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Ensure that drills match your center’s environment

Ambulatory Safety Monitor, September 15, 2005

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The AAAHC standards committee made an addition to the footnote on standard 8.B.2.c regarding emergency drills. The standard calls for a comprehensive emergency plan to address internal and external emergencies, including a requirement for at least four drills per year for the internal emergency plan, according to the 2005 edition of the Accreditation Handbook for Ambulatory Health Care.

The footnote specifies that drills must be appropriate to the facility's activities and environments. This year, that notation was clarified with the following examples:

• Medical emergencies
• Surgical fires
• Hurricanes
• Bomb threats
• Chemical, biological, or nuclear threats
• Building fires
• Tornadoes
• Earthquakes
• Violence

The AAAHC made this modification because surveyors found that organizations didn't understand what the accreditor meant by "appropriate to the facility's activities and environment," says Stephen Kaufman, RN, MA, AAAHC senior director of accreditation. "For example, an ambulatory surgery center on the Southeast coast performing an earthquake drill would be better served having a policy on and performing a hurricane drill."

Choosing the drills to use

One of the four exercises a year must include a fire drill, Kaufman says. As with all drills, the AAAHC doesn't require that organizations perform them in a certain way.

"You should understand all local and state fire regulations, though," Kaufman says. Also, do the following in your fire drills:

• Make sure you have an audible fire alarm
• Practice the evacuation of staff and patients
• Ensure your fire extinguishing equipment is accessible, working, and that staff know where it is and how to use it

The resuscitation drill required in standard 8.B.3 can count as one of the four drills and one from which all facilities benefit. Other drills that are less regional than weather emergencies are those that might be associated with terrorist activity.

"These days, almost anyone is susceptible to terrorist events," Kaufman says.

Policy and documentation

In your policy on emergency drills, include who conducts them. Also make sure you document the drills when they are performed. For example, note who led the drill, who was in attendance, and when the drill took place.

This documentation will show the surveyor that you practice what you have in your policy.

Helpful hints for successful drills

Kaufman offers the following tips for performing worthwhile emergency drills:

• Although the standard doesn't outline when your drills must be done, space them out over the course of a year. This will allow you to educate and train your staff on an ongoing basis. Keep in mind that the Centers for Medicare & Medicaid Services requires fire drills to be done quarterly, however.
• Call the local fire department ahead of time and let staff know when the drill will be so they can participate.
• Put on physical drills, not just tabletop drills.

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