Crisis Standards of Care: State of Arizona Clinical Workgroup Agenda - PDF document

3/6/2014 Crisis Standards of Care: Crisis Standards of Care: State of Arizona Clinical Workgroup • Agenda for October 11, 2013 State of Arizona Clinical Workgroup – 1230 ‐ 1245 • Introductions – 1245 ‐ 1300 Arizona Dept of Health Services & Partners • IOM crisis standards of care (CSC) – 1300 ‐ 1400 Phoenix, AZ • Discuss possibilities for expanded scopes of practice for healthcare professionals during CSC October 11, 2013 – 1400 ‐ 1500 • Discuss possible methods for reporting status of limited space, staff, & supplies (3Ss) at a healthcare facility during CSC Facilitator – 1500 ‐ 1530 Frank G. Walter, MD, FACEP, FACMT, FAACT • Wrap up azdhs.gov azdhs.gov He alth and We llne ss for all Ar izonans He alth and We llne ss for all Ar izonans 2 Crisis Standards of Care: Arizona CSC: Approved by SDMAC Planning Committee, 6/27/13 State of Arizona Clinical Workgroup Desired Future Develop & implement a compassionate, ethically-based healthcare response for State catastrophic disasters, using crisis standards of care (CSC) co-developed by key stakeholders. Vision Arizona will become a national model in CSC planning and implementation by • Review work of 7/17/13 meeting February 2014. Mission Provide framework & standards for response to & recovery from catastrophic • Objectives for 10 ‐ 11 ‐ 13 disasters, enabling optimal community resilience for the healthcare system, statewide. – Recommend expanded scopes of practice for Values Transparency: Provide open, honest, factual, & timely communication & information sharing. healthcare professionals during CSC Consistency: Implement processes & procedures across the continuum of care; applying the same methodologies to achieve optimal community health. Fairness: Support respect & dignity for all populations when providing healthcare across the – Recommend methods for reporting status of continuum of care. Accountability: Take responsibility for actions, complete assigned work, & follow through on limited space, staff, & supplies (3Ss) at a requests & communications. Resiliency : Provide for the recovery of emotional, spiritual, intellectual, and mental health healthcare facility during CSC needs and facilitate the well-being of the community. Evidence-based: Formulate decisions on medically founded, state-of-the-art, & research tested (when available) facts & processes to promote optimal community health. azdhs.gov azdhs.gov He alth and We llne ss for all Ar izonans He alth and We llne ss for all Ar izonans 3 4 Crisis Standards of Care: Presentation Outline for 10 ‐ 11 ‐ 13 State of Arizona Clinical Workgroup • Accomplishments on July 17, 2013 • IOM crisis standards of care (CSC) – Recommended activation criteria for crisis • Expanded scopes of practice for healthcare standards of care (CSC) professionals during CSC – Recommended primary, secondary, & tertiary • Methods for reporting status of limited space, triage methods for limited healthcare staff, & supplies (3Ss) at a healthcare facility resources during CSC • Using evidence ‐ based guidelines when possible azdhs.gov azdhs.gov He alth and We llne ss for all Ar izonans He alth and We llne ss for all Ar izonans 5 6 1

3/6/2014 IOM Crisis Standards of Care IOM Crisis Standards of Care • Seek community & provider engagement • Substantial change in usual healthcare operations & level of preparing for & during CSC care • Justified by specific circumstances • Adhere to ethical norms during CSC • Formally declared by state government • Provide necessary legal protections for healthcare – Scope providers & institutions using CSC • > Statewide • Ensure intrastate & interstate consistency during – May authorize • Alternate care sites CSC • Alternate staffing levels – Clear indicators, triggers, & lines of responsibility • Expanded scopes of practice • Long ‐ term crisis – Evidence ‐ based clinical processes & operations azdhs.gov azdhs.gov He alth and We llne ss for all Ar izonans He alth and We llne ss for all Ar izonans 7 8 IOM CSC: 3 Cs Allocation of Specific Resources along the Care Capacity Continuum • Conventional care Incident demand/resource imbalance increases – Space, staff, & supplies (stuff) [3Ss] in daily practice Risk of morbidity/mortality to patients increases Recovery • Contingency care CSC Triggers Conventional Contingency Crisis – 3Ss not used in daily practice Space Space fully used Patient care areas Non ‐ patient care areas used for patient repurposed care • Functionally equivalent patient care Facility may be damaged or unsafe Staff Usual staff called in & Expanded staff Trained staff unavailable or unable to – Patient care areas repurposed working responsibilities care for volume of patients Elective procedures & – Elective procedures & admissions deferred admissions deferred Stuff Cached & usual supplies Conservation, adaptation, & Critical items lacking – Expanded staff responsibilities used substitution with safe re ‐ Possible re ‐ allocation of life ‐ sustaining – Conserve, adapt, & substitute supplies use of select items resources Standard of Care Unchanged Functionally equivalent care Best possible care in difficult – Safely re ‐ use select supplies circumstances with limited resources: Requires state empowerment for Normal Operations Extreme Operations • Crisis care SDMAC activation, Clinical guidance & protection for triage – Adaptive 3Ss not used in daily practice decisions, & Authorization for alternate care sites – Best possible care in difficult circumstances with limited Source: IOM, Crisis Standards of Care, 1 ‐ 41 resources azdhs.gov azdhs.gov He alth and We llne ss for all Ar izonans He alth and We llne ss for all Ar izonans 10 Scope of Practice Presentation Outline for 10 ‐ 11 ‐ 13 • Definition • IOM crisis standards of care (CSC) – Extent of licensed healthcare professional’s ability • Expanded scopes of practice for healthcare to provide services consistent with their professionals during CSC • Competence • Methods for reporting status of limited space, • License staff, & supplies (3Ss) at a healthcare facility • Certification during CSC • Privileges Source: IOM, Crisis Standards of Care, 1-41 & 7-4 azdhs.gov azdhs.gov He alth and We llne ss for all Ar izonans He alth and We llne ss for all Ar izonans 11 2

3/6/2014 Scopes of Practice Scopes of Practice • EMTs • Healthcare providers should practice in • Nurses – NA, LPN, RN interprofessional teams, practicing to the top – APN, CNS, NP of their licenses. – RNFA, Nurse Anesthetist – Thomas R. Frieden, MD, MPH • Pharmacists – Head of the U.S. Centers for Disease Control and • Physicians Prevention (CDC) • Physician’s Assistants • Psychologists azdhs.gov azdhs.gov He alth and We llne ss for all Ar izonans He alth and We llne ss for all Ar izonans Scopes of Practice Scopes of Practice • Possibilities • Possibilities – Limited licensure reciprocity – Non ‐ EMS expanded scopes of practice • Recognize out ‐ of ‐ state healthcare licenses for the duration of a healthcare crisis • Relaxed documentation requirements – EMS expanded scopes of practice • Altered staffing ratios • New, external staff • Alternate destination policies or vehicles • New tasks with just ‐ in ‐ time training, in addition to • Treat & release prior preparedness training • Hospital evacuation – Minimum risks • Vaccine administration – Maximum population benefits • New tasks with just ‐ in ‐ time training – In addition to prior preparedness training • New practice settings or durations • New practice settings or durations – Clinics – Clinics – Units, etc. – Hospitals, etc. azdhs.gov azdhs.gov He alth and We llne ss for all Ar izonans He alth and We llne ss for all Ar izonans Colorado Legislation: Arizona Board of Nursing Emergency Medical & Trauma Services Act • Governs all nursing practice • Allows physicians assistants (PAs) & EMTs to practice under the supervision of any licensed Colorado • Nursing practice legislated & reflected in physician rules & regulations • Allows for out ‐ of ‐ state physicians & nurses with • Advisory opinions issued for extended licenses in good standing & Colorado physicians & practice nurses with inactive, unrestricted Colorado licenses to – Practice under the supervision of a licensed Colorado physician or nurse azdhs.gov azdhs.gov He alth and We llne ss for all Ar izonans He alth and We llne ss for all Ar izonans 3