Preparing Your Practice for Pandemic Influenza

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Preparing Your Practice for Pandemic Influenza

• Zsolt Nagykaldi, PhD and Jim Mold, MD, MPH
• OUHSC Department of Family and Preventive
  Medicine, OKC

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Objectives

• Review most important Federal and State
  guidelines for pandemic preparedness
• Demonstrate best practices learned from a recent,
  AHRQ-funded OKPRN project (Task Order 2)
• Provide an outline for hands-on planning in your
  practice
• Show what you can do now to improve your surge
  capacity and preparedness

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What We Have Learned From The Literature

• Level of practice preparedness is unsatisfactory
  (only 21 reported well prepared Alexander
  et al, 2006)
• Limited community-level planning (local
  coordination, communication, prioritization of
  resources, command)
• Lack of primary care clinician and mid-level
  training for pandemic / disaster scenarios
• Lack of funding and planning for Personal
  Protective Equipment (PPE), antivirals, and
  vaccines
• Various gaps between the public and private
  sectors (state-level communication, coordination,
  organization)
• Lack of definitions and metrics (e.g. surge
  capacity), especially in primary care
• Serious gaps in reimbursement (preparation
  execution)
• Successful models and best practices do exist
• Issues of legal / financial protection are
  nebulous

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Pandemic Influenza Scenarios

• Likelihood Likely (10-60 years), but timing is
  unknown
• Potential Impacts 1968-type scenario (moderate)
  
• 1918-type
  scenarios (severe to catastrophic)

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Most Likely Scenario

• Department of Homeland Security, 2004

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CDC Recommendations for Medical Offices

• Web www.hhs.gov/pandemicflu/plan
• www.pandemicflu.gov/plan/healthcare/med
  ical.htm
• Checklist divided into three parts
• Structure for planning and decision-making
• Development of a written pandemic influenza plan
• Elements of an influenza pandemic plan

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Structure for Planning and Decision-Making

• A planning committee
• A clinician
• A nurse or M.A.
• A representative of the clerical staff
• Office manager (and patients??)
• A designated pandemic flu coordinator
• A point of contact (e.g. at county or state
  health department)

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Development of a Written Plan

• Obtain and review federal and state plans
• http//www.ok.gov/health/
• (Disease, Prevention, Preparedness Public
  Health and Medical Systems Preparedness and
  Response Pandemic Influenza)
• Obtain and review community response plan and/or
  help develop one
• Plan for receiving notifications and obtaining
  copies when federal, state, and local plans are
  updated (role for OKPRN)

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Elements of a Plan

• Plan for monitoring influenza activity and public
  health advisories (OSDH surveillance OK-HAN
  PHIDDO)
• Method for reporting unusual cases of flu-like
  illness
• Names and numbers of key public health and other
  key healthcare entities (hospitals, EDs, home
  health agencies, nursing homes, commercial
  clinical labs, relevant community organizations)
• Plan for notification and triage of both sick and
  non-sick patients (significant communication gap)
• Local infection control measures
• Vaccine and antiviral use plan (rationing)
• Occupational health plan for employees

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Triage and Surge Management Principles

• Develop written triage protocols for influenza in
  your practice
• Train and empower your nurse(s) and office staff
  to implement triage protocols
• Review and adjust protocols periodically
• Implement some of these protocols routinely
  during seasonal influenza outbreaks (e.g.
  antiviral Tx, patient self-management phone
  support)

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Infection Control Measures 1

• MASKS mnemonic
• Masks for patients with cough and fever
• Alcohol gel for sanitizing hands
• Seat potentially infectious patients apart from
  others (over 6 feet)
• Klean by disinfecting hard surfaces and
• Signs in waiting room and exam rooms and verbal
  support

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Infection Control Measures 2

• If possible, separate patient paths and
  practice
• teams (flu and clean team / clinic)
• Acquire Personal Protective Equipment (PPE)
• and test their use (make plans for obtaining
  more in
• a surge)
• Build personal hygiene culture in your practice
• Teach your patients best hygiene practices
  during
• seasonal influenza outbreaks
• Put patient self-management support systems in
• place (phone and online triage and patient
• education see TO2 tools)

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Vaccine and Antiviral Use Plans

• Come up with a shared prioritization plan
• Coordinate the acquisition and distribution of
  supplies in your community
• Develop local partnerships to share resources
  across institutions and sectors (public/private)
• Plan multiple coordinated campaigns to reach out
  (send unified message to public)
• Use technology to facilitate patient
  self-management, tele-triage, and communication
• Work with local agencies to secure order

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Occupational Health Plan for Employees

• Ensure personal safety of your staff and their
  families' before they are called to serve others
  (50 may not show up)
• In-practice, hands-on training is much more
  effective than theoretical training with little
  relevance to primary care practice
• Develop a continuous practice self-support plan
  for staff including accommodation, food,
  medications, communication with family, special
  needs
• Staff skill-set may need to be expanded to
  include general disaster management skills (e.g.
  more substantial first-aid)
• Skills that are not practiced regularly usually
  deteriorate by time (ongoing practice and testing)

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Enabling Preparedness Technologies

• Practice websites 15-20 penetration, no time or
  expertise to design or update sites (advantages
  ubiquitous, standard)
• Telephony systems limited use, no expertise
  (advantages inexpensive options, easy operation
  and access, high level of reach)
• Mass e-mail provider misconceptions, low
  utilization, address database update issues,
  (adv. ubiquitous, standard)
• Patient portal very low penetration, high cost
  add-on, maintenance issues, (advantages high
  level of personalization)
• Patient registry data searches, i.d. of high
  risk population)
• Billing and scheduling system patient
  demographics data
• Text messaging alternative in young and ethnic
  populations
• Mass media general public health messages or
  practice tailored messages in rural areas

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Questions

• ?
• www.okprn.org/News/ILITraining.html
• znagykal_at_ouhsc.edu