The EHR goes down at 4:30 on a Tuesday afternoon, just before the evening medication pass. Nurses look at each other. Someone asks where the paper forms are. Someone else remembers a binder that was last updated two years ago. Care continues, but documentation and safety checks become scrambles.
A downtime kit is a simple, inexpensive preparation. It does not prevent outages, but it keeps them from turning into emergencies.
Plan for several kinds of events:
Planned downtime: vendor maintenance windows and upgrades
Unplanned system outage: the EHR vendor has a problem
Local outage: your internet, network, power or computers fail
Security incident: you shut systems down deliberately to contain an attack
The kit should work for any of them, since staff will not always know the cause right away.
Create one kit per unit or care area, in a labeled, easily accessible container.
Current census and room list, printed daily or each shift
Medication administration records for each resident, refreshed on a regular schedule
Treatment administration records
Allergy and diagnosis lists, code status and key care plan summaries
Physician and pharmacy contact information
Family and emergency contact lists
Ask your EHR vendor about the reports and printing options available to produce this data, and whether a read-only offline view is offered. Decide how often the printouts are refreshed, and who is responsible.
Blank paper medication and treatment records
Nursing notes and incident reports
Admission, transfer and discharge forms
Order forms and lab requisitions
Pens, clipboards and labels
A one-page quick guide for declaring downtime and who to call
Steps for documenting on paper, including time stamps and signatures
Steps for recovering and entering data after systems return
Assign roles before an event:
Downtime leader: usually the charge nurse or manager on duty, who declares downtime and communicates updates
IT contact: who calls the vendor or IT provider and relays status
Recovery lead: who coordinates re-entry of paper documentation once systems are back
Post these roles in the kit and at the nurse station.
Staff need to know:
How they will be notified that downtime has started and ended
What to do if they cannot reach IT
When to notify the administrator and DON
How and when families and physicians should be informed if care is affected
Consider an overhead page or text group, with a backup method that does not depend on the failed system.
Clinical leadership should define:
How medications will be verified without the usual electronic checks
How orders will be received and transcribed
How double-checks will be handled for high-risk medications
What to do with new admissions
These are clinical decisions, but IT can help ensure the information needed is available.
When systems return, enter paper documentation in order, noting the actual time of care. Verify that the system captured everything correctly, then file and retain the paper records according to policy. Hold a short review: what worked, what did not and what should change in the kit.
Run a drill at least annually, a short tabletop or a real planned downtime in a controlled unit. People who have handled a paper medication record once are far more confident when it matters. CMS emergency preparedness requirements for long-term care facilities also emphasize continuity of operations, so downtime drills fit naturally into that program.
Downtime affects more than nurses. Decide in advance who will tell physicians, pharmacies and, when appropriate, residents' families that systems are limited, and what you will say. A short script reduces anxiety and avoids inconsistent messages. Make sure the contact list is printed, current and stored with the kit rather than only inside the system that is down.
Assign someone to check each kit monthly for expired printouts, missing forms and outdated contacts. Add it to the facility checklist alongside fire extinguishers and crash carts.
UnityCare IT works with long-term care facilities and their EHR vendors to prepare downtime procedures, including report configuration, printing setup and drill support.
Call or text: 405-285-3845
New customers: start@unitycareit.com
Existing customers: support@unitycareit.com
Address: UnityCare Technologies, 2524 N Broadway Ste 554, PMB 947974, Edmond, Oklahoma 73034-4172