Exercise plans for high impact events and follow up with after-action report

Start with tabletop exercise

Once pharmacists and hospital managers have outlined the possible high impact emergencies that could occur, it's time to exercise their disaster plans.

"Exercise the plan so you'll know whether your plan will work," says Richard G. Thomas, PharmD, DABAT, emergency management coordinator at the Phoenix Children's Hospital in Phoenix, AZ.

"You can only approximate to some degree what the reality will be and whether the plan will work," Thomas notes. "But you need to test your resources to see what can be done, and you do this through a series of exercises."

The first step is a tabletop exercise.

"You have a plan, propose a scenario, and get stakeholders in the room to see what they say," Thomas says. "Bring in people who were not part of the plan preparation so you can find out if there are different things you haven't thought about, what the impact of it will be, and how the plan will work."

After this, it's time to develop a functional exercise: "You try to do everything in real time, but you are pretending in terms of the scenario," Thomas explains.

For example, instead of waiting for a number of patients to come in sick with the flu, you simulate an influenza outbreak, having people describe their pretend flu-like symptoms, he says.

Then the staff involved have to describe how they'll handle it and what they'll do to take care of the patients. This can be done in a limited way, such as role-playing in a conference room, rather than throughout the entire hospital as would occur during a full-scale exercise.

"Full-scale exercises are very challenging to plan and are very resource intensive," Thomas says. "There needs to be a major commitment on the part of the institution to be able to do one of those, so, usually, most major facilities will do maybe one or two of those a year."

Still, the limited functional exercise will give hospital staff a good approximation of the real situation and some practice in handling it, he adds.

Once the hospital has completed the exercises, it's time to put together an after-action report that details the strengths, weaknesses, and what needs to be fixed in the disaster/emergency plan, Thomas says.

"Assignments have to be made to individuals responsible for making changes," he explains. "Then there usually is a follow-up, and often-times the institution will have the emergency management committee or safety committee hear the results of the report, making sure everything is addressed and resolved."

By going through this process, the hospital can come up with a plan for how to handle the emergency the next time, Thomas adds.

The after-action report also is necessary for when a real disaster or emergency occurs.