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.
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.
“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.”
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.
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.”
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