After-Action Report/Improvement Plan Template



[Event Name]Ex: [Your facility Name] 2020 Full Scale Event: Multifaceted Highly Infectious Disease/Critical Supply Shortage(If you were affected by flooding/tornado or civil unrest you can add natural disaster/civil unrest to the event name also)After-Action Report/Improvement Plan02/11/2021 Date you complete your AARThe After-Action Report/Improvement Plan (AAR/IP) aligns event objectives with preparedness doctrine to include the National Preparedness Goal and related frameworks and guidance. Event information required for preparedness reporting and trend analysis is included; users are encouraged to add additional sections as needed to support their own organizational needs. Remove this paragraph before finalizing your AAREvent OverviewEvent Name[Insert the formal name of event, which should match the name in the document header]Event DatesJanuary 1, 2020- December 31, 2021ScopeThis is a full-scale progressive real-world event. The event affected entire community healthcare and response organizations locally and globally. Mission Area(s)Prevention, Protection, Mitigation, Response, and RecoveryCore Capabilities1 Foundation for Health Care and Medical Readiness2 Health Care and Medical Response Coordination 3 Continuity of Health Care Service Delivery 4 Medical SurgeObjectivesYou may want to tweak, add, or delete these objectives as needed for your specific facilityEvaluate emergency plans and ability to identify and respond to a pandemic infectious disease outbreak.Assess internal and external communications systems Inventory and evaluate resource needs and methods for requesting additional support with specific focus on specifying and typing resource requests though the Tennessee emergency management system (including equipment and medical supplies).Assess organizations’ ability to coordinate with outside agencies including public health, emergency management agencies (EMA), the regional Healthcare Coalition and corporate system (if applicable if not remove) Evaluate how to manage and recover from an emerging infectious disease outbreak.Threat or HazardEmerging Infectious Disease Outbreak, Supply and Resource Shortages, Natural Disaster (if applicable)Event OverviewLate 2019, the Centers for Disease Control (CDC) and the World Health Organization (WHO) authorities identified multiple cases of a new coronavirus (COVID 19). Because of worldwide susceptibility and global travel, transmission quickly spread. With the unfolding of events in China, supply chains became severely disrupted. In particular, PPE supplies, including N95 masks. As the event unfolded, face shields, viral media kits, gowns, gloves, and surgical masks were in short supply. With public concerns mounting and early stockpiling, resupplies became limited, if at all available. Healthcare facilities faced dire shortages with no definable date for resolution. Mental health service messaging blanketed the community as a spike in suicide rates was noted. In the midst of this event, East Tennessee also experienced natural disasters, including area wide flooding and the effects of a middle Tennessee tornado that affected many area facilities communication systems. (If applicable)Early June also saw the rise of civil unrest with protest events across our region. Although most protest events were peaceful, tensions mounted in several communities as demonstrations turned more destructive. (If applicable)An Emergency Use Authorization (EUA) was granted by the FDA in late November for Phizer and Moderna COVID 19 vaccines. Supplies were limited and tier systems for distribution were put into place with priority given to vulnerable populations and those with direct COVID patient care.Participating OrganizationsThis event was comprehensive in that almost every organization, business, citizen was affected. A list of specific partnering organizations is listed below in Appendix B Point of Contact[Insert the name, title, agency, address, phone number, and email address of the primary event POC (e.g., event director or event sponsor. This would be your facility name and contacts)]Executive SummaryThis is where you write out the details of the event. I’ve written up a generalized one below, but you will need to tweak or write your own to match your facility experience.Areas in red need to be looked at specifically for change or addition. Here is where you can add applicable photos or graphs.Late 2019, the Centers for Disease Control (CDC) and the World Health Organization (WHO) authorities identified a new coronavirus, SARS-CoV-2, causing multiple outbreaks of a novel infectious disease, later designated at COVID 19. Origination point came from within the Hubei Province of China and quickly escalated into an outbreak. Transmission paths indicated person to person infection, predominately spread by respiratory droplets, with little to no pre-existing immunity. Because of worldwide susceptibility, the global population was soon affected. The United States saw their first confirmed case on January 19, 2020, and Tennessee on March 5, 2020. Patient symptomology included: fever, dry cough, shortness of breath, and respiratory issues. Contributing to the spread of transmission was a relatively long incubation period (2-14 days) and non-symptomatic patients. Most individuals were told to isolate at home and recovered well from the virus, but hospitalizations were required for others. As the number of infected individuals grew, so did those requiring hospitalization, which became one of the factors that put a strain on hospital capacity as well as personal protective equipment (PPE). Nationally, clusters of cases in Washington state, and later New York, saw unprecedented demands on the response/healthcare system as patient counts soared. Although in many areas the progression was less aggressive, these surges were soon mirrored in every state across the nation. These staggering numbers increased well into December, with December 31 statistics for Tennessee listed below (TN Dept of Health data):586, 802 confirmed cases6907 fatalitiesThe healthcare system became overwhelmed in an effort to maintain essential services with the ever-growing restrictions and case load. Fears of the repercussions of holiday gathering were realized when these numbers continued to surge into the new year. As Tennessee made plans for promises of upcoming vaccine and holiday concerns, Tennessee was recognized by the CDC as being one of the hardest hit regions in the United States, ranking first in the nation for daily cases per 100,000 over the past seven days on December 16, 2020. This ranking continued, with Tennessee remaining in the top 5 over the next few weeks. The imminent crisis saw unpreceded actions taken to mitigate transmission and protect our vulnerable populations. Schools were dismissed, businesses closed, elective surgeries cancelled regionally, curfews enacted, and fear escalated among the general population. (List specifics for your county here)This fear resulted in hoarding of food, cleaning supplies, and personal hygiene products, clearing stores quickly of these supplies. Worried well visited health care facilities, further added to a distressed system. (If applicable, list how your facility was affected during the lock down, and then as the event escalated)(List what your facility did specifically to meet the needs of the event and to optimize PPE use and the struggle you faced trying to get PPE.) Here are a few things you should mention: activating plan, revising plan, opening Incident Command, regular meetings/updates for your staff to keep them informed of changing guidance from the CDC and the State of Tennessee, and other measures you took to ensure the safety of your staff and patients.The Knox/East Tennessee Healthcare Coalition’s Regional Memorandum of Understanding (MOU) was activated early in the event as shortages increased. (I’ve attached the regional MOU, if your facility is listed you should include this paragraph and maintain for your records). The current MOU is signed by 107 jurisdictional members including hospitals, long term care, dialysis, home health, hospice, ancillary clinics, and other healthcare community partners. After a few cluster incidents, long term care facilities, representing such a vulnerable population, became a focus of early intervention and visibility. Every nursing home, assisted living, and homes for the aged facilities were tasked with completing a facility-wide testing (within a 48 hour period), by June 30. Although supplies were distributed from the state for most of these testing events, the Coalition supplemented supplies when needed. Once the baseline testing was complete, nursing homes were also required to do weekly staff testing. (Only include if you are one of these facilities)In the midst of this event, East Tennessee also experienced natural disasters, including area wide flooding and the effects of a middle Tennessee tornado event March 2-3, which killed 18 people and another tornado event in Southeast Tennessee, causing the death of ten people, on April 12. These deadly storms caused extensive damage and the COVID 19 event affected response as well as recovery efforts. (if applicable)Early June also saw the rise of civil unrest with protest events across our region. Although most protest events were peaceful, tensions mounted in several communities as demonstrations turned more destructive. (If applicable)The scope of this event created unique challenges that stressed, in an unprecedented manner, the entire healthcare community. Emergency plans were updated (if applicable) to meet lessons learned and best practices of the event. Established and new networks, strong partnerships, adaptability, and trust between competing organizations gave (your facility name) the opportunity to meet the challenges and become better prepared to serve our staff, patients, and community. Looking forward, (your facility) will continue to support the evolving needs this pandemic brings and work to find the ‘new normal’. There will be continued improvements to planning processes based on lessons learned and best practices as this event continues into 2021, with focus on mitigation, recover, and vaccination. Analysis of Objective CapabilitiesObjectivePerformed without Challenges (P)Performed with Some Challenges (S)Performed with Major Challenges (M)Unable to be Performed (U)Evaluate internal organizational plans ability to identify and respond to an emerging infectious disease outbreak.Assess the internal and external communications systems utilized during such events.Evaluate the resource needs and methods for requesting additional support (to include equipment and medical supplies).X(everyone should check (M) on this objective)Assess the organization’s ability to coordinate with outside agencies. Evaluate how to manage and recover from an emerging infectious disease outbreak.Ratings Definitions:Performed without Challenges (P): The targets and critical tasks associated with the healthcare preparedness capability were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws.Performed with Some Challenges (S): The targets and critical tasks associated with the healthcare preparedness capability were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws. However, opportunities to enhance effectiveness and/or efficiency were identified.Performed with Major Challenges (M): The targets and critical tasks associated with the healthcare preparedness capability were completed in a manner that achieved the objective(s), but some or all of the following were observed: demonstrated performance had a negative impact on the performance of other activities; contributed to additional health and/or safety risks for the public or for emergency workers; and/or was not conducted in accordance with applicable plans, policies, procedures, regulations, and laws.Unable to be Performed (U): The targets and critical tasks associated with the healthcare preparedness capability were not performed in a manner that achieved the objective(s).Table 1 includes the event objectives, and performance ratings for each core capability as observed during the event and determined by the evaluation team.Table 1. Summary of PerformanceObjective Outcome [Objective 1] (if you changed objectives at the top of this form, you will need to change them here. If you didn’t, I’ve added the ones listed above for you)Evaluate emergency plans and ability to identify and respond to a pandemic infectious disease outbreak.StrengthsStrength 1: [Observation statement]Strength 2: [Observation statement]Strength 3: [Observation statement]Areas for ImprovementArea for Improvement 1: [Observation statement. This should clearly state the problem or gap; it should not include a recommendation or corrective action, as those will be documented in the Improvement Plan.]Area for Improvement 2: [Observation statement]Area for Improvement 3: [if applicable][Objective 2]Assess internal and external communications systems StrengthsStrength 1: [Observation statement]Strength 2: [Observation statement]Strength 3: [Observation statement]Areas for ImprovementArea for Improvement 1: [Observation statement. This should clearly state the problem or gap; it should not include a recommendation or corrective action, as those will be documented in the Improvement Plan.]Area for Improvement 2: [Observation statement]Area for Improvement 3: [if applicable][Objective 3]Inventory and evaluate resource needs and methods for requesting additional support with specific focus on specifying and typing resource requests though the Tennessee emergency management system (including equipment and medical supplies).StrengthsStrength 1: [Observation statement]Strength 2: [Observation statement]Strength 3: [Observation statement]Areas for ImprovementArea for Improvement 1: [Observation statement. This should clearly state the problem or gap; it should not include a recommendation or corrective action, as those will be documented in the Improvement Plan.]Area for Improvement 2: [Observation statement]Area for Improvement 3: [if applicable][Objective 4]Assess organizations’ ability to coordinate with outside agencies including public health, emergency management agencies (EMA), the regional Healthcare Coalition and corporate system (if applicable if not remove) StrengthsStrength 1: [Observation statement]Strength 2: [Observation statement]Strength 3: [Observation statement]Areas for ImprovementArea for Improvement 1: [Observation statement. This should clearly state the problem or gap; it should not include a recommendation or corrective action, as those will be documented in the Improvement Plan.]Area for Improvement 2: [Observation statement]Area for Improvement 3: [if applicable][Objective 5]Evaluate how to manage and recover from an emerging infectious disease outbreak.StrengthsStrength 1: [Observation statement]Strength 2: [Observation statement]Strength 3: [Observation statement]Areas for ImprovementArea for Improvement 1: [Observation statement. This should clearly state the problem or gap; it should not include a recommendation or corrective action, as those will be documented in the Improvement Plan.]Area for Improvement 2: [Observation statement]Area for Improvement 3: [if applicable]Appendix A: Improvement PlanThis IP has been developed specifically for [Organization] as a result of [Event Name] conducted from January 1, 2020- December 31, 2021.Any areas you listed above as Areas for Improvement will need to be documented here, with action items to correct. This is one of the most important parts of this document, so make sure the information you put here is attainable in your time frame. Issue/Area for ImprovementCorrective ActionPrimary Responsible OrganizationOrganization POCStart DateCompletion Date1. [Area for Improvement][Corrective Action 1] [Corrective Action 2][Corrective Action 3]2. [Area for Improvement][Corrective Action 1][Corrective Action 2]Appendix B: Event PartnersDon’t forget to list your facility!Event PartnersFederalCDCStateTennessee Department of HealthRegionKnox/East Tennessee Healthcare CoalitionCountyYour County EMA ................
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