Preparing for electrical power system failures

AORN Journal, April, 2007 by Suzanne C. Beyea

Most people take electrical power for granted, never thinking about whether it will be there when they need it. Each day, electricity is available in a highly ubiquitous manner. One can plug in a light, coffee pot, computer, or television and do so without considering the benefits of having electricity available. Power outages are generally rare, and they often are a temporary inconvenience. For some individuals, power outages can be fun, providing an opportunity to use candles and flashlights and tell ghost stories. When the power outage is prolonged or when it occurs at an inconvenient time, however, it may not seem like such an adventure. Most individuals cope well during a power outage but are relieved when the power is restored.

Electrical outages can and do occur at health care facilities, and these types of events take on a different meaning than power outages at home. In health care organizations, patients often depend on modern technologies that require electricity. In some situations, these technologies are essential to life. The potential hazards created by power outages in health care facilities prompted the Joint Commission to issue a Sentinel Event Alert, which was developed following a number of hurricanes and power blackouts during which hospitals and other health care facilities experienced significant gaps in their ability to obtain and provide adequate power for sustained periods of time. (1)

The Joint Commission has received three reports of sentinel events associated with failures of electrical power systems in health care facilities. One or more patient deaths resulted from these power failures, which occurred both in single facilities and across entire large medical centers.

BACK-UP POWER

Many health care employees are aware that redundant systems exist in health care facilities to provide back-up power in the event of an electrical outage. In fact, many clinicians have observed brief power outages during which "emergency" or generator power took over. Back-up power al lows clinicians to finish surgical procedures in progress and provides electricity to essential health care devices (eg, ventilators, IV pumps). Generally, power outages are resolved quickly, and the back-up power systems are able to meet any essential facility needs.

Most clinicians also have heard stories, however, of the widespread power outages that occurred during hurricane Katrina in which there was insufficient emergency power to provide adequate ventilation or cooling in the affected health care facilities. Furthermore, many patients could not be evacuated from these facilities because the elevators were inoperable. Unfortunately, these types of events can take place anywhere a power outage occurs, and health care organizations and patients are particularly vulnerable. (1)

CONTINGENCY PLANNING

Although power outages are outside of a clinician's control, how health care organizations and clinicians respond to such an outage can be controlled. Proper contingency planning and ongoing readiness training can help prevent tragedies when a power outage occurs.

In an effort to minimize the risks associated with catastrophic electrical outages, the Joint Commission recommends that health care organizations conduct regular vulnerability assessments. A practical first step in ensuring patient safety is to acknowledge that power outages can and most likely will occur. Clinicians also must be certain that all essential equipment is plugged into electrical sockets that will continue to receive back-up power in the event of a power outage. The Joint Commission also recommends that health care organizations

* complete an inventory of emergency power systems;

* conduct an assessment of the adequacy of emergency power systems for critical equipment over an extended period of time;

* ensure that those individuals responsible for operating power systems have demonstrated competency in this role;

* test generator fuel oil for usability on a regular basis;

* communicate the capabilities and limitations of the emergency power system to the organization's leadership team; and

* establish contingency plans for members of the health care team to follow during any power loss, whether brief or sustained.

The Joint Commission provides additional guidance about emergency electrical power systems within its accreditation standards and has approved and will publish new testing standards for emergency generators in 2007. (1) These new standards will require health care organizations to test generators at least once every 36 months; and the test must be conducted for a minimum of four continuous hours. (1)

ORIENTATION

Health care organizations should provide orientation and periodic continuing education to all employees about contingency plans related to power losses. These contingency plans should address issues such as providing power to

* alarm systems,

* emergency communication systems,

* exit signs and exit route lighting,

* storage for biological specimens, and