Download Contingency Planning: What is Your Nightmare?

Contingency Planning: What is
Your Nightmare?
OSHP 78th Annual Meeting
Elizabeth Dallman, PharmD; Kellie L. Evans, PharmD;
Harrison T. Jozefczyk, PharmD;
Nicholas L. Manion, PharmD; Maggie K. Sherry, PharmD
Health-System Pharmacy Administration Residents
OhioHealth
Objectives
• Define contingency planning and its importance
to an organization.
• Describe the process used to identify, assess,
and prioritize the pharmacy service line areas of
risk at OhioHealth.
• Explain lessons learned through this project that
could be applied to other facilities.
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OhioHealth
• Enterprise Risk
Management (ERM) is
an organization-wide
approach to risk:
–
–
–
–
–
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Identification
Assessment
Communication
Cost-effective
Holistic management
ERM Brings Risks Together
Valuation Creation and Preservation
Enterprise Focus on Risks
Strategic
Risks
Operations
Risks
Finance
Risks
Human
Capital
Risks
IT Risks
Legal/
Compliance
Risks
Reputation
Risks
Through the ERM process, our goal is to facilitate the aggregation and
interactions of these risk areas.
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What is Contingency Planning?
A plan used by an organization to respond to:
Specific system failure
Disruption of operations
May use any number of resources including:
Workaround
procedures
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Glossary of Commonwealth Terms.
Mass
Alternate
work area
Reciprocal
agreement
Replacement
resources
Importance
Limited literature
Development opportunity
Service line engagement
Stakeholder buy-in
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Goal
To identify, assess, and prioritize the
pharmacy service line areas of risk and
establish strategies and action plans to
mitigate and control these potential events.
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Timeline
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Foundational Phase
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Literature Search
• Most literature is related to overall health-system
functions
• Limited pharmacy specific information
• Stronger focus on community pharmacy
– Natural disasters
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Literature Examples
WHO Hospital
emergency response
checklist
Pharmacy Leader’s Role
in Hospital Emergency
Preparedness Planning
Combined external and
internal hospital disaster:
impact and response in
a Houston trauma center
intensive care unit
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Internal Stakeholders
Directors
Front Line
Staff
Site
Managers
Pharmacy
Medication
Safety
Operations
Managers
Clinical
Managers
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External Stakeholders
OhioHealth
Vendors
Miscellaneous
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• Risk management team
• System Director of Safety Management
• Executive leadership
• Associates
• Wholesalers and distributors
• 503b outsourcing
• Transportation
• Security
• Local, state, and national agencies
• Various regulatory bodies
• Community at large
Determination of Project Scope
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Timeframe
Focus
Identify
• 96 hour window
• Basic pharmacy
operations
• 1-3 top priorities
Risk Assessment
• Identify top risk points for OhioHealth Pharmacy
Services
• Survey to gain stakeholder input
– Individualized perspective
• Site location vs. pharmacy role
• Micro vs. macro approach
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Stakeholder Assessment Survey
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Risk Assessment Data Process
Compiled and
organized survey
responses
SWOT analysis
to determine
“buckets” of risk
Stratified/
prioritized risk
“buckets”
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Risk Assessment Results
Bucket
Subcategory
In scope?
Severity
Probability
Rank
Staffing shortage
Supply compromise
Site-level
Y
5
4
20
Drug shortage - supply chain
Y
5
4
20
Environment
Partial - clean room
Y
4
3
12
Legal
USP 797/800
Y
5
2
10
Personnel safety
Exposure
Y
5
2
10
Staffing shortage
System
Y
5
2
10
Supply compromise
General supplies shortage
Y
5
2
10
IT collapse
Electronic Medical Record
Y
3
3
9
IT collapse
Loss of remote access
Y
3
3
9
IT collapse
Automation (robots, med carousel)
Y
4
2
8
Legal
Diversion
Y
2
3
6
Supply compromise
Recall
Y
2
3
6
Supply compromise
Drug shortage - site specific inventory loss
Y
3
2
6
Environment
Complete evacuation
Y
5
1
5
Environment
Partial - loss of power
Y
5
1
5
IT collapse
Complete (downtime out)
Y
5
1
5
IT collapse
Automated Dispensing Cabinet
Y
5
1
5
Pharmacy security
Robberies, trauma, shootings
Y
5
1
5
IT collapse
Printers
Y
2
2
4
Environment
Partial - refrigerator
Y
1
3
3
Legal
TJC/DEA/FDA
Y
3
1
3
Legal
Staff competency
Y
3
1
3
Legal
340B
Y
1
1
1
Top Priorities List
Bucket 1
• Staffing shortage – Site level
• Drug shortage – Supply chain
Bucket 2
• Environment – Partial loss of clean room
Bucket 3
•
•
•
•
Drug shortage – Inventory loss
Drug Recall
Staffing shortage – System
Personnel safety - Exposure
Development Phase
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Plan
• Review the
wholesaler disaster
plan
• Meet with SMC†
to gain input
• Determine any gaps
Supply Chain
Inventory Loss
†
Site Manager’s Council
* Plan of Distribution
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Bioterrorism
Drug Cache
• Review CHEMPACK/
Emergency Drug
Cache POD*
• Create Bioterrorism
Drug Cache POD*
• Gain approval of
SMC†
• Begin framework for
one of the other
identified areas
Further Work
Supply Chain
• What would happen if our wholesaler’s
Columbus distribution center caught fire?
• What drugs would we need to continue
operations?
– Maximum of 500 drugs could be submitted to
wholesaler as “must-haves”
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Development of Drug List
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Item #
Alphabetical Listing of Drugs
WHO List
Critical Drug
601
Minoxidil (Systemic)
No
No
602
Mirtazapine
No
No
603
MiSOPROStol
Yes
Yes
604
MitoMYcin (Ophthalmic)
No
No
605
MitoMYcin (Systemic)
No
No
606
MitoXANTRONE
No
No
607
Modafinil
No
No
608
Montelukast
No
No
Bioterrorism POD
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Delivery Phase
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Final Deliverable
Policy and procedure template to be given to
hospital leadership that outlines:
• Detection
• Chain of command
• Risk mitigation
• System vs. hospital responsibilities
Hospitals customize plan to meet their
individual needs!
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Questions in any Contingency Plan
What is the THRESHOLD for implementation?
What STAKEHOLDERS should be involved in planning?
Is the plan SYSTEM-WIDE or HOSPITAL specific?
How do we TRAIN end-users?
Who is accountable to keep contingency plans UPDATED?
What will the needs of the system/hospital be in the FUTURE?
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Supply Chain Inventory Loss
Threshold
• Vendor supply chain interruption
Stakeholders
• Wholesalers
• System pharmacy supply chain
System
Response
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• Phone chain begins with System
Supply Chain Manager
• System critical item list
Bioterrorism Drug Cache POD
Threshold
Stakeholders
System
Response
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• Bioterrorism as identified by a
declared public health emergency
• Risk Management Team
• Departmental Leadership
• Storage and distribution of drug
• Tiered response
Refinement & Implementation
• Continued discussion with stakeholders
• Present for approval at Risk Management
Committee for system adoption
• Implementation and education on policies and
procedures for involved staff
• Drill/ practice procedures with front line
employees
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Lessons Learned
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Key Takeaways
• In a time of emergency, a plan can reduce panic
and stress; it’s important to discuss contingency
planning before an event occurs
• Your risk assessment is continuously changing
as your hospital/health system grows
• A system policy can streamline response to an
emergency, but differences between multiple
sites can make this challenging
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References
1. Nates JL. Combined external and internal
hospital disaster: impact and response in a
Houston trauma center intensive care unit. Crit
Care Med. 2004;32(3):686-90.
2. Bell C, Daniel S. Pharmacy Leader's Role in
Hospital Emergency Preparedness Planning.
Hosp Pharm. 2014;49(4):398-404.
3. World Health Organization. WHO Hospital
emergency response checklist. 2011.
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