Establishing a temporary practice
Emergencies can cause significant damage to a building’s infrastructure, causing it to be uninhabitable and unsafe. Therefore, when preparing the practice for a disaster, it is worth considering how the practice will continue providing essential services to the community if it is damaged or affected.
If it is determined that the practice will continue to provide services, then an appropriate and safe location for the temporary practice will need to be identified.
To facilitate this process, emergency management coordinators are encouraged to approach other business owners who might agree for a temporary clinic to be set up in their building if the need arises. Possible venues might include community halls, schools or vacant shops. These arrangements should occur as part of the planning process. If an agreement is made, it should be documented in writing and a copy kept by both parties. Further, all staff should be made aware of any arrangements so that in the event that the practice needs to temporarily relocate, all staff can assist with the physical relocation and communicate this to patients.
GPs should clarify with Medicare whether they are able to use the same provider number within the temporary practice or if a temporary provider number can be accessed. It is also suggested that GPs operating from a temporary location/practice seek endorsement from their relevant medical indemnity organisation to ensure that they are adequately covered.
Planning for reduction in staffing
In an emergency, practices may experience a significant reduction in staffing capacity. This may mean a decrease in the level of service they can provide to patients.
The emergency management coordinator is advised to consider how the practice will continue operating with a reduction in key staff. One way to help alleviate staffing issues in the event of an emergency is to provide staff with education and training in other roles (where a similar level of expertise is required) within the practice so they may be able to provide other duties.
It may be possible to make a reciprocal arrangement with a nearby practice to provide staff for a short period of time in the event of an emergency and to pool staff and resources in an emergency. PHNs may also be able to provide advice and/or support in the event of an emergency.
It is essential to maintain the temperature of vaccine fridges between +2 °C and +8 °C. To ensure temperature maintenance, vaccine fridges must be stored in a well-ventilated room with good circulation. Practice staff should monitor and record the temperatures at the start and end of each day.
There needs to be a contingency plan for managing vaccines in the case of a disruption to power. For example, it is recommended that practice staff make arrangements with local pharmacies and hospitals to store vaccines at appropriate temperatures in the event of an emergency. There is also the option of installing a back-up battery for vaccine fridges which automatically powers fridges when the power is cut off and shuts off when power resumes. Such batteries last 36–48 hours and when power is restored the batteries are automatically recharged.
Familiarity with vaccine management guidelines for the relevant state or territory health department is recommended.
The Department of Health’s National vaccine storage guidelines – Strive for 5 (2nd edn) outlines the basic principles for safe vaccine management.
Information technology and data
Practice operations rely increasingly on computer hardware, software and IT systems for the general practice setting. This equipment can be damaged or its functionality lost in the event of an emergency.
During the emergency planning process, it is advisable to stocktake all hardware and equipment in the practice. In the event that any equipment is destroyed or damaged, staff will be able to ascertain what needs to be replaced. This list can be used as part of the practice’s asset register.
If the practice leases computers and hardware, it is important to contact the leasing company as soon as possible to discuss the damage and the process involved in replacing items.
If IT equipment has been damaged as a result of a disaster, determine the operational status of equipment. For safety purposes, seek advice from a professional. Practices may need to transfer any equipment and computers that have not been damaged to a safe operational area within the practice to ensure their protection.
After an emergency, the practice may have limited or no access to computers. This may be due to damage to computers or damage to or loss of functionality of the server.
Practices should keep at least one fully charged laptop stored with current practice/patient data or ensure access to the previous day’s back-up (whether physical or on a secure cloud).
It is important that practices have suitable media-reading devices to effectively restore data when IT systems are affected.
Software and applications
Software is generally stored on a disk or other device, is downloadable from the vendor’s website, or stored in the computer’s permanent memory. When first purchased, software is either registered to the practice or to an individual working within the practice.
It is recommended that a list of all software and access codes be created and maintained, including software support phone numbers. This list can be used as part of the practice’s asset register.
If software and applications do not work due to server damage, assistance should be sought from an experienced IT technician, who will need to reinstall them.
In the general practice setting, data protection is key to effective business continuity. Information management and information technology should always be considered as a high priority in emergency planning. Advanced planning will make the recovery phase significantly easier and faster.
Critical information should be kept current and stored off-site as part of high-quality back-up systems for information technology. As a minimum, daily back-up of all data should be performed (including email, shared documents, network file and databases and clinical and practice software) and verified. When a disaster is imminent, a hard copy list of all patients seen should be kept so that records can be updated when business as usual resumes.
Restore procedures should also be tested regularly. This may include contacting software vendors for productspecific recommendations regarding restoration processes and data integrity checks.
A regular recovery check should also be performed (dependent on the risk assessed by the individual practice) to ensure that recovery methods are working and appropriate for the practice. This can be coupled with a test plan to verify data integrity (eg searching for patient X to confirm their history and demographics are correct as documented in the test plan).
It is important to conduct regular audits on desktop computers/workstations to ascertain what data is being stored on local drives. There may be some applications that are not connected to the server and therefore not backed-up daily.
Paper medical records
If your practice still has paper medical records in storage, there are a range of activities staff can undertake to minimise damage to these records in an emergency. However, paper medical records can be damaged irrespective of the protective measures employed.
During disaster planning and preparations, a list of disaster recovery specialists in the area should be created, including their names, phone numbers and area of expertise. If paper medical records are damaged by water or fire, practices will need to have systems in place to assess whether the records can be recovered. It is advisable to access services from disaster recovery specialists during the emergency planning process to understand what services they provide.
When dealing with damaged paper records:
- assess the damage and review the possible options for recovery
- separate the damaged records from the undamaged records
- handle them as little as possible – even if the paper record is saturated, in most cases the majority of the writing will remain legible if water-fast pens have been used
- it may be appropriate to air or fan dry them onsite, if only slightly damaged by water
- it is recommended that practices contact an appropriate disaster recovery specialist for records that have significant damage.