It’s been 41 days since Thomas Eric Duncan presented as the first Ebola patient to be diagnosed (and misdiagnosed) on American soil. I’ve been on national TV four times to address hospital preparedness for Ebola and I am in deep gratitude to the 500 registered nurses throughout the U.S. who took your time to share what you know about the state of hospital preparedness.
Hospital preparedness 41 days later is still all over the map. The good news – more and more registered nurses are reporting that their hospitals are prepared. Hospitals are especially focused on the ED (the point of entry) and the ICU (which would ultimately treat the patient). These nurses reported that hospitals have established:
- Core volunteer teams which are efficient, smart and appropriately take the stress off the mass of providers.
- Full training and unannounced drills.
- Stockpiles of adequate Personal Protective Equipment (PPE) and respirators.
- Isolation units.
- Extensive protocols which suggest they plan to take care of their RNs. They are planning for two RNs per patient and four-hour shifts. This is prudent in view of the fact that treating an Ebola patient is some of the most intensive care an ICU nurse will ever provide.
- A “trained observer” to watch the providers don and doff PPE.
That’s the prepared hospitals and that’s one side of the spectrum. The bad news – many RNs are still reporting that facilities are not prepared, especially community hospitals. Even 41 days later, some hospitals are still telling their nurses, “Don’t worry. Ebola’s not coming through our door.” Many nurses say it’s going to be total chaos if an Ebola patient presents. In the hospitals that are unprepared there is:
- Lack of adequate PPE. Some nurses have ordered their own PPE.
- Still no formal training. Instead, the RNs are getting emails with links to videos and to CDC documents. Many hospitals are also challenged by the changing CDC guidelines and can’t keep up with training.
- No designated isolation unit.
- No protocols or less than instructive protocols.
Even if a hospital’s ED is prepared, nurses in the other departments are saying, “What about me?” They are concerned about the Ebola patient who slips past the ED and lands on their unit – especially with flu season about to crank up. Given that Ebola and flu share some of the same general symptoms, misdiagnosis is possible. Every nurse has been covered in body fluids and nurses want assurance that the body fluids they’re exposed to are not the body fluids of an Ebola patient. Also patients will present to clinics, doctor’s offices, long-term care facilities, etc., and those RNs are also concerned. Every facility needs to communicate its preparedness protocols to ALL nursing, medical and ancillary staff.
Specialized Ebola centers are being established throughout the U.S. Emory University Hospital has proven that we can safely treat Ebola. They’ve been a role model for treating patients and experiencing no ancillary exposures. Emory has generously shared everything they have done with other, interested hospitals. Any hospital would be smart to follow Emory’s model.
Legal nurse consultants should be aware that it’s already becoming the standard of care to transport a patient to a designated Ebola center if that patient exceeds the capability of the facility. However, the next Ebola patient isn’t going to know where to go. They won’t know where the Ebola centers are located.
While not every facility needs to be an expert on treating Ebola, every facility needs to be prepared at the points of entry. Preparedness can’t be hit or miss. We can’t afford one hospital to be unprepared – especially after witnessing the public panic and the damage to the economy from the unprepared Dallas hospital in the Duncan case.
Hospitals who are not prepared are setting themselves up for huge liability with malpractice issues. Certified Legal Nurse Consultants would be addressing misdiagnosis, lack of preparedness, negligent treatment and possibly even secondary exposures.
Liability risks aside, lack of preparedness is bad business practice. The Dallas hospital suffered a 53% decrease in ED visits and even the medical offices associated with the hospital lost patients.
To protect the American public we have to protect RNs – who are the front-line providers. As of today, we have more of an Ebola panic than an Ebola crisis. Hospitals would be smart to avert both and the best way to do so is to get themselves prepared.
I’m Just Sayin’
P.S. Comment and share whether or not you feel more protected today.