Disasters come in many forms and the scenarios in each may differ, but oftentimes they result in the loss of vital computer access. When hospitals prepare for expected and unexpected downtime, plans often focus on the electronic health record (EHR) and are well suited for short duration events, those lasting 24 hours or less. Few plans address a complete loss of systems like what can be encountered following, for example, a ransomware attack, which may last anywhere from days to weeks.

It is difficult to imagine life completely without computers, but that can be the reality for some hospitals, regardless of what disaster has befallen them.

“Pharmacy preparedness for such an event is vital for continued safe, effective and timely patient care,” said Randy Gerwitz, consulting director, pharmacy services at Vizient. “The level of preparedness for a prolonged downtime event—one lasting days to weeks—influences performance during the event and throughout the recovery process.”

Site-specific emergency operations plans (EOPs) are common in the hospital setting, and most pharmacy departments maintain a downtime kit with basic information and supplies, such as common IV labels, batch sheets and critical order sets. But the following the strategies can greatly improve efficiency and begin laying the groundwork for recovery, which often can be significantly longer than the event itself.

1. Keep current hard copies of downtime plans in the department. This may seem obvious, but as organizations become more digital, many house policies and procedures in electronic formats that are accessed from their intranet to maintain version control.

2. Store copies of key documents offline, using a flash drive or similar device. The ability to easily generate additional copies of less commonly used forms saves time and stress. Never plug the flash drive into a networked computer during an event. If the computer was impacted, this can corrupt the drive and the ability to access the contents may be lost.

“It’s also important for multiple staff members to know where to find items 1 and 2,” added Gerwitz. “Ransomware attacks often occur during the off shifts when IT has a smaller and potentially less experienced staff working.”

3. Consider making the development and maintenance of hard copy versions of key CPOE order sets part of the change control process. Similarly, establish hard copy MAR formats appropriate for the patient populations served. Also consider adding basic instructions for the use of downtime forms to the forms themselves. Maintain a single source of truth that can be replicated and distributed during an event to avoid outdated forms. Add all of these to the downtime flash drive or a physical form repository as appropriate for your institution.

4. Meet with key vendors and discuss options for ordering drugs and supplies in the absence of functioning computer systems. Define a plan that not only maintains supplies but facilitates recovery and vendor payment. Also, consider establishing cross-organizational relationships and/or agreements with local retail pharmacies to ensure paper prescriptions will be honored.

5. Maintain a healthy supply of paper, toner and/or ink, as well as prescription blanks. Automated replenishment of these supplies is common, but can be a vulnerability for a department like pharmacy in the event of downed systems.

“Prescription blanks in the age of electronic transmission are generally not kept in any volume,” said Gerwitz. “Most pharmacy directors probably don’t know how many electronic prescriptions are generated each day. Request data on previous orders and set a target level based on that information.” Also, consider asking the medical staff office to supply stamps with the providers’ names and other information as required by your state or insurers.

6. Work with your education department to develop on-demand training documents for providers. Many will have never worked from paper and may have never seen a paper chart. Examples include – how to write a complete order or prescription, a progress note, history and physical and how to find documents in a paper chart.

7. Develop staffing plans for an extended event. This a marathon, not a sprint. Protecting the staff from fatigue and burn-out is exceptionally important not only for the well-being of the team but also for the safety of the patient. Long hours will be needed during recovery as well, so don’t drain the tank in the first week.

Actions taken in the first few hours may impact the entire event, but confirming procedures and tools prior to a disaster can minimize stress and facilitate the delivery of services more effectively.  

To learn more about how Vizient pharmacy subject matter experts can help your organization maximize pharmacy performance, contact us today.

Published: August 21, 2018