Where were you on July 19, 2024? If you were in an airport, you’ll likely remember that date. That’s when a routine software update from cybersecurity firm CrowdStrike, inadvertently crashed customers' Windows systems and disrupted travel worldwide. But it wasn’t just travelers and the airline industry that felt the impact. Provider organizations, patients and those who had a procedure scheduled experienced disruptions. From the Cleveland Clinic and Emory Healthcare to Mass General Brigham and Rush University System for Health, institutions large and small experienced outages. This problem surfaced just five months after a ransomware attack at UnitedHealth Group's Change Healthcare caused widespread difficulties and a significant financial fallout for hospitals, pharmacies and medical groups. These issues highlight an essential need. Whether it’s a cyber attack, a faulty software update or a natural disaster, health systems need a plan to ensure continuity and safety during system outages.

Are Outages Inevitable?

The Joint Commission believes for most hospitals, experiencing a cyberattack that adversely affects operations is not an “if” but a “when” question. To illustrate, a survey of 641 healthcare IT and security professionals by the Ponemon Institute found that 89% of the respondents’ organizations experienced cyberattacks during the previous 12 months. The attacks occurred in small, independent practices as well as in large, integrated and well-protected healthcare systems. What’s more, regardless of where they occurred, the most common types of cyber attacks impacted patient care.¹

Understanding Hospital Downtime Labels

The distinct possibility that an outage will impact your organization adds importance to making plans in case one does occur. Identifying and implementing mitigation and preparedness actions serve to reduce disruptions and assure patient safety. This includes developing plans and procedures and identifying the resources necessary to keep patients safe and maintain hospital operations.

One of those resources is downtime kits that help you to maintain operations when systems are offline. Essential items to add to the kit include pen, paper, fax capabilities and downtime labels. These downtime labels incorporate the numerous functions that continue to operate offline.

• Admissions and patient transfer - ID wristbands
• Nursing communications - communication labels
• Charting - charting labels
• Food service - food service labels
• Lab tests - specimen and test tube labels
• Prescriptions - prescription pads
• Anesthesias and drugs name and no-name drug labels and tapes
• Discharge - discharge checklist

Downtime Labels Help Prevent Medication Errors

Hospital downtime labels are specialized labels used during system outages to manually document critical patient information. The key data elements of downtime labels include:

• Patient Identification: Name, date of birth, and medical record number.
• Medication Details: Drug name, dosage, route of administration, and time of administration.
• Procedural Information: Details of procedures performed, including time and staff involved.
• Time Stamps: Precise times for all recorded actions to ensure chronological accuracy.
• Staff Identification: Names and signatures of the staff responsible for care.

These elements are vital for maintaining treatment integrity, allowing healthcare providers to track and document patient care accurately during system downtimes. These labels decrease the risk of errors and enhance patient safety.

For example, during an outage that impacts EHR systems, the risk of medication errors increases due to the lack of automated checks and balances. Preventing dosing errors depends upon proper labeling. Medication labels including prescription pads, no-name drug labels and tapes, provide a clear, manual method of documenting this information, reducing the likelihood of mistakes.

Downtime Labels Help Maintain Chain-of-Custody

Specimen processing is another potential flashpoint. Stickers placed on the specimen, the downtime log and sent to the department section for placement on the instrument printout will help maintain an accurate chain-of-custody.

Facilitate Continuity in Patient Treatment

Downtime labels play a pivotal role in maintaining continuous care. By offering an immediate, manual alternative to electronic records, these labels help healthcare providers keep track of ongoing treatments, avoid duplications, and ensure that no step in the care process is overlooked.

Strategic Planning for Downtime Scenarios

How often does the clinical staff use manual processes to execute patient care functions? In most organizations, it’s rarely if ever. In response to the Ascension cyber attack, Connie Smith, head of the Wisconsin Federation of Nurses and Health Professionals said, “For a lot of our nurses, they’ve never paper charted at all.” “We were using forms that we pulled out of drawers that hadn’t seen the light of day in a long, long time.”

Making preparations in advance will enable operations to continue functioning during a cyberattack and that starts with input from departmental stakeholders, including:

• Admissions and scheduling
• Facilities management, specifically inpatient and outpatient settings
• Inpatient medical staff, nursing, nutrition and food services and operating rooms
• Outpatient clinics
• Pathology and laboratories

When vital systems are offline, these associates provide key insights into operational and patient safety risks. They can also suggest alternative procedures that keep the clinical staff effective.

Risk Assessment and Management

It’s essential to identify vulnerabilities and develop a plan that includes downtime labels. Preparing labels in advance ensures they are ready for use during an outage. This will minimize disruption to patient care.

Development of Downtime Protocols

Creating robust downtime protocols is crucial for ensuring that your healthcare facility can continue to operate smoothly during an outage. A step-by-step guide for developing these protocols should include:

• Type of labels - Identify the specific types of labels required to maintain operations.
• Placement - Strategically place labels in areas where they are needed most. This typically includes Central Stores, nursing stations, nurse servers and other point-of-care storage areas.
• Inventory - Stock an adequate supply of downtime labels. The Joint Commission suggests organizations should be prepared to have life- and safety-critical technology offline for four weeks or longer, so order inventory accordingly.
• Staff Training - Labels are crucial for patient and medication safety in normal operations. But during outages, alternative manual procedures are necessary which makes staff training essential.
• Regular Drills - Conduct drills to ensure familiarity with the protocols.

Incorporating downtime labels as part of an emergency response plan will ensure continuity of care during system outages. These labels are an important part of the manual documentation process. Here's how a medical center used them during an unexpected outage caused by a cyber attack:

• Patient Identification Wristbands and Labels - were used to document key patient information such as names, patient identification numbers and dates of birth, ensuring that all staff could quickly identify patients and retrieve essential data.
• Medication Labels - detailed the drug name, dosage, route of administration, and time of delivery. These labels were placed on manual medication administration forms and patient charts to ensure all staff had access to up-to-date treatment information.
• Procedure Labels - Track key milestones such as the procedure start and end times, staff involved, and materials used for surgical and other procedural departments.
• Time Stamped Labels - Document each step in the treatment process. These are often customized based on each organization's unique protocols.

Challenges and Solutions

Patient care is challenging. However, securely managing patient data provides an additional challenge without typical procedures in place.

Compliance with Emergency Management Standards

Design downtime labels to protect patient privacy while still providing all necessary information. Make sure they only include essential data. Store them securely after use to comply with HIPAA regulations.

On a positive note, your outage prep will meet Joint Commission Emergency Management Standard EM.11.01.01. This requires a hospital to conduct a hazards vulnerability analysis (HVA) which includes cyberattacks.

Technology Integration

Looking to the future, RFID technologies could automate some processes making it easier to track and manage resources. This integration could enhance operational efficiency and reduce the burden on healthcare providers during system downtimes.

United Ad Label

In an era where healthcare is increasingly reliant on electronic systems, preparing for outages is more important than ever. Hospital downtime labels are a critical component of any contingency plan, ensuring that patient care can continue uninterrupted. United Ad Label's labeling solutions help healthcare facilities run effectively during normal operations and difficult outages.