This regulation requires dialysis (ESRD) facilities to establish and maintain an emergency preparedness training program for all staff, contracted individuals, and volunteers. Training must occur at hire, at least every two years, and whenever policies are significantly updated, covering evacuation procedures, patient communication, CPR certification, and use of emergency equipment and drugs. Facilities must document all training and CPR certifications and ensure staff can demonstrate knowledge of emergency procedures, including instructing patients on self-disconnection from dialysis machines.
View official sourceE-0038 (Rev. 204, Issued: 04-16-21; Effective: 04-16-21, Implementation: 04-16-21) §494.62(d)(1): Condition for Coverage: (d)(1) Training program. The dialysis facility must do all of the following: (i) Provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. Staff training must: (iii) Demonstrate staff knowledge of emergency procedures, including informing patients of— (A) What to do; (B) Where to go, including instructions for occasions when the geographic area of the dialysis facility must be evacuated; (C) Whom to contact if an emergency occurs while the patient is not in the dialysis facility. This contact information must include an alternate emergency phone number for the facility for instances when the dialysis facility is unable to receive phone calls due to an emergency situation (unless the facility has the ability to forward calls to a working phone number under such emergency conditions); and (D) How to disconnect themselves from the dialysis machine if an emergency occurs. (iv) Demonstrate that, at a minimum, its patient care staff maintains current CPR certification; and (v) Properly train its nursing staff in the use of emergency equipment and emergency drugs. (vi) Maintain documentation of the training. (vii) If the emergency preparedness policies and procedures are significantly updated, the dialysis facility must conduct training on the updated policies and procedures. Interpretive Guidelines for §494.62(d)(1). Training Program- General ESRD facilities are required to provide initial training in emergency preparedness policies and procedures that are consistent with their roles in an emergency to all new and existing staff, individuals providing services under arrangement, and volunteers. This includes individuals who provide services on a per diem basis such as agency nursing staff and any other individuals who provide services on an intermittent basis and would be expected to assist during an emergency. The training provided by the facility must be based on the facility’s risk assessment, policies and procedures as well as the communication plan. The intent is that staff, volunteers and individuals providing services at the facility are familiar and trained on the facility’s processes for responding to an emergency. Training should include individual-based response activities in the event of a natural disaster, such as what the process is for staff in the event of a forecasted hurricane. It should also include the policies and procedures on how to shelter-in-place or evacuate if the natural disaster was not able to be forecasted. Training should include how the facility manages the continuity of care to its patient population, such as triage processes and transfer/discharge during mass casualty or surge events. Furthermore, the ESRD facility must train staff based on the facility’s risk assessment. Training for staff should mirror the facility’s emergency plan and should include training staff and focus on procedures are relevant to the hazards identified. For example, for EIDs, this may include proper use of PPE, assessing needs of patients and how to screen patients and provide care based on the facility’s capacity and capabilities. Many large ESRD Networks already implement trainings for staff regarding evacuation procedures of the facilities. Through this requirement, all facilities are required to demonstrate upon survey that that staff know the current evacuation plans, alternate locations as well as their emergency contacts. Among the training, ESRD staff must be able to demonstrate knowledge on procedures for informing patients on how to disconnect themselves from a dialysis machine in the event of a disaster/emergency. The ESRD facility must train staff on informing patients on whom to contact if the facility is closed and cannot provide treatment due to an emergency situation and how they can locate an alternate dialysis facility (e.g. Kidney Community Emergency Response Program (KCER)) or hospital that can assist them. The ESRD facilities are expected to rearrange patient appointments if a disaster or emergency is forecasted through emergency notification channels, such as national weather forecasts. For instance, for inclement weather such as a snow storm which could cause community-wide closures and dangerous road conditions, we would expect the facility to make the appropriate arrangements for patients to receive their dialysis or be transferred into an inpatient setting to be provided with the appropriate care. Therefore, ESRD facilities may gear their training and testing program to include evacuation procedures in the event the facility is unable to close prior to an emergency. All ESRD facility patient care staff are required to maintain current CPR certifications and all nursing staff are required to be properly trained in clinical emergency protocols that include the use of emergency equipment and emergency drugs. The training and CPR certifications must be documented and maintained on file. Survey Procedures • Verify the facility has an emergency preparedness training program and that it is updated at least every 2 years. • Interview staff and ask them to describe the evacuation procedures and plan. • Verify current copies of CPR certifications for all patient care staff are on file.