1. WcMhpc LTC “bad bug” Exercise October 24th, 2018
WCHPC LTC EXERCISE

2. Exercise Objectives 1.Staffing during a crisis…
2.Isolation & EVS during a crisis
3.Communications during a crisis
Exercise Objectives
WCHPC LTC EXERCISE

3. Contact information for HMAC
Phone
WCHPC LTC EXERCISE

4. Inject #1 (00:00)
During morning bathing, a CAN reports to the RN that she noted a small rash on “Rose”, a dementia patient in the “memory unit” at your facility. The rash is located in the webbing of the fingers and elbow folds.
Discussion/activity:
What are the initial steps that the facility will do?
Record note in resident's chart
Complete a more formal skin assessment on “Rose” with RN
Notify rounding provider of noted rash
WCHPC LTC EXERCISE

5. Inject #2 (00:05)
In another wing of the facility, a second CNA reports to their RN similar findings on “Dan”, a new resident that came from a homeless shelter via the hospital for rehab secondary to community acquired pneumonia. “Dan” states that he has had this rash in his “private” area for about a week or two and is has gotten much worse recently moving onto his waist and up his back/shoulder blades. He also states that it has a rather “nasty” itch. He notes that it was “really hard to play bingo a few days ago as he had to itch a lot and that made playing difficult; a few of his table mates had to move closer to him to help him with his card.
Discussion/activity:
What additional questions should be asked at this time?
Would a trend be noticed within the facility?
Is there a daily way to have all unit leads meet and chat about trends?
WCHPC LTC EXERCISE

6. Inject #3 (00:10)
After morning rounds, the charge nurse calls the Administrator on call and notifies them that there is a “suspicious rash” on a few of the patients
Discussion/activity:
What are the next steps
On call provider notification for examination
Do you have an in-house infectious disease specialist
If not, who could you call
WCHPC LTC EXERCISE

7. Inject #4 (00:20)
Staff are beginning to openly discuss the news of a “rash outbreak”
Discussion/activity:
What type of communication to staff could/do you use
Dose your facility utilize social media
For staff notification
To get in front of the “rumor train”
What about others that may need to know
LPH
MDH
Regional Partners
WCHPC LTC EXERCISE

8. Inject #5 (00:30)
The rounding provider has arrived and has stated that it is their impression that this may be some sort of “scabies” like rash, he would like to get more information from some resources and in the mean time he would like to have skin assessments done on all residents that are in the facility, especially those that were at bingo a few days back.
Discussion/activity:
What would it take to do skin assessments on all residents
How do you communicate this to staff without instilling fear in them
WCHPC LTC EXERCISE

9. Inject #6 (00:35)
Staff are stating that they do not feel safe and are threatening to leave. They do not believe that the facility can protect them from this “nasty” bug
Discussion/activity:
What can you do to reassure the staff
Do you have PPE
Are your staff trained to wear this type of PPE
Gloves
Gown
No skin-to-skin, skin-to-clothing, or clothing-to-clothing contact
WCHPC LTC EXERCISE

10. Inject #7 (00:45)
A local media source is asking for a report form the facility as they have received information from and “valued” source that there is a “crisis” at the local LTC facility
Discussion/activity:
Do you have a PIO
Have they received proper training
Will they speak alone or with representation and support MD
LPH
WCHPC LTC EXERCISE

11. Inject #8 (00:55)
The nursing staff that are caring for the male with pneumonia and rash state that he is now having increased difficulty with his breathing, he has an alter level of consciousness, and his vital signs are getting “bad”; they think he might be having a reaction to one of the new antibiotics that he was started on yesterday for his pneumonia
Discussion/activity:
How do you handle this
Do you notify EMS of the possible special precautions
Would you contact the hospital to give a brief report as to the current situation and possible need for isolation at the hospital
WCHPC LTC EXERCISE

12. Inject #9 (01:05)
The skin checks have been completed and there are 3 additional residents and 1 staff that have similar rash with itch.
Discussion/activity:
What are your plans with the 5 residents, do you have a plan to address this issue
Isolation
treatment
What do you do about the staff member, do you have a plan to address this issue
Treatment
Do you need to notify any outside resources at this time
LPH
MDH
Regional Partners
WCHPC LTC EXERCISE

13. The End Please take a moment to gather your thoughts
A de-brief session and time for you to complete the evaluations will take place shortly
WCHPC LTC EXERCISE

14. Summarize the Exercise
Identify that this is a safe forum for open and honest conversation
What went well during the exercise?
What did not go so well?
Are there any suggestions or areas for improvement?
Have each participant complete the evaluation form.
Summarize the Exercise
WCHPC LTC EXERCISE

15. Complete the Survey Monkey
A link will be sent from the to a survey monkey
Please complete one per facility as a group or compile the information form each participant and fill out one survey per site.
WCHPC LTC EXERCISE

16. The End…
Thanks for participating and we at the HMAC hope this was not only enjoyable, but that you were able to take something away for future reference, planning, and response…
Shawn Stoen, WCHPC RHPC
David Miller, C & WC HPC Education & Exercise
WCHPC LTC EXERCISE