State of California-Health and Human Service Agency
California Department of Public Health
NURSING STAFFING ASSIGNMENT AND SIGN-IN SHEET
(DHPPD SALARIED/DUAL ROLE/NURSE ASSISTANT)
1. FACILITY NAME
2. DATE OF PATIENT DAY (MM/DD/YY)
3. DIRECTOR OF NURSING/DESIGNEE
4. SHIFT
1
2
3
5. SHIFT START TIME (HH:MM AM/PM)
6. STATION/WING/UNIT/FLOOR
7.
NURSING SERVICES
ASSIGNMENT
EMPLOYEE NAME
ACTUAL
ACTUAL
SHIFT
MEAL BREAK
DISCIPLINE START/ END START/END EMPLOYEE SIGNATURE
x
x
x
x
x
x
x
8. I have reviewed and verified all staffing assignments are true and accurate. Employees not captured in payroll
records, nurse assistants or employees who are primarily engaged in duties other than nursing services that
provided nursing services during the patient day are recorded and their direct care service hours to be included in
Direct Care Service Hours Per Patient Day are accounted for with an original signature.
X
DIRECTOR OF NURSING/DESIGNEE SIGNATURE
CDPH 530 (06/19)
1
State of California-Health and Human Service Agency
California Department of Public Health
DHPPD SALARIED/DUAL ROLE/NURSE ASSISTANT
NURSING STAFFING ASSIGNMENT AND SIGN-IN SHEET
INSTRUCTIONS
Direct caregivers not captured in payroll records must capture their direct care service
hours on this form. This includes nursing management, supervisors, registry, contract,
nurse assistants, and corporate staff.
For example, this may apply but not be limited to, the direct care service hours provided
by such employees as a Director of Nursing in a facility with 60 or more beds and a
Director of Staff Development when providing nursing services beyond the hours
required to carry out the duties of these positions.
SNFs with a subacute unit, shall not count direct care service hours provided in the
subacute unit for purposes of determining compliance with the 3.5 and 2.4 minimum
standards. CCR, Title 22, section 51215.5(h) prohibits nursing staff assigned to the
subacute care unit from being assigned other duties outside of the subacute care unit
during any given shift. Direct care service hours of nursing services provided by crosstrained staff who are otherwise regularly assigned to departments such as medical
records, housekeeping, dietary or laundry, must be captured on this form. Documentation
must delineate the time spent on nursing services. Failure to provide this information will
result in the exclusion of all direct care service hours for such employees.
The Nursing Staffing Assignment and Sign-In Sheet must be legible. All employee
names must be include both first and last name.
Corrections and modifications must be completed on the Nursing Staffing Assignment
and Sign-In Sheet to document employee absences, substitutions, and/or schedule
changes. Legible pen/ink changes are acceptable.
Each direct caregiver included on the Nursing Staffing Assignment and Sign-In Sheet
must provide an original, written signature next to their printed name. This signature
verifies the employee was present in the facility, provided nursing services, and actually
worked the hours stated. Initials are not acceptable.
Only the employee that worked the nursing assignment may sign for him/herself.
The form must be signed by the Director of Nursing or his/her designee verifying the
information on the Nursing Staffing Assignment and Sign-In Sheet is complete, true and
accurate.
CDPH 530 (06/19)
2
State of California-Health and Human Service Agency
California Department of Public Health
1. Enter the facility name.
2. Enter the date of the patient day in MM/DD/YY format.
3. Enter the name of the person who has Director of Nursing responsibility for the day.
4. Circle the appropriate shift: one, two or three.
5. Enter the shift start time in HH:MM AM/PM format.
6. If applicable, enter the name of the specific location in the facility for the patient
assignments.
7. Record only direct caregivers not otherwise captured in payroll records. Enter
the specific patient assignment and the employees name responsible for the
patient assignment. Enter the employees discipline (RN, LVN, CNA, NA, Psych
Tech). Enter the employees actual shift start and end time. Enter the start and end
time of the employees meal breaks. The employee must sign the form.
8. At the conclusion of each patient day, the Director of Nursing or his/her
designee shall sign the form verifying the nursing assignments are true and
accurate and that all assignments are accounted for with an employee signature,
or state a reason why the assignment was vacant. The DON or designee should
not sign the 530 form to verify his or her own time. The facility administrator or
other designated staff should sign to verify the hours.
CDPH 530 (06/19)
3
Complete a review of the literature and select a minimum of 3 articles that are appropriate research articles related to your question. A research article may be quantitative, qualitative, or integrative. A research article may to related to a Quality Improvement study, an Evidence-Based Practice study, or a Research article that reports new knowledge.
Critique each of the articles using the appropriate Appraisal Form below, either C, E, or F.
If a question included in the form you selected is not applicable to your particular study, select option 3, Not Clear.
An Integrative Review, Appraisal form C, can be used for a meta-analysis or systematic review.
Please Note:
– For this assignment I need the proper appraisals and the 3 articles pdfs uploaded.
– I have uploaded the 3 templates that you may need to complete this assignment.
Select 3 articles of your choice. However you must use my PICOT TOPIC:
My Picot Question is:
In patients over 65 who are at risk of falling, does the use of measures to avoid falls and tactics to make sure people take their medicines (I) compared to methods for preventing falls that don’t include techniques for sticking to medications or standard care (C) lead to fewer falls and better adherence to medications (O) over a 6-month period (T)?
P: Patients over 65 who are at risk of falling
I: Interventions to avoid falls and methods to make sure people take their medications
C: Interventions to avoid falls that don’t include methods for keeping up with medications or normal care
O: Fewer falls and better drug compliance
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APPENDIX C
Appraisal Guide:
Findings of a Integrative Review
Citation:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Synopsis
How many persons were involved in conducting the review?
What topic or question did the integrative research review address?
How were potential research reports identified?
What determined if a study was included in the analysis?
How many studies were included in the review?
What research designs were used in the studies?
What were the consistent and important across-studies conclusions?
Clinical Significance
Across studies, is the size of the treatment or the strength of the association found or the
meaningfulness of qualitative findings strong enough to make a difference in patient outcomes
or experiences of care?
Yes
No
Not clear
Are the conclusions relevant to the care the nurse gives?
Yes
No
Not clear
The conclusions clinically significant?
Yes
No
Not clear
Applicability
Does the IRR address a problem, situation, or decision we are addressing in our setting?
Yes
No
Not clear
Are the patients in the studies similar to those we see, either overall or in a subgroup of patients?
Yes
No
Not clear
What changes, additions, training, or purchases would be needed to implement and sustain a
clinical
protocol based on these conclusions?
Yes
No
Not clear
Specify
Is what we will have to do to implement the new protocol realistically achievable by us (resources,
capability, commitment)?
Yes
No
Not clear
How will we know if our patients are benefiting from our new protocol?
Yes
No
Not clear
Specify
Should we proceed to design a protocol incorporating these conclusions?
Yes
No
Not clear
Comments
___________________________________________________________________________
___________________________________________________________________________
APPENDIX E
Appraisal Guide:
Findings of a Qualitative Study
Citation:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Synopsis
What experience, situation, or subculture does the researcher seek to understand?
Does the researcher want to produce a description of an experience, a social process, or an event,
or is the goal to generate a theory?
How was data collected?
How did the researcher control his or her biases and preconceptions?
Are specific pieces of data (e.g., direct quotes) and more generalized statements (themes,
theories) included in the report?
What are the main findings of the study?
Credibility
Is the study published in a source
that required peer review?
Yes
No
Not clear
Were the methods used appropriate
to the study purpose?
Yes
No
Not clear
Was the sampling of observations or
interviews appropriate and varied
enough to serve the purpose of the study?
Yes
No
Not clear
*Were data collection methods
effective in obtaining in-depth data?
Yes
No
Not clear
Did the data collection methods
avoid the possibility of oversight,
underrepresentation, or
overrepresentation from certain
types of sources?
Yes
No
Not clear
Were data collection and analysis
intermingled in a dynamic way?
Yes
No
Not clear
Brown
APP E-1
*Is the data presented in ways that
provide a vivid portrayal of what was
experienced or happened and its
context?
Yes
No
Not clear
*Does the data provided justify
generalized statements, themes,
or theory?
Yes
No
Not clear
ARE THE FINDINGS CREDIBLE?
Yes All
Yes Some
No
Clinical Significance
*Are the findings rich and informative?
Yes
No
Not clear
*Is the perspective provided
potentially useful in providing
insight, support, or guidance
for assessing patient status
or progress?
Yes
Some
No
ARE THE FINDINGS
CLINICALLY SIGNIFICANT?
Yes All
Yes Some
Not clear
No
* = Important criteria
Comments
___________________________________________________________________________
___________________________________________________________________________
APP E-2
Brown
APPENDIX F
Appraisal Guide:
Findings of a Quantitative Review
Citation:
Synopsis
What was the purpose of the study (research questions, purposes, and hypotheses)?
How was the sample obtained?
What inclusion or exclusion criteria were used?
Who from the sample actually participated or contributed data (demographic or
clinical profile and dropout rate)?
What methods were used to collect data (e.g., sequence, timing, types of data, and
measures)?
Was an intervention tested?
Yes
No
1. How was the sample size determined?
2. Were patients randomly assigned to treatment groups? What are the main findings?
Is the study published in a source that required peer review?
Yes
No
Not clear
Was the design used appropriate to the research question?
Yes
No
Not clear
*Did the data obtained and the analysis conducted answer the research question?
Yes
No
Not clear
Were the measuring instruments reliable and valid?
Yes
No
Not clear
*Were important extraneous variables and bias controlled?
Yes
No
Not clear
*Was the study free of extraneous variables introduced by how, when, and where the study was done?
Yes
No
Not clear
*If an intervention was tested, answer the following five questions:
1. Were participants randomly assigned to groups and were the two groups similar at the start
(before the intervention)?
Yes
No
Not clear
2. Were the interventions well defined and consistently delivered?
Yes
No
Not clear
3. Were the groups treated equally other than the difference in the interventions?
Yes
No
Not clear
4. If no difference was found, was the sample size large enough to detect a difference if one
existed?
Yes
No
Not clear
5. If a difference was found, are you confident it was due to the intervention?
Yes
No
Not clear
Are the findings consistent with findings of other studies?
Yes
No
Not clear
Are the findings credible?
Yes
No
Not clear
Clinical Significance
Is the target population clearly described?
Yes
No
Not clear
Is the frequency, association, or treatment effect impressive enough for you to be confident that the finding
would make a clinical difference if used as a basis for care?
Yes
No
Not clear
Are the findings clinically significant?
Yes
No
Comments
Not clear
Rewatch the same Patient Interview. This time, you will focus on writing the diagnosis and differential discussion. The discussion should include the following sections:
A summary of findings
Psychodynamic formulation
Primary diagnosis with ICD code
Prognosis
Plan including medications, labs, therapy, patient education, follow up, non-pharmacological treatments
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So what’s been happening over the past week or two that prompted you to make this appointment? I’ve been feeling really down and I’m crying over everything, OK? And when did you first begin to have these kind of problems? I’ve been feeling pretty depressed for the past four months. It’s just been the worst year ever. I was laid off and then I wound up losing my job. My mom died and I had to identify her body, which was very traumatic. And I also have a special needs son who is in the hospital for a week, I’m sorry to hear about your mom, that must have been hard. How is your son doing now? Oh, he’s better now. Thanks for asking. He’s autistic and has epilepsy. I feel like I’m always waiting for the next crisis or hospitalization. It just makes me anxious sometimes. Oh, I understand. Being a mother of a special needs child must be challenging at times. I’m glad to hear he’s doing well now. You also mentioned you lost your job. What do you do for a living? I have a bachelor’s in art history and I worked at the museum. I’ve always had a job up till now. So it’s been a big change for me. Yeah, that must be a big change in the dynamic for you and your husband. How long have you been married? We’ve been married ten years. OK, well, I’m glad he’s been a good support for you. I’m just checking. This is your only marriage. Yes. OK, and how would you describe your marriage? You know, we’re a great team. My husband’s a teacher and he’s he’s very supportive. Good. And do you have a lot of friends or other supportive relationships or groups? Uh, not really. I’m not very religious and I don’t belong to any groups or anything. I mean, I have a few friends, but having a special needs child keeps me pretty busy. Yeah, tell me, have you ever had symptoms like this before? Yes, I had postpartum depression after my son was born. Otherwise, I’ve always been able to manage. But lately, everything has been building up and I’m just not coping very well. I feel like I cry over every little thing. Well, when you’ve had depression before, did you see a therapist or take any medication need to be hospitalized for mental health? Yes, I took Paxil and I saw a therapist for about a year, but I never needed to be in the hospital. OK. Was that helpful for you? Yes. I think things gradually got better as I learned how to handle the stress of being a mother of a special needs child. Good. What about your mental health in general? Do you take any other medications? Yes, I have high blood pressure and I take lisinopril. OK. Do you have any allergies to foods or medications and have you had any surgeries, no allergies? I had a C-section with my son, but that’s the only surgery. OK, well, it sounds like you’ve been pretty healthy, except for the blood pressure. I’d like to ask you more about how you’re feeling now. You’ve been feeling depressed for four months. How has this affected your energy? Yes, I feel like I sleep all the time, but I’m still tired. OK, so you’re sleeping more than normal. But what about motivation? Do you feel less motivated to do things you normally do? Yes, I thought it was because I’ve been so tired, but I just can’t seem to even start doing anything, dishes are piling up in the laundry needs to be done. And I’m not working right now. So there’s no reason to be behind on any of these things. But I just look at the mess and I can’t get up the energy to start doing it. And then I feel guilty for just sitting around doing nothing. I see. That sounds like you have no motivation and you’re feeling overwhelmed and guilty. It must be very frustrating for you. It sounds like it might be making you feel worse. Let me ask you, how’s your appetite? Most days I don’t even feel like eating. I think I’ve lost some weight, but I haven’t checked, OK? Have you had any thoughts about hurting yourself or anyone else? That day, the day my son was in the hospital, I thought it might have given him the wrong dose of his seizure medication and I I felt like it could have been my fault that he was in the hospital. And I I thought about taking pills. I was in a really bad place that day.
My husband made me feel better. He made me realize that I’ve been giving in this medication every day for years. And I probably was just worrying about our son and and feeling guilty. And that’s not even why my son was admitted anyway. He had an allergic reaction. So I know I didn’t do anything wrong. Yeah. Look, feelings of guilt are part of the symptoms of depression. So it makes sense that you are feeling guilt even though, you know, an allergic reaction couldn’t have been your fault. Your husband sounds like he’s a supportive spouse, so I’m glad you have them. Have you had any other thoughts of suicide or hurting yourself? No, I, I know that I, I couldn’t do that to my family, but that made me realize how bad the depression was getting in that I really need to get help.
I’m OK, I’m OK, I’m just I’m just feeling really overwhelmed, yeah, it’s OK. I’m certainly glad you were able to recognize that you need help and you’re here today. We’re definitely going to be able to recommend some therapy and treatment to help you start feeling better. I understand that you’re feeling overwhelmed, but this is what we do here and you’ve come to the right place. Do you feel like you’re ready for a few more questions? Yes, I’m I’m good. OK, has anyone in your family ever had psychiatric diagnosis? My mother also had depression. I think she took medication for it, but otherwise, no. OK, I’m looking at your intake form and it looks like you checked no to all of these. But I’m going to double check and ask you if you’re having any problems with various parts of your body moving from your head to your toes. Have you had any fatigue or weight loss? No. Do you have any problems with headaches, seizures, vision or hearing, smelling or taste throat problems or any thyroid problems? No. Any problems with your heart or lungs, like shortness of breath or coughing? Uh, problems with your stomach, bowels or urination? No. Any problems trying to move your arms or legs? I don’t think so. Joint problems or problems walking and. No. Any rashes? No. Any problems with seizures, numbness or tingling? Uh, have you noticed any bruising or bleeding? Uh, overall, I’m feeling OK today. Good. I’m glad to hear that. Now we’re going to talk a little bit about your background. Can you tell me a bit about where and how you grew up? I was born and raised here with both my parents. And I have a brother who’s two years younger than me. And how would you describe your parents and childhood? Um, my parents were loving. I had a pretty good childhood. I guess lots of friends did pretty well in school. How would your parents react when you got into trouble? I really got into trouble, but they would just ground me. So no spanking or abuse of any kind? No, no, nothing like that. OK, what about school? Were there any problems with bullying or did you have any struggles with low self-esteem? Not really. I was a star student, pretty active in sports. I had a lot of friends. Good. And you never had any legal problems either? No. So just a few last questions about tobacco, alcohol and drugs. Do you use any now or have you ever taken any in the past? I drink wine and I use marijuana edibles occasionally, but I’ve never smoked cigarettes or used any other drugs. OK, well, I think we’ve covered everything unless there’s anything else you want to add. No, I think I’ve told you everything about me. OK, good. Next, we’ll talk about a treatment plan for you. Purchase answer to see full
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Review figure 11.5, Explanation of benefits, in the textbook. Answer the following three questions.
a. Why are the charge and allowable charge different amounts? Explain your answer in technical terms and then explain your answer in layman’s terms.
b. Differentiate between the contractual adjustment and the charge. Explain your answer in technical terms and then again in layman’s terms.
c. If the procedure on line 4 was denied by the payer for incorrect coding, how would the benefit payment change? What are the revised benefit payment and coinsurance amounts?
Title: Theories of Psychotherapy & Counseling: Concepts and Cases
Author: Richard Sharf
Publisher: Cengage Learning
Edition: 6th
ISBN Code: 9781305087323
ISBN Code 2: 9781305087323
Originality ReportSafeAssign enabled
Discussion Question 3: Person-Centered Therapy
In person-centered therapy, core conditions such as unconditional positive regard, empathy, and congruence are essential to successful therapy. Discuss why these conditions are so crucial in establishing the relationship between therapist and client and how might the therapeutic process be affected if these conditions are lacking?
Research Assignment: Changes in Professional Practice
This activity is designed to help the student compare nursing research to current nursing practice. In the classic research article, The Hazards of Immobility (1967), Download The Hazards of Immobility (1967),the effects of immobility on the functions of various body systems are discussed, as well as the nursing interventions utilized to prevent these effects.
The student will read the article and select one of the functions to research. The student will locate a minimum of two (2) current nursing research articles related to the selected function to compare and contrast to this classic nursing research article.
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Add to these posts with journal article as a reference.
Post One :
Comments on key findings
There is a significant improvement of preparedness to disaster by individual hospitals since the start of the Hospital Preparedness Program (HPP); I will comment that quality and safe services have been guaranteed to patients or victims of disasters. Since disaster planning programs started in 2002, the individual hospitals have received training and tools to handle emergencies. Private hospitals and organizations are community-based organs that respond quickly to disaster and have more information about the community than the public hospitals. Thanks to UPMC for findings that help the government to implement disaster and response programs.
The Coalitions of Emergency response teams are building a foundation for preparedness; Health facilities have formed coalitions in the effort of strengthening the disaster preparedness services through sharing the HPP programs. Collaborations and coordination between hospitals, both private and public have enhanced the emergency and disaster response teams operations. Through the networking of hospitals, training and tools or resources have been shared or acquired. I comment that both the private and public hospitals have played a significant role in enhancing all-disaster preparedness. I congratulate the UPMC for engaging the government for such quality research that has enlightened the healthcare field. Better services are now a guarantee to victims whenever they occur.
In our hospital, the funding sources are well established non-profit organizations based on healthcare services. The government is part of the funding source to our emergency management programs. We also receive grants from individual well-wishers. Stakeholders play a significant role in opening channels through which funds come to our facility to serve our people. Our facility is private and has sustained the quality level of services through such support from other non-governmental organizations. We hope to deliver the best quality and safe services in the future to help our people.
References
Toner E, Waldhorn R, Franco C, Courtney B, Rambhia K, Norwood A, Inglesby TV, OToole T.
(2009). Hospitals rising to the challenge: The first five years of the U.S. hospital preparedness program and priorities going forward Prepared by the Center for Biosecurity of UPMC for the U.S. Department of Health and Human Services under Contract No. HHSO100200700038C.
U.S. Department of Health and Human Services Assistant Secretary for Preparedness and
Response: Strategic Plan 2010 – 2015.
Post Two:
Comment on one of the key findings described in the Toner et al. document.
My most focus this semester is the individual preparedness of the hospital regarding emergencies. I choose to focus on the first critical findings in Toner document “disaster preparedness of individual hospitals has improved significantly throughout the country since the start of HPP” (Toner et al., 2009). In this finding, individual hospitals in the US increased emergency preparedness by engaging top leaders such as CEO in planning for disaster preparedness and response, established situational awareness and communication capability to increase efficiency, and improved on the dynamics of disaster planning. Before 2002, individual hospitals had little emergency preparedness, and the introduction of the health development program has agitated the need to be prepared to mitigate emergency impacts and hospital operations. Post-2002, senior leadership has recognized the need for emergency preparedness and developed a new perception of what disaster can cause. The results of the preparedness have been investments to avail resources, rigorous coordination with community emergency plans such with the fire departments, increases quality planning from coordinators, training to staff on specific responsibilities and role in the event of a disaster, improved communication agencies with hospital departments among others. From my analysis, individual hospital preparedness has evolved compared to the past perceptions that were inclined to emergencies.
Identify other funding sources for your hospital emergency management projects.
Individual Hospital management on emergency is expensive. However, hospitals can cover some expenses directly from the facility while others require funding from outside sources such as Feds. Also, commitment from the state, local and federal government bodies is essential to facilitate preparedness in hospital and protect the social welfare of Americans as well as across the globe (Public Health Emergency, 2019). Fundings have to be in the form of resources and equipment’s useful for prevention and responding to emergencies. For example, funding to avail vaccines is a mitigating measure while funding for new construction of a facility is as a result of the occurrence of a disaster.
HHS BARDA: in partnership with public health vaccine to fund a vaccine against Marburg and other related bioterrorism infections to offer a solution in America and across the globe.
Competitive grants from the state, federal, and private organizations are issued to assist in planning and mitigating emergencies such as fire or natural disasters.
Charging high cost for health care services and taxes and devoting the resources to emergency programs.
State funds for emergency programs.
Emergency medical service fund
References
Toner E, Waldhorn R, Franco C, Courtney B, Rambhia K, Norwood A, Inglesby TV, OToole T. (2009). Hospitals rising to the challenge: The first five years of the U.S. hospital preparedness program and priorities going forward Prepared by the Center for Biosecurity of UPMC for the U.S. Department of Health and Human Services under Contract No. HHSO100200700038C.
Hospitals Rising to the Challenge:
The First Five Years of the U.S. Hospital Preparedness Program
and Priorities Going Forward
Evaluation Report | March 2009
Sponsored by the U.S. Department of Health and Human Services under Contract #HHSO100200700038C
The Center for Biosecurity is an independent, nonprofit organization of the University of Pittsburgh Medical Center (UPMC).
The Centers multidisciplinary professional staff, with experience in government, medicine, public health, bioscience, law, and
the social sciences, works to affect policy and practice in ways that lessen the illness, death, and civil disruption that would
follow large-scale epidemics, whether they occur naturally or result from the use of a biological weapon. Experts at the Center
publish research findings regularly and are consulted by government agencies, businesses, academia, and the media for independent analyses of issues pertaining to national and global epidemic preparedness and response.
Center for Biosecurity of UPMC
The Pier IV Building
621 E. Pratt Street, Suite 210
Baltimore, Maryland 21202
443-573-3304
http://www.upmc-biosecurity.org
Acknowledgments
This work was commissioned by the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (ASPR), under Contract No. HHSO100200700038C. This report would not
have been possible without the more than 100 dedicated and committed hospital and state preparedness planners and other experts who contributed their time to provide the Center for Biosecurity project team with critical
insight into the state of U.S. hospital preparedness, or without the participants of the June 2008 Issue Analysis
Meeting in Baltimore, Maryland. The project team would also like to give special thanks to the leadership and
staff of the ASPR Office of Preparedness and Emergency Operations components of the Hospital Preparedness
Program and State and Local Evaluation for their guidance and support in the development of this report.
Suggested Citation
Toner E, Waldhorn R, Franco C, Courtney B, Rambhia K, Norwood A, Inglesby TV, OToole T. Hospitals Rising
to the Challenge: The First Five Years of the U.S. Hospital Preparedness Program and Priorities Going Forward.
Prepared by the Center for Biosecurity of UPMC for the U.S. Department of Health and Human Services under
Contract No. HHSO100200700038C. 2009.
Hospitals Rising to the Challenge:
The First Five Years of the U.S. Hospital Preparedness Program
and Priorities Going Forward
Evaluation Report | March 2009
Project Team
Center for Biosecurity of UPMC
Eric Toner, MD (Principal Investigator)
Senior Associate
Richard Waldhorn, MD (Co-Principal Investigator)
Distinguished Scholar
Crystal Franco (Project Manager)
Senior Analyst
Brooke Courtney, JD, MPH
Associate
Kunal Rambhia
Analyst
Ann Norwood, MD, COL, USA, MC (Ret.)
Senior Associate
Thomas V. Inglesby, MD
Deputy Director and Chief Operating Officer
Tara OToole, MD, MPH
Director and Chief Executive Officer
Project Contacts: Eric Toner, MD, and Richard Waldhorn, MD
Hospitals Rising to the Challenge | March 2009
Contents
List of Tables and Figures……………………………………………………………………………………………………………iii
Executive Summary……………………………………………………………………………………………………………………. v
I. Project Overview
Summary………………………………………………………………………………………………………………………………. 1
Methodology…………………………………………………………………………………………………………………………. 2
II. State of U.S. Hospital Preparedness Prior to the Hospital Preparedness Program
Historical Context…………………………………………………………………………………………………………………… 7
Pre-HPP Hospital Preparedness Research…………………………………………………………………………………. 11
III. History of the Hospital Preparedness Program
Legislative and Funding History………………………………………………………………………………………………. 17
Program Guidance (FY2002FY2008)……………………………………………………………………………………….. 19
Impact of Guidance Evolution on Data Collection and Reporting………………………………………………… 20
Hospital Preparedness Research Conducted after HPP Implementation……………………………………….. 21
IV. Key Findings
1. Disaster preparedness of individual hospitals has improved significantly
throughout the country since the start of the HPP………………………………………………………………….. 23
2. The emergence of Healthcare Coalitions is creating a foundation for
U.S. healthcare preparedness. ……………………………………………………………………………………………. 36
3. Healthcare planning for catastrophic emergencies is in early stages; progress
will require additional assistance and direction at the national level…………………………………………. 46
4. Surge capacity and capability goals, assessment of training, and analysis of
performance during actual events and realistic exercises are the most useful
indicators for measuring preparedness………………………………………………………………………………… 55
V. Conclusions
1. The HPP has improved the resilience of U.S. hospitals and communities and
increased their capacity to respond to common medical disasters.………………………………………. 57
2. The HPP should focus on building, strengthening, and linking Healthcare
Coalitions to lay the foundation for a national disaster health and medical
response system……………………………………………………………………………………………………………….. 58
3. Administrative adjustments to the HPP could improve the programs
effectiveness and efficiency. ………………………………………………………………………………………………. 59
4. To prepare the nation to respond to catastrophic emergencies, HHS should
provide continued leadership to assist states in their efforts to address the many
procedural, ethical, legal, and practical problems posed by a shift to disaster
standards and ACFs that is required when demand for care overwhelms available resources……… 60
5. Catastrophic emergency preparedness is a national security issue and requires
the continued funding of the HPP………………………………………………………………………………………… 61
Center for Biosecurity of UPMC
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Hospitals Rising to the Challenge | March 2009
Appendix A. List of Acronyms……………………………………………………………………………………………………. 63
Appendix B. Center for Biosecurity Descriptive Framework for Healthcare
Preparedness for Mass Casualty Events: The Framework and Crosswalk of
Elements of Preparedness………………………………………………………………………………………. 65
Appendix C. Map of Working Group Participants Contacted for Participation…………………………………. 79
Appendix D. HPP Guidance Terminology by Year…………………………………………………………………………. 81
Appendix E. Summary of HPP Program Guidance: FY2002FY2008………………………………………………. 83
Appendix F.
Summary of Studies on Hospital Preparedness Since the Establishment
of the HPP by Year…………………………………………………………………………………………………. 87
Center for Biosecurity of UPMC
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Hospitals Rising to the Challenge | March 2009
List of Tables and Figures
Table 1. Number of Virtual Working Group Participants by Sector………………………………………………….. 4
Table 2. Studies on Pre-HPP Hospital Preparedness by Year………………………………………………………….. 12
Table 3. Hospital Preparedness Program Funding: FY2002FY2009……………………………………………….. 18
Figure 1. Timeline of Significant Events for Healthcare Preparedness: 19892007……………………………… 9
Figure 2. Percent HPP Hospital Participation by Reporting States, Municipalities,
and Territories: 2006 (n = 58)………………………………………………………………………………………… 19
Figure 3. Percentage of Hospitals with Redundant Communications Capabilities by
Number of HPP-Participating States, Municipalities, and Territories: 2006
(n = 58)………………………………………………………………………………………………………………………. 30
Figure 4. Percent Hospital Use of Corrective Actions/Improvement Plans Following a
Drill or Exercise by Number of HPP-Participating States, Municipalities, and
Territories: 2006 (n = 58)………………………………………………………………………………………………. 36
Figure 5. HHS Medical Surge Capacity and Capability (MSCC) Framework………………………………………. 39
Figure 6. Multi-Agency Coordination (MAC) Model for Regional Healthcare
Emergencies ………………………………………………………………………………………………………………. 42
Figure 7. Percentage of HPP-Participating States, Municipalities, and Territories with
a Functional ESAR-VHP System that Allows Volunteer Health Professionals
to Register for Work in Hospitals or Other Facilities during Emergencies: 2006
(n = 62)………………………………………………………………………………………………………………………. 45
Figure 8. Administrative and Clinical Adaptations to Resource-Poor Situations…………………………………. 48
Center for Biosecurity of UPMC
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Hospitals Rising to the Challenge | March 2009
Executive Summary
Executive Summary
Hospitals are the backbone of the healthcare response to common medical disasters (i.e., mass casualty events
that occur with relative frequency, overwhelm a single hospital, and require a communitywide health response)
and, in particular, to catastrophic emergencies, such as an influenza pandemic or large-scale aerosolized anthrax
attack. The need for hospitals to be prepared to respond to disasters has increasingly become a priority for hospital leaders. They have been influenced by events such as the 2001 terrorist attacks and Hurricane Katrina and
the increased emphasis placed by accreditation organizations and regulatory agencies on the importance of such
disasters.
Established by the U.S. Department of Health and Human Services (HHS) in 2002, the goal of the Hospital
Preparedness Program (HPP)1 is to enhance the ability of hospitals and healthcare systems to prepare for and
respond to bioterror attacks on civilians and other public health emergencies, including pandemic influenza and
natural disasters. Current HPP priorities include strengthening hospital capabilities in the areas of interoperable communication systems, bed tracking, personnel management, fatality management planning, and hospital
evacuation planning. Past priorities include improving bed and personnel surge capacity, decontamination capabilities, isolation capacity, pharmaceutical supplies, training, education, drills, and exercises.
The HPP was initially administered by the Health Resources and Services Administration (HRSA). Congress directed the transfer of the HPP to the Office of the Assistant Secretary for Preparedness and Response (ASPR) under
the 2006 Pandemic and All-Hazards Preparedness Act (PAHPA).2 All 50 states, as well as the District of Columbia,
the nations three largest municipalities (Chicago, Los Angeles, and New York City), the Commonwealths of Puerto
Rico and the Northern Mariana Islands, three territories (American Samoa, Guam, and the U.S. Virgin Islands),
Micronesia, the Marshall Islands, and Palau, have received over $2 billion in HPP funding through grants, partnerships, and cooperative agreements since 2002.
In 2007, ASPR contracted with the Center for Biosecurity of the University of Pittsburgh Medical Center (UPMC)
(Center) to conduct an assessment of U.S. hospital preparedness and to develop recommendations for evaluating
and improving future hospital preparedness efforts. The first deliverable was the Centers Descriptive Framework
for Healthcare Preparedness for Mass Casualty Events,3 which is a description of the most important components
of preparedness for mass casualty response at the local and regional hospital and healthcare system levels (Appendix B). Hospitals Rising to the Challenge: The First Five Years of the U.S. Hospital Preparedness Program and
Priorities Going Forward is the second deliverable under the contract. It is the Centers assessment of the impact
of the HPP on hospital preparedness from the time of the programs establishment in 2002 through mid-2007, as
well as our preliminary recommendations for improving the state of U.S. hospital preparedness going forward.
This evaluation report is based on extensive analyses of the published literature, government reports, and HPP
program assessments, as well as on detailed conversations with 133 health officials and hospital professionals
representing every state, the largest cities, and major territories of the U.S.
1
2
3
The original name of the program was the National Bioterrorism Hospital Preparedness Program (NBHPP).
Public Law No. 109-417.
Toner E, Waldhorn R, Franco C, et al. Descriptive Framework for Healthcare Preparedness for Mass Casualty Events. Prepared by
the Center for Biosecurity of UPMC for the U.S. Department of Health and Human Services under Contract No.
HHSO100200700038C. 2008.
Center for Biosecurity of UPMC
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Hospitals Rising to the Challenge | March 2009
Executive Summary
Key Findings
Disaster preparedness of individual hospitals has improved significantly throughout the country
since the start of the HPP.
Since 2002, individual hospitals throughout the U.S. have made considerable progress in disaster preparedness.
For the most part, hospital senior leadership is actively supporting and participating in preparedness activities,
and disaster coordinators within hospitals have given sustained attention to preparedness and response planning
efforts. Hospital emergency operations plans (EOPs) have become more comprehensive and, in many locations,
are coordinated with community emergency plans and local hazards. Disaster training has become more rigorous
and standardized; hospitals have stockpiled emergency supplies and medicines; situational awareness and communications are improving; and exercises are more frequent and of higher quality.
The emergence of Healthcare Coalitions is creating a foundation for U.S. healthcare preparedness.
One of the most significant factors contributing to strengthened healthcare preparedness is the emergence of
Healthcare Coalitions, which, since the establishment of the HPP, have involved collaboration and networking
among hospitals and between hospitals, public health departments, and emergency management and response
agencies. These coalitions represent the beginning of a coordinated communitywide approach to medical
disaster response. If they can continue to be developed and strengthened around the country, coalitions would
logically become the foundation of a more robust national disaster health and medical response capacity, as
envisioned in Homeland Security Presidential Directive 21 (HSPD-21),4 to respond to catastrophic emergencies
in which one communitys Healthcare Coalition could come to the assistance of anothers coalition. The HPP has
played a critically important role in catalyzing the creation of these coalitions, which did not exist in most communities before the programs establishment.
Healthcare planning for catastrophic emergencies is in early stages; progress will require additional
assistance and direction at the national level.
The U.S. healthcare system is not currently capable of effectively responding to a sudden surge in demand for
medical care that would occur during catastrophic events, such as those described in the Department of Homeland Security (DHS) National Planning Scenarios.5 Emergencies of this magnitude would overwhelm the medical
capabilities of communities, regions, or the entire country and require drastic departures from customary healthcare practices. Such a phase shift in the provision of care to disaster standards would be unlike anything that
has ever been done in the U.S. It also is extremely difficult to plan for because it involves the development of
clinical standards of care for disasters and a process for implementing such standards, both of which raise complex clinical, legal (federal and state), and ethical issues. Most hospitals and states have begun to address this
problem and have found the Agency for Healthcare Research and Quality (AHRQ)/ASPR guidance documents,6,7
to be very useful, but none are adequately prepared. While many issues related to developing and implementing
disaster standards are ultimately state responsibilities, continued national leadership and direction are essential
for sustained state and local progress in catastrophic emergency planning.
4
5
6
7
The White House. Homeland Security Presidential Directive/HSPD-21. October 18, 2007.
http://www.whitehouse.gov/news/releases/2007/10/print/20071018-10.html. HSPDs were issued by President Bush
to communicate decisions about the nations homeland security policies.
U.S. Department of Homeland Security (DHS). National Preparedness Guidelines.
http://www.dhs.gov/xlibrary/assets/National_Preparedness_Guidelines.pdf. September 2007.
Agency for Healthcare Research and Quality (AHRQ), Assistant Secretary for Preparedness and Response (ASPR). Altered
Standards of Care in Mass Casualty Events. Prepared by Health Systems Research Inc. under Contract No. 290-04-0010.
AHRQ Publication No. 05-0043. Rockville, MD: Agency for Healthcare Research and Quality. April 2005.
Phillips SJ, Knebel A, eds. Mass Medical Care with Scarce Resources: A Community Planning Guide. Prepared by Health
Systems Research, Inc. under Contract No. 290-04-0010. AHRQ Publication No. 07-0001. Rockville, MD: Agency for
Healthcare Research and Quality 2007.
Center for Biosecurity of UPMC
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Hospitals Rising to the Challenge | March 2009
Executive Summary
Surge capacity and capability goals, assessment of training, and analysis of performance during
actual events and realistic exercises are the most useful indicators for measuring preparedness.
The most useful metrics for measuring individual hospital preparedness were those that were clearly defined and
not overly burdensome for hospitals. Useful HPP metrics included numerical surge capacity and capability goals
(e.g., targets for staff, supplies, and space), training of personnel, and performance during actual events and
structured exercises. Measuring individual hospital preparedness should also be based on the Joint Commission
Standards for Emergency Management, which already significantly overlap with HPP guidances. Assessment
of Healthcare Coalition preparedness should be based on the ability of coalitions to perform critical coalition
functions, such as providing situational awareness during an event and maintaining and operating reliable and
redundant communications systems.
Conclusions
The HPP has improved the resilience of U.S. hospitals and communities and increased their capacity
to respond to common medical disasters.
Prior to 2002, most hospitals did not have adequate plans to handle common medical disasters, much less
catastrophic emergencies comparable to the National Planning Scenarios. Over the course of six years, the HPP
has catalyzed significant improvements in hospital preparedness for common medical disasters. Hospitals have
implemented communications systems, incident command system concepts, stockpiles of medicines and supplies, situational awareness tools, and memoranda of understanding for sharing assets and staff during disasters.
The HPP should focus on building, strengthening, and linking Healthcare Coalitions to lay the
foundation for a national disaster health and medical response system.
The development of Healthcare Coalitions has been the single most important step toward preparing the U.S.
healthcare system to respond to catastrophic disasters that require the healthcare assets of an entire region or the
country. A national system of functional Healthcare Coalitions capable of responding to such disasters is unlikely
to develop without further federal support and guidance. To be able to respond collectively to these types of
catastrophes, the coalitions would need to be coordinated and linked with each other through a nationwide
system that could effectively call upon and coordinate all necessary national assets. The development of such a
system would clearly need to be integrated with existing federal and state disaster response programs and with
the development of a more robust national disaster health and medical system, as outlined in HSPD-21.8
Administrative adjustments to the HPP could improve the programs effectiveness and efficiency.
These changes include: transitioning the HPP grant to a multi-year project cycle, where awardees would have at
least two years to complete grant work; streamlining and coordinating all federal grants that contain guidance for
hospitals and public health agencies; creating or adopting a healthcare-specific National Incident Management
System (NIMS) training program for use by hospitals and public health agencies that participate in the HPP; and
continuing to phase in the Homeland Security Exercise and Evaluation Program (HSEEP) standards for hospital
exercises and drills in the HPP guidance.
8
The White House (2007).
Center for Biosecurity of UPMC
vii
Hospitals Rising to the Challenge | March 2009
Executive Summary
To prepare the nation to respond to catastrophic emergencies, HHS should provide continued
leadership to assist states in their efforts to address the many procedural, ethical, legal, and
practical problems posed by a shift to disaster standards and alternate care facilities (ACFs) that is
required when demand for care overwhelms available resources.
Hospitals and Healthcare Coalitions are struggling with how best to prepare for catastrophic emergencies that
may require a shift to disaster standards of care. While many of these issues must ultimately be addressed
and resolved at the state and local levels, states continue to struggle with some fundamental issues, including
developing clinical guidelines and procedural or legal frameworks for shifting to and using disaster standards.
HHS should continue to provide leadership and direction on these issues by: creating a resource for planners
across the U.S. to share information on approaches, guidelines, and tools for disaster standards that have been
developed by states, medical experts, professional societies, and others; convening a working group specifically
focused on implementing disaster standards of care and ACFs and on exploring the developme
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Read the statistics from Donate Life America below, then review the TEDtalk by Dan Ariely Are we in control of our own decisions?Links to an external site.. A specific section relevant to this discussion begins at 5:22. You can choose the Transcript tab, scroll to the timecode 05:22, then choose play, to go directly to the start of the section. Pay particular attention to two points in the talk, opt-in versus opt-out forms and subscriptions.
Although there have been advances in medical technology and donation, the demand for organ, eye and tissue donation still vastly exceeds the number of donors.
Donate Life America Statistics
More than 100,000 men, women, and children currently need life-saving organ transplants.
Every 10 minutes, another name gets added to the national organ transplant waiting list.
An average of 18 people die each day from the lack of available organs for transplant.
In 2011, 8,127 deceased organ donors and 6,017 living organ donors resulted in 28,535 organ transplants.
Last year, more than 42,000 grafts were made available for transplant by eye banks within the United States.
According to research, 98% of all adults have heard about organ donation, and 86% have heard of tissue donation.
90% of Americans say they support donation, but only 30% know the essential steps to take to be a donor.
You can join the discussion by responding to one or more of the questions below, or pose your analysis of the topic this week.
Should the U. S. go to an opt-out option on drivers licenses? Justify your position with more than an opinion.
Should people be allowed to sell a kidney?
Should there be a priority list other than best match for organ donation? How would you set up the priority list?
Should people be allowed to donate deceased loved ones organs?
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Our muscle strength, endurance, and power can benefit our daily activities, especially in our career fields. For example, a mailman/mailwoman may have a heavy load to load out, and to have stronger muscles or a good endurance, will help him to deliver mail/deliveries down a whole block.
For most, using the stairs and walking places can tire them out for a little. If we had good muscular endurance, we could walk more places and feel less tired at the end of the day. If a work building has stairs to get to certain floors, those with better endurance can get to their office quicker and also not have to worry about being tired as quickly as perhaps their coworker may have to.
Having good muscular strength also helps in lifting/grabbing/moving objects. For anyone who has to move furniture, clean, move items, or carry things around the house, muscular strength can help them do this also without tiring out and help them get more done in a shorter amount of time. Power isn’t needed as much in daily activities but perhaps it could also be used to lift and carry objects.
For me, my muscular fitness is at a low/average level. My consistency with exercise is not ideal because I’m only exercising every other week and only once a week. I take a dance class that lasts only 1 hr long. However, the intensity is high, so I do get a good workout when I go. Comparing myself to when I was in a really good fitness state, my state now would be low/average. My endurance hasn’t diminished as much, but my muscle strength has. My flexibility has also diminished slightly. I would say that my power has also diminished too. I wouldn’t say I have completely reversed my level of good fitness, but I would place myself in the low/average fitness level.
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Healthcare organizations need to create a robust culture of emergency preparedness. Organizational commitment, training, and collaboration with the community are crucial to enhance the preparedness in the case of disasters. The organizations also require strong leadership and individual commitment towards ensuring a culture of preparedness. To this end, four components are required. Firstly, building and fostering relationships is required to identify critical stakeholders in society (Barrett & Whaley-Martin, 2013). Healthcare organizations should also formulate processes that enhance effective communication (Medina, 2016). For instance, this can assist stakeholders to observe and understand the incident command or response system. Also, organizations should test response plans to assess the effectiveness of results in the case of a disaster (Barrett & Whaley-Martin, 2013). However, these testing plans should be executed frequently. Organizations should also identify potential hazards. This ensures the proper identification and resolution of issues before they arise (Medina, 2016).
Various strategies are used to sustain emergency preparedness programs. It is crucial to ensure the commitment of leaders, partnerships, and proper funding of these programs. Financial grants enhance the sustainability of emergency preparedness programs by ensuring that there is enough funding for activities associated with the response, recovery, and mitigation of the disaster (Barrett & Whaley-Martin, 2013). The creation of a regional coordination plan is also crucial since it provides guidelines for resolving such issues. Consequently, it enhances the sustainability of these programs. These plans should be tested to meet the needs of the healthcare organization. It may include changing the procedures to sustain and enhance the effectiveness of operations when hazards occur. Political commitment is another important aspect of ensuring the sustainability of such programs (Barrett & Whaley-Martin, 2013). Partnerships with other agencies can also increase the collaboration and sustainability of disaster preparedness programs.
References
Barrett, C., & Whaley-Martin, A. (2013). Connections matter when disaster hits. Retrieved from https://www.chausa.org/publications/health-progress/article/november-december-2013/connections-matter-when-disaster-hits.
Medina, A. (2016). Promoting a culture of disaster preparedness. Journal of Business Continuity & Emergency Planning, 9(3), 281-290.
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