Disaster Response Involving Pharmacists

Disasters are increasingly affecting more and more communities. ¹ In addition to natural or manmade disasters, epidemics and pandemics are altering society. A complete healthcare team is vital in responding to these disasters or incidents. Pharmacy team members are integral regardless of the complexity of the emergency, disaster, or event. ² During disasters, pharmacists are usually the most accessible health care professionals for the public. ³ Both traditional and non-traditional roles for pharmacists and pharmacy team members are required when responding to a disaster, epidemic, or pandemic. A Delphi study identified 43 pharmacists’ roles for the 4 phases of a disaster: prevention, preparedness, response, and recovery. ⁴

Pharmacy team members should remain informed regarding the potential for disasters and become familiar with emergency preparedness policies. ⁵ Preparing for a state of emergency is not easy, therefore establishment of a timely and efficient management team early is imperative. ⁶ During a disaster there are many roles that pharmacists may assume and it is important to understand the local laws, stay up to date on emergency decrees, and know scope of practice to assist in these critical situations. ¹

Most recently, hospital pharmacies have been responding to the Coronavirus Disease (COVID-19) pandemic. In response to COVID-19, communication is vital. Sharing a cohesive message to the entire pharmacy department and having a single source of communication is necessary. ⁷ As the response to COVID-19 is fluid, having one central location and means for identifying newer messages will assist with process changes throughout the event. Establishment of a physical COVID-19 repository that contains all key communications with dates may be helpful. Additionally, identifying a means for noting when a process changes and date on the document can assist all team members with the frequent operational changes. Some other potential sources of communication could be an application via an electronic device folder that is available. In addition to an identified location for communication, multiple touchpoints and/or meetings with the team are crucial for providing information regarding new processes, answering concerns or questions, and providing stability and reassurance for the department which will assist a pharmacy team in responding to a crisis. Frequent meetings in real time with agendas which are consistent are recommended. ⁷ As new processes are implemented, the flexibility of staff will allow a team to continue to provide high-quality care to patients. ⁷ Sharing the same message multiple days during huddles may also ensure the information reaches the entire team. Additionally, having an open forum at the end of the huddle for suggestions and comments may help improve the operations.

In addition to communication, becoming familiar with any federal, state, or local emergency orders and laws are needed in order to ensure regulations and directives are being met. For instance, there may be a declared state of disaster where the governor temporarily suspends certain requirements which can aid in treating patients and distributing medications. The orders may also share any reporting requirements needed for dispensing and administering medications. Becoming familiar with any legal support or current information sources would benefit pharmacists. ⁸

During the COVID-19 pandemic, the distribution and requirements for some medications have changed. Remdesivir is one example where the drug was originally dispensed as an investigational drug but then shifted to emergency use authorization (EUA) prior to Food & Drug Administration (FDA) approval. Pharmacists are not only essential in assisting with investigational drug studies but also critical in obtaining drugs through compassionate use protocols. ⁹ Furthermore, this medication was originally allocated and disseminated by the state before wholesale distribution. During the initial procurement of remdesivir, allocations of the medication varied. One operational consideration is to separate the necessary doses of the medication from the main pharmacy stock and designate it for these patients to ensure all complete their course. Pharmacists’ guidance should include ensuring proper storage, packaging, handling, dispensing, labeling, and deployment of medications. ⁵

During the COVID-19 pandemic there have been a number of drugs that have been on shortage. Coordinating medications can be one of the most challenging aspects of responding to an event as there are many factors that may affect the supply of a drug. Some of the factors include production, inventory practices, restricted distribution, and distributors/wholesalers. ¹⁰ The top 4 reasons for drug shortages have been previously identified as: unknown cause, manufacturing, business decision and supply/demand. ¹¹ Depending upon how widespread the event is and what impact it has on the country determines the potential for a drug shortage. One of the management strategies which should be developed is to establish a multidisciplinary drug shortage team who can review the information. ¹⁰ Pharmacists can participate in this process to provide alternative regimens for medications in limited supply.^6,10 With that said, stockpiling is also not recommended as hoarding can affect inventory control. ¹⁰ Another concern is the delivery of medications which can be delayed for a multitude of reasons, including storms, supply-chain breakdown, damage to infrastructure and limited staffing. ¹⁰ Collaborating with other facilities and redistributing existing medications may be needed. As the supply of medications can change from 1 day to the next, being proactive and anticipating current and potential needs is essential in order to ensure medications are available. Some proactive actions which may be helpful during the COVID-19 pandemic to assist with inventory management is collaborating with the medical staff for alternatives prior to depleting stock. Another tool which has assisted in notifying providers of drug shortages is the utilization of the electronic health record (EHR). Many EHRs can utilize notifications via pop-ups when medications are ordered. Notifications at the point of ordering may direct the provider to substitutes when feasible and conserve medications when alternatives are not possible.

During the COVID-19 pandemic, pharmacy team members may also take steps to conserve not only medications but personal protective equipment (PPE) by limiting the need for nursing to enter a patient’s room multiple times. ⁹ For example, converting medications from an intravenous route to oral, when feasible, may decrease the need for responding to drug pump alerts. ⁹ Additionally, timing medications so they are administered together when possible will help decrease the number of entries into a patient’s room by a nurse thus decreasing PPE utilization. As PPE is needed during the compounding process reviewing the workflow for the IV room and implementing batching and reducing entries may also assist in reducing PPE utilization. Eliminating aerosolized treatments and favoring metered dose inhalers for patients admitted to a hospital can limit the aerosolized exposure to hospital personnel for patients with airborne or droplet transmittable diseases. ⁹ Pharmacists can play a vital role in medication selection and timing to decrease PPE waste and limit exposure risk for other healthcare professionals. Utilizing pharmacists’ skill sets to their full potential during an emergency disaster may increase provisions of health. ⁶

During the COVID-19 pandemic, the media may also try to contact pharmacy team members in order to find out the departments process and response. During this time, it is recommended not to respond to the media and to notify your manager/director, administration, or the public relations department. This will ensure a consistent message is being shared. Additionally, there may be factors or processes that one may not be aware of and a response could result in incorrect information being shared with the media. Thus, notification to administration and or public relations is key.

As disasters and events such as COVID-19 continue to occur, pharmacists may assist in numerous ways to improve patient care. Working together in a positive manner ensures that needs are met and collaborating with other departments can foster ideas and resources for the entire healthcare team. ⁷ Communication and continuous review of processes are keys to identifying opportunities for improvement during these type of events. Pharmacists and the pharmacy team as a whole can provide a multitude of services during response to these events to improve many of the processes involved in crisis management to increase the overall quality of care for patients.