Natural disasters come in many forms—tornados, earthquakes, wildfires and hurricanes, to name a few. In order to ensure the safety of patients and meet the medical needs of their communities, health systems and pharmacies painstakingly plan for these and other scenarios through building codes and facility layouts. They also draft site-specific emergency operations plans (EOPs) to ensure that staff are trained and ready to respond to an increased medical need.

The Centers for Medicare & Medicaid Emergency Preparedness final rule, effective November 2017, provides specific requirements that hospitals and other health care providers must follow. The four critical pieces of disaster planning include risk assessment and planning, development and implementation of policies and procedures, ensuring a robust communication plan, and providing ongoing training and testing of your plan.

Yet, even with these dedicated efforts, each emergency situation offers valuable “a-ha” moments. According to Gretchen Brummel, PharmD, BCPS, director, pharmacy advisory solutions for Vizient, it’s also beneficial to consider pharmacy best practices gleaned from prior disaster events and use them to inform future disaster planning. Brummel offers these tips to aid pharmacies facing potential emergency scenarios.

1. Addressing limited electrical power

When power is lost, backup generators, while most likely part of every hospital’s EOP, will not completely cover all of the hospital’s electrical needs. Prioritization should be given to vital resources, such as medication refrigerators, to ensure they are plugged into outlets served by generators.

“Like the rest of the hospital, continuity of service can be impacted by a pharmacy’s access to electricity or internet because both are needed to process prescriptions. But pharmacies can plan ahead by having manual processes for prescription processing in these situations,” Brummel said.

For times when the electronic medical record is not functioning, previous methods should be used, such as paper or manual documentation and tracking for prescribing, transcribing, dispensing and administering medications.

2. Opening communication channels

Good communication with staff are intrinsic to continued hospital operations. Pharmacists should be prepared to work through their health system’s EOP and immediately reach out to their state board of pharmacy, the Drug Enforcement Agency and their group purchasing organization, which may be able to offer additional support services.

Contacting local, state and federal agencies is also important, as each is responsible for various facets of the recovery. Federal aid via the strategic national stockpile may take up to 72 hours to arrive, so state and local support will be critical in the interim. Planning scenarios and designating contact persons specific to pharmacy should be part of the health system’s EOP. 

“Reaching out to local and state officials is important because the governor’s office will be coordinating state resources. The governor may also provide a temporary order granting authorization for special emergency medication use or coordinating release of medications from the strategic national stockpile,” Brummel said.

“Open communication with local officials and other hospitals also allows for good resource allocation and swift crisis responsiveness within the community. Regular discussions and networking with other directors of pharmacy in the region may be helpful in disaster planning,” added Brummel.

3. Planning ahead with distributors

Hospitals typically receive one to two deliveries each day, and their par levels on the shelves reflect this. If cut off from this frequency, medication supplies will begin to dwindle quickly. Adding to the complexity of the issue is that, in some instances, lifesaving medications may be in a shortage situation.

“Pharmacists will want to stay in communication with wholesalers and distributors when disasters hit. Special deliveries or drop shipments may be necessary to ensure appropriate medications are available and able to be delivered,” Brummel said. “Pharmacists and staff should also consider creating a list of vital medications to help ensure the on-hand supply of these medications will support patient needs. Stock can be rotated so that inventory doesn’t expire.”

In addition, Brummel said that the pharmacy EOP should also include communication protocols between pharmacy and the supply chain, as this team may provide supplies that are used to administer medications, such as syringes, IV tubing and IV fluids.

4. Meeting staff medication needs

When normal work routines are upended by disaster, health care professionals respond to provide continuity of service to patients. Staff may not remember to bring personal medications with them if called in before a storm or if the devastation makes getting home all but impossible.

“In addition to supporting direct patient care, health system pharmacies may need to serve employees who have been cut off from their personal medications during a disaster,” said Brummel. “As a result, the hospital pharmacy may need to dispense small amounts to employees, for example a 24-hour supply, and repeat daily as warranted by the length of the disaster or until they are able to return home.”

5. Participating in emergency planning

Hospitals regularly convene meetings of emergency management committees. Given that the hospital pharmacy is a nexus of patient care, particularly in the aftermath of a disaster, it is important that these meetings include a representative of the pharmacy team.

“The one thing I want readers to remember is the importance of pharmacy representation on an organization-wide committee that focuses on preparation for disaster recovery,” Brummel said.

Pharmacists’ thorough emergency planning, both in the department and on the hospital-wide committee, are critical to disaster recovery. By planning ahead with these and other learnings, service continuity and patient care are better supported, and the recovery from Mother Nature’s wrath may be made easier.

For information about leveraging the expertise of Vizient pharmacy solutions in the event of a disaster, click here.

Published: May 8, 2018