Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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. 2 OhioHealth • Enterprise Risk Management (ERM) is an organization-wide approach to risk: – – – – – 3 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. 4 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 5 Glossary of Commonwealth Terms. Mass Alternate work area Reciprocal agreement Replacement resources Importance Limited literature Development opportunity Service line engagement Stakeholder buy-in 6 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. 7 Timeline 8 Foundational Phase 9 Literature Search • Most literature is related to overall health-system functions • Limited pharmacy specific information • Stronger focus on community pharmacy – Natural disasters 10 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 11 Internal Stakeholders Directors Front Line Staff Site Managers Pharmacy Medication Safety Operations Managers Clinical Managers 12 External Stakeholders OhioHealth Vendors Miscellaneous 13 • 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 14 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 15 Stakeholder Assessment Survey 16 Risk Assessment Data Process Compiled and organized survey responses SWOT analysis to determine “buckets” of risk Stratified/ prioritized risk “buckets” 17 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 20 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 21 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” 22 Development of Drug List 23 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 24 Delivery Phase 25 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! 26 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? 27 Supply Chain Inventory Loss Threshold • Vendor supply chain interruption Stakeholders • Wholesalers • System pharmacy supply chain System Response 28 • Phone chain begins with System Supply Chain Manager • System critical item list Bioterrorism Drug Cache POD Threshold Stakeholders System Response 29 • 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 30 Lessons Learned 31 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 32 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. 33 34