Editor's note: This article was originally published in ONS Connect in May 2012.
By Tamara B. Dolan, RN, MSN, OCN®
In the early hours of September 13, 2008, Hurricane Ike—a category 2 hurricane—hit Galveston Island, TX, bringing with it sustained winds of up to 110 miles per hour and storm surges reaching as high as 17 feet. By the next day, more than 200 shelters had opened across Texas to house the estimated 40,000 people who had been forced to evacuate from their homes.
Aside from displacing them from their homes, the hurricane also affected the cancer care of patients in the area. ONS member Nancy Wells, RN, BSN, OCN®, a practice administer for Texas Oncology in Sugar Land, TX, explains that some facilities in the area were closed for two days or longer.
In cases when a clinic was closed for just a short time, appointments were delayed and rescheduled for a later date. For longer closures, additional measures were taken to ensure continuity of care. “Patients with critical needs received care from other Texas Oncology practices that were not impacted.” Wells explains. “Patients in the areas more directly impacted were connected with other Texas Oncology practices to ensure their care continued.”
ONS member Naomi Bolognani, RN, OCN®, is the oncology program manager at Baystate Franklin Medical Center in Greenfield, MA. In August 2011, Tropical Storm Irene left more than 500,000 Massachusetts residents without electricity. In Greenfield and its surrounding areas, flooding washed away roads and forced people to evacuate from their homes.
The clinic remained open after Tropical Storm Irene, but staff members faced new challenges. Bolognani and other employees were unable to make it to work because the roads were inaccessible. Fortunately, many staff members live nearby, work part-time, and are able to pick up additional hours when emergencies arise. “We also have a per diem pool that we can pull staff from in times of need,” Bolognani says.
An Ounce of Prevention
The National Weather Service gave Wells’ South Texas community 24–48 hours’ notice that the hurricane was anticipated. This allowed Wells and her colleagues to put in place strategies to help alleviate potential problems. For example, the practice administrator and nurse manager printed the appointment schedule for the upcoming two weeks as well as patient phone numbers, preventing the need to return to the clinic in the immediate aftermath of the storm.
“Advanced preparation helps us avoid chaos and ensures that our patients get the care they need even if our clinic is not functional due to power outages or flooding,” she attests.
Like Wells, Bolognani believes in the importance of advanced preparation. “Cancer is a disaster in and of itself to most people,” she says. “Being prepared and informed alleviates additional unneeded stress.”
During a natural disaster, Bolognani says that patients need to know to contact their provider office for help. “We are blessed to have an extraordinary social worker who has the ability to find any resources a patient may be in need of.”
In fact, Bolognani says, “One of the most important pieces of information that we deliver to patients before a disaster occurs is that if they have any concerns or questions whatsoever, they are to call the office number or go to the Emergency Department.”
Getting the Right Information to Patients
“We are constantly reevaluating our disaster preparedness plan to continue to ensure the safety of our employees and patients and to provide continuity of care,” Wells explains. “After Hurricane Ike, we expanded our hurricane preparedness efforts and communication to include patient handouts highlighting Texas Oncology’s policies and procedures in the event of a disaster, including the practice’s phone number so that patients can get in touch with us quickly.”
Written information is also provided to patients at Baystate. “Every new patient receives a binder during a teaching session,” Bolognani notes. “Included in this informational binder is a magnet displaying our business address, hours of operation, and emergency after-hours number.”
That phone line is staffed by an answering service that puts patients in touch with a physician on call. “Any redirection of services would be communicated at the time of the phone call. The needs of the patient are communicated to the on-call physician who, in turn, addresses the issues with the patient,” Bolognani explains.
In addition to a central phone number that patients can call to transfer care and to check about clinic reopening dates, Texas Oncology has also placed its emergency access information on its website. “Patients can easily access emergency information and updates on clinic closings via a disaster button on the homepage of Texas Oncology’s website through their computer or smartphone,” Wells says.
Emergency Kits for Patients With Cancer
It is also critical that patients be prepared to help themselves. In addition to a basic emergency supply kit, patients with cancer may need additional items. Wells suggests that patients with ports consider taking a Huber or other non-boring needle, supplies for dressing changes (if necessary), a supply of prescription and non-prescription medications, a thermometer and—if counts are low—a face mask.
In addition, Bolognani stresses, “It is extremely important for patients to have pertinent medical information with them when disaster strikes.”
Wells suggests that patients work with their doctors to create this medical summary. “We can prepare packets for patients to take with them when we have sufficient warning that the practice could possibly lose power, such as during a hurricane,” she says. Prior to Hurricane Ike, “we gave patients a copy of their last history and physical exam, order summary, regimen order summary, and last labs,” she explains.
Texas Oncology is also introducing a care guide that will be distributed to new patients. “In the new patient packet, we will include information from the government on disaster preparedness, such as evacuation routes and necessary supplies,” she says.
If it becomes necessary to evacuate, patients should take their health insurance card with them. They should also look into what services will or will not be covered should they need to seek care in a new location.
Wells suggests patients who relocate may be able to get assistance finding a US Oncology network practice at www .usoncology.com. In addition, their current providers may be able to offer alternatives. Wells and Bolognani’s facilities are both part of larger, multisite practices, so transferring patients between practices is an option. If the practices maintain electronic medical records that can be accessed between facilities, it makes the process even easier.
“Patients with cancer have more than enough to think about,” Bolognani says. “They need to focus on the task at hand—that being to continue treatment and the healing process.”