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What really is Avian Flu?

            It is worthwhile to start a strategic plan by knowing the enemy. Avian influenza, more commonly known as the “bird flu”, is a viral illness from influenza viruses in wild birds characterized by fever and respiratory problems. It can easily be transmitted from birds to humans and from one human to another. Studies have shown that the spread has been most common in child to child and child to adult scenarios.

            Avian flu has several strains, classified as low pathogenic and highly pathogenic. The cause of concern is the highly pathogenic H5N1 strain which affects and kills humans. Preventive measures are being taken to keep it at bay. Importation of birds and bird products from affected countries, which are mostly Asian countries, has been put on ban.

            While there is currently an effort for vaccination against bird flu, it takes knowledge of the form the virus takes to infect humans and six months to produce the vaccine. It also takes at least two years to vaccinate all of the United States. While waiting for this time, the virus continues to kill and infect birds and humans alike.

            As primary providers of healthcare, local hospitals must be vigilant in prevention, treatment, and maintenance against avian flu. Thus, a strategic plan is imperative so that we are prepared for any possible developments with the virus, especially in our immediate communities. The plan is set in response to the worst-case scenario of having avian flu in the epidemic (community spread) or pandemic (inter-country spread) level and is categorized into three stages: prevention, which aims to manage avian flu before it becomes a serious risk in the community; cure, which is a plan on how to manage the disease when the community is already infected; and follow-through, or the steps to be taken after the epidemic or pandemic.

Prevention

Education and Training

            Education is still the best defense that the community can have against avian influenza. When people know what bird flu is, how to prevent it, and how to manage infection, they will be able to aid us in the local hospital in preventing or managing isolated bird flu cases as well as epidemic or a pandemic scenarios. Apart from supporting information drives and campaign to orient people on bird flu, training and education will also be given to all staff members. The training will cover how the virus came to be, how it is passed by and into humans, preventive measures, management of the disease, classification of patients, and contingency plans for outbreaks.

            To aid the concern of compromising work hours and service time for patients, the trainings will be carried out by stages and will be departmental. Each department will also be subdivided in such a case that a portion of one department will have a scheduled training seminar, while their co-portion will be in a later schedule and shall be on duty in the meantime. This will enable the workflow to be uninterrupted despite the training exercises. Departmental trainings will also help make a definitive training that is specific to the role that each department has such that labor is complementary and well-divided among all staff members.

            When trainings have been carried out, cross-training will be put in place. This will allow staff to serve other departments despite their non-specialty in them when the need arises. For instance, staff in the physical therapy department can assist and help transport non-physical therapy patients. Thus, despite their definitive and role-specific training, the hospital can still deploy them elsewhere when staff shortage arises.

Foreign Travel

            While measures are being taken by air and sea ports to prevent the pandemic spread of avian flu, it is the initiative of the local hospital to suspend all foreign travels of staff until the threat of avian flu ceases. In such an isolated case where a staff is really needed to be sent overseas for a highly important errand, a screening shall be done before and after his trip. He will also need to absent himself from work for at least three days after returning from the trip, and may only return after this period when clearance has been given by the hospital. International conferences and meetings will be suspended and teleconference arrangements will be made where applicable.

Medical Interventions

            A staff shall be assigned to monitor updates on vaccinations against bird flu. Prompt implementation shall be carried out once available. Vaccines shall be administered to all hospital staff. The vaccine will also be made available to their family members. Likewise, enough stocks shall be secured to make the vaccines available to the public.

            Routine checkup will also be made for all staff. Prompt screening shall be given to staff who are suspected to be infected by the flu, especially those who exhibit a case of fever and poor respiratory conditions. Infected employees shall be given a leave of absence and may only return to work once clearance is given by the hospital.

            The Food Services Department will be requested not to buy and serve birds and bird products, including chicken and eggs. It is also equally important to continue the use of high-quality surgical masks, disposable gloves and gowns, which are actually now being used in the hospital on a daily basis. Incineration of disposed materials and accessories will be a viable method in preventing the spread of the virus through them.

Management Teams

            As important as putting a plan in place is structuring a team plan where people will be tasked specific responsibilities to implement once the plan is in place. The following organizational chart will be used for the purpose of this strategic plan.

·      Medical Director – shall be the key implementation person and shall approve all efforts from the planning team

·      Administration and department heads – shall assist the medical director in planning efforts and orient their staff per department on the finalized planning initiatives

·      Staff – shall abide by the administration and department heads

o   Facility staff – shall provide and secure enough equipment and facility for patients

o   Nursing staff – shall frontline health care and infection control, including monitoring of public health advisories, patients, and admission of risky cases

o   Human resources – shall promote occupational health, information, support, and ensure enough staffing as well as coordination with other proponents of avian flu preparations including government offices, other local hospitals, and non-governmental groups

o   Pharmacy staff – shall ensure enough vaccination and medical supplies

o   Food services – shall ensure enough supply of food and water for hospital staff and patient in case self-confinement becomes necessary

o   Transport services – shall ensure enough transportation means for evacuation when the need arises, and facilitate a comprehensive transport schedule to meet the needs of employees and patients

o   Other hospital staff members shall be tasked to aid in different other areas that need to be addressed

Telecommuting

            When a serious disease occurs in the community, it may be necessary to assign some staff to work off the hospital site, or telecommute, as backup and support. Telecommuting will enable the hospital to provide support to the community and reduce the risk of infecting its entire staff. However, there are many issues that need to be addressed with the prospect of telecommuting. First, we should identify jobs that can be done through telecommuting. Accounting, human resources, and most non-health care roles are the ones on top of the list. The wide use of the internet today makes this step extensively easier.

            Secondly, we should be able to identify staff who are capable of telecommuting. There should be consideration given to the equipment and internet connection speed of staff who can be assigned to telecommute, as providing additional equipment for them will not be a very viable option given that cost-effectiveness is one factor that should be regarded. The hospital will also likely need to train additional people to be on-site coordinators to these off-site employees. Another option is to structure a networking system for employees to connect to, be they on or off the site.

            Thirdly, privacy is an important aspect that needs to be discussed with telecommuting. With the use of web, medical information becomes out in the open. To secure them, encryption and website security measures shall be observed. Telecommuters will also be given a password-protected access to the hospital administration website.

            Lastly, payroll issues such as gauging actual hours worked by off-site employees shall be addressed. This is possible by the use of web-camera technology, where the on-site coordinator can monitor actual presence of employees logged into the administrative system.

Cure

            When the bird flu becomes an epidemic or a pandemic, management or Plan Level B shall be instituted. The plan shall include management of patients, employees, and continuing efforts to prevent a bigger spread of the disease.

Admission Strategies

            All patients exhibiting symptoms of avian flu shall be immediately brought into an isolation room for classification. When a number of bird flu cases starts to populate the hospital, non-bird flu cases shall be referred to a surge facility temporarily. This will eliminate their risk of contracting the disease from admitted bird flu patients.

Patient Classification

Patients being admitted shall be classified into three classes.

·      Class 1 – are patients who are fatally infected, may die anytime, and whose degree of infection is highly contagious. No outside contact except with protected healthcare providers shall be permitted with Class 1 patients. Special care shall be taken.

·      Class 2 – are patients who are infected, contagious, but not on a fatal degree. No outside contact except with protected healthcare providers and care givers shall be permitted.

·      Class 3 – are patients who are being observed for possible infection. No outside contact except with protected healthcare providers and care givers shall be permitted.

Key health care personnel shall be assigned to monitor the patients. Extra care should be taken by personnel monitoring Class 1 and 2 patients. Transfer of patients according to their monitoring status shall be immediately done when needed.

Bedding Strategies

Bedding strategies shall also be put into place. Bird flu cases shall be given priority according to the class of the patient. Class 1 patients shall be allotted a quarantine area, while Class 2 and 3 patients shall be assigned separate rooms for confinement and treatment. This may lead to a case wherein existing non-bird flu patients will need to be moved to another facility, a hospital or a surge facility, to keep them from contracting the infection and to free up bed space. A surge capacity plan shall be coordinated with nearby hospitals, gymnasiums, and schools.

Transportation

            Transportation will be secured and given to non-bird flu patients in case an outbreak occurs in the hospital to prevent them from contracting the disease. High-risk cases shall be the first ones to be transported to nearby hospitals and healthcare units. Other patients who are not high risk shall be temporarily housed in surge facilities and health care capacity areas that do not put them in the threat of the infection.

Self-confinement

            The hospital may reach a point where self-confinement or hospital-wide quarantine becomes necessary. There are two reasons in doing these: first, to avoid spreading the disease to the rest of the community, or second to avoid the community-wide disease from infecting the people inside the hospital. In preparation for such a case, Food Services staff was tasked to ensure enough supply of food and water for patients and hospital employees for at least 96 hours (4 days). Pharmacy Services staff are likely tasked to keep enough stocks of medicines. During the period of self-confinement, no outside contact can be made except by use of communication devices inside the hospital.

Medicine Dispensing

            While the hospital is taking measures to ensure that there will be enough vaccines, once available, and medicine for patients and employees, infected by bird flu or not, there is still the need for a plan for dispensing these items when shortage indeed occurs. This will enable proper distribution of the items according to the degree of need.

            Primarily, vaccines shall be made available to employees who are in direct contact with bird flu patients. They include admission personnel, nurses, care givers, and doctors. Excesses will be distributed to other employees and patients as well when needed. Medicines shall also be dispensed according to the degree of the medical case. Medicines that have been found to be effective in easing bird flu patients shall be temporarily reserved for bird flu patients except in emergency cases. However, regular medicines that have no use or connection with the cure of bird flu shall be dispensed normally.

Absenteeism

            Absenteeism may arise due to illness among staff or their family members. This has two effects: poor performance of hospital staff and the issue of being understaffed which is difficult to manage at a time of a serious outbreak.

            To aid this, flexible working schedules may be instituted for employees who are caring for sick family members. However, these employees shall be constantly screened and monitored to ensure that they are not contracting the disease themselves. The Human Resources Department is also tasked in providing a comprehensive shifting scheme so that employees may be able to report to work at the best time possible for them. This way, absences will be lessened. However, in case the absenteeism is brought about by ill employees, a different management plan may be necessary. This is where the benefit of cross-training is seen. Giving non-care providers training to assist care providers in case the need for them arises is helpful. Securing volunteers and partnerships with healthcare groups and healthcare staffing services may also be made.

Psychological Support

            To further encourage the staff to serve despite the odds they are facing professionally (because of the overwhelming number of cases) and personally (infected family members), psychosocial support is another necessity. A helpline so staff can discuss concerns with professionals in private and an atmosphere of support in the workplace is especially helpful.

Release of Patients

            Well and treated patients shall be screened before release and be scheduled for monitoring. Deceased patients will have to be released to their families, unless risks of disease spread in such manner arises, in which case bodies shall be cremated. However, no findings regarding this have been found in the immediate time.

Follow Through

            After the surge of bird flu patients and when things start to ease back normally, there are still several things that need to be done. Monitoring shall be continued for released patients so that any unexpected case of relapse can be aided. Employees shall also be continuously monitored for infection. Statistics shall be recorded and submitted to authorities where applicable for community information. Continuous monitoring of advisories shall also be made.

Summary

            It is important for local hospitals to be prepared and well-organized in facing an outbreak of an illness. The main concern of this strategic plan is to be able to continue operation with the least possible risk for the hospital employees. In doing so, each department is entailed to subscribe and abide by the contents of this plan and efforts of implementation arising from this. Compliance and cooperation will bring the success for this plan, especially when the real need for it arises. Every department is tasked to know their roles in the plan by heart, and be able to carry out these roles effectively and efficiently to complement the hospital-wide efforts in serving its patients, combating the disease, and surviving the outbreak.

References

Bird flu: what you need to know. 2005. Retrieved March 25, 2007, from http://edition.cnn.com/2005/HEALTH/conditions/10/14/eu.birdflu.facts/

Long-term care and other residential facilities pandemic influenza planning checklist. 2006. Retrieved March 25, 2007, from http://www.pandemicflu.gov/plan/LongTermCareChecklist.html

US health agency unveils pandemic preparedness plan. 2005. Retrieved March 25, 2007, from http://usinfo.state.gov/xarchives/display.html?p=washfile-english&y=2005&m=November&x=20051102152522cmretrop0.312771&t=livefeeds/wf-latest.html

Winters, M. 2006. Hartford hospital: avian influenza strategic plan. Human Resources Management Department, Hartford Hospital.

 

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