There Are 31 Different Codes and Alerts with OSF

9/15/2016

Welcome to Welcome

Harmonizing Healthcare Emergency Codes Charles Denham, MD

Chairman, TMIT

TMIT High Performer Webinar September 15, 2016

For resource downloads go to: www.safetyleaders.org

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TMIT Purpose Statement If you wish to follow us on Twitter, go to: http://twitter.com/TMIT1 Our Purpose: or use #safetyleaders hashtag We will measure our success by how we protect and enrich the lives of families…patients AND caregivers.

Our Mission: Also, go to: To accelerate performance solutions that save lives, www.facebook.com/SafetyLeaders save money, and create value in the communities we and related sites serve and ventures we undertake.

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The following panelists certify: Disclosure Statement Speakers and Reactors that unless otherwise noted below, each presenter provided full disclosure information; does not intend to discuss an unapproved/investigative use of a commercial product/device; and has no significant financial relationship(s) to disclose. If unapproved uses of products are discussed, presenters are expected to disclose this to participants.

William R. Scharf, MD, is a Physician Change Agent in the Division of Clinical Excellence with OSF HealthCare Systems. He graduated from Illinois Wesleyan University, and received his medical degree from the University of Illinois in Chicago. Dr. Scharf received postdoctoral training in general surgery from the University of Illinois Hospital, Cook County Hospital, and the West Side Veterans Administration Hospital in Chicago. He has nothing to disclose.

Mr. Keil has 41 years of direct experience in the healthcare field of facilities management. Mr. Keil's background includes 15 years of direct experience in the management of healthcare facilities, 13 years as the Director of Plant and Technology Management for the Joint Commission on Accreditation of Healthcare Organizations®. Has nothing to disclose

James Mitchell, MBA, joined Texas Children’s in September of 2015 and has an extensive background in Crisis Management, Business Continuity and IT Disaster Recovery in both the Energy (BP) and Investments (Invesco) industries. While at Invesco, James developed the IT Crisis Management and Disaster Recovery process as well as developing and leading an international team to drive these efforts. He has nothing to disclose.

Aaron Freedkin, MS, CHEP, EMT, is the most recent addition to the Texas Children’s Emergency Management Team having just arrived in May of 2016. Aaron previously served in Emergency Management with MD Anderson in the Texas Medical Center for over 6 years, is an Emergency Medical Technician, is a Certified Health Emergency Professional and has a Master of Science in Disaster & Emergency Management from Touro University. He has nothing to disclose. William Scharf Ode Keil James Mitchell Aaron Freedkin William Adcox Chief William H. Adcox serves as the Chief of Police and CSO at The University of Texas MD Anderson Cancer Center and The University of Texas Health Science Center. Chief Adcox holds an MBA degree from UTEP and is a graduate of the PERF's Senior Management Institute for Police and the Wharton School ASIS Program for Security Executives. He has nothing to disclose.

Inspector Vicki King served 27 years with the Houston Police Department, rising to the rank of Assistant Chief and earning a master's degree in Criminal Justice. As Chief of Detectives, Tactical Support Commander, and Director of Forensic Services, she oversaw some of HPD's highest-profile cases, including serial homicides, corruption, domestic violence, sexual assaults, and gangland slayings. She has nothing to disclose.

Gregory H. Botz, MD, FCCM, is a professor in the Department of Critical Care at the UT MD Anderson Cancer Center. He received his medical degree from George Washington University School of Medicine in Washington, DC. He completed an internship in internal medicine at Huntington Memorial Hospital and then completed a residency in anesthesiology and a fellowship in critical care medicine at Stanford University in California. He also completed a medical simulation fellowship at Stanford with Dr. David Gaba and the Laboratory for Human Performance in Healthcare. Dr. Botz is board-certified in anesthesiology and critical care medicine. He is a Fellow of the American College of Critical Care Medicine. Has nothing to disclose.

Jennifer Dingman realized, after her mother's death in 1995 due to errors in medical diagnoses and treatment, that there is little to no help available for patients and their families in similar situations. This life-changing experience left her feeling vulnerable, and she decided to dedicate her life to help prevent medical tragedies from happening to others. She has nothing to disclose.

Charles Denham, MD, is the Chairman of TMIT; a former TMIT education grantee of CareFusion and AORN with co-production by Discovery Channel for Chasing Zero documentary and Toolbox including models; and an education grantee of GE with co-production by Discovery Channel for Surfing the Healthcare Tsunami documentary and Toolbox, including models. HCC is a former contractor for GE and CareFusion, and a former contractor with Siemens and Nanosonics, which produces a sterilization device, Trophon. HCC is a former contractor with Senior Care Centers. HCC is a former contractor for ByoPlanet, a producer of sanitation devices for multiple industries. Dr. Denham is a collaborator with Professor Christensen. Vicki King Gregory Botz Jennifer Dingman Charles Denham

Voice of the Patient and Family In the News and Polling Highlights:

News Update and Jennifer Dingman August 2016 Webinar Polling Founder, Persons United Limiting Substandards and Errors in Healthcare (PULSE), Colorado Division Co-founder, PULSE American Division TMIT Patient Advocate Team Member Charles Denham, MD Pueblo, CO Chairman, TMIT TMIT High Performer Webinar September 15, 2016 TMIT High Performer Webinar September 15, 2016

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In The News In The News

Opioid Overdose Hits Mainstream September 2016

September 15, September Articles 2016 • Root Cause Analysis of Ambulatory Adverse Drug Events That Present to the Emergency Department • Measuring Adverse Events in Hospitalized Patients: An Administrative Method for Measuring Harm

• Multidisciplinary Testing of Floor Pads on Stability, Energy Absorption, and Ease of Hospital Use for Enhanced Patient Safety

• Rapid Learning of Adverse Medical Event Disclosure and Apology

• Associations of Injurious Falls and Self-Reported Incapacities: Analysis of the National Health Interview Survey Improving Patient Safety Culture in Primary Care: A Systematic Review

• Pharmacists Views and Practices in Regard to Sales of Antibiotics Without a Prescription in Madinah, Saudi Arabia

• Building a Highway to Quality Health Care

• Setting Up a Patient Care Call Center After Potential HCV Exposure

• Three Simple Rules to Improve Medication Safety

Source: Park M. Grandmother in heroin photo gets 180 days in jail. CNN. 2015 Sept 15. Source: Journal of Patient Safety September 2016 http://www.cnn.com/2016/09/15/health/heroin-photo-woman-court/index.html http://journals.lww.com/journalpatientsafety/pages/currenttoc.aspx

Learn from Mortality Review AND the Living: Part 2 - A Deeper Dive Omission vs. Commission

Jeanne M. Huddleston, MD, FACP, FHM

Hospitalist Chairperson of Mortality Review Subcommittee Mayo Clinic Rochester, MN

TMIT High Performer Webinar July 21, 2016

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Anonymous Polling Questions

Raw Information case I am interested in a webinar with speakers who have reviews launched Mortality Review from scratch

100% Identification of No Problem issues problem 90% 84% Agreed and 71% Strongly or Very Strongly Agreed,

80% and 57% Very Strongly Agreed

Prioritization of Further No further 70% information review review 60% 57% Reviewer Work Is there anything 50% that could mitigate Yes No future events? 40%

30% Aggregate Committee Work Report 20% learning 14% 9% 10% 8% 4% 5% 1% 1%

Clinical 10 9 8 7 6 5 4 3 2 1 Quality Very Practice Strongly Agree Agree Neutral Neutral Negative to Disagree Strongly Very Strongly Agree Neutral Disagree Strongly Agree Disagree

Source: TMIT High Performer Webinar Series; Learn from Mortality Review AND the Living: Part 2 – A Deeper Dive – August 18, 2016

High MeaningfulImpact Care Hazards Use isto Patients,dead. Long Students, live and something Employees better! The Mortality Review topics I want to learn more about are:

Cardiac Arrest • 30 Day Heart Failure and Pneumonia Mortality • How to recognize the infection in post-op patient and timely treatment • Adverse event prevention tools and education that have worked • Identified trends in mortality • all that can impact improved patient care and hospital processes • IS there a difference in quality of care for patients < 65 vs >65? Choking and Drowning A Medical-Tactical Approach • AMI within 24h • Missed Diagnosis undertaken by clinical and non- • AMI's Sepsis • none clinical people can have • CARE huddles • OR, Procedure Room culture Opioid Overdose • categorizing system issues in a meaningful way • physician involvement enormous impact on loss of life • differentiating preventable vs. non-preventable death • report examples and harm from very common • DNR/DNI Timeframe • reviewer engagement hazards: Anaphylaxis • Engaging physicians • reviewing highly invasive procedures in patients at end of life • failure to rescue • sepsis • High Impact Care Hazards • Heart Failure • Sepsis are frequent, severe, Active Shooter • Hospital acquired infections • "Sepsis " preventable, and • How can Nursing and other disciplines facilitate the physician • Shock, Sepsis, missed potassium variability diagnosis more effectively, based on what you have learned? measurable. • starting from scratch • How they were completed and communicated with leaders of the • STEMI- post PCI mortality Non-trans Accidents • Lifeline Behaviors organization. Also how do you evaluate the results/benefit of conducting such reviews. • the actual review process and any tools you feel you can share undertaken by anyone can • how to engage patients and family members since hospitals are being • too many to type here now-a list is helpful save lives. strongly encouraged to have them at the table. • tools used for the reviews Transportation Accidents • How to get MD champions and MD buy in • What are the criteria you use for sending cases from LPN or admin. to • How to present to properly present it to physician in Medicine the physicians? Committee. • what data is collected and how is it presented (data and stories) Bullying

Source: TMIT High Performer Webinar Series; Learn from Mortality Review AND the Living: Part 2 – A Deeper Dive – August 18, 2016

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CAREMeaningful Huddle Concept: Use A Resourceis dead. for Long Group live Events something (eg. Schools orbetter! Meetings) Anonymous Polling Questions

I am interested in DEEP DIVE webinars on the Med Tac Causes of Death of Healthy People

100% CARE Huddle™ CARE Huddle™ Hazards Assessment Critical Actions in Response to Emergencies 90% 83% Agreed and 57% Strongly or Very Strongly Agreed, C – Critical  Location  Scene Safety ______80% and 41% Very Strongly Agreed A – Actions in  Call 911 R – Response to  Time of Day ______70%  Medical Response E – Emergencies  Weather Conditions  CPR 60%  Automatic External The CARE Huddle is a ______Defibrillator (AED) preparedness strategy.  Facilities 50%  Stop The Bleed Kit ______41% It helps you assign life saving  EpiPen® Kit  Access Routes 40% actions to participants at events.  Narcan® Kit ______30%  First Aid Kit It helps you execute critical  Threats  Meet First Responders actions to common emergencies. ______20% 16%  Injury Potential 15%  Find a Caregiver On-site Make sure everyone with an 11% ______10%  Find the Parent assignment knows what to do 5% 4% 5% and has a copy of the CARE  Known Hazards 1% Huddle. ______10 9 8 7 6 5 4 3 2 1 Very © 2016 TMIT © 2016 TMIT © 2016 TMIT Strongly Agree Agree Neutral Neutral Negative to Disagree Strongly Very Strongly Agree Neutral Disagree Strongly Agree Disagree

Source: TMIT High Performer Webinar Series; Learn from Mortality Review AND the Living: Part 2 – A Deeper Dive – August 18, 2016

Anonymous Polling Questions Anonymous Polling Questions

I am interested in participating in a Community of Practice developing I am interested in a webinar on ALL CAUSE HARM to those we serve the Med Tac tools such as the C.A.R.E. Huddle (patients) and those who serve (our caregivers)

100% 100%

90% 41% Agreed and 16% Strongly or Very Strongly Agreed, 90% 91% Agreed and 68% Strongly or Very Strongly Agreed,

80% and 11% Very Strongly Agreed 80% and 52% Very Strongly Agreed

70% 70%

60% 60% 52% 50% 50%

40% 40%

30% 30% 20% 20% 20% 15% 16% 16% 15% 11% 10% 10% 7% 7% 10% 8% 5% 5% 5% 3% 3% 3%

10 9 8 7 6 5 4 3 2 1 10 9 8 7 6 5 4 3 2 1 Very Very Strongly Agree Agree Neutral Neutral Negative to Disagree Strongly Very Strongly Agree Agree Neutral Neutral Negative to Disagree Strongly Very Strongly Strongly Agree Neutral Disagree Strongly Agree Neutral Disagree Strongly Agree Disagree Agree Disagree

Source: TMIT High Performer Webinar Series; Learn from Mortality Review AND the Living: Part 2 – A Deeper Dive – August 18, 2016 Source: TMIT High Performer Webinar Series; Learn from Mortality Review AND the Living: Part 2 – A Deeper Dive – August 18, 2016

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EmergencyMeaningful Code Harmonization: Use is dead. Long live something better! Anonymous Polling Questions

I am interested in a webinar addressing EMERGENCY CODE HARMONIZATION STANDARDIZED CODES:  RED for fire 100%  BLUE for adult medical emergency 90% 70% Agreed and 45% Strongly or Very Strongly Agreed,  WHITE for pediatric medical emergency 80% and 32% Very Strongly Agreed  PINK for infant abduction 70%  PURPLE for child abduction 60%  YELLOW for bomb threat 50%  GRAY for a combative person 40%  SILVER for a person with a weapon and/or 32% 30% hostage situation 20% 13% 14% 13%  ORANGE for a hazardous material 11% 11% 10% spill/release 3% 2% 2%  TRIAGE INTERNAL for internal disaster 10 9 8 7 6 5 4 3 2 1 Very Strongly Agree Agree Neutral Neutral Negative to Disagree Strongly Very Strongly  TRIAGE EXTERNAL for external disaster Agree Neutral Disagree Strongly Agree Disagree

Source: TMIT High Performer Webinar Series; Learn from Mortality Review AND the Living: Part 2 – A Deeper Dive – August 18, 2016

The patient safety topics (ANY) that are Keeping me up at night are: The patient safety topics (ANY) that are Keep?ing me up at night are:

• After 45 years in the medical arena, I have learned to sleep most • How to engage the physicians in the mortality review process as a • Quality measures and if you have a system that would help in a post nights. Thank you for affording me the opportunity to continue being a separate entity from peer review do you have a system that would work in a post acute care part of the solutions. environment. • I am interested in reviews of mortality and harm that use real clinical • Amiodarone errors, missed sepsis and shock definitions and not surveillance • Restraints • Are we truly capturing all the clinical indicators and the treatment the • I am unable to participate d/t non-hospital provider setting. Theses • Sepsis patient received sessions have extraordinary! • Sepsis • Clinicians not Keeping up with evidence-based care due to their • Infection in post-op patients • Sepsis, postop resp. failure perceived lack of time • Lack of leadership engagement, (it often seems as if leadership does • We just send cases to medical staff peer review and not look into the • Communication, suicide after discharge not understand the correlation between cost, quality, patient and system failures employee satisfaction.... I am a consultant and the ceo of a large • Delay in dx - sepsis hospital said to me, i ag the unwillingness to hold every individual • Why culture of medical staff is difficult change? Difficult to get • Discharging patients back to rural and indigent communities which accountable for their practice (i.e. nurses are held accountable for medical staff to lead safety changes. have very few resources, e.g. Shortage of primary care providers to washing their hands, too offer physicians are not)" • You've touched on it - readmissions!! follow them after they leave the hospital • Medication safety • Documentation and use of standardized templates for preventive • Missed STEMI diagnosis in e.d. exams • Missing the warning signs of patients deteriorating b/c of being so • EHR use in office and hospital physician/RN records and progress task oriented--lack of critical thinking skills, lack of communication-- notes copy & paste"" during handoffs, etc. The simple things that prevent so much such as • Having meaningful goals of care discussions at the right time in a hand hygiene or lack of it, patient's care journey • Needing more nurses in number, with stong clinical skills, with strong • Hospital acquired infections backbones. This generally is a time and experience type of growth. • Hospital acquired infections However, this is the problem...We need them now and in the future. A nightmare. • How can care improve rather then decrease in the coming challenges of financial costs increasing? • Nursing sensitive adverse events • How can we support the early diagnosis of conditions? What advise • Opioid prescribing rates • How organizations support clinicians involved in the cases been • Physicians who do not answer calls, residents reviewed?

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Crack the uncommon code with standardization Health Care Emergency Codes, A Guide for Standardization – Hospital Association of Southern California

October 2004

The Hospital Association of Southern California (HASC) recognized that standardized emergency codes could make a difference in hospitals after a September 1999 shooting at West Anaheim (CA) Medical Center left three workers dead…

When staff members saw the gun, they instinctively called the emergency code for a violent patient, Truesdell says. “When you call a code for a violent person, there’s a team that usually responds to subdue the person. There’s a different response code for someone with a weapon,” she says…

Following the incident, Truesdell and other HASC members wondered whether standardized codes could have prevented this tragedy.

After the shooting, HASC decided standardized emergency codes throughout the region could benefit employees the most. “Many people work in different hospitals, like nurses who travel from one hospital to another,” Truesdell says. “Everyone has to go through new employee orientation, but it gets confusing if one hospital uses a specific code and another hospital uses a different code.” While visiting a hospital, Truesdell experienced code confusion firsthand. “The hospital called a code orange, which California hospitals typically use for a hazmat spill,” she says, noting it was actually the hospital’s infant abduction code. To prevent emergency code confusion and possibly reduce tragedies, HASC focused on standardizing emergency codes in southern California hospitals, using its safety and security committee.

Source: Healthcare Security and Emergency Management Newsletter. Crack the uncommon code with standardization. Hcpro: 2004 Oct. Col 3 No 10. Pg 6. http://www.hcpro.com/HOM-42311-742/Crack-the-uncommon-code-with-standardization.html Source: Hospital Association of Southern California. HEALTH CARE EMERGENCY CODES A GUIDE FOR CODE STANDARDIZATION. HASC, 2014. http://www.hasc.org/hospital-emergency-codes © 2016 TMIT © 2016 TMIT © 2006 HCC, Inc. CD000000-0000XX 29 © 2006 HCC, Inc. CD000000-0000XX 30

Standardization and implementation of a standard emergency code call system within WRMC Standardization and implementation of a standard emergency code call system within WRMC

Madigan Army Medical Center, Tacoma, WA MAJ Michael Wissemann, AN, United States Army Preceptor: LTC Tamara Freeman Prepared for LTC Matthew Brooks

March 2009 Updated 2014

Code Blue: Medical Emergency (Adult) Code Gray: Combative Person A problem exists with the continuity of the code calls within in the Army Medical Code Green: Patient Elopement Department (AMEDD). As military personnel move, or Permanent Change of Station Code Orange: Hazardous Material Spill/Release (PCS), from assignment to assignment, they must unlearn what they had learned at a Code Pink: Infant Abduction previous hospital and reeducate themselves with a new code system. As seen in the Code Purple: Child Abduction opening anecdote [HASC], getting it wrong may have dire consequences, if not only for Code Red: Fire the patient, but for the hospital employee. These behaviors and responses may be hard Code Silver: Person with a Weapon, Active Shooter, and/or Hostage Situation to change as they are often drilled at facilities until they become conditioned. Code Triage: Alert / Internal Emergency / External Emergency Code White: Medical Emergency (Pediatric) Code Yellow: Bomb Threat

Source: Hospital Association of Southern California. HEALTH CARE EMERGENCY CODES A GUIDE FOR CODE STANDARDIZATION. HASC, 2014. Source: Wisseman MAJ M. Standardization and implementation of a standard emergency code call system within Western Region Medical Command http://www.hasc.org/hospital-emergency-codes Madigan Army Medical Center, Tacoma, WA . 2009 Mar. http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA516594

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Colorado Hospital and Health System Emergency Code Standardization Project STANDARDIZED HOSPITAL EMERGENCY CODE -- STATE OF LOUISIANA

Updated March 2005 June 2011

Code Red: Fire CODE BLUE: Medical Emergency – Cardiac/Respiratory Arrest Code Blue (location): Cardiac Arrest* CODE RED: Fire Code Orange: Hazardous Material Spill CODE GREY: Severe Weather Code Black: Bomb Threat CODE BLACK – Bomb Code Pink: Infant /Child Abduction CODE PINK: Infant/Child Abduction Code Gray: Combative Person CODE YELLOW: Disaster – Mass Casualty Code Silver: Unauthorized Person with a Weapon CODE ORANGE: Hazardous Materials Tornado Watch: Tornado Watch CODE WHITE: Security Alert – Violence/Hostage Tornado Warning: Tornado Warning * Code Blue will be used to announce any cardiac or respiratory arrest in the hospital, regardless of location or patient age.

Source: Colorado Hospital Association. Colorado Hospital and Health System Emergency Code Standardization Project. Updated 2011 Jun 1 Source: State of Louisiana. STANDARDIZED HOSPITAL EMERGENCY COD, A recommendation for Louisiana Hospitals as presented to the Legislative, Regulatory & Policy Council of the Louisiana Hospital Association. 2005 Mar 16.

Standardized Emergency Codes - Tools and Resources: Kansas Hospital Association Standardized Emergency Codes - Tools and Resources: Kansas Hospital Association

2010 2014

Code Black: Bomb threat Code Red: Fire Code Green: Mass Casualty/ Disaster Code Blue: Cardiac arrest, medical emergency Code Red: Fire Code Black: Bomb threat Code Blue: Cardiac arrest/ Respiratory arrest Code Pink: Infant abduction Code Orange: Hazmat/ Bioterrorism Code Orange: Hazardous material spill/release Code Pink: Infant/ child abduction Inclement Weather Alerts: Plain text messaging for all watches and warnings Code Gray: Violence/ Security alert Plain language overhead codes are recommended for the following situations, incidents or events, and their subsequent response:  Active shooter  Hostage situation  Armed violent intruder  Facility evacuation Source: Kansas Hospital Association. Standardized Emergency Codes - Tools and Resources. 2010.  Plant facility system alert (e.g., generator failure, etc. Source: Florida Hospital Association. Overhead Emergency Codes: 2014 Hospital Guidelines. Joint Commission. 2014. https://www.jointcommission.org/assets/1/6/EM-2014_RECOMMENDATIONS_FOR_HOSPITAL_EMERGENCY_CODES_FINAL_(2).pdf © 2016 TMIT © 2016 TMIT © 2006 HCC, Inc. CD000000-0000XX 35 © 2006 HCC, Inc. CD000000-0000XX 36

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Standardized Emergency Codes - Tools and Resources: Kansas Hospital Association Standardized Emergency Codes - Tools and Resources: Kansas Hospital Association

2007 2011 for 1/1/12 Implementation

Code Black: Bomb Threat/ Suspicious Package Code Yellow: Disaster Plan Activation (Internal or External) Code Red: Fire Code Orange: Hazardous Material/ Spill/Release (Internal/ External) Code Blue: Medical Emergencies (Adult or Pediatric) Plain Speech/Text Earthquake: Severe Weather (Watch or Warning) Plain Speech/Text Shelter-in-Place (With Instructions) Plain Speech/Text Snow Emergency Plan Plain Speech/Text Tornado (Watch or Warning)

Source: Wisconsin Hospital Association. Wisconsin Hospital Standardized Alert Code Recommendations. WHA. 2011. http://www.wha.org/data/sites/1/emergencyprep/StandardizedAlertCodeRecommendations.pdf Source: Kentucky Hospital Association. Recommended Emergency Codes. Emergency Preparedness Committee KHA. 2007.

Plain Language Frequently Asked Questions (FAQs) Plain Language Frequently Asked Questions (FAQs)

June 2010

“For the purpose of the National Incident Management System (NIMS), plain language is designed to eliminate or limit the use of codes and acronyms, as appropriate, during incident response involving more than a single agency … NIMS defines common terminology as: normally used words and phrases—avoiding the use of different words/phrases for similar concepts—to ensure consistency and to allow diverse incident management and support organizations to work together across a wide variety of incident management functions and hazard scenarios.”

Source: DHS. Plain Language Frequently Asked Questions (FAQ’s). OEC, DHS: 2010 June. Source: DHS. Plain Language Frequently Asked Questions (FAQ’s). OEC, DHS: 2010 June. https://www.dhs.gov/sites/default/files/publications/PlainLanguageFAQs_0.pdf https://www.dhs.gov/sites/default/files/publications/PlainLanguageFAQs_0.pdf

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Standardized Emergency Codes Standardized Emergency Codes

Standardized Emergency Code Card and List Developed by HASC

“The Hospital Association of Southern California (HASC) recognized that standardized emergency codes could make a difference in hospitals after a September 1999 shooting at West Anaheim (CA) Medical Center left three workers dead.”

“There were 47 different codes to indicate an infant abduction and 61 different codes for a combative person. HASC also discovered that few hospitals had a code for someone “Adopting code uniformity enables the carrying a weapon.” numerous individuals who work across multiple facilities to respond appropriately to specific emergencies, enhancing their own safety, as well as the safety of patients and visitors.”

Healthcare Security and Emergency Management. October 2004. Crack the uncommon code with standardization. Accessed http://www.hcpro.com/HOM-42311-742/Crack-the-uncommon-code-with-standardization.html. Wall, Patricia CAE. Hospital Emergency Codes Standardized health care emergency codes for California. Accessed http://www.hasc.org/hospital-emergency-codes.

Harmonizing Emergency Codes – Lessons Learned Harmonizing Emergency Codes – Lessons Learned

William R. Scharf, MD Ode Keil MS, MBA Physician Change Agent Executive Director, Facilities Planning and Operations Division of Clinical Excellence OSF Healthcare System OSF HealthCare Systems Peoria, IL Peoria, IL TMIT High Performer Webinar TMIT High Performer Webinar July 21, 2016 July 21, 2016

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ONE OSF The Opportunity Code Standardization An employee at an OSF hospital was working at a different OSF facility when a “Code Yellow” was called. The employee appeared distressed as no one was responding. At the hospital where he worked, “Code Yellow” referred to a bomb threat; at the facility he was visiting, “Code Yellow” was a request for patient assistance.

Strategic Effectiveness

Internal Survey Internal Survey

There are 31 different None of the Codes or Codes and Alerts with Alerts was the same OSF Healthcare System across all seven hospitals

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Really? Really?

Code Purple Code Green Code Yellow Code White . SJMC: Hazardous spill . HFMC: Tornado . SJJWAMC: Patient . SAMC: Combative patient assistance needed . SMMC: Infant missing . SJMC: Combative patient . SJJWAMC: Emergency C . SFMC: Radioactive incident . SFMC: Hazardous spill . SJMC: Bomb threat section . Others: no Code Purple . Others: no Code Green . SAMC: External . SJMC: Evacuate the building disaster/influx of patients . Others: no Code White . HFMC: Trauma . Others: no Code Yellow

CODE SFH SAMC SJJWAMC SJMC SFMC SMMC HFMC OSF CHANGE Assistance Needed Code Yellow Code Gray Bomb Threat Bomb Threat Bomb Threat Bomb Threat Code Yellow Code Orange Code Black no overhead page Cardiac/Respiratory Arrest Code Blue Code Blue Code Blue Code Blue Blue Alert Code Blue Code Blue Code Blue Census Alerts for Really? Page Only CHOI/SFMC Child Cardiac/Respiratory Pediatric Blue Code Blue PALS Arrest Alert Combative Patient/Visitor Code White Code Control Code Green Code Strong Other Codes Combative person will make a threat to come here Dr. Minor Alert with a weapon Code Orange Contaminated Patients . Dr. Major . Code Tandem Hazmat Decontamination Team Code Orange Green Alert Code Orange Electronic Health record Code Paper Code Paper down . Dr. Minor . Code Lift Emergency C‐Section Code White Emergency Preparedness Code 1000 Code Alert Code Brown Evacuate the building Code Vacate Code White Plain Language Orange Alert External Disaster/ Internal & Possibly Code Triage‐ . Code 1000 . Code Strong Code Yellow Code Orange Mass Influx of Patients External External Different levels Fire Code Red Code Red Code 7‐11 Code Red Red Alert Code Red Code Red Code Red . Code 7-11 . Code Paper Hazardous Material Spill Do Not Have Code No overhead page Code Orange Code Purple Green Alert No Overhead Page Code Orange Hostage Situation Code Gray Page to Trauma Incoming Trauma to ED Trauma Alert Trauma Code Trauma Alert Code Yellow Team . Code Walker . Code Alert Code Pink=Infant Infant/Child Missing Code Pink Code Pink Security Alert Code Pink Pink Alert Code Purple Code Pink Pediatric=Child Internal Crisis ED Code Surge > 4 Possibly Code Triage ‐ Internal Disaster Code Orange Page for ED Code Alert Pts Waiting 1 Hour Internal Overload Lift help for patient /visitor Code Lift Code Lift Patient Missing Code Walker Code Elopement Silver Alert Patient with Chest Pain Code Heart Possible Mass Casualty Code Orange Alert Power Dip or Outage Code Tandem Plain Language Radioactive Incident Code Purple Purple Alert Severe Weather Code Gray Weather Watch Code Gray Plain Language Stroke Alert Stroke patients Stroke Alert Inhouse Page Threat made with a Dr. Major Code Silver Code Silver Code Black Code Silver weapon/Active shooter Tornado Code Gray Code Black Code Black Weather Warning Black Alert Code Green Plain Language Tornado Watch Code Grey Weather Watch Gray Alert Code Gray Plain Language Utility Failure Brown Alert Plain Language

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Examples of Standardization

. Music boxes . Player pianos Standards and Formats . Cylinder records vs disc records . 78 rpm records Principles and Concepts . 33 1/3 vs 45 rpm extended play records . 240 vs 405 line televisions . 12v vs 6v electrical systems in automobiles . FM radio

Great Baltimore Fire

Standards and Formats

ONE OSF Code Standardization

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States with Standardized Codes Principles in Code Determination . Alaska . New Hampshire . Arizona . Louisiana . Code designations were largely determined by the level of standardization in 17 states . California . New Jersey . There is a national trend towards “Plain Language – Clear . Colorado . Ohio Text” . Florida . Oregon . A color code was selected in situations that could incite . Rhode Island panic . Georgia . Kansas . Washington . . Kentucky West Virginia . Wisconsin

Plain Language – Clear Text System Code and Alert Names

CODE BLUE Medical Emergency- . “There is a tornado watch in effect in Peoria and Tazewell Cardiac/Respiratory Arrest counties until 2 pm today” CODE RED Fire . “There is a confirmed large and extremely dangerous CODE ORANGE Hazardous Material Spill tornado located east of Conway Springs and moving CODE PINK Infant/Child Abduction northeast at 35 mph. [toward the Wichita area] This is a particularly dangerous situation. Major damage to houses CODE SILVER Unauthorized person with weapon and buildings are likely and complete destruction CLEAR Code or alert cancelled possible." “PLAIN LANGUAGE-CLEAR TEXT” Script-specific announcements

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How Much Change?

Facility Number of Changes to Five Standardized Color Codes SFE 2 Adopt Code Orange, Dr MajorCode Silver SAMC 1 Adopt Code Orange SJJWAMC 3 Adopt Code Silver, Code 7-11Code Red, Security AlertCode Pink SJMC 2 Adopt Code Pink, Code PurpleCode Orange SFMC 5 Switch from 5 Alerts to Codes, Adopt Code Silver, Green AlertCode Orange, SMMC 3 Adopt Code Orange, Code PurpleCode Pink, Code BlackCode Silver HFMC 2 Adopt Code Silver, Adopt Code Pink

Questions

Readiness Levels in Plain Language

James A. Mitchell

Assistant Director, Texas Children’s Houston, TX

Aaron S. Freedkin

Emergency Management Manager, Texas Children’s Houston, TX

TMIT High Performer Webinar July 21, 2016

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Texas Hospital Association Plain Language Initiative Readiness Levels in Workgroup Plain Language Key Findings TARGETED & TAILORED Recommendations

Existing Alert Levels Problem Statement

Existing CARLA language is not clear NORMAL OPERATIONS – LEVEL 4 Existing CARLA language is too subjective Existing CARLA language is too broad SIGNIFICANT EVENT (INCREASED READINESS) – LEVEL 3 Existing CARLA language lacks differentiation for PARTIAL activations

HIGH READINESS (CARLA ALERT) – LEVEL 2

MAXIMUM ALERT (CARLA) – LEVEL 1

67 68

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Proposed Plain Language Alert Levels Proposal NORMAL OPERATIONS ‐ Passive Monitoring Develop plain language alert levels that are clear and concise, yet provide sufficient differentiation to ensure we neither over nor under respond to events and required actions are clearly understood. ADVISORY ‐ Active Monitoring

ALERT ‐ Preparing for Activation

ACTIVATION – Partial (Incident Command System)

ACTIVATION – FULL (Incident Command System)

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Example – No Notice Events Example – Escalating Events

Situation Advisory Alert Activation Partial Activation Full Situation Advisory Alert Activation Partial Activation Full Alert/Security Activation/Partial Life Threatening Situation Incident Command Advisory Alert Activation/Partial Active Shooter N/A N/A Severe Weather Activation/Full Location Operations & Logistics Severe Weather Severe Weather Situation Incident Command, (April 18th 2016) All Sections Action Action Situation Action Logistics Alert/Information Systems Activation/Partial Unplanned Information N/A System Unavailable Incident Command & Logistics N/A Advisory Alert Activation/Partial Activation/Full System Loss Hurricane Action Action Severe Weather Severe Weather Incident Command All Sections (Ike 2008) Alert/Facilities (96 Hours) (48 Hours) (36 Hours – Ride Out) (24 Hours – Lock Down) Activation/Partial Fire Alarm Activation/Full Alert Fire N/A Incident Command, Activation/Partial Location All Sections Facilities Operations & Logistics Internal Flooding Incident Command, Activation/Full Action N/A Internal Flooding Activation/Partial (February 2016) Logistics All Sections Alert/Medical Situation Activation/Full Abercrombie Mass Casualty Incident N/A Incident Command Operations, Action All Sections Action Logistics & Planning Alert Activation/Partial Alert/Security Power Outage Facilities N/A Incident Command, N/A Bomb Threat N/A Life Threatening Situation N/A N/A (West Campus – 2016) On Emergency Power Area Command Action Actions

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Polling Questions

Tailored & Targeted Messaging I am interested in participating in a national collaborative on Emergency Code Harmonization and Plain Language

10 9 8 7 6 5 4 3 2 1 Very Strongly Agree Agree Neutral Neutral Negative to Disagree Strongly Very Advisory Strongly Agree Neutral Disagree Strongly Agree Disagree

Alert The Emergency Code issues I would like to be addressed are: Activation Partial

Activation Full

Polling Questions Polling Questions

I am interested in a webinar on the latest data to support investing in Teamwork taught by the global subject matter experts. The topics I want to see addressed in future webinars are:

10 9 8 7 6 5 4 3 2 1 Very Strongly Agree Agree Neutral Neutral Negative to Disagree Strongly Very Strongly Agree Neutral Disagree Strongly Agree Disagree

I am interested in a deep dive webinar on errors of OMMISSION.

10 9 8 7 6 5 4 3 2 1 Very Strongly Agree Agree Neutral Neutral Negative to Disagree Strongly Very Strongly Agree Neutral Disagree Strongly Agree Disagree

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Speakers and Reactors Voice of the Patient and Family

Jennifer Dingman

Founder, Persons United Limiting Substandards and Errors in Healthcare (PULSE), Colorado Division William Scharf Ode Keil James Mitchell Aaron Freedkin William Adcox Co-founder, PULSE American Division TMIT Patient Advocate Team Member Pueblo, CO

TMIT High Performer Webinar September 15, 2016

Vicki King Gregory Botz Jennifer Dingman Charles Denham