In 2018, hurricanes, storms, floods and fires touched every region of the country, with multiple natural disasters exceeding $1 billion in damages each. According to the National Centers for Environmental Information (NCEI), 2018 was one of the most active and expensive years for disasters and emergency events with total economic damages exceeding $91 billion.i

In addition to providing high quality, cost effective patient care, hospital and pharmacy leaders play a significant role in proactively addressing health security, which means their community and patients are prepared for and protected from events that can adversely impact health status. Specifically, this means ensuring access to high-quality medical services during and after emergencies; and storing and deploying medical and pharmaceutical products, including vaccines, prescription drugs, other medical supplies and equipment.ii

Planning improves care

There are two types of disasters: planned, or those that you know are coming and can prepare for, like hurricanes; and unplanned, those that just happen, like a bridge collapse or an active shooter scenario. While much of the preparations are similar, this article will focus on steps hospital and health system pharmacies can take to prepare for natural disasters.

First and foremost, hospital pharmacies should develop emergency response plans if they don’t already have one in place. This may seem like an over-simplification, but the number of facilities that do not have formal disaster preparation plans in place is less than expected. As part of this plan, pharmacy departments should prepare for planned and unplanned emergencies. They should develop procedures to help limit the impact of these events on hospital operations and anything that would prevent them from providing quality patient care during disasters.

Medical University of South Carolina (MUSC) of Charleston is a great example of how planning and preparations by pharmacy leaders can mitigate the impact of natural disasters on patient care. According to Heather Easterling, PharmD, MBA, administrator of Pharmacy Services, Medical University of South Carolina has experienced four hurricanes in the last four years, two of which were severe.

Reliable drug supply is vital

While there are multiple priorities related to providing excellent patient care in a disaster scenario, ensuring a reliable supply of drugs for use during a planned disaster like a hurricane event is generally a pharmacy leader’s most pressing concern. For that reason, we strongly encourage hospital pharmacy leaders to work closely with their wholesaler on a disaster supply order far in advance of the season. From the beginning of hurricane season in April, we offer lists of suggested critical drugs, over-the-counter medications, and other medical supplies recommended for hospitals pharmacies to have ready heading into and after a hurricane.

Easterling agrees that one of the most important steps in planned-disaster prep is to have a standing hurricane or storm order with your wholesaler on file. MUSC’s default is a six-day supply. “If we anticipate a hurricane will hit on Thursday, we’ll place an emergency order on Monday or Tuesday. It’s important to communicate with your wholesaler to let them know the order is coming, and it’s equally important for manufacturers and wholesalers to tell us as soon as they know there’s a problem, so we can go ahead and start making arrangements for conservation and making clinical alternative arrangements for some drugs,” said Easterling.

Once your disaster supply arrives, you must have proper storage, particularly for drugs that require refrigeration. Hurricanes typically make an impact in the fall, when pharmacies are already stocked with ample supply of flu vaccines, so pharmacy leaders need to consider how to allocate space in general, but specifically refrigeration space. According to Easterling, MUSC invested in lab-grade refrigerators kept in storage until they set up in protected areas within the hospital (higher floors, interior spaces, with access to emergency power) as needed.

Whether patient evacuations are required or you’re dealing with power or network interruptions, many patients may not be admitted to the hospital information system or listed in the automated dispensing cabinet patient list. This can lead to potential medication and dosing errors. Pharmacists play a critical role in maintaining proper access and administration of medications during disaster response.

Support the team supporting patients

“Once you have supplies and planning is complete, you can’t overlook the people, or staff involved. Creature comforts are among the most important, yet often overlooked, things to consider in disaster prep,” added Easterling. “For example, a snowstorm hit in 2018 and Charleston isn’t well equipped to handle snow and ice. As a result, we had staff on site for 96 hours. Yes, they’re working a lot, but there is also a lot of downtime – where do they sleep? Where do they shower? Do you have enough supplies to feed them? You have to care take of your team for them to best take care of your patients.”

Depending on location and severity of natural disasters, it can be a challenge for a pharmaceutical distributor to deliver to all markets. Even areas not directly affected by the storm can face limited access. As a result, pharmacy leaders’ biggest concern is often ‘How will you get to me?’ During Hurricane Harvey, McKesson could deliver to markets outside of Houston, but not into Houston proper. We used boats and creativity to deliver medications to hospitals and inland areas. Your distributor should be in constant contact during a disaster, communicating updates and solutions. McKesson even equips distribution staff with satellite phones to ensure we never lose touch.

Just like we work with hospital and health system pharmacies to implement business continuity plans to prepare for natural disasters, we follow similar contingencies across our distribution network in affected regions. Ultimately, we do everything we can to deliver life-saving medicines so that hospitals can take care of their patients. It might take us a little longer to get there, but we’re going to do everything we can to get there.

iNOAA National Centers for Environmental Information (NCEI) U.S. Billion-Dollar Weather and Climate Disasters (2019). https://www.ncdc.noaa.gov/billions/
iiThe 2019 National Health Security Preparedness Index, Robert Wood Johnson Foundation

Cindy Thornton

About the author

Cindy Thornton is a Vice President of Distribution Operations for McKesson Pharmaceutical Solutions and Services. Her role encompasses process improvement, talent development, expense reduction and developing a strong alignment across the network at all levels of the organization. Cindy brings over 39 years of experience in leadership and distribution while focusing on the overall positive impact to our employees and customers.

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