In the event of a hospital cyber attack, one of the best strategies is establishing an interim communication system. While networks are down, you and your colleagues will likely need to coordinate the use of cell phones, landlines, or hand-written documentation to maintain care and communicate clearly.
Additionally, the following recommendations can help you stay organized—and calm—under pressure, while the appointed response team deals with the effects of the attack.
#1 Maintain Patient Information Sheets (“Nurse Brain”)
One of the easiest ways to curb potential damages during a cyber attack is to act preemptively, analog-style: Keep a separate, hand-written sheet of paper for each patient containing vital information such as:
- Patient identifiers (name, date of birth, medical record number)
- Allergies
- DPOA name
- Contact information
- Code status
- Important medications
- Most recent vitals
- Relevant lab work
- Primary care provider
- Phone number and family contact information
- Plan of care
- Nursing notes
An analog version of each patient’s pertinent information helps ensure you’ll have critical data readily available, especially during planned downtime or cyber attacks.
Whatever you call them, “patient report sheets”, “kardex”, or even “nurse brains” can be highly effective tools during times of crisis. These paper documents serve as a failsafe containing all of the most vital information you may need about your patients.
#2 Team Up with Your Coworkers
Not everyone is familiar with paper charting, especially younger colleagues who may have grown up in the digital age. As best you can, offer assistance and gentle reminders as necessary to maintain a supportive team environment during the attack.
For example, newer resident doctors have likely never had to write orders by hand. They may need reminders on these key elements required for a prescription medication order:
- Date
- Patient’s name, medical record number, and date of birth
- Clinician name, address, DEA number
- Name of medication
- Strength, form, and dosage of medication
- Instructions for use (including holding parameters if applicable)
- The prescribing physician’s signature
#3 Provide Extra Care and Reassurance to Patients
During times of disruption, patients and their families will require (and likely ask for) additional attention and reassurance. Whenever possible, try to avoid in-depth conversations about the cyber-attack itself.
It’s also best to remind them that they’re still a priority despite the challenging circumstances.
#4 Be Sure to Document the Crisis Situation
In the event of an attack, it’s important to note the circumstances to give context to any patient charts and notes you take. So, try to get in the habit of noting that the patient chart was done in a crisis situation of a cyber-attack.
Providing context for your documentation may be valuable if:
- Future legal proceedings occur as a result of the cyber attack
- Any errors or discrepancies crop up in ongoing patient data
It bears mentioning that it’s crucial to adhere to hospital policy on this issue. Your employer may have specific requests on what should be documented in the event of a crisis.
#5 Focus on Basics and Prioritize Care
During stressful situations, it’s a good idea to rely on the most foundational nursing principles. When in doubt, remember the ABCs:
- Airway
- Breathing
- Circulation
Until the attack is resolved, aim to triage patients based on acuteness and prioritize your care protocol accordingly. In this case, you can use the classic SBAR acronym:
- Situation
- Background
- Assessment
- Recommendation
If you need to streamline documentation while systems are down, it can help to focus on significant changes or deviations from the norm, rather than exhaustive details. This will help save you and your colleagues time while ensuring important information is documented efficiently.
#6 Take Advantage of Downtime
No matter how heightened things can feel in a crisis, you’re likely to find yourself in a “wait state” at some point during the attack. During this time, you can:
- Familiarize yourself with hospital policy – Your hospital likely has downtime procedures, so make sure you’re familiar with them. It’s also important to know where to access printed patient information in the event of system outages. Do your best to be patient—there are bound to be a plethora of moving parts as leadership works through the process of retrieving and organizing data manually.
- Connect with patients – Use downtime as an opportunity to sit with patients and connect on a deeper level. Though much of modern care work depends on computers, devices can often distract nurses and other staff from providing sincere bedside manner and individualized care. In other words, one silver lining of an attack might be restoring the human-to-human bonds care work is meant to enhance—even during the most challenging of situations.
- Exercise gratitude and remember your purpose – Gratitude can be one of the most reliable antidotes, even in the darkest moments. Try to focus on your overarching mission as an RN: to provide exceptional, compassionate care to people in need. Often, you can extend this commitment even beyond your circle of patients, strengthening relationships with colleagues as well.
#7 Focus on What’s in Your Control
The fact of the matter is, in any crisis—a cyber attack, a natural disaster, or some other hardship—most factors are out of your hands. If you can, try to save mental, emotional, and physical energy by focusing on what is within your control: your relationship with your patients and colleagues.
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Sources:
Abelson, Reed. “Fallout from Cyberattack at Ascension Hospitals Persists, Causing Delays in Patient Care.” The New York Times, The New York Times, 23 May 2024, www.nytimes.com/2024/05/23/health/cyberattack-ascension-hospitals-patient-data.html. Accessed 23 June 2024.
Lyngaas, Sean. “Damaging Hacks Expose the Weak Underbelly of America’s Health Care System | CNN Business.” CNN, Cable News Network, 16 May 2024, edition.cnn.com/2024/05/16/tech/damaging-hacks-expose-the-weak-underbelly-of-americas-health-care-system/index.html. Accessed 23 June 2024.
“What Is a Cyberattack?” IBM, 15 Aug. 2021, www.ibm.com/topics/cyber-attack. Accessed 23 June 2024.
“Common Signs of a Cyber-Attack or Data Breaches.” Ministry of Health, www.moh.gov.sg/licensing-and-regulation/cybersecurity-for-healthcare-providers/common-signs-of-a-cyber-attack#:~:text=Usual%20files%2C%20applications%2C%20or%20services,been%20changed%20without%20your%20involvement. Accessed 23 June 2024.
“What Is a Nursing Brain Sheet?” Nurse.Org, nurse.org/education/nursing-report-brain-sheet/. Accessed 23 June 2024.
Kenny, Brian J. “Pharmacy Prescription Requirements.” StatPearls [Internet]., U.S. National Library of Medicine, 9 Jan. 2024, www.ncbi.nlm.nih.gov/books/NBK538424/. Accessed 23 June 2024.