Mohave County
Department of PUBLIC HEALTH
700 W. Beale Street, Kingman AZ

Planning for pandemic influenza is critical. The Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention developed the following checklist to help organizations that provide home health care services assess and improve their preparedness for responding to pandemic influenza. Home health agencies will likely be called upon to provide care for patients who do not require hospitalization for pandemic influenza, or for whom hospitalization is not an option because hospitals have reached their capacity to admit patients. These agencies may become overburdened very quickly and shortages of personnel and supplies for providing home health care may occur. 

The list is comprehensive but not complete; each home care agency will have unique issues that will need to be addressed as part of a pandemic planning exercise. Also, some items on the checklist may not be applicable to a given agency. Collaboration with hospitals, local pandemic planning committees and public health agencies will be essential to ensure that the affected population receives needed health care services. 

Checklist Sections
Structure for planning and decision making
Development of a written pandemic influenza plan
Elements of an influenza pandemic plan

1. Structure for planning and decision making.

Tasks

Not Started

In Progress

Completed

Pandemic influenza has been incorporated into emergency management planning for the organization.

A planning committee has been created to specifically address pandemic influenza preparedness.

A person has been assigned responsibility for coordinating preparedness planning for the practice or organization. (Insert name, title and contact information)                                                     
                                                                                                               

Members of the planning committee1 include the following: (Insert name, title and contact information for each)
Administration:                                                                                     
Nursing:                                                                                               
Clerical:                                                                                               
Other:                                                                                                    

A point of contact has been identified for questions/consultation on infection control (e.g., hospital- or state health department-based infection control professional, healthcare epidemiologist). (Insert name, title, and contact information)                                                                                            
                                                                                                                 

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2. Development of a written pandemic influenza plan.

Tasks

Not Started

In Progress

Completed

Copies of relevant sections of the Department of Health and Human Services Pandemic Influenza Plan have been obtained. (www.hhs.gov/pandemicflu/plan/)

Copies of available state and/or local pandemic influenza plans have been obtained.

A written plan has been completed or is in progress that includes the elements listed in #3 below.

The plan describes the organizational structure (i.e., lines of authority, function and assignment of responsibility) that will be used to operationalize the plan.

The plan complements2 local response plans in communities served by the home health care agency.

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