hospitals. paredness plan that must be reviewed, and Medicare/Medicaid Participating updated at least annually. The plan must do The proposed new regula- Providers Affected the following: The new Regulations affect hospitals, tions are not mandatory at (1) Be based on and include a docu- long term care facilities, religious non- this time. mented, facility-based and community- medical healthcare institutions, ambulatory Before issuing new regula- based risk assessment, utilizing an all- surgical centers, hospices, inpatient resi- tions in mandatory final hazards approach.

3 Dential psychiatric treatment facilities, pro- (2) Include strategies for addressing form CMS, as any US Fed- grams of all-inclusive care for the elderly, Emergency events identified by the risk transplant centers, organ procurement cen- eral agency, must first pub- assessment. ters, intermediate care facilities for indi- lish its proposed new regu- (3) Address patient population, includ- viduals with intellectual disabilities, home lations in the Federal Regis- ing, but not limited to, persons at-risk; the health agencies, comprehensive outpatient ter and accept and consider type of services the hospital has the ability rehabilitation facilities, critical access hos- to provide in an Emergency ; and continuity public comments. pitals, community mental health centers, of operations, including delegations of rural health centers, Federally-qualified CMS is accepting public authority and succession plans.

4 Health centers and end-stage renal disease comments until February (4) Include a process for ensuring coop- facilities. 25, 2014. eration and collaboration with local, tribal, Proposed New Regulations for Hospitals CMS's December 27, 2013 regional, State, and Federal Emergency We are including verbtim starting to preparedness officials' efforts to ensure an Federal Register announce- the right on this page the proposed new integrated response during a disaster or Regulations for hospitals. ment is available at http:// Emergency situation, including documenta- Although there are minor variations in tion of the hospital's efforts to contact such the separate Regulations for each of the officials and, when applicable, its partici- classes of providers listed above, each set The new Regulations them- pation in collaborative and cooperative of Regulations for each separate class of planning efforts.

5 Selves begin on Federal providers tracks the general template set (b) Policies and procedures. The hospi- out in the hospital Regulations . Register page 79181, page tal must develop and implement emer- Nursing Involvement 101 of the PDF document. gency preparedness policies and proce- CMS has expressed an expectation Hospital requirements be- dures, based on the Emergency plan set that healthcare facilities will involve gin on Federal Register forth in paragraph (a) of this section, risk nurses, nursing managers and nurse practi- page 79186, page 106 of the assessment at paragraph (a)(1), and the tioners throughout the risk assessment and communication plan at paragraph (c) of Emergency preparedness plan development PDF document. this section. The policies and procedures process and implementation of required Long term care require- must be reviewed and updated at least an- staff training.

6 Ments begin on Federal nually. At a minimum, the policies and Providing for adequate nursing staff- Register page 79187, page procedures must address the following: ing is also a critical component throughout 107 of the PDF document. (1) The provision of subsistence needs the Emergency preparedness process. FEDERAL REGISTER December 27, 2013 for staff and patients, whether they evacu- FEDERAL REGISTER December 27, 2013 Pages 79081-79200 ate or shelter in place, include, but are not Pages 79081-79200 limited to the following: Legal Eagle Eye Newsletter for the Nursing Profession February 2014 Page 4. More legal Information for nurses is available at Legal Eagle Eye Newsletter for the Nursing Profession Home Page. More legal Information for nurses is available at Legal Eagle Eye Newsletter for the Nursing Profession Home Page. Emergency preparedness : Hospitals (Continued).

7 (i) Food, water, and medical supplies. (iii) Patients' physicians. (ii) If the hospital experiences an actual (ii) Alternate sources of energy to main- (iv) Other hospitals natural or man-made Emergency that re- tain the following: (v) Volunteers. quires activation of the Emergency plan, (A) Temperatures to protect patient (2) Contact information for the follow- the hospital is exempt from engaging in a health and safety and for the safe and sani- ing: community or individual, facility-based tary storage of provisions. (i) Federal, State, tribal, regional, and mock disaster drill for 1 year following the (B) Emergency lighting. local Emergency preparedness staff. onset of the actual event. (C) Fire detection, extinguishing, and (ii) Other sources of assistance. (iii) Conduct a paper-based, tabletop alarm systems. (3) Primary and alternate means for exercise at least annually.

8 A tabletop exer- (D) Sewage and waste disposal. communicating with the following: cise is a group discussion led by a facilita- (2) A system to track the location of (i) Hospital's staff. tor, using a narrated, clinically-relevant staff and patients in the hospital's care both (ii) Federal, State, tribal, regional, and Emergency scenario, and a set of problem during and after the Emergency . local Emergency management agencies. statements, directed messages, or prepared (3) Safe evacuation from the hospital, (4) A method for sharing information questions designed to challenge an emer- which includes consideration of care and and medical documentation for patients gency plan. treatment needs of evacuees; staff respon- under the hospital's care, as necessary, (iv) Analyze the hospital's response to sibilities; transportation; identification of with other health care providers to ensure and maintain documentation of all drills, evacuation location(s); and primary and continuity of care.

9 Tabletop exercises, and Emergency events, alternate means of communication with (5) A means, in the event of an evacua- and revise the hospital's Emergency plan, external sources of assistance. tion, to release patient information as per- as needed. (4) A means to shelter in place for pa- mitted under 45 CFR (e) Emergency and standby power tients, staff, and volunteers who remain in (6) A means of providing information systems. The hospital must implement the facility. about the general condition and location of Emergency and standby power systems (5) A system of medical documentation patients under the facility's care as permit- based on the Emergency plan set forth in that preserves patient information, protects ted under 45 CFR (b)(4). paragraph (a) of this section and in the confidentiality of patient information, and (7) A means of providing information policies and procedures plan set forth in ensures records are secure and readily about the hospital's occupancy, needs, and paragraphs (b)(2)(i) and (ii) of this section.

10 Available. its ability to provide assistance, to the au- (1) Emergency generator location. (6) The use of volunteers in an emer- thority having jurisdiction, the Incident (i) The generator must be located in ac- gency and other Emergency staffing strate- Command Center, or designee. cordance with the location requirements gies, including the process and role for (d) Training and testing. The hospital found in NFPA 99, NFPA 101, and NFPA. integration of State and Federally desig- must develop and maintain an Emergency 110. nated health care professionals to address preparedness training and testing program (2) Emergency generator inspection and surge needs during an Emergency . that must be reviewed and updated at least testing. In addition to the Emergency power (7) The development of arrangements annually. system inspection and testing requirements with other hospitals and other providers to (1) Training program.