An End-Stage Renal Disease center is a facility that provides chronic maintenance dialysis to ESRD patients on an outpatient basis, including dialysis services in the patient's place of residence. A certified ESRD facility provides outpatient maintenance dialysis services, home dialysis training and support services, or both. A dialysis center may be independent or hospital-based.
In the State of New Hampshire, End-Stage Renal Dialysis Centers are also required to follow HE-P 811 Administrative Rules.
Before going any farther, make sure your organization has developed a site-specific Hazard Vulnerability Assessment. Use the hazards that make your facility most vulnerable to narrow in on important planning considerations.
The Wisconsin Department of Health Services has created a toolkit for End-Stage Renal Dialysis Centers. If your facility does not already have a plan in place, this would be a good place to start. This toolkit offers an overview of the requirements for ESRDs, as well as some sample templates that can be used in their planning efforts. In topic areas where there was not a tool or template readily available, the toolkit offers planning worksheets that feature a list of example questions to help facilities think through relevant issues that can help them draft their plans and policies.
The ESRD facility must develop and maintain an emergency preparedness plan that must be reviewed and updated at least annually. Interpretive guidance for the regulation regarding planning and assessment can be found here.
The plan must do all of the following:
The ESRD facility must develop and implement emergency preparedness policies and procedures, based on the risk assessment, emergency plan, and communication plan (below). The policies and procedures must be reviewed and updated at least annually.
ESRDs should cover fire, equipment or power failures, care-related emergencies, water supply interruption, and natural disasters, among others identified in the HVA.
At a minimum, the policies and procedures must address the following:
ESRDs must also develop and maintain an emergency preparedness communication plan that complies with Federal, State, and local laws and must be reviewed and updated at least annually. The communication plan must include all of the following:
There are two sections that apply to the Training and Testing component of the Emergency Preparedness Program. One section covers internal training, and the other external or community exercises and drills.
Training
Staff Training
Annually, all ESRDs must provide training in emergency preparedness policies and procedures to all new and existing staff, individuals providing on-site services under arrangement, and volunteers. The training must:
All documentation regarding these requirements must be maintained and accessible.
Patient Orientation
ESRDs are required to provide an appropriate orientation and training to patients, specifically with regard to the emergency procedures outlined above in Staff Training (emergency numbers, disconnection, evacuation sites, etc.).
Testing
The facility is required to conduct testing of the emergency plan at least twice, annually. An analysis of the emergency plan should be conducted after all exercises and events and must be documented.
One of the exercises can be a functional exercise that is community-based (involves more than just the facility), or an individual, facility-based exercise if a community-based exercise opportunity is not available. If the facility experiences an actual emergency that requires the activation of the emergency plan, the facility is exempt from engaging in a community-based or facility-based functional exercise for one year following the event.
The second exercise could include a second functional exercise that is community-based or facility based. However, it can also be a tabletop exercise that includes group discussion led by a facilitator using a narrated, clinically-relevant emergency scenario, a set of problem statements, direct messages, or prepared questions that are designed to challenge an emergency plan.