ASHP InterSections ASHP InterSections

January 17, 2013

From the President

Filed under: Uncategorized — Tags: , , , , — Kathy Biesecker @ 6:23 pm

Kathryn Schultz, Pharm.D., FASHP

AS WE BEGIN A NEW YEAR, I always like to look back at the year that was and focus on moments of success. In my inaugural address, I urged all ASHP members to become Most Valuable Pharmacists (MVPs) within their institutions. And I’ve been privileged to hear from many ASHP members over the last six months about the exciting things they are doing to improve the care of their patients.

In particular, I want to draw your attention to the many MVPs and pharmacy heroes who stepped up before, during, and after the recent devastation of Hurricane Sandy in the Northeast. As you’ll see in our feature story, “Pharmacists Take on Superstorm Sandy,” pharmacy MVPs were everywhere during this unprecedented event.

Even as their own homes and families were being affected, ASHP members in New Jersey, New York, and Connecticut courageously and selflessly took on new duties, helping to evacuate patients, setting up pharmacies in temporary quarters, and managing the medication therapy regimens of patients—often without access to patient records or traditional medication supply chains.

At New York University’s Langone Medical Center, N.Y., for example, Arash Dabestani, Pharm.D., MHA, FASHP, senior director of pharmacy, had to dive into emergency prep in a new environment (he had just been at the hospital a week when the storm hit).

Dabestani managed to arrange hotel rooms for pharmacy staff to ensure full coverage, but on the night of Oct. 29, water flooded the hospital’s basement and Langone lost power. Even the back-up generators failed, forcing staff to evacuate more than 300 patients to nearby hospitals. Without power, pharmacy team members had to climb up to 15 flights of stairs just to deliver medications.

It’s been a tough few months for pharmacists and hospital staff throughout the New York-New Jersey region. Extensive overtime has been common as the hospitals and clinics try to clean up and get back to a more-normal operating mode. Pharmacists everywhere have had to put on their game faces and exhibit real flexibility and courage in the wake of this terrible storm.

As you read their stories, I’m sure you’ll be amazed, as I was, at the innovation and dedication of our pharmacy colleagues. They’ve come so far since that fateful late October storm. These heroes continue to prove just how critical pharmacists are to the health of our patients and to the entire health-system enterprise. They are true MVPs.

Pharmacists Take on Superstorm Sandy

Filed under: Current Issue,Feature Stories — Tags: , , , , , , — Kathy Biesecker @ 6:21 pm

Health care teams, including pharmacists, helped to evacuate 700 patients from Bellevue Hospital in New York City during Hurricane Sandy.

PHARMACISTS AND OTHER HOSPITAL WORKERS the allied health professions know that when disaster strikes, they may have to lodge in place at their facilities to ensure that there is no disruption in patient care and assist with any potential evacuation or influx of patients. It’s part of the job.

So, when hospitals and health care systems in New York, New Jersey and Connecticut learned of Superstorm Sandy’s approach in late October, administrators and clinicians throughout the tri-state area flew into action, disseminating contingency plans and drilling workers on the steps to take when the storm touched down.

At AtlantiCare Regional Medical Center in Atlantic City, N.J., staff tapped into the system’s emergency preparedness infrastructure, determined which services to cancel, and discharged as many patients as possible. Concerned about the possibility of running short on medications, Corporate Director of Pharmacy Sandra Baggs, RPh, MBA, coordinated with the hospital’s drug distributor to ensure ample supplies.

“The Friday before the storm, we started to back up inventory because we anticipated that there probably would be no delivery on Saturday or Monday,” Baggs said. “But our distributor did initiate an order for Saturday, came by in person, and stayed in constant communication throughout the storm.”

Staff at the medical center wound up staying at the hospital for several days, she added. “They were in empty hospital beds, on air mattresses, in any nook and cranny that we had available.”

The pharmacy department’s greatest challenge was to support local pharmacies that could not open because of flooding or power outages. “We rolled out our log books and prescription wheels and went right into retail mode,” Baggs said. “Fortunately, we didn’t sustain any damage or lose any power ourselves.”

Across the river, in lower Manhattan, hospital workers and patients weren’t so lucky.

Disaster Strikes

At NYU Langone Medical Center, N.Y., N.Y., preparations began several days before Sandy’s arrival. According to Arash Dabestani, Pharm.D., MHA, FASHP, senior director of pharmacy, the biggest concern was accessibility.

Arash Dabestani, Pharm.D., MHA, FASHP

“We pretty much knew that roads and tunnels were gong to close, so our challenge was ensuring that we would have enough staff for the storm and a few days after,” he said.

Dabestani set about arranging hotel rooms for pharmacy staff, coordinating with those who lived close enough to the center to walk to work, and planning shifts to maintain full coverage. At first, it seemed that such efforts would be enough.

But on the night of October 29, at the peak of Sandy’s fury, water flooded the hospital’s basement and elevator shafts, and the hospital lost power. Although back-up generators kicked in half an hour later, all but one failed, casting much of the hospital into darkness and forcing the evacuation of more than 300 patients to nearby hospitals.

For Dabestani, this was as much a trial by fire as by water: He had only been working at NYU for a week, having moved from California for his job. “Everyone was talking about the flooding, and I had no idea what areas of the hospital they were talking about,” he said.

It wasn’t long before the requests poured in: Patients needed discharge medications for the evacuation. With no elevator service, staff had to climb stairs, sometimes as many as 15 flights, to deliver both the orders and the drugs.

“Everyone gets that adrenaline rush. We had people from outside the pharmacy helping us out, people capable of walking up to the floors,” said Dabestani.

Once the patients—and their doctors and nurses—were evacuated, the pharmacy’s challenge shifted to remote drug management.

“Everything had to be decentralized. Different departments moved to other buildings, and the pharmacy had to support off-site operations,” said Anthony Ricchiuti, R.Ph., associate director of pharmacy. “We had to send pharmacy staff out to them.”

Pitching In

Further inland, facilities such as Brookdale Hospital Medical Center in Brooklyn stood ready to assist their communities. The New York Department of Health contacted Brookdale to determine whether the hospital was capable of taking in evacuees from local nursing homes. Within two days, Brookdale staff transformed two unused floors into patient-ready rooms.

“I couldn’t believe they were able to do it,” said Qazi Halim, M.S., R.Ph., director of pharmacy. “They did the plumbing, painting, and wiring, and set up the beds in about 48 hours. The engineers, IT staff and ancillary staff all jumped in to make sure everything was ready.”In the pharmacy, staff prepared to work with emergency support personnel from the U.S. Public Health Service (USPHS) Rapid Deployment Force (RDF) who were en route.

“Our role was to help them so that the incoming patients could get their medications and continue their therapy,” said Halim. “We ended up taking in 112 patients from neighborhood hospitals and nursing homes. They came by the busload.”

The PHS-2 RDF team, headed by Pharmacy Branch Director CDR Keith Olin, Pharm.D., was among the first team of USPHS officers deployed from the Washington, D.C., area to Brookdale.

From left, U.S. Public Health Service Rapid Deployment Force CDR Keith Kiedrow (staff pharmacist) and Branch Director CDR Keith Olin, Pharm.D.

Once there, the team set up a pharmacy on each newly reopened floor. CDR Olin noted that working in a hospital during disaster relief efforts is unusual for USPHS RDF teams, which typically work in gymnasiums, convention centers, or other large public gathering places.

“When we first arrived, we were briefed by the hospital, and we were ready to see our first set of patients, about 30 to 50 patients, in three hours,” CDR Olin said. “From the pharmacy standpoint, we worked with Qazi to see what the hospital had in stock. Our federal drug cache came in as we were about to evaluate patients, and the hospital remained on stand-by to support us with any additional medications we might need.”According to CDR Olin, the federal drug cache is utilitarian in nature. “Our standard cache includes a limited but very durable formulary that covers a broad range of therapeutic classes,” he said.

Medication reconciliation proved to be a challenge since some patients did not have complete medical records.

“We evaluated the patients to see what their ailments were, but because of the emergency situation, we didn’t know when their last dose of medication was administered. In the beginning, the main objective was trying to assess the patient as quickly as possible and get them started back on their medications to minimize the interruption,” CDR Olin said, noting that many of the patients were taking eight to 10 medications.

For cases in which neither the hospital nor the USPHS team had a particular medication on hand, authorized USPHS staff would write a prescription. However, local retail pharmacies, unfamiliar with prescriptions issued by a federal facility, were cautious about accepting them.

“We were fortunate because we had a contact at the New York State Board of Pharmacy who helped to educate local pharmacies about the acceptability of our prescriptions,” said CDR Olin. “Still, it took us a good 48 to 72 hours to get things moving.”

Superstorm Sandy is estimated to have cost more than $50 billion in damages.

The Aftermath

Pharmacists and hospital staff throughout the region logged extensive overtime hours in the days and weeks following the storm. At AtlantiCare, the staff prepared mini-clinics outside the emergency department.

“We anticipated a surge of things like people cutting themselves, needing tetanus shots, and suffering minor injuries. We didn’t want to back up the ED,” said Baggs.

At Brookdale, patients evacuated from affected nursing homes remained in the reopened floors of the hospital for weeks after Superstorm Sandy. The PHS-2 RDF Team Pharmacy Branch consisted of seven pharmacists who worked 12-hour day/night shifts for 15 days.

In subsequent days, two more USPHS RDF teams cycled through. One stayed for a full 15-day deployment, and the other stayed for five days (at that time, all the patients had been discharged to permanent care facilities).

At NYU, rebuilding hasn’t been easy. The medical center did not reopen for inpatient services until December 27, nearly two months after the storm. The emergency department, which was in the initial stages of an expansion when Sandy struck, was flooded and will not reopen until later this year.

According to Dabestani, the medical center’s investigational drug services took a hit. “Patients on research drugs have become a focal point for the pharmacy. It’s one area other hospitals can’t cover, so that became our life for several days after the storm as we tried to get [the services] back up and running.”

Then there was the clean-up.

“We had equipment and medications in flooded areas, and we spent a lot of time securing our medications, making sure there were no medications laying around the floors, gathering our drug carts and code carts, and bringing items back to the pharmacy,” said Dabestani. He added that the staff spent hours sorting through inventory, seeing what was compromised, and arranging credit for what was damaged.

“Moving forward is a challenge, but you do what you have to do.”

–By Terri D’Arrigo


At Bellevue Hospital, All Hands on Deck During Hurricane Sandy

Editor’s Note: After Hurricane Sandy flooded the lower floors of Bellevue Hospital Center, N.Y., with 10 million gallons of water, rendering the fuel pumps for the center’s back-up generators useless and many of the nursing units without power, the nation’s oldest public hospital was forced to do something no one in its 276-year history ever anticipated: Evacuate or discharge every single patient. Michael Blumenfeld, R.Ph., M.B.A., director of pharmacy services, spoke with InterSections about the days leading up to the evacuation and the challenges the pharmacy team faced.

National Guard troops were deployed to help evacuate patients from Bellevue Hospital in Lower Manhattan to other area hospitals.

Q. How did the pharmacy staff prepare for the storm?

We began planning as soon as we were aware that the storm was on its way. We knew we had to ensure that we had enough medications and staff to get through three or four days of intense weather. I contacted our wholesale representative and arranged to have our usual Monday delivery on Sunday. Our assistant director in purchasing also had been ordering supplies through the week, which supplemented the Sunday delivery.

In addition to our regular staff, about 20 pharmacists and 14 pharmacy technicians made themselves available to help during the storm. There were two sets: Those who lived close by and could walk to the hospital, and those who had to take refuge in the hospital on cots. They knew that once they were here, they were here for the duration.

Q. What were your procedures during the storm?

We operated in shifts, with six hours of sleep each. The management team slept in offices in the chairs for an hour or two a night. We had power for the first 24 hours, Sunday into Monday, and then on Monday, the lights went out. The emergency power wouldn’t come up. Most of the circuits just weren’t operational.

Our staff managed to find a working outlet in one of the clinical offices. With extension cords from our engineering department, we jerry-rigged four computers, which were manned by rotating pharmacy staff to verify orders and review patient profiles. Once the phones went out, orders would go from the office carried by teams of people. We had technicians going around the pharmacy with flashlights pulling the drugs. Then, teams of volunteer runners would bring the meds to the floors.

We closed our satellite pharmacies and deployed pharmacists to critical care and most med-surg specialty areas. They communicated through runners or came to the pharmacy to get the medications themselves. There was not one day when they didn’t manage. Many of them worked 16 to 20 hours per day. I had to send staff away to sleep for fear they were too tired to work.

Q. What happened during the evacuation that Wednesday?

First, we discharged patients who were ready to go home. For the rest we provided five-day doggie bags of their medications to make sure the continuum of care wouldn’t be interrupted. We knew other facilities may not have had the same formularies and would need time to either borrow medications from us or purchase them from their distributors.

By Thursday evening, all patients were out of the hospital, down from a patient census of more than 700. As we left on Friday, I passed people with tears in their eyes. For the first time in 276 years, Bellevue had no patients.

Pharmacy staff joined other health care workers to help move patients.

Q. Do you have any words of advice for other pharmacists or pharmacy directors regarding disaster preparedness or functioning during a disaster?

Take the advisories seriously. Look at it from every point of view. Most disaster plans are along the lines of “if this fails, then we do that, and if that fails, then we do this.” Make sure that your plans work with a complete failure of all your systems. It doesn’t sound possible, but we lost everything.

Think of what would happen if patients had to be transferred out. How will you ensure the continuum of care? If you decide to send doggie bags, how many days will they cover? How will you communicate with other facilities? Have the discussion once a year, whether you live in a disaster-prone area or not.

–By Terri D’Arrigo




Storm Prep Pays Off for Brooklyn Hospital

Rebecca Deoras, Pharm.D., pediatric clinical pharmacy coordinator

Editor’s Note: While hospitals near the Atlantic Ocean braced for Hurricane Sandy and prepared to evacuate as necessary, medical centers located inland readied themselves for an influx of patients. Rebecca Deoras, Pharm.D., pediatric clinical pharmacy coordinator at Brooklyn Hospital Center in New York, spoke with InterSections about the center’s preparations and the challenges of treating patients who were evacuated from other facilities.

Q. What kind of preparations did Brooklyn Hospital make for the storm?

A few days before the storm, we sent out notifications to staff to make travel arrangements. We alerted them to the possibility that we might be taking in patients from other areas. Administration set up command centers manned by departmental leaders, and the hospital provided cots and sleeping arrangements throughout the facility as well as free meals for all staff that were here. The hospital also provided reimbursement for travel, coordinated carpools, and provided car services for the entire week post-hurricane.

The medical center discharged some less-critical patients and opened a few extra wards with 20 to 30 additional adult beds in areas such as an old pediatric intensive care unit and an area of the detox ward that wasn’t being used. Many parents chose to hunker down here with their kids. They just felt safer here.

Q. Did the pharmacy make any special preparations?

Yes. I was extremely impressed by the work of our operations leaders as well as our buyer, who placed an order once we knew the storm was coming. We were able to get a large order in the Friday before the storm hit. Normally, we are on high alert with all of the drug shortages going on anyway, so we just ramped it up.

I think another thing that helped was the staggered scheduling of staff members because these situations are not an “all hands, right now” situation. Sometimes good planning means telling staff to either come in but not work around the clock, or stagger longer schedules. Everyone feels the sense of need early on, but this is an endurance thing. We are still managing the strain of the storm.

Q. How did the storm affect pharmacy services?

Although our computerized prescriber order entry system went down for about six hours, we fared pretty well.  Many pharmacy personnel, including clinical staff, pharmacy residents, staff pharmacists, and our directors stayed at the hospital for multiple days. We did this willingly in order to provide the same, pre-storm level of care to our patients. Transportation was a huge issue. With no subway service and not enough gas to make it back and forth to the hospital, staying at the hospital was important to guarantee the continuance of pharmacy services.

We had no medication issues, but some of the outside pharmacies that [discharged] patients were trying to use had no power, and we weren’t able to call in medications. This was particularly crucial for medications such as warfarin, where dose changes needed to be made to maintain patient safety. My ambulatory care clinic colleagues mentioned that there were scheduling issues for these anticoagulation patients because the clinic had to close for a few days. Luckily, these issues were short-lived, and our clinics were up and running very soon after the storm.

Q. How did your patient load change, and what were the challenges involved?

My department took in about 10 pediatric patients from a nearby hospital. We didn’t have many challenges with them because we already interface with that hospital. The majority of the increased patient load came from a nearby nursing home that was evacuated to a shelter in the high school across the street from TBHC. These elderly nursing home patients often needed more advanced medical care than was being provided at the shelter. Because of that, some of those patients had to be admitted. What made this challenging was the lack of information on these patients—no medical charts, limited information on current medications, etc. We had to run additional labs, test drug levels, and so on, to see if they had taken medications recently. Several of them then stayed with us for a few weeks until we could get them into another nursing home.

Q. What has been the storm’s aftermath for pharmacy staff?

We had faculty members and students from Long Island University Arnold and Marie Schwartz College of Pharmacy who were based at New York University (NYU) Medical Center come to TBHC while their hospitals and facilities were closed. The students rounded with our various teams so they could continue their training.

Brooklyn Hospital Center pharmacy staff

Q. Do you have any words of advice for other pharmacists or pharmacy directors regarding disaster preparedness or functioning during a disaster?

Being prepared and thinking ahead is great, but sometimes it can only take you so far.  Our institution was extremely prepared for the storm itself and its aftermath, but situations like the gas shortage are hard to plan for. Then, you have to think on your feet and roll with the punches. Also, make sure that your employees have a safe way to get to work, and that it’s safe to be there. If they feel safe and taken care of while providing care, that feeling will trickle down to the patients.

There was also a component of emotional strain of being on “lockdown” during the storm. During that time, no one could communicate with their families. You can’t check on your property, and you know that you will return home at some point to a mess. Leaders have to account for that toll on the staff and make allowances both during and after the fact to support their staff.

–By Terri D’Arrigo


January 3, 2013

ASHP Research & Education Foundation Board meeting, Bethesda, Md.

Filed under: Calendar Event — Kathy Biesecker @ 5:48 pm

Commission on Credentialing meeting

Filed under: Calendar Event — Kathy Biesecker @ 5:47 pm
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