1 a tale of 2 cities- disaster relief from 1,100 miles away christopher arendt, pharmd...
TRANSCRIPT
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A Tale of 2 Cities- Disaster Relief from 1,100 Miles Away
Christopher Arendt, PharmD
Pharmacotherapy Coordinator
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Disclosure
• Nothing to disclose.
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Objectives
• After attending this lecture the participant should be able to:– Describe the system used to provide
maintenance medications to disaster victims.– Understand the lessons learned in preparing
for Mass dispensing.– Recognize the importance of the chain of
command during a disaster.– Describe the ideal supply chain and distribution
system in a disaster
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The Scenario
Katrina Rita Health Recovery Week 16 Months later
Katrina Photo: Jeff Schmaltz, MODIS Rapid Response Team, NASA/GSFC
Rita Photo: Jacques Descloitres, MODIS Rapid Response Team, NASA/GSFC
Sept 21st, 2005Aug 28th 2005 Jan 28th -Feb 3rd 2007
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• Thousands of Refugee’s will be sent to Camp Ripley in Northern Minnesota in the next 3 to 5 days. Be ready to receive by September 5th, 2005.
• Need Medical attention. Primary care needs. Medications. Food. Shelter. Staff. Mental Health. Social workers. Security.
Operation “Northern Comfort”
Mayo gets a phone call from the State of Minnesota
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Mayo Responds
• Sent Computers (Guardian Rx), Printers, Labels, Office Supplies
• Sent Pharmaceuticals• Arranged Wholesaler (Cardinal)
Delivery on-Site through Carrier.
• Sent Pharmacy Supplies• Established contacts and supply
chain network• Established Pharmacist/Tech
commitment from Mayo and other MN pharmacies (MPhA)
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Mayo Responds
Operation: “Northern Comfort”
Camp Ripley
9/5/2005
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We were ready…We were ready…
……and they never came to and they never came to Minnesota.Minnesota.
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ACT 2
• The Louisiana Office of Public Health asks Mayo for assistance Sept 9th, 2005.
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The Mayo Response
• Mayo looks for volunteers in key areas– Logistics/ Security/ IT– Nurses/Care Assistants/Clerical Support– Providers/NP/MD
• Mental Health• Internal Med/Family Med/Peds• Infectious Disease
– Pharmacy• Pharmacist/Technician
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The Mayo Response• Mayo in conjunction with
University of Minnesota and College of St. Katherine's established the “Minnesota Minnesota LifelineLifeline” Medical group.
• Team 1 left Monday 9/12/05 morning w/ 9 vans
• Team 2 left -9/14/05 Wednesday on Commercial Flight out of MSP with U of M folks.
• 2 Trucks with supplies headed south 9/12/05
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The Pharmacy Response
Robust Supplies. Repackaged Alphabetically into numbered totes for ease of retrieval.
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The Pharmacy Response
Alphabetical labeling and Pharmaceuticals
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The Pharmacy Response
Code SuppliesFormulary
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The Pharmacy Response
Scheduled Drugs and ability to account for them
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The Pharmacy Response
Personal Packs
Ciprofloxacin 500 mg tabs BID x 3 days
Disp # 6
Loperamide (Imodium) 2 caps now. Then 1 cap after each loose stool. Max 16 mg/24 hrs.
Disp # 30.
Alcohol Based Sanitizer
Drug Info Sheet
If Allergy- Got If Allergy- Got Azithromycin Azithromycin (ZPak)(ZPak)
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The Pharmacy Response
• Computer system and Labeling system (Guardian Rx). Zebra Thermal Printer, Laser Printer
• Pharmacy supplies (vials, ovals, beakers)
• Misc Supplies (Calculator, pens, marker, tablet cutters, grinders, mortar and pestle, scissors, forms, drug info resources, drug info, stapler, Pharmacy tape dispense, note pads, baggies etc….)
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The Pharmacy Response
• Vaccine– Pneumococcal– Hepatitis A, B– Influenza– Tetanus– MMR
• Needle Stick Emergency Kit– Lamivudine + Zidovudine (Combivir)
Used to supplement Public Health Supplies of Vaccine
Hepatitis B confirmed
in the water supply.
Let’s Talk Do’s and Don’ts
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Pharmacy Teams
• Pharmacist + Tech– 8 Weeks of support, 4 teams ( 2 weeks/team)
• Support of department/Inst – “Whatever it takes”
• Pharmacy Job: Assembled, managed and ordered drug supplies day and night
• Helped administer at vaccination sites
• Opened a Disaster-relief Out-Patient Pharmacy out of an RV
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Where did the supplies Where did the supplies come from?come from?
•Public HealthPublic Health
•MayoMayo
•Private DonationsPrivate Donations
•ManufacturersManufacturers
•WholesalersWholesalers
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Protect your assets!
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What do you do when another disaster strikes during your relief effort?
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What is your communication back up plan?
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Lessons LearnedLessons Learned
.
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Communication is critical• Establish ONE phone contact number
– But always have a backup
• Calling Tree and Phone Rosters at your finger tips
• Know key players throughout your profession– Boards of Pharmacy– State Health Officials– Industry
• Suppliers• Data/IT/IS
– Have 24 hour contact lists
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Communication is critical
.
• Establish collaborative agreements right away– Therapeutic Substitution – Rx Writing
• DEA List/RX Pads Info- Get info pre-deployment• Know State Requirements/Get Medicare & Medicaid Provider
info up-front
– Contact Local Pharmacies for Support• Set up time to call, facilitate communication w/in
chains. Ie…CVS, Walgreens, Wal-Mart
– Talk with the DEA right away• Suppliers need permissions up front to ship ALL
meds.
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Communication is critical
• Establish supply chain rules– Must go through one contact for all donations
and purchases of pharmaceuticals• Minimize “Dumping” of expired meds• Allows better inventory accountability• Reduces time spent (Discovery, follow-up,
disposal)
– Have a disposal plan– Have a re-distribution plan
• Ie…Charitable Pharmacy
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Team
• Send people in pairs (Buddy System).
• Send people with similar interests and personalities.
• Send people without young children.
• If it involves drugs, include pharmacy up front. [Vaccine fiasco]
• Establish sound chains of Team Command. Give everyone a copy.
• Recruit more help from others.
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Team• Help monitor each others stress and exhaustion
levels (Buddy system)• If you set up a meeting time, stick to it.• Recognize the roles and responsibilities of other
team members. Help each other if you can, or at least offer to help.
• No job is beneath any team member. No job is above any team member.
• Starting at 5AM and ending at 2AM..a really bad idea
• Mix up teams - makes greater satisfaction
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With or without walls it can become a pharmacy!
MN Comfort
Camp Ripley, MN
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With or without walls it can become a pharmacy!
Mobile Pharmacy
Lafayette LA
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If you pile it they will come…
Set up Stock rules• Entry point in ONE
Location– Wasted time tracking
down items. Some items turned up weeks later.
• Establish delivery lines and times– Fed Ex– UPS– Distributor
Heyman Center Pharmacy, LA
Camp Ripley, MN
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Totes-Push Packs and Go-Kits
• Standardize the pack
• Pack by Therapeutic class, not by drug name.
• Always use both generic and trade names to label items in the Therapeutic Class.
• Less is more
• If items require refrigeration, buy more refrigeration, coolers, make ice, and check multiple times daily to ensure it’s done.
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Totes-Push Packs and Go-Kits• Split the work between multiple people
(day/eve/night)
• Set ground rules in the beginning– You restock pack or you fill out the stock
request form (let us know what you used). – Establish “ownership” of the kit with providers– If you need something new, let me know early
so I can try to get it here by tomorrow.– Remove redundancy ( 1 item per class)
• Set up a FORMULARY• Ie..you don’t need 5 different ACE Inhibitors.
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Team Prescriptions• Personal packs
– Great idea. – Could go with Bulk Bottles to save time/effort.– Get allergy list pre-departure for Emergency– Was a method of taking attendance
• Bus Med Bag– Nausea, Headache, Travel Sickness and Back pain Kit.– Sent legend drugs (don’t get back) after c/o motion sickness
• No Legend drugs with last bus.
– Send with bus “Charge” person. Inform Team of Bag on Bus
• Employee Prescriptions– No problem, but if it requires refrigeration…No.
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Emergency Supplies
• Code Cart– Nice to have there, but not used
• Was never unwrapped from Shrink wrapping
– No one performed daily checks• Sent documentation log with modified procedure• Need self diagnostic style machines (AED Pro)
– 4 AED’s also sent out with teams• Should send AED with each team & make sure
they know how to use.• Need more AED’s• Contacted MFR…Backfilled our needs.
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Lessons for Incident Command• One person needs to coordinate the phone
list!
• More Phones and Computers for Group
• Keep the All Inclusive morning meeting
• Keep the Round Table approach to Q/A– Get a bigger table & room- Many players.
• Give the Command Structure and Contact list to EVERY Team Member (lanyard around neck)
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Pharmacy Services
• Think outside the rule laden box.• In-Patient and Out-Patient Pharmacy collaboration
achieved remarkable results.• Even the best drawn plans are merely sketches.• Be open and ready to explore alternative methods
of accomplishing a task.• Be willing to ask for help.• Having one person responsible for coordination is a
must.• Keep the staff aware of what is going on.
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The Ideal Supply Chain
• Central point of Distribution/ repackaging• Real time shipping status• Mobile Distribution units• Real Time counts/Use reports• Direct from supplier shipping 24/7• Portable med management system /Drug info
resources• Language resources• Financial support• Teamwork
WEB
PDA
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Can Technology Bridge the Gap?
…YES! But…
• Need power
• Need Communications
• Need User Understanding (JIT Training)
• When we go to a sticks and stones When we go to a sticks and stones mentality, this won’t work.mentality, this won’t work.
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Summary• Be Fluid, Flexible and try to have Fun• Communication, Communication Communication.
– Solid, scheduled and redundant.
• Know your Chain-of-Command and follow it• Pharmacy involvement early on makes the logistics
easier• While the Ideal Supply Chain does not exist, good
support can make a major difference
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Thank you!
Contact InformationChristopher Arendt, PharmDPharmacotherapy CoordinatorMayo Clinic, Saint Marys Hospital1216 2nd ST SWRochester, MN 55902507-255-0384 (w) [email protected]