Table 6 Indicators of standard deviation and change
Area | Cases of deviation from the standard | Changes based on the FOCUS-PDCA model According to the standard preparation guidelines |
|---|---|---|
Planning | • Failure to conduct a risk assessment to identify biological hazards, vulnerabilities and internal and external capacities • Failure to design and develop a preparedness plan (operational response plan, training plan, and training plan) in biological events • Annual monitoring and review of processes and protocols in biological events based on the results of exercises, experiences and lessons learned irregularly. | • Conducting a risk assessment to identify biological hazards, vulnerabilities and internal and external capacities (HVA) • Designing and preparing the preparedness plan (early warning system, operational response plan, training plan and exercise plan) in biological events • Designing and compiling the plan for the continuity of vital services and recovery (rehabilitation and reconstruction) in biological events • Annual monitoring and review of processes and protocols in biological events based on the results of exercises, experiences and lessons learned regularly |
Staff and volunteers | • Failure to prepare an updated list of employees and volunteers • Failure to establish a work policy for non-clinical employees in order to reduce the spread of contamination (working hours, reduction of personnel) | • Preparation of updated list of employees and volunteers and their contact numbers for recall • Employing and training additional staff (nurses of the retirement center) according to the anticipated needs in the face of biological events • Reduction of non-clinical staff in biological event response guidelines |
Education and training | • Failure to formulate annual educational programs according to the type of biological event • Failure to hold specialized training courses for employees in the face of biological events | • Holding a conference and a training class on the use of personal protective equipment in biological events, all employees have been trained • Conducting a comprehensive exam for the nursing group using the Ascii method (one of the test stations was the topic of infection control and personal protective equipment in biological events.) • Periodic supervision of the infection control supervisor to make the trainings effective • Conducting a CBRNE virtual training course and discussing the specialized topics of biological events |
Practice and maneuver | • Failure to implement all kinds of exercises (discussion-oriented, operation-oriented) in biological events based on possible scenarios at least annually (within the organization) based on national guidelines. • Failure to evaluate the effectiveness of exercises | • The program was compiled and taught • It was evaluated in various exercises (table and operational) • Designing, compiling and implementing all kinds of exercises as joint and inter-organizational exercises with organizations responding to biological incidents • Evaluating the effectiveness of exercises, identifying weaknesses and strengths, and revising existing programs if necessary |
Biological triage | • Failure to design a protocol and follow up the suspect through telephone triage | • Designing the protocol and follow-up process of the suspicious person after identification through telephone triage in the face of biological events |
Diagnosis and treatment management | • Failure to designate an equipped waiting and examination room for suspected or sick people • Lack of referral and follow-up of suspected or infected outpatients to designated comprehensive health centers for biological events | • Considering a separate space for triage and admission of patients during biological crisis • Taking into account the necessary preventive measures in times of biological crisis with the cooperation of the involved organizations such as health centers, universities of medical sciences, etc. in the guidelines compiled to respond to biological events |
Management of corpses | • Failure to isolate infected bodies in biological incidents. • Absence of separate capacity to accept corpses | • Triage and separation of infected bodies in biological incidents according to the type of biological incident (in terms of decontamination method and burial conditions) • Increasing the capacity to receive dead bodies by creating a temporary mortuary and contracting with other centers and ensuring the provision of special shrouds and covers |
Continuity of performance | • Lack of performance analysis and review of actions taken in response to biological events | • Performance analysis and review of actions taken in response to biological events in order to make the hospital more resilient and respond better in subsequent events |
Essential support services | • Failure to foresee alternative sources for establishing vital arteries of the hospital | • Prediction of alternative sources of fuel required for the operation of buildings, generators and essential transportation services • Forecasting alternative sources for establishing vital arteries of the hospital (water, electricity and communication infrastructures, etc.) • Also conducting water outage maneuvers (developing the water storage source) and electricity (to ensure that the emergency electricity is not overloaded) |