Emergency Plan Manual

AHCA Form 3110-1022, Rev March 2013 Rule 59A-8.027, Florida Administrative Code http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Home_Care/HHA/index.shtml#other . Page 46 of 54 medical device determine a back-up plan. Clients will be instructed to: When the power goes out, they should NOT: • Perform an action to the device that they aren’t sure of • Assume the device is working correctly • Leave home without the device • Forget the power outage booklet Our customers will have an established plan to obtain and organize their medical device information, take necessary actions so that them can continue to use their device, have the necessary supplies for the operation of their device, and know where to go or what to do during a power outage. Instruct the patient/caregiver to create an Emergency Patient’s file that amend to have family contact emergency information, supplies used, medication taken, instructions in case of hurricane and other disasters, insurance cards, current home care doctor’s orders, plan of treatment, what a family member, friend, shelter or hospital should do to help me in an emergency, copy of the power of attorney (personal and medical) allowing someone to act on my behalf if I am not able to, contact information for their health care provider(s) and pharmacy, where to go for medical supplies., instructions for using the medical device and all device manuals, also have handling the Device Information, recommend to have handling: My Device is: _______________________________ Model: _______________________ Device Supplier: _____________________________ Phone #: _______________________ We will help our customer to answers the following questions: Can a power surge cause my device to stop working? If yes, what type of surge protector do I need? Does my device have a back-up system? If yes, how long will it operate and where is it located? Can my device operate on another power source? If yes, what type? Could I be harmed if my device stops for a short period of time? If yes, what is that time period? Will my device still work if it does not have power for an extended period of time? If yes, how long can it work without power? What happens if I lose power in the middle of a treatment? Should I restart a treatment if it is stopped in the middle or resume where it stopped? Do I need extra medical supplies that would last for a minimum of 3 days? If yes, where are they located? Does my device or do my supplies have to be kept at a certain temperature? If yes, what temperature? Do I need a portable cooler and ice packs to store refrigerated supplies and medicines? If yes, where are they located? Do I need the proper products to clean my device? If yes, what are they and where are they located? Is there specific information about power outages for my specific device that I should write here? Can my device use batteries in the event of a power outage? Can I change the batteries in my device? If not, who should I contact? Do I have a functioning flashlight with an extra supply of batteries? If so, where are they located? What type of batteries does my device use? How many batteries does it take to operate my device? How long will the device last on battery power? How do I switch operation of my device from battery to electric power? Establish What to Do After Power is Lost and Restored Notify Contacts Notify the following when power is lost and restored: Ƒ/RFDO SRZHU FRPSDQ\ 3KRQH BBBBBBBBBBBBBBBBBBBB Ƒ/RFDO ILUH GHSDUWPHQW 3KRQH BBBBBBBBBBBBBBBBBBBBB Ƒ)DPLO\ DQG IULHQGV 3KRQH BBBBBBBBBBBBBBBBBBBBBBB Ƒ+HDOWK FDUH SURYLGHU V 3KRQH BBBBBBBBBBBBBBBBBBBB Ƒ+RPH FDUH SURYLGHU V 3KRQH BBBBBBBBBBBBBBBBBBBB Ƒ3ULPDU\ 3K\VLFLDQ 3KRQH BBBBBBBBBBBBBBBBBBBBBBB Ƒ0\ VXSSOLHV DUH SXUFKDVHG DW BBBBBBBBBBBBBBBB________________ Phone # _______________________ Ƒ7\SH RI WUDQVSRUWDWLRQ XVH BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 3KRQH BBBBBBBBBBBBBBBBBBBBBBB Ƒ0\ SKDUPDF\ LV BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 3KRQH BBBBBBBBBBBBBBBBBBBBBBB Check Supplies Look for the following when checking supplies and do NOT use if: Ƒ3DFNDJLQJ LV WRUQ RU GDPDJHG Ƒ7KH\ DUH ZHW RU GU\ DQG VKRXOGQ¶W EH Ƒ7KH\ DUH YHU\ KRW RU YHU\ FROG DQG VKRXOGQ¶W EH Ƒ7KHUH DUH ORRVH RU PLVVLQJ SLHFHV DQG VKRXOGQ¶W EH Check Device Look for the following when checking your device and do NOT use if you find: Ƒ6LJQV RI GDPDJH LQFOXGLQJ SRZHU FRUGV Ƒ,QFRUUHFW GHYLFH VHWWLQJV If the patient’s home has a Generator, instruct: NEVER use portable generators indoors, even if you have ventilation. If you feel Angel Home Care Services, Inc.