Checklist

Safety / Infection Control Activities

Develop a pandemic safety plan and appoint a safety officer to modify as required.

Develop an agency/facility pandemic safety plan and appoint a safety officer to modify as required.

Provide staff education about COVID-19 infection control and update polices as required.

Support N95 respirator fit-testing for all agency/facility employees and just-in-time education on recommended infection control precautions including fit checking, applying simple mask to patients with cough, and hand hygiene.

Monitor availability of N95 respirators/powered air-purifying respirators (PAPRs) and other supplies including alcohol-based hand disinfectants, gloves, etc., and watch and alert coalition members to supply shortages. Make recommendations on possible alternatives.

Prepare guidelines for conservative and re-use of N95 respirators/PAPRs if severe shortages are imminent (ideally regionally and in conjunction with local public health, occupational safety, and infection prevention providers and agencies - for example, consider use by only the highestrisk staff, re-use in selected situations, continued use while working on cohorted units, etc.).

Plan contingencies if appropriate levels of respiratory protection are unavailable.

Develop guidance for staff monitoring for signs of illness (including self-reporting, selfquarantine, and start/end of shift evaluation) and create a mechanism for reporting both illness and absenteeism.

Develop a return to work post illness policy for health care workers. This should be as consistent as possible across the coalition.

Encourage HCFs to plan for staff access to medical care for themselves and their families; determine whether illness will be handled as workers' compensation or personal insurance depending on situation/criteria and share best practices.

Hospitals and Health Care Activities
Coordination Regulatory Activities

Determine coordination mechanisms, scope, and likely authorities between coalition hospitals and health care systems including information sharing, resource monitoring/assistance, and policy coordination. This should include the role of the coalition to engage with vendors of PPE, pharmaceuticals, and other medical supplies that may be in shortage. Conduct a coordination conference call with healthcare facilities to ensure awareness and consistency

Determine mechanism to engage outpatient settings (homecare, ambulatory care) in information sharing and policy/response coordination.

Determine mechanisms to engage skilled nursing facilities in information sharing and policy/ response coordination.

Determine actions that the state of emergency management or public health agency is likely to take that affect health care including:
• Suspension or modification of requirements for hospitals or clinics
• Specific emergency orders or actions that may limit liability or expand scope of operations (for facilities and providers, including volunteers)
• Requests for 1135 waivers from the Centers for Medicare & Medicaid Services (CMS)
• Crisis standards of care activation
• Issuance of clinical guidelines for care and resource allocation
• 'Taking powers' of the state relative to medical materials and staff (i.e., does the state have ability to commandeer resources under their emergency powers and does this include medical materials?)
• Promulgation or enforcement of legal obligations of medical staff to provide care

Evaluate available indicators that may be needed for planning or by other partners and how to track them, e.g., number ED visits available beds, available ventilators, number of potential COVID-19 cases, staff illness/absenteeism.

Evaluate indicators that have effects on hospitals and coordinate access through the health care coalitions (e.g., status of EMS agencies, alternate care sites, epidemiologic information/forecasting, availability of supplies).

Determine a process for expedited credentialing of supplemental staff and for the orientation/mentoring of supplemental or shared staff.

Determine threshold for use and priority list for supplemental staff (e.g., first shared health care system staff, then similarity credentialed and licensed staff, then Medical Reserve Corps, etc.)

Determine indicators and potential triggers for implementation of alternate care systems in conjunction with public health.

Develop public messages that emphasize using emergency departments only for life-threatening emergencies and coordinate with the joint information system. Be prepared to manage the expectations of the public relative to scarce resources (what is the shortage, what is being done, who are the priority groups, etc.).

Health Care Facility Activities

Determine incident management activation/configuration based on impact (phased approach) as well as incident action plan cycle and development process.

Identify SMEs to inform operational decisions and potential resource allocation decisions.

Determine methods for patient/family information provision including alternate languages/interpretive services.

Determine staff communication mechanisms and redundant information management process.

Determine indicators and potential triggers for changing services provided (e.g., limit elective services).

Determine strategies to maintain services for at-risk patients during outbreak period (e.g., pregnant, dialysis) but unrelated to COVID-19.

Determine likely resource shortages and identify relevant vendor, cache, and coalition options for managing shortages.

Develop service restriction plans in case of staff shortages or increased demand (e.g., respiratory care, nutritional support, pharmacy, laboratory, radiology, elective surgeries/procedures).

Develop/update crisis standard of care language in emergency operations plan including the potential for triage decision-making (who, process, communication, considerations) and staff management (how will staff expertise be maximally utilized vs. add additional training for some staff.

Evaluate the plan for providing just-in-time staff education via electronic and other nonclassroom means including information about the COVID-19, transmission, infection prevention measures, usual clinical symptoms and course, risk factors, and complications.

Emergency Department Activities

Determine screening process and location (e.g., curb side screening prior to entry, supplemental screening at intake, etc.).

Determine how suspect cases will be isolated from other waiting patients and during ED care.

Emphasize hand and respiratory hygiene and other infection prevention techniques through education, policies, signage, and easy availability of supplies.

Develop referral plans for patients that do not need emergency care.

Develop care plans that reduce the number of staff caring for suspect/confirmed cases and protocolize care.

Adjust daily nursing expectations/duties as required to meet demand.

Develop environmental services room decontamination and waste stream plans.

Assure the specific needs of pediatric and at-risk populations are addressed in surge capacity planning.

Provide patients and families with information about stress responses, resilience, and available professional mental health/behavioral health resources.

Develop palliative care plans for implementation when needed.

Outpatient Services/Community Health Centers/Free Standing Health Facilities Activities

Develop staffing plan to allow for expanded service hours when needed. Determine if outpatient locations and services should remain open if the threat is too great to staff and patients.

Determine screening process and location (e.g., curbside screening prior to entry, supplemental screening at intake, separate well/ill clinics, etc.).

Develop telemedicine service plan for use for patients with special needs or general population.

Develop a plan to expedite medication refills, obstetrician visits, and other office visits prior to the arrival of COVID-19 cases in the community. The practice should have days to weeks to pre-emptively manage its workload in anticipation of limited elective services during the outbreak period.

Develop a process for screening and triage of phone and email requests for care to limit office visits to those that require an in-person provider evaluation.

Develop a process to limit/cancel non-essential visits which can `flex' with the demands of the COVID-19 outbreak.

Emphasize hand and respiratory hygiene and other infection prevention techniques through education, policies, signage, and easy availability of supplies. Develop patient movement and transportation route plans.

Evaluate maximal use of space. Convert specialty clinics to acute care, extend hours, etc.

Consider which clinics may be converted into in-patient units (e.g., surgicenters).

Develop referral/deferral plans for patients that do not need acute care (e.g., perform virtual/telephone medication management, automate prescription refills).

Homecare Activities

Determine incident management process and authorities; assure administrative engagement and support.

Establish prioritization process for homecare intake or ongoing services including denial and referral to other services. Adjust home visit schedules and responsibilities as required.

Establish liaison process with hospitals to share information on current and projected capacity and needs.

Establish liaison process with health care coalition to provide updates on capacity and assist with resource and staffing issues including the process for requesting additional resources from coalition partners or emergency management.

Determine contingency staffing plan.

Address staff transportation-related issues that may be anticipated such as reduced access to fuel.

Develop/provide education to homecare professionals about COVID-19 transmission, and complications (in addition to infection control/staff safety information as outlined above).

Emphasize hand and respiratory hygiene and other infection prevention techniques through education, policies, signage, and easy availability of supplies.

Develop/provide just-in-time training to staff taking on non-traditional roles as required to maintain critical services. Coordinate with health care coalition to determine potential options.

Obtain or develop printed materials (including at appropriate reading level and in relevant languages) for clients including information about COVID-19 (including infection prevention measures and clinical disease), service modifications due to COVID-19, and resources. These materials should encourage patients to have at least a 30 day supply of usual medications on hand.

Long-term Care/Skilled Nursing Activities

Determine incident management process and authorities; assure administrative engagement and support.

Liaison with the health care coalition/hospitals to assure maximal available residential beds.

Determine potential supply shortages and work with vendors and the health care coalition if resource availability is limited.

Develop a process to address shortages of supplies at the facility level including administration, nursing, medical direction, and subject matter expert input - ideally this can be a regional construct rather than at each facility.

Develop a plan for more advanced care at the facility if hospital capacity is unavailable. This should involve nursing, medical direction, administrative representatives, and include consideration of telemedicine.

Determine any potential regulatory relief (CMS 1135 or other waivers, state regulations relief, staffing requirements, etc.) that may be needed to effectively respond to COVID-19 as well as issues regarding staff licensure/certification.

Determine with medical director and nursing director changes in thresholds for emergency department referral. These may vary across the period according to demand.

Evaluate potential staffing and responsibility changes and how less-trained staff and families could contribute to operations.

Evaluate potential staffing and responsibility changes and how less-trained staff and families could contribute to operations.

Develop a process for rapid credentialing and training of non-facility supplemental health care staff.

Alternate Care Site/System Activities

Assure integration with public health and other health systems regarding consistent scripts for web and telephone based nurse triage lines/9-1-1 public safety answering points/ poison control centers/locally generated "apps" and integration with additional telephone/virtual prescribing - particularly for at-risk populations.

Determine support needed from the health care system for `flu clinics' for early screening and treatment as planned by public health.

Understand/assist with plan for alternate care site(s) for hospital overflow - roles, responsibilities, authorities, staffing, material resources, criteria, level of clinical care (understanding that this may not be feasible if staff absenteeism is high at the hospitals).

Assure the specific needs of pediatric and at-risk populations are addressed in surge capacity planning.

Assure enough staff, supplies, prophylaxis, and logistical support are on hand before opening the site.

Provide patients and families with information about stress responses, resilience, and available professional mental health/behavioral health resources.

Completion

Additional Comments

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Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.