Full Text
A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 AFTER ACTION REPORT/IMPROVEMENT PLAN (AAR/IP) White Salmon Joint Command Drive-Through Vaccination Clinic Klickitat County Public Health Department i KCHD 2010 ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 Klickitat County Public Health White Salmon Joint Command Drive Through-Vaccination Clinic 2010 ii KCHD 2010 ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 White Salmon Joint Command Drive -Through Flu Vaccination Clinic After Action Report /Improvement Plan (AAR/IP) KCHD 501 NE Washington Phone [PHONE REDACTED] • Fax [PHONE REDACTED] Prepared by: Jane Palmer/Beth Robison iii KCHD 2010 ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 Administrative Handling Instructions 1. The title of this document is: After Action Report/Improvement Plan (AAR/IP) for the 2010, White Salmon Joint Command Drive-Through Vaccination Clinic. 2. The information gathered in this AAR/IP is classified as ‘For Official Use Only’ (FOUO) and should be handled as sensitive information not to be disclosed. This document should be safeguarded, handled, transmitted, and stored in accordance with appropriate security directives. Reproduction of this document, in whole or in part, without prior approval from Klickitat County Public Health Department is prohibited. 3. At a minimum, the attached materials will be disseminated only on a need-to-know basis and when unattended, will be stored in a locked container or area offering sufficient protection against theft, compromise, inadvertent access, and unauthorized disclosure. 4. Points of Contact: a. Kevin Barry Director KCHD 228 W Main MS CH-14 Goldendale, WA 98620 [PHONE REDACTED] [EMAIL REDACTED] Jane Palmer Nursing/Community Health Manager 501 NE Washington White Salmon, WA 98672 [PHONE REDACTED] [EMAIL REDACTED] Beth Robison Skyline Hospital 211 Skyline Drive White Salmon, WA 98672 [PHONE REDACTED] [EMAIL REDACTED] iv KCHD 2010 ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 This page is intentionally blank v KCHD 2010 ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 vi KCHD 2010 Table of Contents Administrative Handling Instructions iv I N T R O D U C T I O N Executive Summary viii Major viii Primary Areas for Improvement ix C H A P T E R 1 Overview 1 Name 1 Start Date 1 End Date 1 Duration of Event 1 Location 1 Sponsor 1 Program 1 Mission 1 Capabilities 1 Scenario Type 2 Participating Agencies 2 C H A P T E R 2 Event Design Summary 3 Event Purpose and Design 3 Goals, Capabilities, Objectives and Activities 3 Scenario Summary 4 C H A P T E R 3 Analysis of Capabilities 5 Homeland Security Target Capabilities: Communications Capability 1 5 Capability 2 5 Capability 3 6 C H A P T E R 4 Conclusion 7 A P P E N D I X A Improvement Matrix 8 A P P E N D I X B Glossary of Acronyms 9 ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 This page is intentionally blank vii KCHD 2010 ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 Introduction I Executive Summary The White Salmon Joint Command Drive-Through Vaccination Clinic After Action Report and Improvement Plan is an analysis of the Klickitat County public health involvement in a shared Drive Through Immunization POD. This report focuses on the actions of the Klickitat County Health Department (KCHD) during the time period of July 2010-October 2010. The report organizes and discusses information obtained from local public health, hospital, state agencies, the media, and KCHD employees. This report details the sequence of actions comprising the operation, the results discovered through review of the event, a discussion of those findings, a conclusion and improvement plan. KCHD demonstrated the ability to plan and coordinate a drive through vaccine administration clinic with connections to Skyline Hospital, regional and other partners. Ground work for these connections had been occurring through years of multi-disciplinary planning between regional and local agencies. The core response of the drive through clinic and joint command was successful, but with every event the opportunity to learn and identify areas of improvement exists. Based on the planning team’s deliberations, the following objectives were developed: Objective 1: Test a joint ICS command structure between Skyline Hospital and KCHD Objective 2: Share resources: staffing/vaccine Objective 3: Set up and safely administer influenza vaccine using a Drive Through clinic approach The purpose of this report is to analyze the results, identify to be maintained and built upon, identify potential areas for further improvement, and support development of corrective actions. Major The major identified during this event are as follows: • Building partnerships within our community • Vaccine delivery to the public using a Drive Through clinic • Adaptability/flexibility in managing changing environment viii KCHD 2010 ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 Primary Areas for Improvement Throughout the event, several opportunities for improvement in Klickitat County’s ability to respond to the event were identified. The primary areas for improvement, including recommendations, are as follows: • To improve communications both internally and with hospital partner concerning ICS structure, job action sheets, planning forms and action sheets • To better coordinate fiscal planning/reimbursement of vaccine for Medicare clients • To clearly articulate and plan for greater depth in ICS leads; e.g. Supply Lead. This operation was a success. We were able to set up and operate a drive through vaccine distribution clinic, transition to an indoor operation site on day 2 and pass the Incident Commander role to another staff person. Relationships within agencies were strengthened and realization of the need to share information and resources during the planning phase was identified. ix KCHD 2010 ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 1 KCHD 2010 Chapter 1 Exercise Overview Klickitat County Health Department and Skyline Hospital conducted a Functional Vaccination Drive -Through Point of Distribution clinic on October 8 & 9, 2010. Exercise Name White Salmon Joint Command Drive-Through Vaccination Clinic Exercise Start Date October 8, 2010 Exercise End Date October 9, 2010 Duration of Exercise 2 days Location Skyline Campus White Salmon, WA Exercise Sponsor Klickitat County Health Department & Skyline Hospital Mission Response Capabilities Planning ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 Incident Management Mass Prophoylaxis Scenario Type Biological - naturally occuring influenza Exercise Planning Team Leadership Jane Palmer RN/BSN Beth Robison 501 NE Washington White Salmon, WA [PHONE REDACTED] 211 Skyline Dr White Salmon, WA [PHONE REDACTED] Participating Agencies Klickitat County Health Department, Skyline Hospital, Region 8 PHERP, The Enterprise 2 KCHD 2010 ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 Chapter 2 Exercise Design Summary his chapter is intended to provide a summary of the event planning process for the 2010 White Salmon Joint Command Drive-Through Vaccination Clinic T Event Purpose and Design This event was completed as a real life response to a seasonal Flu outbreak. Design for this event was based on pandemic planning and emergency response planning for potential communicable diseases previous to this event. The event was funded by Public Health Emergency Preparedness and Response, Klickitat County and Skyline Hospital. Event Objectives, Capabilities, and Activities Capabilities-based planning allows for exercise planning teams to develop exercise objectives and observe exercise outcomes through a framework of specific action items that were derived from the Target Capabilities List (TCL). The capabilities listed below form the foundation for the organization of all objectives and observations in this exercise. Additionally, each capability is linked to several corresponding activities and tasks to provide additional detail. Based upon the identified exercise objectives below, the exercise planning team has decided to demonstrate the following capabilities during this exercise: Homeland Security Target Capabilities: Planning Objective 1: To plan for and staff a coordinated drive through POD vaccination clinic. Target Capabilities: To keep community partners engaged in planning efforts Activity 1: Regular planning meetings with Skyline Hospital staffs Homeland Security Target Capabilities: Incident Management Objective 1: To test Joint Command between Skyline Hospital and Health Department staffs. 3 KCHD 2010 ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 Target Capabilities: To coordinate hospital and health department ICS staffs Activity 1: Share resources, planning and implementation of a 2-day POD operation Homeland Security Target Capabilities: Mass Prophylaxis Objective 1: To safely administer seasonal influenza vaccine using a drive-through Point of Distribution Target Capabilities: To provide seasonal influenza vaccine via a drive-through clinic to area residents. Scenario Summary Beginning in July 2010, Klickitat County Public Health staffs began discussion the upcoming influenza vaccination campaign. The decision to provide community vaccinations at the White Salmon annual Health Fair was decided on. Conversations lead to discussing the possibility of providing a joint venture with Skyline Hospital staffs as the decision was made to host the health fair at the hospital campus. The community has relied on the annual health fair as a venue to receive seasonal influenza vaccinations. The opportunity to coordinate hospital and public health resources was mutually agreed upon. Planning meetings were held at Skyline Hospital weekly through August and September 2010. The final planning/walk-through meeting was held October 7, 2010. 4 KCHD 2010 ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 Chapter 3 Analysis of Capabilities his section of the report reviews the performance of the implemented capabilities, activities, and tasks. In this section, observations are organized by capability and associated activities. The target capabilities linked to the exercise goals and objectives of the event are listed below, followed by corresponding activities. Each activity is followed by related observations, which include analysis and recommendations. T Homeland Security Target Capabilities: Planning, Incident Management, & Mass Prophylaxis Capability 3 - Planning: Capability Summary: Regular planning meetings were held with Skyline Hospital staffs and Klickitat County Health Department staff. Review of POD set up/design and consultation with other LHJ’s familiar with drive- through vaccination clinics were done. Activity 1.1: To plan for and staff a coordinated drive through POD vaccination clinic. Observation 1.1: Area for Improvement - Fiscal reimbursement did not meet community expectations. The hospital fiscal department was not able to bill Medicare. This caused dissatisfaction among the senior population. Analysis: Initial plans for Medicare roster billing was not possible with the hospital system. The vaccine was purchased from the Health Department inventory. Medicare roster billing was not explored prior to the planning, advertising and purchasing of the vaccine. Recommendations: In future jointly sponsored clinics, the planning team will explore which agency is best suited to purchase and bill for influenza vaccine. Capability 2 – Incident Management: Capability Summary: The initial Incident Commander position was held by Health Department staff. The planning sheets, job action sheets and ICS structure/forms were not clearly understood and familiar with all participants. Due to illness, the shift of Incident Commander on day 2 was handled with ease. 5 KCHD 2010 ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 Activity 2.1: To test Joint Command between Skyline Hospital and Health Department staffs. Observation 2.1: Area for Improvement – Job action sheets, reporting/recording/planning forms differed between Public Health and Hospital causing some confusion on which one to use. Analysis: The unified command structure requires careful, deliberate planning and sharing of resources and information. While the basic ICS structure is understood by both agencies, it is apparent that job action sheets, reporting/recording/planning forms differ. The professional relationships between all parties allowed for successful implementation of the clinic. Recommendations: All ICS materials will be shared and agreed upon prior to implementation of the clinic. Agreement will be made on planning documents to be used by all participants. Capability 3 – Mass Prophylaxis: Capability Summary: The Drive Through clinic was a first for the community. Post evaluations indicate the popularity of this format for vaccine administration. The staffs were able to shift nimbly during the clinic to accommodate change in weather, and the arrival of “walk-ins”. There was concern with low visibility of traffic controllers, not checking in/out with supervisor when taking a break, walkie-talkies that were not interoperable and a missing outdoor canopy that was planned for. Activity 3.1: To safely administer seasonal influenza vaccine using a drive-through Point of Distribution Observation 3.1: The administration of vaccine using a Drive-Through clinic was successful. Potential safety flaws were identified and need for additional equipment was identified. Analysis: The drive-through clinic entrance and exit was at the bottom of the hill. This is also the site where staff and patients enter to park their cars. While linear flow of the drive-through was maintained, the potential for bottlenecks and accidents was evident as staff and patients had to enter and exit at the same location. The weather conditions were dark and wet making it a challenge to see traffic controllers and their flashlights. There were not enough walkie talkies and some did not work. Some staff members were unaware of the need to sign in and out and were unclear on their role responsiblites. Recommendations: Consider a different location for future Drive-through clinic operations, purchase additional canopy, flashlights and walkie-talkies. Staff will need pointed orientation/just in time training concerning role assignment and reporting requirements when leaving their post. 6 KCHD 2010 ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 Chapter 4 Conclusion KCHD and Skyline Hospital demonstrated the ability to cooperatively plan and execute a Drive-Through Vaccination clinic as well as implement a unified command structure. Ground work for these connections has been occurring through years of interagency partnering on a variety of topics/events. These connections create strength in Klickitat County’s response capabilities and capacities for public health emergencies. The core of the response to providing a Drive-Through Vaccination clinic and unified command structure was highly successful, but with every response the opportunity to learn and identify areas of improvement exists. The areas for improvement include: sharing incident command forms, job action sheets and ICS structure with each partner; determining the best fiscal agent to meet the needs of the public prior to future clinics; purchase additional supplies and identify a supply lead. Annual influenza vaccination campaigns have long been an effective way to increase the number of persons receiving vaccine. KCHD coordinated efforts with Skyline Hospital to test the capability of unified command and joint planning of a Drive-Through point of distribution. This coordinated response provided an opportunity to identify improvements to increase efficiency in providing mass vaccinations to the citizens of Klickitat County. 7 KCHD 2010 ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E H 1 N 1 P O D APPENDIX A 8 Improvement Plan Matrix This Improvement Plan (IP) has been developed specifically for Klickitat County Public Health as a result of the White Salmon Joint Command Drive-Through Vaccination Clinic conducted on October 8-9, 2010. These recommendations draw on both the After Action Report and the After Action Conference. This IP includes the key recommendations and corrective actions identified in Chapter 3: Analysis of Capabilities. Improvement Plan Matrix: Capability Observation Title Recommendation Corrective Action Description Capability Element Primary Responsible Agency Agency POC Start Date Completion Date Capability 1: Planning Observation 1.1: The administration of vaccine using a Drive-Through clinic was successful. Potential safety flaws were identified and need for additional equipment was identified Recommendation 1.1.1: In future jointly sponsored clinics, the planning team will explore which agency is best suited to purchase and bill for influenza vaccine CAD 1.1.1.1: Identify which agency will purchase and bill for vaccine Planning KCHD and Skyline Hospital Head Exercise Planner 03/01/11 09/01/11 Capability 2: Incident Management Observation 2.1: Job action sheets, reporting/recording/ planning forms differed between Public Health and Hospital causing some confusion on which one to use. Recommendation 2.1.1: All ICS materials will be shared and agreed upon prior to implementation of the clinic. Agreement will be made on planning documents to be used by all participants. CAD 2.1.1.1: Agreement will be made on planning documents to be used by all participants prior to exercise Planning KCHD and Skyline Hospital Head Exercise Planner 02/01/11 09/01/11 Capability 3: Mass Prophylaxis Observation 3.1: The administration of vaccine using a Recommendation 3.1.1: Consider a different location for future Drive-through CAD 3.1.1.1: Identify different locations for Drive- Planning KCHD and Skyline Hospital Head Exercise Planner 11/01/10 On going ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E 2 0 1 0 9 KCHD 2010 Capability Observation Title Recommendation Corrective Action Description Capability Element Primary Responsible Agency Agency POC Start Date Completion Date clinic operations. through Recommendation 3.1.2: Purchase additional canopy, flashlights and walkie- talkies. CAD 3.1.2.1: Purchase additional canopy, flashlights and walkie-talkies Planning KCHD Community Health Manager KCHD 10/1/10 06/01/11 Drive-Through clinic was successful. Potential safety flaws were identified and need for additional equipment was identified. Recommendation 3.1.3: Staff will need pointed orientation/just in time training concerning role assignment and reporting requirements when leaving their post. CAD 3.1.3.1: Provide pointed orientation and just in time training to staff Training KCHD and Skyline Hospital KCHD Community Health manager 11/01/10 On going ---PAGE BREAK--- A A R K L I C K I T A T C O U N T Y P U B L I C H E A L T H F U N C T I O N A L E X E R C I S E H 1 N 1 P O D APPENDIX B 10 GLOSSARY OF ACRONYMS AAR/IP – After Action Report / Improvement Plan CAD – Corrective Action Description ICS – Incident Command System KCHD – Klcikitat County Health Department POC – Point of Contact POD –Point of Distribution