Disaster planning pharmacy experts offer advice on preparing for next flu pandemic

If swine flu virus returns, some are ready

Hospital pharmacies across North America had a real life disaster drill this spring when a new influenza virus began making people sick.

What alarmed public health officials was the discovery that it was a novel H1N1 influenza A virus, the first new flu virus to raise a pandemic alarm in 40 years. It also appeared initially to be quite virulent as it killed dozens of people in Mexico before it jumped to the United States.

By early May, the virus seemed more ordinary than health authorities had feared, but public health officials remained concerned about the potential for the virus to re-emerge this fall in a deadlier pandemic.

The infamous 1918 flu pandemic was caused by an H1N1 influenza A virus that was genetically different from the one that emerged in 2009. The 1918 flu virus first appeared in the late spring and summer with a mild outbreak. When it entered a second phase in the fall, it spread quickly around the world, killing millions of people, including many people between the ages of 20 and 40. (See flu pandemic timeline.)

Against this backdrop, hospital pharmacists have helped their institutions prepare and assess readiness for handling an influenza pandemic.

"Clearly this is an endemic and evolving situation that involves a novel virus," says Richard G. Thomas, PharmD, DABAT, emergency management coordinator in the emergency department and rapid treatment unit pharmacist at Primary Children's Medical Center in Salt Lake City, UT.

"One of the challenges whenever you have a new outbreak of an infectious disease is getting enough information about the disease to characterize it and put the risk into perspective," Thomas says.

"Everyone should be concerned about whether this flu will come back in the fall," Thomas says. "And will there be enough time to generate a vaccine that will include what's already anticipated to be the flu strain and this new H1N1 variety remains to be seen."

Hospitals already have policies and procedures in place for dealing with infectious diseases like influenza, which typically kills more than 30,000 people a year in the United States, says Carsten Evans, PhD, FASHP, assistant dean of continuing professional education in the College of Pharmacy at Nova Southeastern University in Fort Lauderdale, FL.

These policies and procedures include promoting hand-washing and flu vaccination among patients and staff.

"We're trying to reinforce education about good hand hygiene and cough etiquette," says Sharon S. Cohen, RN, MSN, CEN, CCRN, an emergency preparedness clinical nurse specialist/instructor trainer with the department of emergency preparedness at Broward Health in Fort Lauderdale, FL.

"If you cough in your hand then use a tissue and wash your hand immediately," Cohen says. "Try to cough in the bend of your arm so your hands don't get contaminated."

And if hospital employees see that someone has an influenza-like illness and that they're coughing, then they should ask the person to wear a mask for self-protection and the protection of those nearby, Cohen adds. "They need to keep a three-foot distance between each person."

During the spring H1N1 influenza A outbreak, Broward Health printed hand-washing and cough etiquette tabletop cards to put out in all public areas, including waiting rooms, business offices, and the cafeteria, Cohen says.

A flu pandemic is more challenging for hospitals because of the increase in patients crowding the emergency room and the higher level of panic.

One of the keys to staying the course during a pandemic flu is to keep all lines of communication open between the hospital pharmacy, the hospital's emergency preparedness department, county preparedness and public health departments, physicians, and the community.

"You need to provide clinicians with as much information as possible on the current outbreak," says Erin Mullen, RPh, PhD, assistant vice president for Rx Response, a Washington, DC-based coalition that includes PhRMA.

"If the hospital emergency room is seeing a spike in unusual influenza-like illnesses, then you should report these to the local public health authority," Mullen says. "Providing as much information and being as open and transparent with employees and the public is the best way to go about it."

Hospital pharmacists could stress to hospital staff the importance of not over-reacting, says Deborah J. Larison, PharmD, BCPS, clinical pharmacy specialist in emergency medicine at Sarasota Memorial Hospital in Sarasota, FL.

"We're encouraging everyone to develop a family disaster plan, not just for a pandemic, but also for hurricanes, tornadoes, and fires," Larison says. "We're encouraging them to reassess their family emergency plans, which I have done with my family, and not spread rumors."

Pharmacists at Sarasota Memorial Hospital have established a direct communication link to county emergency management officials, and this has been invaluable, Larison says.

"What has truly made the biggest difference in the preparedness of this hospital is the pharmacy's direct involvement in our county emergency management discussions and planning," Larison says.

Hospitals might already send administrators, infection control staff, and epidemiologists to county emergency response planning sessions. But this isn't enough, Larison notes.

"They're not experts in the supply chain issues and drug-related issues that occur in highly infectious disease epidemics," Larison says. "Having someone from pharmacy in those meetings and contributing effectively helps us be well prepared."

Pharmacists should be part of their hospital's disaster planning process or at least be in close communication with the people who are involved with disaster planning, Mullen suggests.

For instance, hospital pharmacists need to be in the loop so they can answer this very important question: "If resources for a particular product like an antiviral become very scarce, how do you request assistance?" Mullen says.

"Chances are the emergency planner for the hospital knows that information, so this would be a good time for the pharmacy to connect with the emergency planner and find out whether we have contingency plans in place or whether we need to start working on that," Mullen adds.

Hospital pharmacists need to be proactive, joining in conference calls with the Centers for Disease Control and Prevention (CDC) and state and local health departments during the early days of a pandemic, Cohen suggests.

"We need to be sure we're all speaking the same language and are on the same page," Cohen says.

The pandemic updates from official sources should then be communicated to hospital staff and the community, a process that ensures the information disseminated is accurate and reliable, she adds.