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.
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