- Email: [email protected]
Community plan for extreme heat waves
Geriatric Nursing 37 (2016) 326e328
Contents lists available at ScienceDirect
Geriatric Nursing journal homepage: www.gnjournal.com
AALNA Section
Community plan for extreme heat waves Margo Kunze, RN, CALA, LuAnne Leistner, MS, RN Board of Directors, AALNA (American Assisted Living Nursing Association)
The winter is gone and we are all already enjoying, depending on where you live, the spring or summer weather. Having the joy of living on the New Jersey coast, I have seen both in the same day. While the change is welcome it brings with it a set of precautions we must look at and prepare for to protect ourselves, our families and our residents. We are very proactive in the winter months to assure our residents have warm clothing, warm food and beverages, and a controlled environment providing heat. Weather related and other environmental conditions may affect residents’ use of the community courtyards, gazebos and other outdoor spaces. Extreme weather conditions may include factors such as temperature, heat index, humidity, wind chill, thunder and lightning storm forecasts, precipitation, and extreme temperatures. Community staff should heed weather related forecasts/conditions and consider securing the doors to the courtyard during these times while permitting residents in the courtyard for only short time frames and with supervision as conditions permit. Signs and symptoms of hypothermia or hyperthermia should be reported to the Physician/Healthcare Provider (HCP). The Center for Disease Control (CDC) reports that seniors are more prone to heat stress because: 1. Older adults do not adjust well to sudden changes in temperature. 2. Older adults are more likely to have a chronic medical condition that disrupts normal body responses to heat. 3. Older adults are more likely to take prescription medicines that impair the body’s ability to regulate temperature, or inhibit its ability to produce perspiration. Detailed information regarding the signs and symptoms and other clinical information of heat exhaustion, heat stroke and sun stroke is contained in the 3 part guidelines established by the CDC located elsewhere in this issue of the Pulse. As caregivers and nurse managers we must take a proactive approach in preparing for
E-mail address: [email protected] (Calvin Groeneweg, RN C-AL). 0197-4572/$ e see front matter http://dx.doi.org/10.1016/j.gerinurse.2016.06.007
extreme weather events and assure we have educated our staff, given written information to our residents and their families and provided for or coordinated with other services to provide heat reducing steps to protect our residents. ➢ Nursing must take the lead and acquaint the Executive Director and all department heads with the dangers and mitigation interventions available to prevent heat stroke or other adverse reactions to rapid or prolonged periods of extreme heat. This is a community wide responsibility and not just a nursing issue. ➢ A plan must be developed. ➢ Once a plan is formulated all staff on all shifts, residents and families must be educated, as appropriate to the dangers as well as the preventive modalities. ➢ The dangers of heat stroke and death need to be clearly understood and shared with staff, residents and their families utilizing the information in the CDC Preventative Guidelines or other sources. ➢ What can your community do to prevent adverse events? B Create easy to read printed materials about signs and symptoms of heat stroke and sun stroke. B Distribute the handouts to everyone. B Leave handouts as reminders, in multiple locations in your community (activities, dining room, beauty parlor, front desk and lobby). B Create spaces that allow for shade such as pergolas, shade structures, sun umbrellas, and sun shades. B Consider installing misters in climates with dry heat. B Do not take residents outdoors during heat advisories or Air Quality Indexes over 100. B Be aware of skin sensitivity to sun and use sunscreen lotion with an SPF of 30 or greater. Reapply frequently per directions on the bottle. B Know where your residents are during very hot days-assign staff to check ask residents to sign out even if just going out to sit on the porch or into the garden. B Assign staff to monitor who is outdoors and for how long. B Ask residents to return to the community if they have been out too long.
AALNA Section / Geriatric Nursing 37 (2016) 326e328 B
B
B
B
B
Provide hydration stations throughout the community inside and out (dining room, activities room, front lounge/ living rooms, outdoors in the areas most frequently used by residents). One community took small bottles of water, froze them, and placed them in buckets of ice in all of the outdoor areas every day. Staff was assigned to assure the buckets were never empty. Offer water regularly throughout the day, even if a resident says “I’m OK.” Note, once you recognize the feeling of thirst, dehydration is already taking place. Advise residents to drink cool, non-alcoholic, non-caffeinated beverages. For some residents extremely cold liquids because they can cause stomach cramps. Water is the best choice. Provide an assortment of cool/cold drinks in addition to water iced tea, iced coffee, juices, etc. Caffeine free is recommended. Assure residents have not inadvertently turned their heat on in their rooms when the intent was to put the air conditioning on to cool. Personal care associates to check each time they enter a resident room. Dietary needs to provide healthy cold entrees as a choice, not just tuna or egg salad. Elders often do not eat well during a heat spell, so need to be encouraged by providing appetizing cold choices. Ask residents what they fed their families in the summer, you may get wonderful ideas from really great cooks. Naturally the dietary requirements of your state must be met while providing variety and a lighter option for your residents. Avoid heavy sauced meat entrees unless requested by residents, keep it light, keep it refreshing, keep it balanced. Our residents are not always adventurous when approached with new food combinations or products, but, we can try to offer them more weather compatible choices. Some suggestions made by other communities: - Tomato aspic or other jellied, molded salads. - Gazpacho soup. - Caprese salad (fresh mozzarella cheese, roasted red peppers and tomatoes). - Panzanella Salad. - Deviled eggs-cold, protein laden. - Make your own Smorgasbord sandwiches. - Submarine sandwiches can also be a make your own activity. - Fruit pies ala mode rather than heavy cakes or other pastries. - Cold pasta and vegetable salads. - Taco salad (steak, chicken or fish). - Chef Salad. - Cobb Salad. - Waldorf Salad. - Ice cream cakes. - Cold fired or grilled chicken. - Cold turkey breast. - Cold roasted Brussels’ sprout, broccoli, broccoli rabe or cauliflower salads. - Cold fruit and vegetable platters always available. - Hot dogs and hamburgers on the grill with corn on the cob. - Have ice cream, sherbet or novelties available for dessert or snacks. - Offer cold/iced fruit and vegetable juices to replace electrolytes (tomato juice is perfect for this). - Avoid alcoholic beverages during extreme heat waves. - One community made arrangements with their local ice cream truck to stop by twice a day during heat waves.
B
B
327
Maintenance to assure all in-room or community wide air conditioning is in perfect functioning status. All suspect inroom or through wall units should be replaced. - Assure staff is checking units daily by creating a check-off list, housekeeping can be incorporated into this process as they are in almost every room every day-department head to collect and check sheets at end of day. - Establish someone on call to respond to unit malfunction after hours. - Check daily for ice dams in main units. - Assure all unit filters have been appropriately changed and changes were documented. - Have contact numbers for external repairmen available for nursing staff to utilize when instructed by the ED or maintenance department head. - Assure all room units are set to cool unless otherwise instructed by nursing. - Emergency generator checks and documentation to assure AC continues if there is a power outage. - Assure multiple fans are available in case of an AC failure. - Replace faulty or broken units as soon as possible. - Assure kitchen AC and exhaust fans are in working order - With dietary make sure three day bottled water supply is on hand and NOT outdated. - Check all ice machines and water fountains to assure they are in working order. - Respond to all reports of non working refrigerators in resident rooms. Nursing to assure all residents are safe and staff is educated in all aspects of hyperthermic events. - Educate on signs and symptoms of sun stroke and heat stroke/exhaustion (Body temperature above 103 F, Red, hot, and dry skin (no sweating), Rapid, strong pulse, Throbbing headache, Dizziness and nausea). - Make aware heat stroke occurs when the body becomes unable to control its own temperature. The body loses its ability to sweat or cool down. Body temperatures rise to 106 or higher within 10e15 min. - Make aware that some medications can make older people more vulnerable to heat exhaustion. For example, painkillers can mask some of the symptoms of heat exhaustion, and laxatives can increase the risk of dehydration. - Assure residents are wearing temperature appropriate clothing, especially important in the specialty dementia units. - Remind to wear wide brimmed hats and sunglasses. - Be aware of skin sensitivity to sun and use sunscreen lotion with an SPF of 30 or greater. Reapply frequently per directions on the bottle. - Assure residents are coming to the wellness center/ nursing office for medications, if not check why not. - Attending meals-have a check list system to assure they are there for each meal. - Incontinent residents do not decrease urinary output. - Provide/instruct staff members to immediately search for residents who do not come to meals as per their normal routine. - Observe all residents for signs and symptoms of heat stroke, etc. at each encounter. - Assure all nursing staff will respond immediately to any heat related change in resident status. - Taking additional fluids-if on fluid limitations get new orders to account for the change in temperature.
328
AALNA Section / Geriatric Nursing 37 (2016) 326e328
Offer more frequent showers if indicated. Change bed linens more frequently if indicated due to profuse sweating-if profuse sweating alert nursing to reevaluate for dehydration, heat exhaustion or heat stroke. - Do not leave any sleeping residents outdoors unattended. - Notify MD, and family with changes of status. Activities assure that precautions are taken to prevent residents from overheating during activities. - Plan outings and outdoor activities in the coolest part of the day. If possible, seek an air-conditioned environment for the activity. Consider visiting an air-conditioned shopping mall or public library instead of an outdoor petting zoo for an outing. - Limit time spent outdoors in strenuous activity. - Remind to wear hats and sunglasses. - Offer cold/cool beverages frequently during activities. - Offer cold fruit or vegetables as a snack instead of cookies, cake, etc. - Provide with opportunities to prepare cold items if cooking/kitchen available for resident use. - Structure activities periods indoors in air conditioning. - Accompany residents, when possible, outdoors to provide observation and monitoring to prevent overheating. - Observe all residents for signs and symptoms of heat stroke/exhaustion, etc. and report to nursing immediately. - Assure residents are appropriately dressed. -
B
Remind residents outdoors to remain in the shade or come in after a few minutes. - Do not leave any sleeping residents outside. Housekeeping assure that all residents have access to a clean and comfortable environment. - Check that all room refrigerators are in working order during daily room visits report all non working refrigerators to maintenance immediately. - Check all AC units to make sure they are turned to cool unless otherwise instructed by nursing. - Report any drinking fountain or other cooling equipment not functioning to maintenance. - Observe all residents for changes due to heat and report changes to nursing immediately. - Check hydration stations while making rounds and notify dietary if empty or close to empty. - Remind residents who are outdoors to remain in the shade or come after a few minutes. - Do not leave sleeping residents outdoors unattended. -
-
B
This is a suggested list of preparations your community can make to prevent adverse events during extreme heat waves. Your community can add to this list or make your own. The point is for you to have a plan and implement it in an organized way to provide a safe environment for your staff and your residents. Following these steps will aid your community in having a happy, healthy, heat event-free summer.
Contents lists available at ScienceDirect
Geriatric Nursing journal homepage: www.gnjournal.com
AALNA Section
Community plan for extreme heat waves Margo Kunze, RN, CALA, LuAnne Leistner, MS, RN Board of Directors, AALNA (American Assisted Living Nursing Association)
The winter is gone and we are all already enjoying, depending on where you live, the spring or summer weather. Having the joy of living on the New Jersey coast, I have seen both in the same day. While the change is welcome it brings with it a set of precautions we must look at and prepare for to protect ourselves, our families and our residents. We are very proactive in the winter months to assure our residents have warm clothing, warm food and beverages, and a controlled environment providing heat. Weather related and other environmental conditions may affect residents’ use of the community courtyards, gazebos and other outdoor spaces. Extreme weather conditions may include factors such as temperature, heat index, humidity, wind chill, thunder and lightning storm forecasts, precipitation, and extreme temperatures. Community staff should heed weather related forecasts/conditions and consider securing the doors to the courtyard during these times while permitting residents in the courtyard for only short time frames and with supervision as conditions permit. Signs and symptoms of hypothermia or hyperthermia should be reported to the Physician/Healthcare Provider (HCP). The Center for Disease Control (CDC) reports that seniors are more prone to heat stress because: 1. Older adults do not adjust well to sudden changes in temperature. 2. Older adults are more likely to have a chronic medical condition that disrupts normal body responses to heat. 3. Older adults are more likely to take prescription medicines that impair the body’s ability to regulate temperature, or inhibit its ability to produce perspiration. Detailed information regarding the signs and symptoms and other clinical information of heat exhaustion, heat stroke and sun stroke is contained in the 3 part guidelines established by the CDC located elsewhere in this issue of the Pulse. As caregivers and nurse managers we must take a proactive approach in preparing for
E-mail address: [email protected] (Calvin Groeneweg, RN C-AL). 0197-4572/$ e see front matter http://dx.doi.org/10.1016/j.gerinurse.2016.06.007
extreme weather events and assure we have educated our staff, given written information to our residents and their families and provided for or coordinated with other services to provide heat reducing steps to protect our residents. ➢ Nursing must take the lead and acquaint the Executive Director and all department heads with the dangers and mitigation interventions available to prevent heat stroke or other adverse reactions to rapid or prolonged periods of extreme heat. This is a community wide responsibility and not just a nursing issue. ➢ A plan must be developed. ➢ Once a plan is formulated all staff on all shifts, residents and families must be educated, as appropriate to the dangers as well as the preventive modalities. ➢ The dangers of heat stroke and death need to be clearly understood and shared with staff, residents and their families utilizing the information in the CDC Preventative Guidelines or other sources. ➢ What can your community do to prevent adverse events? B Create easy to read printed materials about signs and symptoms of heat stroke and sun stroke. B Distribute the handouts to everyone. B Leave handouts as reminders, in multiple locations in your community (activities, dining room, beauty parlor, front desk and lobby). B Create spaces that allow for shade such as pergolas, shade structures, sun umbrellas, and sun shades. B Consider installing misters in climates with dry heat. B Do not take residents outdoors during heat advisories or Air Quality Indexes over 100. B Be aware of skin sensitivity to sun and use sunscreen lotion with an SPF of 30 or greater. Reapply frequently per directions on the bottle. B Know where your residents are during very hot days-assign staff to check ask residents to sign out even if just going out to sit on the porch or into the garden. B Assign staff to monitor who is outdoors and for how long. B Ask residents to return to the community if they have been out too long.
AALNA Section / Geriatric Nursing 37 (2016) 326e328 B
B
B
B
B
Provide hydration stations throughout the community inside and out (dining room, activities room, front lounge/ living rooms, outdoors in the areas most frequently used by residents). One community took small bottles of water, froze them, and placed them in buckets of ice in all of the outdoor areas every day. Staff was assigned to assure the buckets were never empty. Offer water regularly throughout the day, even if a resident says “I’m OK.” Note, once you recognize the feeling of thirst, dehydration is already taking place. Advise residents to drink cool, non-alcoholic, non-caffeinated beverages. For some residents extremely cold liquids because they can cause stomach cramps. Water is the best choice. Provide an assortment of cool/cold drinks in addition to water iced tea, iced coffee, juices, etc. Caffeine free is recommended. Assure residents have not inadvertently turned their heat on in their rooms when the intent was to put the air conditioning on to cool. Personal care associates to check each time they enter a resident room. Dietary needs to provide healthy cold entrees as a choice, not just tuna or egg salad. Elders often do not eat well during a heat spell, so need to be encouraged by providing appetizing cold choices. Ask residents what they fed their families in the summer, you may get wonderful ideas from really great cooks. Naturally the dietary requirements of your state must be met while providing variety and a lighter option for your residents. Avoid heavy sauced meat entrees unless requested by residents, keep it light, keep it refreshing, keep it balanced. Our residents are not always adventurous when approached with new food combinations or products, but, we can try to offer them more weather compatible choices. Some suggestions made by other communities: - Tomato aspic or other jellied, molded salads. - Gazpacho soup. - Caprese salad (fresh mozzarella cheese, roasted red peppers and tomatoes). - Panzanella Salad. - Deviled eggs-cold, protein laden. - Make your own Smorgasbord sandwiches. - Submarine sandwiches can also be a make your own activity. - Fruit pies ala mode rather than heavy cakes or other pastries. - Cold pasta and vegetable salads. - Taco salad (steak, chicken or fish). - Chef Salad. - Cobb Salad. - Waldorf Salad. - Ice cream cakes. - Cold fired or grilled chicken. - Cold turkey breast. - Cold roasted Brussels’ sprout, broccoli, broccoli rabe or cauliflower salads. - Cold fruit and vegetable platters always available. - Hot dogs and hamburgers on the grill with corn on the cob. - Have ice cream, sherbet or novelties available for dessert or snacks. - Offer cold/iced fruit and vegetable juices to replace electrolytes (tomato juice is perfect for this). - Avoid alcoholic beverages during extreme heat waves. - One community made arrangements with their local ice cream truck to stop by twice a day during heat waves.
B
B
327
Maintenance to assure all in-room or community wide air conditioning is in perfect functioning status. All suspect inroom or through wall units should be replaced. - Assure staff is checking units daily by creating a check-off list, housekeeping can be incorporated into this process as they are in almost every room every day-department head to collect and check sheets at end of day. - Establish someone on call to respond to unit malfunction after hours. - Check daily for ice dams in main units. - Assure all unit filters have been appropriately changed and changes were documented. - Have contact numbers for external repairmen available for nursing staff to utilize when instructed by the ED or maintenance department head. - Assure all room units are set to cool unless otherwise instructed by nursing. - Emergency generator checks and documentation to assure AC continues if there is a power outage. - Assure multiple fans are available in case of an AC failure. - Replace faulty or broken units as soon as possible. - Assure kitchen AC and exhaust fans are in working order - With dietary make sure three day bottled water supply is on hand and NOT outdated. - Check all ice machines and water fountains to assure they are in working order. - Respond to all reports of non working refrigerators in resident rooms. Nursing to assure all residents are safe and staff is educated in all aspects of hyperthermic events. - Educate on signs and symptoms of sun stroke and heat stroke/exhaustion (Body temperature above 103 F, Red, hot, and dry skin (no sweating), Rapid, strong pulse, Throbbing headache, Dizziness and nausea). - Make aware heat stroke occurs when the body becomes unable to control its own temperature. The body loses its ability to sweat or cool down. Body temperatures rise to 106 or higher within 10e15 min. - Make aware that some medications can make older people more vulnerable to heat exhaustion. For example, painkillers can mask some of the symptoms of heat exhaustion, and laxatives can increase the risk of dehydration. - Assure residents are wearing temperature appropriate clothing, especially important in the specialty dementia units. - Remind to wear wide brimmed hats and sunglasses. - Be aware of skin sensitivity to sun and use sunscreen lotion with an SPF of 30 or greater. Reapply frequently per directions on the bottle. - Assure residents are coming to the wellness center/ nursing office for medications, if not check why not. - Attending meals-have a check list system to assure they are there for each meal. - Incontinent residents do not decrease urinary output. - Provide/instruct staff members to immediately search for residents who do not come to meals as per their normal routine. - Observe all residents for signs and symptoms of heat stroke, etc. at each encounter. - Assure all nursing staff will respond immediately to any heat related change in resident status. - Taking additional fluids-if on fluid limitations get new orders to account for the change in temperature.
328
AALNA Section / Geriatric Nursing 37 (2016) 326e328
Offer more frequent showers if indicated. Change bed linens more frequently if indicated due to profuse sweating-if profuse sweating alert nursing to reevaluate for dehydration, heat exhaustion or heat stroke. - Do not leave any sleeping residents outdoors unattended. - Notify MD, and family with changes of status. Activities assure that precautions are taken to prevent residents from overheating during activities. - Plan outings and outdoor activities in the coolest part of the day. If possible, seek an air-conditioned environment for the activity. Consider visiting an air-conditioned shopping mall or public library instead of an outdoor petting zoo for an outing. - Limit time spent outdoors in strenuous activity. - Remind to wear hats and sunglasses. - Offer cold/cool beverages frequently during activities. - Offer cold fruit or vegetables as a snack instead of cookies, cake, etc. - Provide with opportunities to prepare cold items if cooking/kitchen available for resident use. - Structure activities periods indoors in air conditioning. - Accompany residents, when possible, outdoors to provide observation and monitoring to prevent overheating. - Observe all residents for signs and symptoms of heat stroke/exhaustion, etc. and report to nursing immediately. - Assure residents are appropriately dressed. -
B
Remind residents outdoors to remain in the shade or come in after a few minutes. - Do not leave any sleeping residents outside. Housekeeping assure that all residents have access to a clean and comfortable environment. - Check that all room refrigerators are in working order during daily room visits report all non working refrigerators to maintenance immediately. - Check all AC units to make sure they are turned to cool unless otherwise instructed by nursing. - Report any drinking fountain or other cooling equipment not functioning to maintenance. - Observe all residents for changes due to heat and report changes to nursing immediately. - Check hydration stations while making rounds and notify dietary if empty or close to empty. - Remind residents who are outdoors to remain in the shade or come after a few minutes. - Do not leave sleeping residents outdoors unattended. -
-
B
This is a suggested list of preparations your community can make to prevent adverse events during extreme heat waves. Your community can add to this list or make your own. The point is for you to have a plan and implement it in an organized way to provide a safe environment for your staff and your residents. Following these steps will aid your community in having a happy, healthy, heat event-free summer.