Expect the unexpected and disaster plans will work

Small 'Star Trek'-like com device helps

There's very little excitement for Floridian hospital pharmacists when it comes to holding disaster drills for hurricanes. It's old hat, second nature to the hurricane-weary pros that have dealt with this for years.

Disasters might also involve rare, but terrifying events, such as bioterrorism attacks or a pandemic influenza outbreak.

And then there are the mundane types of mini-disasters, such as computer crashes, which can cause a great deal more trouble than anyone can imagine.

It's these latter types of disasters that hospital pharmacists often forget to anticipate, suggests Deborah J. Larison, PharmD, BCPS, a clinical pharmacy specialist in emergency medicine at Sarasota Memorial Hospital in Sarasota, FL.

Larison speaks from both disaster planning experience and a real-life mini-event experience.

"A month or so ago, we had our Pyxys machines, about 90, being upgraded from a distant site," Larison recalls.

The medication dispensing machines suddenly went off-line during the upgrade procedure, and they couldn't be used. No one knew when the problem would be resolved, Larison says.

"We obviously notified our pharmacy team to let them know there was a problem," Larison says. "And we had a back-up plan in place for the hospital, but not for the emergency department."

The hospital's medication orders could be sent through pneumatic tubes, and new orders could be scanned and distributed, she notes.

"But we never considered what would happen in the emergency room," Larison adds.

So when the emergency room's 10 Pyxys were among those that suddenly couldn't work, the pharmacy team called all available pharmacists, including residents and students, to meet in the emergency department, Larison says.

Within four minutes, seven or eight pharmacists and pharmacy students were there, she adds.

"We opened the back of one of the machines manually and dispensed all medications from that machine for ED patients, Larison says.

Pharmacy students served as runners to pick up the medication and deliver it to nurses and physicians. Nurses used patient stickers to identify which patients received which medication.

"We provided care for about four hours in the emergency department and took care immediately of all STAT patients, cardiac arrest patients, and all critical patients who came in," Larison says. "Nobody noticed that we had a glitch in the system, not even the physicians and patients knew."

The team of pharmacists and students were committed to being in the emergency department the entire night if necessary, she adds.

"It was at the end of the day, and everyone pulled together and did a great job," Larison says. "Our computer systems people were amazing."

Although this impromptu disaster plan worked well, the team decided to make some changes based on the experience.

"After every event and drill, we have a hot wash where we meet immediately after the incident and get the players together as much as possible to talk about the issues," Larison says.

Then the team writes a report collectively that incorporates strategies for process improvement.

"The report describes the event, what we did, how we could do it better, what we did just right, and how we could change planning and procedures for the future," Larison says.

After this mini-disaster, the team learned that communication is always the biggest problem, she says.

"No matter what you do to practice or drill for communication, there's always a communication gap, so how do we cover those?" Larison says.

The team asked how they could have used the runners more efficiently and how they could have used the phone more efficiently. The biggest gap was in communicating with runners once they left the team dispensing the medications, Larison says.

"We couldn't communicate with runners until they returned," Larison says. "I could have asked them, 'After you drop off the medication, would you please pick up meds from room 108?'"

So the team suggested that the hospital needed additional Vocera communication devices, which were already being used at the facility (Vocera communications system, Vocera Communications Inc. of San Jose, CA).

The Vocera system allows for hands-free voice communication within a medical facility.

The device hooks onto a lab coat. Just like in the science fiction television series "Star Trek," the device works as a wireless direct communication device. The pharmacist or other medical professional will tap it and say, "Please call Jane," and it will connect to the other person's Vocera device. Then both people can speak privately back and forth.

"It's much smaller than a cell phone and just clips on your lab coat, hanging there," Larison says.

This system would have allowed pharmacists to communicate with runners while they were making medication deliveries, she adds.

The only drawback is that the Vocera system won't work during an electrical outage, Larison notes.

"We have Vocera devices, but we didn't have enough to go around that day," she adds. "So we've ordered more, and more batteries."