ASHP InterSections ASHP InterSections

December 1, 2008

How to Handle a Hospital-Wide Power Outage

Editor’s Note: Craig Steinberg, Pharm.D., pharmacy manager of Sharp Coronado Hospital in Coronado, Calif., is a Disaster Medical Assistance Team member and serves as chairman of the San Diego Pharmacy Emergency Response Team (RxERT). Although the recent wildfires that ravaged Southern California did not reach Coronado, Steinberg noted that the essential elements of emergency preparedness tend to be similar across most situations.

Imagine if your hospital suffered a pre-dawn electrical fire that started in your hospital’s main switchboard. Breakers fail to trip and the emergency switchboard is wiped out, melting components of all power. A minute later, your hospital is totally dark. The emergency generators are running, but they’re unable to feed the emergency switchboard, which is now a smoking ruin.

In other words, there is no electricity.

What would you do? The pharmacy refrigerator contains thousands of dollars worth of medications. How would you provide medications now that your automated dispensing systems are down? With no available computers, how would you know which medications are on the medication administration record (MAR)? And most importantly, are your patients in need of pain or other medications? Think! The clock is ticking!%%sidebar%%

Well, it happened at my hospital on July 18, 2007. Apparently, an electrician had been upgrading an electrical panel when an arc flash occurred, sparking a fire. Although it was extinguished within a minute, all power sources were out for a much longer time.

I was at the scene in a short time. En route to the hospital, I noticed a major problem as I crossed the Coronado Bridge. The big blue sign that flashes ‘Sharp Coronado Hospital’ was out and as I came closer, I saw that no lights were on in the entire hospital.

Hospital staff mobilized and set up an incident command center outside the facility and switched monitors and ventilators for some patients to battery power before moving these patients to a nearby skilled nursing facility that had electricity.

Because we are a small hospital, our pharmacy is closed at night. So the first thing I did was open it. After fumbling with the pharmacy door lock, I entered and found the flashlight. I then checked with the nursing staff to see whether there were any urgent patient needs.

Next, I opened the drawers of the Pyxis machines, but it was too dark to access medications. The medication refrigerators also couldn’t be accessed. Thankfully, the phones were working, so I told the nurses to call for any medication doses they needed.

But I soon realized that there were more difficulties ahead. I learned that the nurses didn’t know the doses needed because the MAR was down. That meant we would need to create new MAR s from scratch, reviewing each patient’s chart.

Thankfully, I had an epiphany. I could call other Sharp hospitals for help. Since we use a shared information system, they could print hard copies of the MAR s. I called a delivery company, and the records landed at our hospital an hour later. We had to update these by hand and distribute medications using the MAR s as a guide.

We also had to make sure items in the refrigerators could be kept cold. I brought items from the pharmacy refrigerator to a working refrigerator in an adjacent building. Normal power slowly returned one circuit at a time. To access restored power, we summoned the maintenance department to provide extension cords. More cords were purchased from a store to use throughout the hospital.

By 9:30 p.m. that night, normal utility services were restored and full patient care services were available. The hospital counted this crisis as one of the emergency drills that are required, although it was not a drill in this instance.

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