tabletop exercise Exercise Assumptions The scenario is plausible There are no trick questions All participants receive information at the same time There may be different answers due to the difference in policies and procedures at each facility ID: 911561
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Slide1
I. B. Contagious
Infectious disease
tabletop exercise
Slide2Exercise Assumptions
The scenario is plausible
There are no trick questions
All participants receive information at the same time
There may be different answers due to the difference in policies and procedures at each facility
Assume there may be some slight exercise artificialities
Basically, if the scenario does not seem to apply to your facility, let’s talk about how it would be different for you
Slide3Exercise Expectations
This is a stress-free, fun environment
There is no failing, just learning
Dialogue is encouraged
There is no single solution
Respond based on existing plans and policies
Focus on problem solving
Look to find ways you can coordinate with other departments to achieve shared goals
Treat the scenario as if it were currently happening
Slide4Review procedures for receiving a person at your facility with a suspected infectious disease
Discuss infection prevention and control standard procedures and how they are used in your facility
Discuss emergency preparedness functions as they relate to caring for a patient with a suspected infectious disease in your facility
Identify the key areas where infection prevention planning and emergency preparedness planning intersect
Identify any planning gaps
Exercise Objectives
Slide5Any questions before we begin?
Slide6Background Information
This exercise is based on a married couple with the names of Irene and Bob.
In general, Irene and Bob are healthy middle aged adults.
Irene and Bob do not have a history of hospital visits or stays.
It is the beginning of March and your facility is seeing normal to slightly increased numbers of flu patients.
Slide7Identification and Notification
It is 7:30 am and Irene and Bob arrive at your facility with symptoms indicative of a
severe flu;
nausea, chills, muscle aches, headache and fatigue.
Immediately upon their arrival to the ED, Irene and Bob are registered and identification of primary symptoms is shared.
Slide8Questions
During registration, what questions would you ask Irene and Bob?
What types of answers to your questions might raise alarm?
What locations would raise alarm when asking about travel?
Slide9Identification and Notification
During registration, you are informed that Irene and Bob have recently returned from a mission in Bolivia.
Slide10Questions
Are you immediately concerned about their travel to Bolivia?
Why or why not?
What are the immediate steps taken to care for Irene and Bob given their symptoms and that they have recently returned from Bolivia?
How, if at all, are these steps any different from what you would normally do with a patient who had
not
been out of the country but was showing the same symptoms?
Slide11Identification and Notification
After registration, Irene and Bob are taken to a room to be assessed.
During the assessment, you also learn that Irene and Bob stayed in a communal hut with dirt floors while in Bolivia.
Based on this information, the triage nurse performs a quick Google search, “fever from Bolivia”, and learn the volunteers may have been exposed to the
Machupo
virus.
Machupo virus is a Bolivian hemorrhagic fever and zoonotic infectious disease.Actual Google search result for “fever from Bolivia”: Bolivian hemorrhagic fever (BHF), also known as black typhus or Ordog Fever, is a hemorrhagic fever
and zoonotic infectious disease originating in
Bolivia
after infection by
Machupo
virus.
Slide12Questions
What are you doing internally with this information?
Nothing?
Would a Google search result like this raise concern?
Who would you be contacting with this information and what information would you be providing to them?
What is your process for contacting outside agencies?
If primary staff is unavailable, who is responsible?
Slide13Suspected Infection
Given the symptoms, the travel to Bolivia and the guidance you received from you local public health agency, you suspect Irene and Bob to have a highly infectious hemorrhagic fever – specifically,
Machupo
Virus.
Machupo
Handouts
Slide14Questions
How does your process of caring for Irene and Bob change?
What are the immediate steps your facility needs to do to care for Irene and Bob?
What does your process look like for identifying the staff who will care for Irene and Bob?
How can you support your staff so they feel safe while caring for Irene and Bob?
Behavioral health concerns?
Slide15PPE and Staff and Patient Safety
Now that you suspect Irene and Bob to have a severe hemorrhagic illness, you determine they need to be moved to a patient care room.
Slide16Questions
At this point, what staff safety precautions are you initiating?
How do you ensure PPE is donned and doffed correctly? What does this look like?
Slide17Questions
How do you prepare to move Irene and Bob to their patient room to ensure the safety of staff, other patients and visitors in your facility?
Mini Exercise:
Visualize the route you would take to move Irene and Bob to their patient care room.
Now, what additional precautions need to be taken in order to move Irene and Bob through the facility?
Slide18Communication
Many different disciplines are involved and working the situation from their respective areas.
Your infection
preventionist
is directing operations for Irene and Bob’s care and communicating with local public health.
Your emergency preparedness coordinator or designee is directing operations for hospital security and restricting movement of other patients and visitors in the building.
Slide19Questions
How are your facility leaders maintaining accurate situational awareness with each other?
What is your process for sharing information regarding this situation with all hospital staff?
What does the process for standing up your hospital command center look like?
Has this situation reached a level that you would stand up your hospital command center?
If not, what are some of your trigger points that warrant standing up your command center?
Slide20Scenario Expands
While hanging a new IV bag for Irene, your charge nurse learns that Irene attended the local high school basketball game over the weekend.
Also, Irene became ill at the game and was assisted to the restroom by some helpful people sitting near by.
Slide21Questions continued
What do you do with this new information?
Slide22Hand Washing and
Equipment Cleanin
g
Irene and Bob are in an in-patient area where mobile equipment is being shared between multiple patient rooms.
Several clinical staff are engaged in Irene and Bob’s care.
Slide23Questions
What advanced precautions are you taking?
What are your equipment cleaning processes?
How are you managing the resources needed to care for Irene and Bob?
Slide24Scenario expands
You were able to stabilize Irene and Bob and airlift them to a Denver hospital.
Describe the procedures for transferring Irene and Bob to another facility.
Slide25Additional Patients
It has now been one week since Irene and Bob’s arrival at your facility.
You have received confirmation from public health that Irene and Bob did in fact have
Machupo
.
Mrs. Clark and her son Ryan are referred to your facility by a local physician. Ryan is presenting with the same symptoms that both Irene and Bob had; nausea, chills, muscle aches, headache and fatigue.
Slide26Questions
Given that one week has passed, realistically, would Ryan’s symptoms raise any red flags?
Keep in mind it is March and still flu season.
What additional patient assessment questions would you ask? Any?
When would these questions be asked?
What would you do differently because of what you learned from the first two patients (Irene and Bob)?
Slide27Additional Patients
Upon questioning Ryan and Mrs. Clark, you learn that Ryan was at the same conference championship basketball game last week that Irene and Bob attended.
You also learn that Ryan was one of the individuals that assisted Irene to the restroom when she became ill at the game.
Slide28Questions
How does your facility respond to a new patient with a suspected hemorrhagic illness?
Who would be providing public information to your community at this point? What does this look like?
How are you preparing to handle additional patients who show up at your facility?
How would additional patients with suspected hemorrhagic illness affect your hospital staffing?
Slide29Your lucky day…
Turns out Ryan just has the flu.
End Exercise
Slide30Hot Wash
Identify the top three strengths you discovered during this exercise?
Can be different for each subject matter and/or individual
Identify the top 3 areas for improvement you discovered during this exercise?
Can be different for each subject matter and/or individual
What additional community partners should be included in future planning efforts to assist the facility in responding to this type of event? What additional planning, training or exercise efforts were discovered during this exercise?
Slide31Thank you!
Thank you for allowing us to come to your facility and have this conversation with you. We believe this to be an important topic to plan for, train for and exercise. Please do not hesitate to contact us if we can be of any additional support.
Deb French
CHA Director of Emergency Preparedness
Deborah.French@cha.com
Teri Hulett
CHA Contractor, Infection PreventionistTeri.Hulett@cha.comAshley BakerCHA Hospital Emergency Preparedness Program ManagerAshley.Baker@cha.com