I. Before Flu Season
CONTAGION SURVEILLANCE & INTERVENTION
1) PR – Vaccinate all students who have consent forms, and as many staff as possible, for both seasonal flu and pandemic illness.
2) PR / MI – Identify student isolation areas at each residential campus, and how such areas would be staffed, equipped (e.g., bedding, disposable dishes and utensils) and supported (e.g., housekeeping, food service).
3) PR / MI – Decisions will be made on a case-by-case basis, usually by the program site Head Nurse in conjunction with the shift Supervisor, guided by the general criteria and procedures for moving students out of isolation and back into the population.
10/27 note: Consider purchasing more portable cots for the agency.
4) MI / CO – Ensure availability of medical consultation and advice for emergency response.
Note: Dr. Dempsey and 2 Nurse Practitioners from his group will be available. Severity of the pandemic, among other factors, will determine whether they can see students on campus or at their office.
5) CO – Establish baselines for student flu cases and employee absences.
6) PR / MI – Develop monitoring & reporting procedures for cases of student flu.
• To start, Head Nurses report weekly via email to Nancy & Shaun (cases of flu) using standardized form
• If/when we see numbers climbing, Head Nurses will report daily via email.
7) PR / MI – Develop monitoring procedures for DC staff absences
To start, designated program administrators report weekly to the Payroll Administrator → Shaun (absence for medical reasons, including family illness, and/or non-planned personal time for reasons associated with flu conditions – e.g., day care, school, etc.)
If/when we see climbing staff absence numbers, daily reporting will be implemented.
8) CO – Establish thresholds for Levels 2 (elevated) & 3 (emergency), and procedures for activating and terminating our differential responses to changing levels.
9) PR / MI – Confirm procedures for the use of the Student Monitoring Sheet and the Student Isolation Log for students with flu.
10) PR / MI – a) Install hand sanitizer units at all time clocks
b) Ensure that all sanitizers are operational and refilled regularly.
11) PR / MI – Heighten housekeeping infection control measures, e.g., frequent sanitizing of common use equipment (e.g., time clocks, common space phones, etc.)
12) PR / MI – In general, Housekeeping staff (incl. students having voc ed. experience) are encouraged to wear gloves and masks while cleaning. Masks and gloves will be available for staff to use on a voluntary basis.
All staff, including Housekeeping staff, assigned to any isolation unit must wear gloves and a mask at all times while in the unit.
COMMUNICATIONS & CONSENTS
13) PR – Obtain parental consent for seasonal flu and pandemic illness vaccinations.
14) GEN – Send informational letter to parents/guardians (NM)
15) PR / MI – MI – Disseminate information about the PMP to all employees.
16) Maintain high staff awareness around pandemic illness and the seasonal flu; disseminate programs and materials covering pandemic fundamentals (e.g. signs and symptoms of influenza, modes of transmission, personal and family protection, provide information for the at-home care of ill employees and family members and response strategies).
Anticipate employee fear and anxiety, rumors and misinformation and communicate accordingly.
TRAVEL, VISITATION, ACCESS TO PROGRAM SITES
17) PR / MI – For home visits: Take temperature before leaving and upon return, when nurses are on campus. Monitor for symptoms.
AUTHORITY, AUTHORIZATION
18) CO – Id. Order of Succession of Authority for agency + each site
• @ Agency level, order is CEO → ExVP → VP for Finance → Dir. of HR.
• @ Program level – Use the OS outlined in the site specific COOP plans
19) CO – Per the HEC COOP Plans, if activation of a different level of this plan is necessary, the Department Head and/or the Program Director and/or his/her designee will formally notify all department / program staff, with appropriate instructions, by available means.
20) GEN – Director of Nursing will serve as the Pandemic Management Coordinator, reporting regularly to the Exec. VP.
21) GEN – RTC Head Nurses will serve as Pandemic Management Site Coordinators for their RTC. They will work closely with the PMC, and will report regularly to the RTC PD.
22) Review the Pandemic Management Plans and options with Dr. Dempsey.
RESOURCES & ESSENTIAL SUPPLY CHAINS
23) PR / MI – Order additional medical supplies to have on hand (masks, aspirin, etc.).
24) CO –Emergency supply stock consisting of food.
HEC routinely maintains an approximately 10 day supply of food on hand, and it is not anticipated that the public water supply would be interrupted due to the pandemic.
25) MI / CO – Communicate with local healthcare facilities to share our plans and understand their capabilities and plans; ensure availability of medical consultation and advice for emergency response.
26) CO – Communicate with our local emergency/supplier agencies (Fire, Police, Red Cross, Ambulance, fuel companies, electric companies, etc.) regarding their plans and their abilities to provide us with services if this becomes widespread.
Note that under severe regional disaster conditions, these agencies and resources will not be able to help much.
27) Consider link on website for communicating pandemic status and actions to employees and others inside and outside the worksite in a consistent and timely way.
HUMAN RESOURCES
28) CO – Prepare to address potential staffing shortages throughout flu season.
Note: See Level 1, # 9 below &/or “Plan for Managing Widespread Infection or Contagion” (HEC Infection Control Manual)
29) CO – Update our employee information to insure we have accurate telephone numbers, etc.
MISCELLANEOUS
30) CO – Identify essential functions, e.g.
a) Ensure adequate shelter and living space for students
b) Provide adequate food and water for students
c) Assure to the extent possible proper necessary staff-to-student ratios at all times
e) Provide of adequate medical care and medication management
f) Provide safety and security
g) Ensure essential communication (e.g. telephones, two-way radios, cellular phones or “runner”)
h) Ensure information management functions (e.g. student case files, personnel files, business and financial files)
i) Be able to pay people (e.g., payroll staff redundancies)
(also see site specific COOPs)
II – Flu Season
Level 1 – Routine conditions
Student threshold:
0 to 20% of student population in isolation
(e.g., @ 50 students, 20% = 10 students in isolation)
DC Staff thresholds:
Up to 20% of Direct Care staff scheduled to work (by program site, by shift) are absent. (Note: the # scheduled to work is usually above the required staff:student ratio)
Non-DC Staffing:
Non-Direct Care staff absences are monitored by work site and department. Actions in response to absences depends directly on the absent staff’s location, role, function and the depth of backup available for their role / position. .
Level 1 Direct Care Staffing
Condition: Staff absences are relatively routine for both Direct Care and non-DC staff. The routine level of absences allows the programs to operate at ratio, primarily by utilizing On-Call staff and/or over time as needed.
Absences are monitored daily at the campus + Department level.
Absences are reported weekly by campus and by Department to the Senior Management Team and the Nursing Director.
Weekly reports are reviewed for upward trending.
Level 1 Actions
1. PR / MI – Close monitoring and reporting of a) student flu cases b) staff absences.
2. PR / MI – Maintain high housekeeping efforts
3. PR / MI – Housekeeping staff (incl. students having voc ed. experience) should wear gloves while cleaning outside of isolation areas. Masks are optional (outside of isolation areas).
4. PR / MI – Follow plans to separate / isolate students with flu.
5. PR / MI – Per the HEC “Plan for Managing Widespread Infection or Contagion” (HEC Infection Control Manual), any student found to have a serious communicable illness that can’t be safely managed by on-campus isolation will be referred to an appropriate medical facility by an HEC physician.
6. PR / MI – Per the HEC “Plan For Managing Widespread Infection Or Contagion” (HEC Infection Control Manual), in the event that a student cannot be cared for separately from other students, but does not require referral for intensive medical care, transport to the home of a parent, legal guardian or responsible family member will be considered.
7. PR / MI – Per the HEC “Plan For Managing Widespread Infection Or Contagion” (HEC Infection Control Manual), in the event that the number of students affected by a serious contagious illness, and/or the status of staffing and resources, make it impossible to care for ill students at the program site, transport to the home of a parent, legal guardian, responsible family member, or referral to a hospital will be considered.
8. PR / MI – Per the HEC “Plan For Managing Widespread Infection Or Contagion” (HEC Infection Control Manual), in the event that the availability of staff is negatively affected by a serious and wide spread contagious illness or infection, the following steps will be considered and/or implemented if necessary to maintain adequate care for students and safe conditions for students and staff.
a) Increased use of on-call and part time staff.
b) Voluntary overtime.
c) Imposition of mandatory overtime.
d) Deployment of administrative and support staff to direct care functions.
e) The temporary reduction of student census (e.g., sending students on approved and plans visits) will be considered.
f) Temporary consolidation of teams, units and/or program sites.
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Level 2 – Elevated conditions
Student threshold:
21% to 40% of student population in isolation
(e.g., @ 50 students, 40% = 20 students in isolation)
DC Staff thresholds:
Between 21% and 30% of Direct Care staff scheduled to work (by program site, by shift) are absent. (Note: the # scheduled to work is usually above the required staff:student ratio)
Non-DC Staffing:
Non-Direct Care staff absences are monitored by work site and department. Actions in response to absences depends directly on the absent staff’s location, role, function and the depth of backup available for their role / position. .
In the event that the Executive Vice President and Pandemic Management Coordinator (Dir. of Nursing) determine that Level 2 conditions do or will soon exist, they will call an Emergency Meeting to determine which action steps will be implemented for Levels 2 and 3.
The following reps will participate in this meeting:
Executive Vice President, Pandemic Management Coordinator (Dir. of Nursing), Worker’s Comp Administrator, Director of Support Services, Director of Special Projects.
Level 2 Direct Care Staffing
Condition: Staff absences are higher than average and/or staff absences are notably increasing in numbers and duration. The elevated level of absences increasingly requires the programs to maintain staff: student ratio by utilizing a combination of On-Call staff, over time, and moving as many as possible Asst. Supes into the count. Other actions (e.g., mandatory overtime) will be considered as needed.
Absences are monitored daily at the campus + Department level.
Absences are reported daily by campus and by Department to the Senior Management Team and the Nursing Director.
Reports are reviewed for upward trending.
Level 2 Actions
1. MI – Nursing Director checks MA Health Dept. and CDC web sites daily.
2. At Level 2 or 3, identify staff who would be willing to come in if short staffed and staff that would be willing to do “infirmary duty” if necessary (i.e., those without families to take care of, etc.).
3. PR / MI – Implement guidelines to support social distancing (maintaining 6 foot distances between people) and to modify the frequency and type of face-to-face contact (e.g. hand-shaking, frequencies of meetings, seating in meetings, etc.).
4. PR / MI – Institute procedures for visits to program sites (minimize movement on campus; modify programming; isolate visitors).
5. PR / MI – Consider limiting staff travel outside the HEC area.
6. PR / MI – Limit student home visits.
7. PR / MI – If severity increases, at the beginning of the workday and with each new shift, all employees should be asked about symptoms consistent with an influenza illness (e.g., fever, chills AND cough or sore throat).
8. CO – Utilize non-direct care staff in DC positions as needed to maintain ratios.
9. CO – Monitor inventories of food and essential supplies.
10. CO – Consider applying to DEEC for emergency waiver on staffing ratios and/or programming (e.g., school closing) at Level 3.
11. PR / MI – Look at our visiting and travel policies and consider differential actions (stop travel/send healthy students home).
12. PR / MI – Consider policies for access to / monitoring of access to program sites by vendors, visitors, etc.
13. PR / MI – Evaluate our supply chain, essential supplies and resources; inventory our current stock and provide sufficient and accessible infection control supplies.
14. identify critical inputs, resources, supplies required to maintain business operations by location and function during a pandemic (e.g. raw materials, suppliers, sub-contractor services/ products, and logistics)
15. E.g., 7 day food supply, heating oil.
16. Note: If flu cases increase, should we increase the amount of cash on hand at all sites? (consistent with disaster conditions)
17. CO – Determine personnel policies regarding flexibility of staff schedules (staggered shifts) and worksites (those who can work from home).
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Level 3 – Emergency conditions
Student threshold:
Greater than 40% of student population in isolation
(e.g., @ 50 students, 40%+ = more than 20 students in isolation)
DC Staff thresholds:
Above 30% of Direct Care staff scheduled to work (by program site, by shift) are absent. (Note: the # scheduled to work is usually above the required staff: student ratio)
Non-DC Staffing:
Non-Direct Care staff absences are monitored by work site and department. Actions in response to absences depends directly on the absent staff’s location, role, function and the depth of backup available for their role / position. .
Level 3 Direct Care Staffing
Condition: Emergency conditions prevail with a combination of high student illness, and staff absences and durations of absences severely affecting program operations. The emergency level of absences barely or does not allow the programs to maintain staff: student ratio utilizing a combination of On-Call staff, over time, and moving as many as possible Asst. Supes into the count.
Mandatory overtime will be implemented by specific program directors as needed.
Absences are monitored daily at the campus + Department level.
Absences are reported daily by campus and by Department to the Senior Management Team and the Nursing Director.
Reports are reviewed for upward trending.
Level 3 Actions
1. PR / MI – Consider instituting limitations on visits to program sites (minimize external entry/contact)
2. MI / CO – Temporarily consolidate teams of healthy / sick students.
3. MI / CO – Temporarily consolidate campuses (maintain sick students at separate campus).
4. MI / CO – Consider sending to visiting resources those well students who have experienced visiting resources and whose behavior would allow visiting.
5. CO – Consider using HA and old ITU building for e.g., storage, isolation units, etc.
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