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Florida hospital's disaster drill prepared it well for flu
Changes were in place when H1N1 arrived
A well prepared hospital pharmacy can look an awful lot like a very smart hospital pharmacy.
When the hospital pharmacy at Sarasota Memorial Hospital in Sarasota, FL, took the lead in holding a pandemic disaster drill in November 2008, little did anyone guess that the drill would be followed within six months by a real-life pandemic scenario.
"We educated our staff in the fall about disaster planning, and some of the predictions we made at the time were that, number one, a pandemic was on the horizon, and, two, we didn't know if the epidemic on the horizon would be worse or less severe than the annual seasonal flu in the United States," says Deborah J. Larison, PharmD, BCPS, clinical pharmacy specialist in emergency medicine at Sarasota Memorial Hospital.
The hospital's pandemic drill took an all-hazard approach and involved a fictional germ that could replicate rapidly and was easily passed from one person to another. While it wasn't specifically designated an influenza virus, the emergency responses tested by the drill would be nearly identical to the responses necessary in the event of an influenza pandemic.
After the drill ended, Larison and other hospital officials assessed how well the hospital and staff did and came up with an action plan for what would need to be improved.
"People did great, but we discovered some shortfalls, and we made some improvements based on what we learned," Larison says. "I think those improvements are paying off right now, honestly."
For example, hospital pharmacists learned that maintaining its supply chain is a challenge during a pandemic.
"One of the things we learned in particular from the drill is that real-time tracking of our supply chain is important," Larison says.
During the recent pandemic scare caused by the novel H1N1 influenza A virus that spread in Mexico and North America after emerging in the spring, there were localized shortages of the two antivirals that were found to be effective in treating the new flu virus. Both oseltamivir (Tamiflu®) and zanamivir (Relenza®) and masks were in short supply in the area, Larison notes.
But Sarasota Memorial Hospital was prepared for the shortage.
"What we discovered during our pandemic drill is that we may not have stocked enough of these products to get us through the first few days of an epidemic," Larison says.
"We discovered the importance of the supply chain," Larison says. "So we contacted our suppliers and had meetings with the purchasing and supply people."
They identified the products they would need to keep in a greater supply, the products they'd be able to order rapidly, and the products they'd need a longer lead time to order, she explains.
"What is happening this spring is spot shortages of these flu drugs and masks," Larison says. "But it's a distribution problem, not a supply problem because there are enough of these products that manufacturers are producing, but they're not being distributed quickly enough."
During a pandemic, everyone orders the same products at the same time and the distribution pipeline becomes clogged.
"We recognized this issue a few months ago with our pandemic drill," Larison says. "So we were able to predict where those spot shortages might occur and prevent them from happening in our institution."
Larison and others involved with the disaster drill predicted the hospital would quickly run out of the influenza antiviral drugs, so they changed the par levels and gradually ordered more doses until the hospital had the new par levels in stock.
"We changed our par levels based on our expectation that the number of patients we could treat on a daily basis was higher," Larison says. "We realized our distributor might not be able to get us enough of the product quickly."
Changing the par level is different from stockpiling, she notes.
"We changed our par levels from 50 doses to now 120 doses," Larison explains. "And we did this over time so we didn't overnight increase our par levels."
This meant there was no overnight huge expenditure and no significant increase in the pharmacy's drug budget within one month's time, she adds. The other major lesson from the fall pandemic disaster drill was that the hospital needed to do a better job convincing staff to be vaccinated against the flu.
"We know that in order for a vaccine to be effective in preventing transmission of the flu in the hospital, a minimum of 35% of health care workers should be vaccinated," Larison says.
"So we evaluated during our drill the percentage of staff members who were vaccinated, and we decided to do a heavy push this year to get our health care workers vaccinated," she explains. "Now, 47-50% of our health care workers are vaccinated for the flu."
The hospital had encouraged employees to get their flu vaccine as the flu season began in the fall of 2008, but when the disaster drill showed that too few had, Larison headed up a second big push.
"We vaccinated people up until the last day of what is considered the vaccination period," Larison says.
One of the most successful methods the hospital employed to encourage vaccination was a drive-through vaccination strategy.
"We had the hospital's employee health team take the vaccine and swabs and station them at the entrance to the parking garages," Larison explains. "As employees pulled in they were asked if they would like a flu vaccine."
If they consented, they would be given a shot right as they sat in their car.
"We also sent employee health workers around to every department for many days to find the people who didn't get vaccinated in the drive-through," Larison says. "We had a competition between departments and held ice cream parties for those who achieved a minimum vaccination rate."
When flu season begins again this fall, the hospital likely will employ many of the same successful methods in encouraging employee vaccination, she notes. "We start an awareness program just before the vaccine becomes available, and so we have a lot of people who get vaccinated fairly early," Larison says.
Since people will still have the H1N1 flu pandemic scare on their minds this fall, Larison anticipates a great deal of interest in the flu vaccination program this year.
"We predict people will voluntarily take the vaccination at a much higher rate than average," she adds.
Larison has developed theories about why many hospital employees decline flu vaccination each year.
For instance, some employees might believe that they would be placed at higher risk of contracting Guillain-Barre Syndrome (GBS) if they take the vaccine, she says.
Larison has researched the subject and found that it would take every resident of Sarasota being vaccinated each year for 11 years to produce one case of GBS.
"In addition, people believe falsely that you get the flu by getting the influenza vaccination, and that's clearly not true," Larison says.
So she has worked at educating hospital staff about the benefits of flu vaccination, including the decade-old research finding that vaccinating healthcare workers reduces all-cause patient mortality during the winter season by 50%.1
Any efforts the hospital makes in improving flu vaccination this fall will be useful, particularly if the novel H1N1 flu virus returns.
Larison predicts this flu epidemic will return in a second wave.
"There is still a lot that's unknown about the current H1N1 variant, and there is a possibility that a second wave will be worse than the first wave," Larison says. "People would be less inclined to distinguish between seasonal flu and novel flu, so I believe that during a second wave the anxiety levels of the public will be greater."