By Yolanda Sims, JD, MHA
KAMMCO Loss Prevention and Risk Management Advisor
Long-term care providers can improve the knowledge and training of staff by conducting a COVID-19 tabletop emergency exercise. A tabletop exercise utilizes a scenario to review and test decision-making processes and existing plans. Leaders should create a tabletop exercise that will increase critical thinking skills, demonstrate how to coordinate decisions and uncover gaps in the current plan that might need to be corrected.
When planning a preparedness tabletop exercise for your organization, consider the following:
Identify roles and responsibilities of staff. Engage everyone. Infection prevention and occupational
health leaders should help to plan the exercise. Include administrators and leadership. Make sure
that nurses, nurse assistants, and others that provide direct resident care are present, as well as staff
responsible for cleaning and disinfection, waste removal, and facilities management (e.g., airflow, entry
and exit ways), and nutrition. Consider inviting rounding providers and/or infectious disease consultants,
to assure that your plan reflects the concepts of monitoring, triage, and transport.
Create several COVID-19 scenarios. One example is to set up a model COVID-19 room onsite. This will
help staff to visualize how best practices will be incorporated into your specific facility setting, and how
the role of staff might change. Include all signage and materials needed to set up transmission-based
precautions. Give hands-on training on appropriate use of PPE, including practice putting on (donning)
and taking off (doffing) of gown, mask, eye protection, and gloves. Another example is to work through
a COVID-19-positive resident’s day. Consider routine COVID-19 scenarios like resident care, room
cleaning, waste removal, dietary needs, and transport of residents for external medical care, like
dialysis. Also, consider more rare scenarios that will require a planned approach and clear staff
expectations to care for COVID-19 residents.
Make clinical management plans. Ahead of the preparedness session, work with rounding providers and local referral hospitals to establish triage and testing criteria and to ensure contact information is available for consultation around the clock. During the exercise, assume that state/regional and federal responders are initiating their plans, procedures and protocols while you are concentrating on the facility’s response.
Encourage participation. A tabletop exercise is intended to be a safe environment that encourages open
and wide-ranging discussion. Participants should feel free to ask questions to one another and challenge
one another’s assumptions. No one should be singled out or punished for what they say during the
exercise. The response process and decision-making are more important than details.
Hold a debriefing. Give participants an opportunity to discuss their experience, what they have learned
and suggest improvements to their emergency planning and preparedness.
At the conclusion of the exercise consider the following debriefing questions:
- Identify the three most important activities accomplished during this tabletop exercise.
- What are the three most important gaps identified during this exercise?
- What are the three most important lessons learned from participating in this exercise?
- Identify three things that could help improve this exercise.
The overall goal of the tabletop exercise is for the provider to assess their preparedness and delegation of responsibilities when responding to the COVID-19 pandemic. No organization is fully prepared for this type of public health emergency. But if you act on the lessons learned during the exercise, you should be able to identify strengths and areas needing improvement with regards to response.
References
- Wendelboe, Aaron, et al. (2020). Tabletop exercise to prepare institutions of higher education for an outbreak of COVID-19. Journal of Emergency Management. 18. 183-184 10.5055/jem.2020.040463
- COVID-19 Toolkit: Information for Long Term Care Facilities. Minnesota Department of Health. June 2020
- COVID-19 Tabletop Exercise. Department of Operational Support. United Nations. Retrieved July 24, 2020, from https://operationalsupport.un.org/en
