Sweltering summers: Will your disaster plan help you beat the heat?
Sweltering summers: Will your disaster plan help you beat the heat?
Coordinate with your hospital to help protect patients
Last summer's long and brutal heat waves contributed to the deaths of hundreds of people, especially the elderly, prompting home health care companies around the country to change the way they respond to extreme heat.
As the heat wave season approaches, Hospital Home Health asked providers in the areas hardest hit by heat waves last summer what they'll do differently this summer. While all providers interviewed said they needed to be more prepared for a potentially life-threatening heat wave, not all agreed that this should be included in a company's disaster preparedness plan.
"Traditionally, a disaster plan included instructions for what you'll do if your nurses can't get to patients because of snow, flood, or a hurricane. In a heat wave it's not the same because you can get to your patients. But because of last year's experience, we need to look for what we have to do in heat, too," says Carol Klein, RN, MPH, the director of professional services at Community Nursing Service of DuPage, in Carol Stream, IL. The company is affiliated with Central DuPage Hospital, in the Central DuPage Health System.
Klein is putting an addendum in her company's disaster preparedness plan that will detail the steps her staff should take when a heat wave occurs. At Saint Francis Medical Center Home Health Department in Peoria, IL, administrative manager Patty Ham, RNC, MS, is developing a separate heat preparedness plan with her clinical staff, social workers, and home health aides, which will be added to the company's disaster preparedness plan.
Whether the subject of heat waves is added to a company's disaster plan, HHH's sources say the new steps they would take to keep patients and staff safe during this summer's hottest days would include the following:
* Upon admission, identify all patients at risk for heat problems.
This summer, Ham's company will have identified all patients considered to be at risk because of environmental or other factors that can be exacerbated by hot weather.
"During the crisis [last year] we'd think, 'OK, this person's at risk for heat problems, and that person's at risk.' That was fine. We handled it, but we need to be more prepared than that," Ham says.
Some of the following factors, when coupled with extremely hot weather, can put patients at risk:
-- suffering from cardiac conditions;
-- having respiratory problems;
-- being a post surgical patient;
-- having multiple system disorders;
-- being immobile or disabled;
-- being very old or very young;
-- having no air conditioning;
-- living alone.
The type of building a patient lives in can put a patient at risk, too, says Susan Schulmerich, RN, MS, MBA, CNA, CEN, the director of Montefiore Medical Center Home Health Agency, in New York City.
"We have a lot of patients who live in old buildings. You'll find them living on the top floor of a four-story walkup with a flat roof and only one window, with no air conditioning or a fan. It'll be over 90 degrees in there. Not only does the patient suffer, but the staff does too in places like that. It's very draining on them," Schulmerich says.
Patients with these risk factors will have their files flagged at the time the patient is admitted to home care at Ham's company.
* Prepare packets of emergency information.
Providers interviewed said their staff were swamped with patients and families calling with questions about where the local "cooling centers" (air conditioned places open to the public) were, what transportation was available, and how to take care of oneself in the heat.
In response, Donna Sierzega, BSN, the clinical nursing supervisor at Rush Home Care Network in Chicago, wrote a newsletter for her staff last summer to help them remember everything they needed to teach their patients. The newsletter also helped the office staff when fielding calls from patients, and reminded all staff to take good care of themselves. The newsletter contained tips on what types of clothing to wear in the heat, advice to go easy on the air conditioning in their cars to prevent it from overheating, and lists of the city's cooling centers and phone numbers for them.
Sierzega also had an educational flier printed up for patients and staff that gave tips and facts about health risks of extreme heat, including:
-- Drink lots of fluids (not those with high sodium or caffeine).
-- Don't go outdoors.
-- Don't do yard work or any other strenuous work.
-- Keep your lights off indoors.
-- Don't use your oven or stove.
-- Refrigerate your medications, even saline solutions such as heparin or those used for wound dressings;
-- Go to a cooling center if you have a heart condition or if you don't have air conditioning or a fan.
-- Take three cool showers a day.
-- Watch for the signs and symptoms of heat stroke and dehydration, including profuse sweating or no sweating at all, confusion, rapid pulse, flushing, lethargy, and confusion.
* Make sure patients have air conditioning or an electric fan.
Klein's addendum to her company's disaster plan will direct field staff to take note of whether a patient has air conditioning or a fan. If they don't have an electric fan, the nurses will contact the patients' families or caregivers to let them know they need to either move the patient out of his or her home until the heat subsides, or they need to get the patient air conditioning or an electric fan.
Ham's agency also has started a special fund that employees can donate to for various reasons. The money from this fund is being used to buy some electric fans to lend to patients who might need one this summer.
* Instruct aides in heat safety for their patients.
"The aides shouldn't be overlooked. We have to make sure they do everything they should to help patients keep cool, like giving them tepid baths, letting them air dry rather than toweling them dry, and ensuring that patients dress appropriately," Ham says.
* Include heat safety in patient education.
All of the sources for this article are asking their field staff to adapt their patient education teaching methods to the possibility of extreme heat. Klein's staff now teach patients to understand how extreme heat could affect their diseases, to drink more fluid, to call home care if they get in trouble with the heat, and to dress appropriately to stay cool.
Patients should be told what can happen if they don't take care of themselves, Schulmerich says. "For example, an elderly patient on cardiac therapy who perspires a lot and loses electrolytes; this can make their medicines have a weird effect," she explains.
"I remind the nurses to look for signs of problems with the heat in their patients, and I tell the aides and therapists that if they see that a patient is having problems in the heat, to alert their supervisor immediately," Klein says.
* Make sure staff document the teaching they do with patients about heat safety.
As with everything else field staff do for patients, nurses must be careful to document the patient education they do during a heat wave, Sierzega says. Ultimately, what the patients do with the information they're given is their decision, and they can disregard your advice if they want to. To protect your company from potential liability, make sure your nurses document fully that they explained heat wave safety precautions to their patients or their caregivers.
Check on patients
* Call to check on risk patients not scheduled for visits.
Ham's plan is still being drafted but is likely to include directions for the care staff to call patients who aren't scheduled for a visit during the heat wave, but who are considered to be at risk for heat-related problems. The nurse would ask these patients how they are doing and if they have air conditioning or a fan, as well as remind them of the safety precautions they should take during a heat wave.
Also, the nurses will ask if the patients have transportation to a cooling center if their homes are too hot to be considered healthy. If they don't have transit, the nurses will help arrange it by calling the patient's family, friends, or social services.
* Use community resources as much as possible.
If a patient doesn't have family or friends who can help, then Klein's staff contact the community resources available in patients' villages to try to set up an alternative to get the patient to an air conditioned shelter, or at least to get them an electric fan.
"If the patient is in an apartment and has no family, then we contact the building's superintendent to ask them to get the patient an electric fan or air conditioner, if possible," Klein explains.
* Advise patients' doctors or case managers of the risk of heat-related complications.
Klein's staff also will try to visit patients they consider to be at risk more often than usual. They will call patients' doctors and explain the situation, and then ask the doctors to issue orders for extra visits so that the nursing staff can see the patients and be sure they're getting through the heat. Klein says the doctors her company worked with last summer cooperated without any problems.
With managed care patients, Klein's field staff call patients' case managers to request authorization to do extra visits. This isn't as easy to do as calling patients' doctors, but Klein says this problem is offset by managed care companies' case managers calling patients themselves to check on them. If the case managers refuse authorization for additional visits, and Klein's staff still believe the patient needs to be seen, they'll do an unreimbursed visit.
* Rearrange visit schedules on hot days.
Try to schedule visits in the early morning and late afternoon, and try to stay indoors from noon to 2 p.m., when the heat is the worst, Sierzega says.
Prioritize patients. Those who must be visited should be seen earlier in the day, and the other less pertinent visits should be moved to a cooler day, if possible.
"But in the long heat waves like last summer, we can't do that for long," Sierzega says.
* Decide what you'll do if a patient's home is too hot to be safe.
If a residence is too unsafe to risk leaving a patient living in it, Schulmerich's staff will call 911 and have the patient taken to a hospital until different housing arrangements can be found for the patient, or until the patient's home can be cooled down enough to be safe. *
* Patty Ham, Administrative Manager, Saint Francis Medical Center Home Health Department, 530 N.E. Glen Oak Ave., Peoria IL 61637. Telephone: (309) 637-0202.
* Carol Klein, Director of Professional Services, Community Nursing Service of DuPage, affiliated with Central DuPage Hospital, in the Central DuPage Health System, part of the VNA First Network., 690 E. North Avenue, Carol Stream, IL 60188. Telephone: (708) 665-7000.
* Donna Sierzega, Clinical Nursing Supervisor, Rush Home Care Network, 1201 W. Harrison St., 3rd Floor, Chicago, IL 60607. Telephone: (312) 850-7500.
* Susan Schulmerich, Director, Montefiore Medical Center Home Health Agency, 1 Fordham Plaza, Suite 1100, Bronx, NY 10458. Telephone: (718) 405-4400.
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