Sooner or later, the computers will not work. It might be a storm that knocks out the internet, a failed server, a vendor outage or a ransomware attack. The question is not whether care continues, because it must, but whether staff know how.
Downtime procedures are the bridge between a technology failure and a safety event. They are also part of what HIPAA calls contingency planning, which includes an emergency mode operation plan so critical processes can continue while protecting ePHI. For long-term care, they fit naturally within the emergency preparedness planning that CMS requires.
Start with a conversation among the administrator, director of nursing, pharmacy contacts, business office and IT. For each system, ask what care or operation stops without it, and how long you can manage manually.
Typical items to consider:
Medication administration records and orders
Resident census, room assignments and diets
Allergy and code status information
Care plans and assessments
Physician orders and lab results
Admissions, discharges and transfers
Billing, payroll and timekeeping
Phones, nurse call and door access
Then rank them by urgency. Medication and allergy information come first.
Paper procedures only work if the paper is current.
Printed downtime reports, generated on a schedule such as every shift or every day. Many EMRs can produce census, medication, allergy and care-plan reports for this purpose. Ask your vendor what is available.
Offline copies on secured local devices, if your system supports a read-only downtime viewer.
Blank forms, such as medication administration sheets, vital sign logs, incident reports, telephone orders and admission paperwork, stored in clearly labeled downtime binders or boxes at every nursing station.
Contact lists: physician, pharmacy, family, vendor, IT and emergency contacts, printed and updated regularly.
Protect the printed material. Downtime reports contain PHI, so they must be stored securely and shredded when no longer needed.
Decide in advance:
Who declares downtime, and who tells staff? Usually the administrator or designee, working with IT.
Who communicates to each shift, and how? Phones may be down too, so plan for overhead paging, runners or radios.
Who tracks what was handled on paper so it can be entered later?
Who updates families, physicians and surveyors if the outage is lengthy?
A 60-page policy will not be opened at 3 a.m. Create a short quick-start for each role:
How to recognize and report downtime
Where the paper forms and printed reports are
Which steps to follow for medication passes
How to document and mark entries
Who to call, with numbers
How to catch up after recovery
Place it on the front of the downtime binder.
Bringing systems back is its own task.
Designate staff to enter paper records into the system, with a second person verifying critical information such as medications
Check the order in which systems are restored, with clinical systems first
Reconcile discrepancies, such as orders written on paper that were not entered
Mark the time the downtime began and ended in the record
Hold a brief review afterward: what worked, what did not, what needs to change
Until you rehearse, you do not really have a plan. Options:
Tabletop exercise: gather leaders for an hour and walk through a scenario, such as a ransomware attack on a Friday evening. Ask what happens at each stage.
Unit drills: run a short planned downtime on one unit, with paper forms, during a quiet period and with clinical leadership approval.
New hire orientation: show new staff where the binder is and how to use it.
Document each exercise. Findings often reveal outdated forms, missing contact numbers and printers that do not work without the network.
Printed reports that are weeks or months old
Forms that no one has seen since the last survey
Downtime binders locked in an office the night shift cannot open
Phone systems that fail along with the network
No plan for who enters data afterward
No battery backup to keep the printer needed for downtime reports running
UnityCare IT works with administrators and clinical leaders to build downtime plans, coordinate EMR downtime reporting with vendors and run tabletop exercises. If your binder has not been touched in a year, a review is a good place to start.
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