Download 5-1 Facility Resource Assessment (Tool)

Hospital Surge Capacity Toolkit
Chapter 5 – Supplies, Equipment, Pharmaceuticals
CHAPTER 5 – SUPPLIES, EQUIPMENT, PHARMACEUTICALS
5-1
FACILITY RESOURCE ASSESSMENT (TOOL)
Note to Safety/Emergency Management Manager – As noted in the Table of Contents below,
sections of the Facility Resource Assessment (Tool) [FRAT] are separated by the department
responsible for its completion. When distributing sections for completion, be sure to also include
a copy of the Overview & Instructions and the Standard Assumptions.
Table of Contents
To Be Completed By:
1.
Personal Protective Equipment (PPE) .........................Safety/Emergency Management
2.
Decontamination ..........................................................Safety/Emergency Management
3.
Ancillary Services ........................................................Safety/Emergency Management
4.
Transport/Receiving Capacity ............................................ Transportation Unit Leader
5.
Surgical Capacity ............................................................................ Director of Surgery
6.
Isolation Capacity ....................................................................................... Engineering
7.
Physical Plant Operations ........................................................................... Engineering
8.
Hospital Labs ................................................................................................ Laboratory
9.
Bed Capacity ...................................................................................................... Nursing
10.
Surge Capacity Staffing ..................................................................................... Nursing
11.
Pharmaceutical Caches ................................................................................... Pharmacy
12.
Ventilators...................................................................................... Respiratory Therapy
May 2008
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Chapter 5 – Supplies, Equipment, Pharmaceuticals
Hospital Surge Capacity Toolkit
Overview and Instructions
This assessement tool can be completed prior to or during a surge emergency to assess facility
resources. Once completed, the data compiled can be utilized in various ways to manage the
surge emergency. Examples of supporting sections include (but are not limited to):



1-4, Transportation
2-6, Surge Plan Phases 1-5 (Tool)
5-2, Hospital Mutual Aid System MOU (Model)
Please follow the instructions below carefully before completing each section of the FRAT:
1.
Please read Standard Assumptions before beginning.
2.
Enter information in the shaded boxes.
3.
Answer all questions to the best of your ability. Feel free to comment on questions
or answers that require explanation.
4.
Please return your portion of the survey to the Safety/Emergency Management
Manager upon completion.
Standard Assumptions
The purpose of these assumptions is to create a common baseline for reporting.
1
Measure resources only under hospital control.
2.
Do not expect mutual aid from outside your facility for at least 96 hours.
3.
Assume an emergency proclamation is in place and that licensing and regulatory
requirements have been modified.
4.
Reported surge capacity must be that which exists above average daily occupancy
(census). (For the purposes of this survey, “average daily occupancy” (census)
should be computed as the average daily number of occupied beds of the preceding
year, 2007).
5.
Report for inpatient care areas only.
6.
Report for two classes of surge beds:
a.
b.
Critical Care/Monitored Beds
General Medical-Surgical Beds (Unmonitored)
7.
Use austere nurse-to-patient staffing ratio of 1:5 for Critical Care Beds (Monitored
Beds) and 1:20 for Other Medical-Surgical Beds (Unmonitored Beds).
8.
Assume need to self-sustain care within the facility for a minimum of 96 hours
without re-supply of equipment, supplies, or staff.
9.
Assume 40% of staff will not report to work due to inability to get there, illness, or
safety concerns.
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Hospital Surge Capacity Toolkit
Chapter 5 – Supplies, Equipment, Pharmaceuticals
(SECTIONS 1 THROUGH 3 TO BE COMPLETED BY SAFETY/EMERG. MGMT.)
HOSPITAL NAME: _______________________________
SECTION 1.
DATE: ________________
PERSONAL PROTECTIVE EQUIPMENT (PPE)
Additional Assumption:
Hospital Personnel Requiring PPE: All employees of the hospital: medical staff (both fulltime and part-time), per diem workers, and independent physicians caring for patients at the
facility. Include medical transport providers employed by hospital.
Use the following definition for PPE:
Level C Protection – Includes all of the following: powered air-purifying respirator (PAPR),
hooded chemical-resistant clothing, gloves, and boots.
HPP (formerly HRSA) recommends that adequate PPE be available to protect current and
additional healthcare personnel during an incident and be tied directly to the number of
healthcare personnel needed to support surge capacity for beds. The surge goal for acute
infectious disease is 1 per 2,000 population above daily census. At a minimum, each hospital
should have 10 Level C units, including PAPRs, suit, gloves, and boots.
Please estimate the following:
Total #
1.
Total number of hospital personnel and independent
physicians caring for patients at the facility requiring PPE.
2.
Number of powered air-purifying respirators (PAPRs).
3.
Number of N95 masks used on a daily basis.
4.
Do you have a protocol for N95 mask distribution and use
during an emergency?
Circle:
Yes No
5.
Do you have an emergency stockpile of N95 masks?
Circle:
Yes No
6.
If yes, how many N95 masks do you currently have in your
emergency stockpile?
7.
Number of complete Level C Protection PPE sets (includes
PAPR, hooded chemical-resistant clothing, gloves, boots).
8.
Number of personnel trained to utilize Level C PPE.
May 2008
Notes
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Chapter 5 – Supplies, Equipment, Pharmaceuticals
Hospital Surge Capacity Toolkit
SECTION 2.
DECONTAMINATION FOR RADIOACTIVE CONTAMINATION
Additional Assumption: Relative to decontamination, units should only be counted if owned
by the hospital and not Fire or Hazmat operated.
1.
Please describe decontamination set-up:
Notes
2.
Total number of portable units.
3.
Number of shower heads per portable unit.
4.
How many ambulatory patients per hour can be decontaminated
per portable unit?
5.
How many non-ambulatory patients per hour can be
decontaminated per portable unit?
6.
Total number of fixed units.
7.
Number of shower heads per fixed unit.
8.
Total number of Geiger Counters.
SECTION 3.
ANCILLARY SERVICES
Please estimate the total availability and capacity of the following ancillary services and
testing/treatments:
Service/Test/Treatment
1.
Blood Bank (on-campus)
2.
CT Scanners
3.
Magnetic Resonance Imaging Machines
4.
Renal Dialysis Unit – Inpatient
5.
Renal Dialysis Unit – Outpatient
May 2008
Total #
of Units
Staffed
24 hours?
Notes
5-1  Facility Resource Assessment (Tool)  Page 4 of 13
Chapter 5 – Supplies, Equipment, Pharmaceuticals
Hospital Surge Capacity Toolkit
(SECTION 4 TO BE COMPLETED BY TRANSPORTATION UNIT LEADER)
HOSPITAL NAME: _______________________________
SECTION 4.
TRANSPORT/RECEIVING CAPACITY
Transportation
1.
Shuttle Buses
2.
Vans
3.
Cars
4.
Trucks
5.
Helicopter
6.
Helicopter Landing Site
Internal
Transportation
7.
Gurneys
8.
Litters
9.
Stretchers
DATE: ________________
Total #
# of Patients Able
Owned by to Transport at
Hospital
One Time
Location
Notes
N/A
Total #
Owned by
Hospital
Location
Notes
10. Wheelchairs
May 2008
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Chapter 5 – Supplies, Equipment, Pharmaceuticals
Hospital Surge Capacity Toolkit
(SECTION 5 TO BE COMPLETED BY DIRECTOR OF SURGERY)
HOSPITAL NAME: _______________________________
SECTION 5.
DATE: ________________
SURGICAL CAPACITY
Location
1.
Surgical Suites for Non-Specialized Cases
2.
Negative Air/Isolation Operating Rooms
3.
Recovery Room (PACU)
4.
Endoscopy Suites
5.
Cardiac Catheterization Suites
6.
Other (e.g., Clinics On-Campus)
# of Suites
Notes



May 2008
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Chapter 5 – Supplies, Equipment, Pharmaceuticals
Hospital Surge Capacity Toolkit
(SECTIONS 6 AND 7 TO BE COMPLETED BY ENGINEERING)
HOSPITAL NAME: _______________________________
SECTION 6.
DATE: ________________
ISOLATION CAPACITY
Additional Assumption: Airborne Infection Isolation Rooms (AIIR), also known as Negative
Pressure Isolation Rooms, should only be counted if they are currently operational for
patients with highly infectious respiratory disease admitted to your acute care hospital.
Room
# of Units
1.
Airborne Infection Isolation Rooms with a minimum of
6 air changes per hour vented to the outside, and equal
or negative pressure in relation to the main corridor?
2.
Fixed High-Efficiency Particulate Air (HEPA) isolation
systems currently on site?
3.
Portable HEPA isolation systems on site?
4.
Under surge, how many additional portable HEPA
isolation systems can be leased, rented, or purchased?
5.
From what vendors? (Please provide names and contact
information)
6.
Does your vendor contract include language citing other
regional obligations of the vendor?
7.
From the time of your request, how long would you
estimate it would take to have the requested portable
HEPA isolation system on-site under regular operation?
SECTION 7.
Notes
PHYSICAL PLANT OPERATIONS
General
1.
What is the average number of engineers on-site?
2.
Maximum?
Notes
Emergency Power
Notes
3.
How many generators do you have serving inpatient
areas?
4.
Do they parallel?
Circle: Yes No
5.
If not, do you have full redundancy for every generator?
Circle: Yes No
If not, what redundancy do you have? Explain.
6.
What percent load can your smallest generator carry?
7.
Do you have generators providing emergency power to
non-inpatient buildings?
8.
What is your average fuel capacity solely dedicated to
emergency power?
9.
How many hours of full emergency load does this
capacity supply?
May 2008
%
Circle: Yes No
________ Gallons
________ Hours
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Chapter 5 – Supplies, Equipment, Pharmaceuticals
Hospital Surge Capacity Toolkit
General
Notes
10. Is boiler fuel oil shared with the generators?
Circle: Yes No
11. Are generators or switchgear susceptible to flooding
(external or internal) or seismic failure?
Circle: Yes No
12. What percent of negative pressure patient room fan
systems are on emergency power?
_________ %
13. Are any chillers on emergency power?
Circle: Yes No
14. What percent of normal summer load?
_________ %
15. Have you finished you Sentinel Event Alert #37 Gap
Analysis?
Circle: Yes No
16. If so, have findings been presented to leadership?
Circle: Yes No
17. Is there a major vulnerability during an earthquake?
Circle: Yes No
18. Are boilers dual-fuled?
Circle: Yes No
19. How many gallons of boiler fuel oil do you have?
________ Gallons
20. How many hours of heating capability is this?
_________ Hours
21. Are high-pressure boilers (steam sterilization) fed by
fuel oil or natural gas?
Circle: Fuel oil
Natural gas
22. How many hour of steam sterilization?
_________ Hours
Water
23. How much on-site emergency water storage do you
have?
Notes
________ Gallons
24. Do you have an external tank that a tanker truck could
replenish?
Circle: Yes No
25. How many days, at 1 gallon/person/day, can this
provide?
[Vol/(Lic. Beds +
Staff)] _____ Days
26. Is there a functioning well on your site?
Circle: Yes No
27. If so, how many gallons per hour can it produce?
________ Gallons
28. Is there an automatic treatment system to render the
water potable?
Circle: Yes No
29. Is the well water piped into the building?
Circle: Yes No
Medical Gas Systems
Notes
30. Do you have more than one set of medical air
compressors?
Circle: Yes No
31. Are they interconnected in case one set fails?
Circle: Yes No
32. Do you have more than one set of medical vacuum
pumps?
Circle: Yes No
33. Are they interconnected in case one set fails?
Circle: Yes No
May 2008
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Chapter 5 – Supplies, Equipment, Pharmaceuticals
Hospital Surge Capacity Toolkit
(SECTION 8 TO BE COMPLETED BY LABORATORY)
HOSPITAL NAME: _______________________________
SECTION 8.
HOSPITAL LABS
Total
1.
What is the maximum number of Basic
Chem-7 Panels & CBCs that can be
completed per hour with average
laboratory staffing?
2.
What is the maximum number of Basic
Chem-7 Panels & CBCs that can be
completed per hour with maximum
possible staffing?
May 2008
DATE: ________________
Notes
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Chapter 5 – Supplies, Equipment, Pharmaceuticals
Hospital Surge Capacity Toolkit
(SECTIONS 9 AND 10 TO BE COMPLETED BY NURSING)
HOSPITAL NAME: _______________________________
SECTION 9.
DATE: ________________
BED CAPACITY
Please list the number of beds at your hospital according to the following categories, using the
average daily occupancy in 2007. The following definition is from the Agency for Healthcare
Research and Quality (AHRQ):
Available Beds: Beds that are licensed, physically set up, and available for use. These are
beds regularly maintained in the hospital for the use of patients, and include accommodations
and supporting services (such as food, laundry, and housekeeping). These beds may or may
not be staffed but are physically available.
Notes
1.
Average daily inpatient occupancy for
2007
2.
Average daily inpatient percent
occupancy for 2007
%
Total #
Available Beds
3.
Adult Critical Care/Monitored Beds
4.
Adult General Medical/Surgical Beds
(Unmonitored)
5.
Pediatric Critical Care/Monitored Beds
6.
Pediatric General Medical/Surgical Beds
(Unmonitored)
Notes
Combined Total
Please estimate the total number of beds that would come from the following:
# of Beds
7.
Early dismissals
8.
Canceled elective procedures
9.
Cots
Notes
10. Gurneys
Combined Total
May 2008
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Chapter 5 – Supplies, Equipment, Pharmaceuticals
Hospital Surge Capacity Toolkit
Please estimate the total number of beds that could be positioned in the following:
Location
# of Beds
Notes
11. Hallways
12. Outpatient Clinic
13. Day Surgery Center
14. Imaging Center
15. Other onsite spaces:



Combined Total
SECTION 10. SURGE CAPACITY STAFFING
1.
Does your facility have a system in place to manage professional and allied health
healthcare volunteers?
Circle: Yes No
2.
Does your facility have a system in place to manage non-healthcare volunteers?
Circle: Yes No
3.
Does your surge staffing plan include services and care (e.g., child care) for healthcare
workers’ families, to allow the employees to report for duty?
Circle: Yes No
May 2008
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Hospital Surge Capacity Toolkit
Chapter 5 – Supplies, Equipment, Pharmaceuticals
(SECTION 11 TO BE COMPLETED BY PHARMACY)
HOSPITAL NAME: _______________________________
DATE: ________________
SECTION 11. PHARMACEUTICAL CACHES
Additional Assumption: Hospital personnel and medical staff include all employees of the
hospital (both full-time and part-time), temporary and per diem workers, and medical staff.
Include all persons performing any hospital-based function, including direct healthcare and
transport, as well as other support services.
Notes
1.
Total number of hospital personnel and medical staff.
Please provide information on the current supply (inventory) of the following at your facility:
2.
Amoxicillin 250 mg capsules
3.
Amoxicillin 500 mg capsules
4.
Ciprofloxacin (Cipro) 500 mg tablets
5.
Doxycycline 100 mg tablets
6.
Levofloxacin (Lavaquin) 500 mg tablets
7.
Do you currently have pediatric dosage forms (i.e.,
liquid or powder for oral suspension) available for any
of these drugs (for treating family members)?
8.
If yes, please provide the number of children for whom
a 3-day supply of prophylactic antibiotics is currently
available.
9.
Does your facility have a current supply (inventory) of
oseltamivir (tamiflu)?
10. If yes, how many packages (each package is one blister
pack of 10 75-mg capsules) of oseltamivir (Tamiflu) do
you have?
Circle: Yes No
Circle: Yes No
______ packages
11. Assuming supplies are available, does your facility plan
to acquire stockpile or increase your current stockpile of Circle: Yes No
oseltamivir (Tamiflu)?
12. If yes, how many additional packages (blister pack of 10
75-mg capsules) of oseltamivir (Tamiflu) will you
______ packages
acquire?
13. Does your facility currently maintain a supply
(inventory) of zanamivir (Relenza)?
Circle: Yes No
14. If yes, how many Relenza packages (inhalers) do you
have?
______ packages
May 2008
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Hospital Surge Capacity Toolkit
Chapter 5 – Supplies, Equipment, Pharmaceuticals
(SECTION 12 TO BE COMPLETED BY RESPIRATORY THERAPY)
HOSPITAL NAME: _______________________________
DATE: ________________
SECTION 12. VENTILATORS
Notes
1.
What is the approximate number of operational
ventilators currently on site?
2.
What is the average number of ventilators in use
on a daily basis over the last 12 months?
3.
What is the approximate number of transport and
disposable ventilators located at your hospital?
(Examples include: Vortran Automatic
Resuscitator, Surevent Disposable Automatic
Resuscitator, CAREvent EMT.)
4.
How many ventilators, if any, can be mobilized
from associated long-term care, sub-acute
facilities, or other satellite clinic facilities?
5.
How many additional ventilators can be leased,
rented, or purchased by your facility to
accommodate a sudden surge of patients?
6.
From what vendor(s)? Please provide name(s) and contact
information.



7.
Does your vendor contract include language
citing other regional obligations of the vendor?
8.
From the time of your request to the vendor, how
long would you estimate it would take to have the
requested equipment on site and ready for patient
use?
9.
How many qualified staff does your facility have
to operate ventilators and manage ventilatory
care? Response should include all trained staff,
not only respiratory therapists, and may also
include people trained to use the “transport” and
“disposable” models.
May 2008
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