DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery”

1. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Hospital Alert CodesA Lecture to OMMC StaffJanuary 26, 2012 Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg Harvey Balucating, MD, DPBS Ariel T. Celzo, MD

2. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Backgrounder: Last January 8 to 9, 2012, OMMC was on Code White Alert because of the Black Nazarene Feast. OMMC had a share of about 20 patients coming from the Feast. (10 – Surgery; 7 – IM; 2 Pedia; 1 – OB-GYN) Hospital Alert Codes

3. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Question I ask / we ask: What usually happens during an activation of a Code White Alert in a hospital setting? Hospital Alert Codes

4. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Question I ask / we ask: What usually happens during an activation of a Code White Alert in a hospital setting? My perception and observations: Stand-by is oftentimes confined to just knowing “We are on Code White Alert. “We are on Code White Alert. Be ready for any emergency or disaster. Be ready to come to the hospital when called for.” Hospital Alert Codes

5. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Question I ask / we ask: What usually happens during an activation of a Code White Alert in a hospital setting? My perception and observations: Staff on stand-by inside the hospital would just have a mental stanceof being physically ready to respond to an emergency when called for without doing other response preparations like supplies and space preparations. Hospital Alert Codes

6. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Question I ask / we ask: What usually happens during an activation of a Code White Alert in a hospital setting? My perception and observations: Staff on stand-by outside the hospital would also just have a mental stanceof waiting for a call and will just go to the hospital when called without a set response timeto be physically present in the hospital. Hospital Alert Codes

7. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Question I ask / we ask: What usually happens during an activation of a Code White Alert in a hospital setting? My perception and observations: There is usually no structured and comprehensive way of doing things to ensure effective alertness or readiness and effective response when the alert code is elevated to a response code. Hospital Alert Codes

8. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! • Question I ask / we ask: • What usually happens during an activation of a Code White Alert in a hospital setting? • ROJoson’s in-depth analysis – January 8 to 14, 2012 (trigger: Black Nazarene Feast) • Primer • Hospital Level • Department Level • Goal: Promote structured and comprehensive way of doing things to ensure effective alertness or readiness and effective response when the alert code is elevated to a response code. Hospital Alert Codes

9. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! • What are hospital emergency and disaster codes? • Hospital emergency and disaster codes are codes, usually using colors, being used in hospitals worldwide to • convey essential information quickly to staff during times of potential and actual emergencies and disasters • prevent stress or panicamong patients and visitors in the hospitals during response to actual emergencies and disasters Primer on Hospital Alert Codes

10. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! • What are the uses of hospital emergency and disaster codes? • Hospital emergency and disaster codes are being used for two purposes: • to convey need to be alert or ready • to convey type of emergency or disaster occurring in the hospital that needs a corresponding response Primer on Hospital Alert Codes

11. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! • How are hospital emergency and disaster codes classified? • Hospital emergency and disaster codes can be classified into • - alert codes • - response codes Primer on Hospital Alert Codes

12. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! How are hospital emergency and disaster codes classified? Hospital alert codesare mainly used in anticipation of surge of patientsfrom an emergency or disaster occurring outside the hospital. Can also be used for anticipated emergencies and disasters involving the hospital itself, such as when there is a forecast typhoon. Primer on Hospital Alert Codes

13. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! How are hospital emergency and disaster codes classified? Response codesare mainly used in response to emergencies and disasters occurring within the hospital such as fire, earthquake, flood, and sudden cardiopulmonary arrest of patients, staff, and guests. However, they can also be used in response to external emergencies and disasters. Primer on Hospital Alert Codes

14. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! How are hospital emergency and disaster codes classified? For alignment purposes, the recommendation is for all hospitals to adopt the alert codes being used by DOH hospitals, as long as the word “Alert” is incorporated in the code, like so, Code White Alert, Code Blue Alert, and Code Red Alert. Primer on Hospital Alert Codes

15. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! How are hospital emergency and disaster codes classified? Color codes without the word “Alert” being used in hospitals shall be considered as response codes. Response codes can make use of colors also. If there are two similar colors being used in the alert and response codes, the presence of “Alert”makes for the distinction. Primer on Hospital Alert Codes

16. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! How are hospital emergency and disaster codes classified? Examples Code Redis a response code in cases of fire in the hospital. Code Red Alertis an alert code for more manpower and supplies in preparation for an anticipated extensive surge of patients. Code Blueis a response code in case of sudden cardiopulmonary arrest in the hospital. Code Blue Alertis an alert code. Primer on Hospital Alert Codes

17. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! What are the conditions in which the different alert codes can be adopted? DOH Conditions in which Code WHITE Alert can be adopted: • Strong possibility of a military operation within the area/region, e.g., coup attempt • Any planned mass action or demonstration within the catchment area • Forecast typhoons (Signal No. 2 up) the path of which will affect the area • National or local elections and other political exercises • National events, holidays, or celebrations in the area with potential for mass casualty incidents • Any emergency with potential 10-50 casualties (deaths, injuries) • Any other hazard that may result in emergency • Unconfirmed report of reemerging diseases, e.g., bird flu, SARS Primer on Hospital Alert Codes

18. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! What are the conditions in which the different alert codes can be adopted? DOH Conditions in which Code BLUE Alert can be adopted: • When 20-50 casualties (red tags) are suddenly brought to the hospital. • Any internal emergency/ disaster in the hospital which brings down their operating capacity (i.e., vital areas) to 50% or which would require evacuation of patients and setting up of a Field Hospital. • For conditions other than mass casualty incidents, the influx of patients is beyond the capacity of the hospital to handle. • Confirmed/documented report of reemerging diseases (SARS, human to human avian flu) within the catchment area. Primer on Hospital Alert Codes

19. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! What are the conditions in which the different alert codes can be adopted? DOH Conditions in which Code RED Alert can be adopted: • When more than 50 (red tag) casualties are suddenly brought to the hospital. • An emergency wherein the services of the hospital is paralyzed since 50% of the manpower are themselves victims of the disaster. • Hospital is structurally damaged requiring evacuation and/or transfer of patients. • Conditions requiring mandatory quarantine of hospital and its personnel (e.g., SARS, avian fl u); uncontrolled human to human transmission of SARS/avian flu within the catchment area. Primer on Hospital Alert Codes

20. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! • What are the general sequential steps in the activation and deactivation of alert codes? • Monitoring of news of potential emergency and disaster that may create a surge of patient incident or event in the hospital. • Assessment of the potential incident or event with a determination on what alert code to activate. • Securing of permission for activation of an alert code from the Hospital Director by the Hospital Disaster Control Director. Primer on Hospital Alert Codes

21. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! • What are the general sequential steps in the activation and deactivation of alert codes? • Activation of an alert code approved by the Hospital Director to be implemented through the Hospital Disaster Control Director. • Surveillance for occurrence of actual emergency and disaster with corresponding response. • Maintenance of readiness of out-of-hospital stand-by staff such that they proceed promptly to the hospital when needed. Primer on Hospital Alert Codes

22. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! • What are the general sequential steps in the activation and deactivation of alert codes? • Securing of permission for deactivation of an alert code from the Hospital Director by the Hospital Disaster Control Director. • Deactivation of an alert code approved by the Hospital Director to be implemented through the Hospital Disaster Control Director. Primer on Hospital Alert Codes

23. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! • What are main targets of readiness in the alert codes of the hospitals? • Having • enough manpower • and • enough supplies • to handle anticipated surge of patients to the hospital. Primer on Hospital Alert Codes

24. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! • What are recommended guidelines in ensuring manpower readiness under each code alert? • Determine the composition of the Hospital Alert Teams as well as Department Alert Teams. • Determine which teams and who should be physically present and which teams and who can be on stand-by outside the hospital in each alert code. Primer on Hospital Alert Codes

25. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! • What are recommended guidelines in ensuring manpower readiness under each code alert? • Use the checklist on essential steps in responding to a surge of patient emergency as a guide to determine who, how many staff, and what teams should be available and made readily available when needed. Primer on Hospital Alert Codes

27. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! • What are recommended guidelines in ensuring manpower readiness under each code alert? • Use the following checklist as a guide in determining who, how many staff, and what teams should be available and made readily available when needed. Primer on Hospital Alert Codes

29. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! What are recommended guidelines in ensuring manpower readiness under each code alert? Use the following manpower stand-by monitoring sheetas a guide: XYZ Hospital / Department Alert Team Members Stand-by Monitoring Sheet Alert Code: White / Blue / Red (encircle one) Date and Time of Activation: Name of Event / Incident: Primer on Hospital Alert Codes

30. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! What are the recommended guidelines on communication systemthat will ensure adequacy and prompt response of manpower? The primary communication device shall be the cellphone as this is readily availableand will facilitate documentation of all activities that transpire which in turn will facilitate evaluation, particularly, on activation and deactivation messages and responses and whereabout messages of members of the surgical teams. The cellphone can be complemented with telephones and other means of communication. Templatesfor text messages shall be used. Primer on Hospital Alert Codes

31. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! What are examples of templates of SMS messages that can be used during the activaiton and deactivation of alert codes? Templates for SMS (text) messages: Primer on Hospital Alert Codes

32. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! What are examples of templates of SMS messages that can be used during the activaiton and deactivation of alert codes? Templates for SMS (text) messages: Primer on Hospital Alert Codes

33. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! What are examples of templates of SMS messages that can be used during the activaiton and deactivation of alert codes? Templates for SMS (text) messages: Primer on Hospital Alert Codes

34. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! What are examples of templates of SMS messages that can be used during the activaiton and deactivation of alert codes? Templates for SMS (text) messages: Primer on Hospital Alert Codes

35. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! What are recommended guidelines in ensuring there are enough supplies to handle anticipated surge of patients to the hospital? Determine the supplies needed for each level of alert code. Use the following supplies monitoring sheet as a guide: XYZ Hospital / Department Supplies Stand-by Monitoring Sheet In Emergency Room / Operating Room / Other Departments (specify) Alert Code: White / Blue / Red (encircle one) Date and Time of Activation: Name of Event / Incident: Primer on Hospital Alert Codes

37. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! What are the ultimate criteria to be used in evaluating an alert code activation? The minimum criteria to be used during the evaluation will be adequacy and response time (to be in the Hospital) of manpower on stand-by outside the hospitaland the adequacy of prepared supplies based on a must-have list. Primer on Hospital Alert Codes

38. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! • What are the general parameters and criteria that can be used in evaluating a hospital alert code system? • Presence of policies and procedures on alert code system • General steps followed during activation and deactivation • Specific guidelines and instructions followed during activation and deactivation • Presence of exercises at least once a year Primer on Hospital Alert Codes

39. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! • What are the general parameters and criteria that can be used in evaluating a hospital alert code system? • Presence of evaluation after every activation of an alert code (see evaluation checklist) • Presence of continual review and improvement activities Primer on Hospital Alert Codes

40. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! • What are the general parameters and criteria that can be used in evaluating a hospital alert code system? • During actual activation of an alert code: • Presence of adequate manpower on alert stand-by based on activated alert code • Response time (being in the hospital) of at least 80% of manpower on stand-by outside the hospital within 30 minutes • Presence of adequate prepared supplies based on activated alert code Primer on Hospital Alert Codes

41. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! What is an example of a checklist that one can be used in evaluaitng the quality of an alert code activation and deactivation? XYZ Hospital Alert Code Activation and Deactivation Evaluation Checklist Alert Code: White / Blue / Red (encircle one) Date and Time of Activation: Name of Event / Incident: Primer on Hospital Alert Codes

49. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! What’s next for OMMC? Formulation of Policies and Procedures on OMMC Alert Code System Completion of ALL Departments’ Alert Codes Exercise on Code White Alert Hospital Alert Codes

50. DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Code White Alert Code Blue Alert Code Red Alert Indication for activation of alert codes Presence of events 5 kms outside OMMC in which surge of patients is anticipated. Anticipated surge of 10 patients – Code White Alert 20 patients – Code Blue Alert 30 patients – Code Red Alert Department of Surgery Alert Code System