Resiliency in Pharmacy

Resiliency: re·sil·ien·cy?ri-?zil-y?n(t)-sē?noun; an ability to recover from or adjust easily to?adversity?or change.

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Hurricane Helene wreaked havoc on the Southeast U.S. last week, killing over 230 people and disrupting heath care services. The storm has severely damaged a Baxter’s IV solution facility in North Carolina that makes most of the IV bags and peritoneal dialysis solutions used in the U.S. ?With the factory out of action, hospitals are running low on IVs once again. At this point it is unclear when Baxter’s plant will be back up and running and they have started to ration IV fluids and peritoneal dialysis solutions.

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?ASHP and Vizient have published excellent resources on managing this round of critical shortages as hospitals across the US have already started rationing IVs to patients.? To make things possibly worse, Hurricane Milton is heading towards Florida, which could damage yet another IV manufacturing plant. The American Hospital Association is urging the Biden administration to quickly boost the supply of IV solutions for hospitals, potentially by using the Defense Production Act.

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In this chaos, sits pharmacy.? Pharmacy is not new to shortages as this is a chronic problem that has been well documented and charted by Erin Fox at the University of Utah.

The shift in medication shortage types is amazing to watch, noting pharmacy must continuously pivot to meet the needs of patients in adversity.

Thank you, Erin!!!? However, when shortages present themselves as an ‘immediate’ event the criticality of conservation and triage must take place by pharmacy in conjunction with leadership.

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And let’s not think this is going to get better anytime soon.? Extreme climate change could impact drug shortages with increased demands in the need for medications due to increases in climate related diseases.? To throw fuel on this ‘shortage fire’ it is not just extreme weather and other events in the US that we need to worry about, it also abroad.? Considering a majority of active pharmaceutical ingredients and components used to make final medication products are sourced internationally.?

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Hospitals have been forced to relocate patients, in turn requiring pharmacy to relocate the medication management processes.?? Meeting immediate transport needs, sterile compounded preps, non-sterile preps, controlled substances management, all while ensuring patients receive the safest medications with little to no interruptions.?

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In this, pharmacy remains resilient and meets the demands of unplanned events and shortages.? The concept of a resilient pharmacy was hinted at 1967 by Earl A Schwerman’s ‘Role of the hospital pharmacist in disaster preparedness’: “Disaster preparedness requires three ingredients-manpower, facilities and supplies. Although the hospital pharmacist’s primary responsibility in a disaster is provision of pharmaceutical supplies, he has- an important multi-faceted role in disaster preparedness.”?

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Noting the context of the era from Schwerman, pharmacists and pharmacy technicians make the perfect partnership in resiliency in the medication management processes.

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In a more formal requirement, Accreditation bodies, such as The Joint Commission (TJC), strongly encourage healthcare institutions to conduct an annual operational risk assessment (TJC, LD.03.08.01; EM12.02.09).? TJC defines a risk assessment as a detailed review of processes, identifying risks and points of vulnerability (weather, shortages?), and prioritizing areas for improvement. While risk assessments cannot predict every event, proactive planning helps facilities better understand potential risks and available resources.

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Risk assessments typically involve input from multiple departments, including facilities, safety, administration, nursing, and medical staff. Pharmacy MUST directly participate and submit departmental risks including a list of critical drugs needed for patients being served. Since medication management extends beyond the pharmacy, plans must account for the entire process, from the shipment of medications (think alt sites for deliveries) to their delivery to patients. The urgency of medication needs varies by patient type, requiring stratification of risks (e.g., ICU patients vs. general ward patients, in transport, post transport, etc.).

During times when normal operations? such as compounding, controlled substances management and facility conditions are disrupted, a resourceful medication management plan is essential. ??Pharmacies today depend heavily on technology for safety and efficiencies in operations. A key question is how pharmacies function in an event if all automated safety systems were unavailable due to power outages or relocation of services? And how they could manage medication processes without these safeguards?

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Keeping in mind that during all of events the regulatory oversight does not go away.? The security and integrity of medications must be maintained.? State Boards of Health/Pharmacy may offer some temporary operational measures, but in the end pharmacy remains accountable.

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As pharmacy teams work within the construct of limited resources, drugs shortages, relocation of services, limited supplies, alternative working conditions, the teams remain resilient and continue to provide ‘pharmaceutical care’ to patients…until the next event.

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Sitting in Omaha all I can think as I watch events unfold is a wholehearted ‘thank you’ to the pharmacy teams for their continued commitment to providing safe patient care during these events.

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