TIP OF THE WEEK

Pandemic Influenza and Preparedness

 

Many of us have suffered from bouts of the flu. While uncomfortable, inconvenient, and disruptive to our daily schedules, seasonal influenza is typically a manageable and non-threatening disease for most healthy people. Seasonal Influenza refers to periodic outbreaks of acute onset viral respiratory infection caused by circulating strains of human influenza A and B viruses. This is the type of flu with which most healthcare workers and the public are most familiar. Treatment and prevention of influenza involves multiple infection control measures, including vaccination, antiviral medications, and management of influenza symptoms and complications.

 

Pandemic influenza refers to a global disease outbreak. A flu pandemic occurs when a new influenza type A virus emerges for which people have little or no immunity, and for which there is no vaccine. The disease spreads easily from person to person, causes serious illness, and can sweep across the country and around the world in a very short amount of time. It is difficult to predict when the next influenza pandemic will occur or how severe it will be. Wherever and whenever a pandemic starts, everyone around the world is at risk. Countries might, through measures such as border closures and travel restrictions, delay arrival of the virus, but they cannot stop it. An especially severe influenza pandemic could lead to high levels of illness, death, social disruption, and economic loss. Everyday life would be disrupted because so many people in so many places become seriously ill at the same time.

 

Type A influenza viruses that infect wild birds and domestic poultry cause avian influenza, also known as bird flu. There have always been avian flu viruses circulating among wild birds and occasionally in some poultry flocks. These have been low-pathogenic strains and for the most part have caused mild or no illness in birds. These low-path bird flu strains do not pose a serious health threat to people. However, the H5N1 virus causing illness and death in both birds and humans is highly pathogenic.

 

PANDEMIC INFLUENZA PREPAREDNESS

An influenza pandemic is projected to have a worldwide impact on morbidity and mortality, thus requiring a sustained, large-scale response that has the potential to quickly overwhelm hospitals and the healthcare system regionally and nationally. Because an influenza pandemic may quickly overwhelm the healthcare community, planning should address: (1) internal continuation of care and (2) coordination of services with local, state, and federal healthcare agencies. Healthcare resources are not easily shared or redistributed; a pandemic will magnify and strain resources on a much larger scale. Collaboration with state and federal partners is vital to ensure that healthcare facilities have assistance with consumables, medication, and vaccines during the pandemic.

 

HEALTHCARE FACILITY RESPONSIBILITIES BEFORE A PANDEMIC

• Develop planning and decision making strategies for responding to pandemic influenza.
• Define roles for disaster response.
• Understand how to access local, state, and federal information and supplies, and to ensure communication with local, state, and federal health/security agencies.
• Identify supply chain issues and develop alternatives as needed (e.g., overseas sources).
• Develop written plans that address disease surveillance; isolation and quarantine practices; hospital capacity criteria; hospital communication; staff education and training; triage; clinical evaluation and diagnosis; security; facility access; facility infrastructure (e.g., isolation rooms); occupational health for employees; use and administration of vaccines and antiviral drugs; facility surge capacity (e.g., durable and consumable supplies); supply chains (purchase, distribution and transportation of supplies); access to critical inventory supplies; and mortuary issues (e.g., storage capacity). This is not a comprehensive list.
• Work with local, state, and national emergency planning committees to integrate with community, state and national pandemic plans and training.
• Participate in pandemic influenza response exercises and drills on local and, if possible, state and federal levels. Incorporate lessons learned into the pandemic disaster response plans.

Preparing for the pandemic flu is a very real and pressing issue for nursing homes and other healthcare providers. Federal and state government agencies agree that it is not a question of “if” a pandemic occurs, but “when.”

 

INFLUENZA PANDEMIC PLANNING ISSUES

• Healthcare facilities may have more warning time and response time for pandemic influenza, especially if the initial outbreak develops in another country. Mass casualty and weapons of mass destruction events are typically a surprise.
• Influenza pandemic is not a contained or local event. Since it is widespread, less federal, state, and local support is available at the individual facility level.
• An influenza pandemic is a sustained crisis. Expect the response to have a longer duration (12 to 24 months).
• Unlike an isolated mass casualty scenario, a pandemic may come and go in waves, each of which can last for six to eight weeks.
• Prevention options (vaccine) and treatment options (medications) are fewer and more uncertain for pandemic influenza. A vaccine will likely not be available early in the pandemic. Antiviral medication is in short supply, is highly susceptible to resistance, and may not be effective.
• Due to the uncertainty of the nature of pandemic, pandemic plans must be flexible with integrated processes for reviewing current recommendations and updating the plan accordingly.

 

 

 

 

 

IN THE NEWS

 

CENTERS FOR MEDICARE & MEDICAID SERVICES ASKS FOR FEEDBACK ON PAPERWORK BURDEN

October 12, 2007 -- Federal Register -_ In compliance with the Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid Services (CMS), published areas for potential improvement in reducing paperwork for healthcare professionals.

 

Interested individuals are invited to estimate the burden and provide suggestions for improvement in the following areas: Medicare Part D, Application for Prescription Drug Plans/Medicare Advantage Prescription Drug Plans, Data Collection for the Nursing Home Value-Based Purchasing (NHVBP) Demonstration, Medicare Advantage Applications (Part C), Medicare Enrollment Application, and Home Health Conditions of Participation.

 

Federal Register: October 12, 2007 (Volume 72, Number 197), Page 58096-58098

 

ENROLLMENT IN MEDICAID TAKES A RARE DIP

October 11, 2007 -- Associated Press -- For the first time in nearly a decade, enrollment in the nation's health insurance program for the poor fell during the fiscal year ending June 30, says a new survey of state Medicaid directors.

 

In turn, that drop led to the second smallest increase in Medicaid spending during the past decade — 2.9 percent. Read more >>

 

CONTINUITY OF CARE: PROCEEDINGS OF THE PINNACLE ROUNDTABLE

October 2007 -- American Pharmacists Association -- Continuity of care is an increasingly important issue for pharmacists throughout the care continuum. “Even according to conservative estimates, hospital errors are the nation’s eighth leading cause of death—ahead of breast cancer, AIDS, and motor vehicle acci¬dents combined,” according to the National Consumers League. Such errors include medication errors, other types of medical errors, and hospital-acquired infections. The Institute for Healthcare Improvement (IHI) has identified poor communication of medical infor¬mation during transitions of care as being responsible for half of all medi¬cation errors among inpatients and one fifth of all adverse drug events. Read more (PDF) >>

 

CARING FOR AMERICA’S AGING POPULATION:A PROFILE OF THE DIRECT-CARE WORKFORCE

September 2007 -- Bureau of Labor and Statistics -- Direct-care workers constitute a low-wage, high-turnover workforce with low levels of health insurance; taking these characteristics into account guides the challenge of how to deal with the growing demand for long-term care by an aging U.S. population. Read the report (PDF) >>

 

A REPORT ON SHORTFALLS IN MEDICAID FUNDING FOR NURSING HOME CARE

September 2007 -- AHCA -- BDO Seidman, LLP (BDO), in concert with Eljay, LLC (Eljay), was engaged by the American Health Care Association (AHCA) to work with its state affiliates and other sources to compile information on the shortfall between Medicaid reimbursement and allowable Medicaid costs in as many states as feasibly possible. Read the report (PDF) >>

 

 

 

OHIO KEPRO EVENTS

 

Guidelines and Coding for Restraints Teleconference

Featuring Carla Brumby and Patsy Strouse, Ohio Department of Health

November 8, 2007 1:00 p.m. to 3:00 p.m.

Dial-in: 1-866-256-9239

Download the Flyer (PDF)

 

 

INDUSTRY EVENTS

 

Reducing the Use of Alarms in the Nursing Home

Ohio Person-Centered Care Coalition Teleconference

November 6, 2007 1:00 p.m. to 3:00 p.m.

Questions? Call Amanda Trzcinski at 1-614-568-0512 or Leasa Novak at 1-800-385-5080, x2208

 

The Many Facets of Pain Management: An Integrated Approach

November 7, 2007, 8:00 a.m. to 4:30 p.m., MetroHealth Medical Center, Cleveland. Call (216) 778-7707 for more information.

 

Cuyahoga Community College Fall 2007 Calendar:
Continuing Education for Gerontology Professionals

 

Medicare Learning Network:
Learning resources and products for the healthcare professional.

 

Alzheimer’s Association Training Events

 

AOPHA Events

 

Case Western Reserve University School of Medicine Courses

 

Ohio Department of Health, Technical Assistance Program – New Programs

 

Ohio Health Care Association Events

 

 

 

An archive of The Nursing Home Weekly Update is available on our Web site. Click here >>