Download Swedish Plan

Operational Pandemic
Preparedness from a Tertiary Care
Facility on the West Coast
John Zarek, RPh
System Clinical Manager
Cardinal Health Pharmacy Management
Swedish Medical Center, Seattle, WA
40th Annual ASHP Midyear
Clinical Meeting and Exhibits
December 6, 2005
Role of Pharmacy
• Ad hoc member of Epidemiology Cmte.
• Provide pharmaceutical care perspective on
medication issues
• Provide leadership role in assuring needed
pharmaceutical products available within
Swedish system
• Provide link to pharmacist at Public Health
Framing Questions
• How should Swedish prepare knowing that there
are limited therapy resources?
• Does King County Public Health (KCPH) have
plans to depot oseltamivir or how it should be
prioritized?
• Does KCPH have recommendations on how
local institutions should be prepared?
• How does KCPH view federal support?
Framing Questions
• How much oseltamivir is available in the
wholesalers?
• What will Roche do if there is stockpiling?
• If there were a pandemic, how many patients
should Swedish plan to treat?
• How do we balance treatment of patients with
prophylaxis of health care workers?
Early Public Health Responses
September, 2005
Oseltamivir: treatment over prophylaxis
• Prioritization
– Patients hospitalized with influenza
– HCW & EMS workers with direct patient contact
– Pandemic health responders, public safety & key
government decision makers
– Other high risk populations (undefined)
Early Public Health Responses
September, 2005
• Prophylaxis if adequate resources
–
–
–
–
–
Post-exposure in certain environments
HCW in emergency departments & EMS workers
ICUs and dialysis units
Highest risk outpatients
Other HCW with patient contact
Antiviral Drug Distribution
HHS Pandemic Influenza Plan, November, 2005
Priority Groups
• Use in treatment in hospitals, clinics, & home
health
• Use in post-exposure prophylaxis (direct
contacts of infected patients)
• Use in prophylaxis (HCWs, public safety
workers, essential service providers)
Early Public Health Responses
September, 2005
• Considering feasibility of acquiring a local
stockpile of oseltamivir
• Considering a hospital stockpile in accordance
with HHS guidelines
• KC healthcare coalition to address medical
surge capacity & pandemic response
• KCPH as possible broker to request and receive
oseltamivir
Decision to Purchase Oseltamivir
•
•
•
•
•
•
•
Treatment versus prophylaxis or both
Contacting Roche
Courses of therapy: 250, 500, 1000?
Anticipated purchase cost: $15-66K
Cardinal Health distribution center inventory
Federal response capability: 72-96 hours?
Integrating influenza treatment with stockpiling
for avian pandemic (ability to handle 1st wave
of infected patients)
Clarifying with Roche about
Oseltamivir Availability
•
•
•
•
•
•
US supply chain
Production plans
Product issues
Effectiveness in humans
Benefits of preventative measures
Perception of federal government response to
limited supply
North Carolina Guidelines on
Stockpiling
• Strongly discouraged personal stockpiling
– No sustained human-to-human transmission in SE
Asia of H5N1 virus
– No H5N1 in US/North American poultry
– Supplies of oseltamivir are limited and should be
reserved for seasonal influenza
– US pandemic plan: use in priority groups
– Inappropriate use may lead to resistance
» NC Dept HHS Memorandum October 19, 2005
Washington State Plan
• Assumes limited resources
• Maximizes response capabilities with
established partnerships/existing assets
• Part of Comprehensive Emergency
Management Plan
–
–
–
–
Initial phases (inter-pandemic period)
Pandemic alert phase (Currently Level 3)
Elevated pandemic alert stage
Pandemic influenza phase
KCPH Health Advisory
October 17, 2005
• Arguments in favor of personal stockpile
– Existing national stockpile is insufficient
– Drug is widely available in private sector for
seasonal flu therapy
– Private sector supply might not contribute
significantly to a pandemic response
– No official recommendations by CDC or HHS
against personal stockpiling
KCPH Health Advisory
October 17, 2005
• Arguments against a personal stockpile
– Not recommended in draft national pandemic
preparedness plan
– May result in shortages for use in treatment &
prevention of seasonal flu
– No pandemic occurring currently
– Effectiveness & optimal dose is unknown
– Inappropriate use, when to start therapy?
– Inequitable distribution
Swedish Plan
• Activate HEICS*: hospital emergency
management plan
• Adapt components of North Carolina guidelines
& new HHS pandemic plan
• Clarify tasks performed at various alert levels
* Hospital Emergency Incident Command System
Swedish Plan
• Coordinate with KCPH and hospital coalition
– application of altered standards of care if mass
casualty
• Coordinate with KCPH to prioritize oseltamivir
utilization
• Continuous respiratory etiquette, increased
screening, decontamination, lock down
Other Issues at Swedish
• Communicating with hospital administration
• Sharing the purchasing costs of drugs &
personal protective equipment
• Helping Physician Division with stockpiling
issue
• Establishing criteria for outpatient use of
oseltamivir
• Communicating with hospital information
officers
KCPH Health Advisory
November 23, 2005
Screening & initial management of suspect
human cases
• Clinicians asked to take travel history on all
radiographically confirmed pneumonia, acute respiratory
distress syndrome or other respiratory illness for which
an alternative diagnosis is not established
• Compare travel history to list of countries with known
avian influenza
KCPH Health Advisory
November 23, 2005
If patient meets clinical/epidemiological
criteria for suspected case of H5N1 virus
• Implement infection control precautions
• Notify hospital Epidemiology & Public Health
• Obtain clinical specimens for state testing
• Evaluate alternative diagnoses
• Decide on inpatient or outpatient care
(coordinate with home health)
• Initiate antiviral treatment within 48 hours of
symptom onset
Today’s Reality
• Effective coordination & communication
between pharmacy-Epidemiology-public healthinfectious disease
• Continuously changing landscape
• Tough choices on who gets treated in the
hospital still to be made if mass casualty event
• Uncertainty of HHS response
• Reliance on coordinated plan with healthcare
coalition
• Reliance on Public Health critical