Department of Pharmacy Policies & Procedures

 

Number: 1:09

 

Effective Date: March, 1990

 

Revisions: 3/97; 8/99; 6/02; 4/08; 4/09

 

Approval: 8/99

 

Subject: DISASTER PLAN

 

A. POLICY

All sections and activities of the Department shall respond in accordance with the appropriate sections of the latest approved revision of the UAMS Medical Center Emergency Incident Command System.  The pharmacy will have duties directly relating to the emergency for Code Green, Code Yellow, and Code Pathogen.  Pharmacy personnel shall remain in the work area to provide service except for Code Green when drugs are supplied to the treatment areas and for Code Pink.    

 

Code Designations:

Mass Casualty                                  CODE GREEN

Tornado/Severe Weather               CODE GRAY

Fire                                                     CODE RED

Bomb Threat                                                 CODE AMBER

Biological Event                               CODE PATHOGEN

Patient Evacuation                          CODE EXODUS

Infant Abduction                              CODE PINK

Utility Failure                                                CODE PURPLE

Hazmat Decontamination              CODE YELLOW

Information Systems Failure IT     RECOVERY PLAN

Patient Overflow                              CODE SURGE

 

B. ON-DUTY PERSONNEL RESPONSIBILITIES

  1. The senior pharmacist on duty will notify the Director of Pharmacy Service immediately of a Code Green or Code Green Standby, Code Yellow or Code Pathogen situation and any of the known circumstances. The Assistant Director for OPC Pharmacy will be notified of emergency conditions by the Director or his representative. The OPC pharmacy will open to provide prescription service to patients being discharged.
  2. If the pharmacy is notified of Code Green Standby, the pharmacy disaster plan is implemented only as far as notification of proper personnel and preparation of supplies. 
  3. All personnel should return to the pharmacy immediately when a Code Green is announced.
  4. Authority within Pharmacy Service will be designated to the following personnel:
    1. Director of Pharmacy Service
    2. Assistant Director(s) of Pharmacy Service
    3. Supervisor of Dispensing
    4. Supervisor of Supply and Production
  5. Depending on the shift involved and circumstances of the disaster, the Director of Pharmacy or his representative will indicate whether additional personnel will be called in.
  6. All out-going telephone calls will be made on extension 686-6221 and must be cleared with the senior pharmacist.
  7. For Code Green, a pharmacist will immediately assemble supplies for transport to the disaster Holding and Evaluation (Yellow – Urgent Victims) area in the Emergency Department – Second Nurses Station. These supplies will be taken on a cart by a pharmacist who will remain with the supplies to dispense them, maintain records and secure additional supplies as needed. One of the Pharmacy support staff will be designated as a "runner" to resupply this cart if needed and to maintain contact between the acute care area and the main pharmacy.

8.    A supply of tetanus toxoid will be provided to the “green" area.  The Green (Stable/Uninjured victims) area is the Emergency Department – Secondary Nurses Station (In the event of a large surge in Green Patients, this treatment area will be relocated to the OPC).

 

C. OFF-DUTY PERSONNEL RESPONSIBILITIES

Depending on the type of disaster and the time of day it occurs, off-duty personnel may be required to come in. No personnel should come unless specifically notified by telephone or other communications that they are needed. All personnel should come to work as normally scheduled.

 

D. SUPPLIES

The Yellow area will be furnished with the following supplies:

  1. One adult emergency cart and one pediatric cart

(This will be delivered by Central Sterile Supply.)

  1. IV Fluids and Sets

Dextran 40 - 500 mL - 6 units

Other fluids will be furnished by Central Sterile Supply

  1. Injectable Drugs

Tetanus Immune Globulin - 250 units - 20 doses

Tetanus Toxoid - Tubex - 20 doses

Morphine Inj 10mg - 20 dose (+record sheet)

Meperidine Inj 50 mg - 25 doses (+record sheet)

Diazepam Inj 10 mg - 20 doses

Broad Spectrum Antibiotic Coverage - (Cefazolin + Gentamicin, or Cefoxitin 2 gm - All pre-mades)

Bacteriostatic Sodium Chloride Inj - 10 vials

Promethazine 25mg inj - 25 ampuls

  1. Oral Drugs

Acetaminophen 300mg tablets

Ibuprofen 200 mg tablets

  1. Other Supplies

3 mL syringes - 100

10 mL syringes - 100

Needles, 21 gauge, 1 in. - 100

"Tubex" syringe Holders - 4

Poloxamer-Iodine Solution - 6 bottles

Tribiotic Ointment - 3.5 gm packets

  1. The "Green" area will be supplied with 20 doses of tetanus toxoid

 

E. IN-PATIENT SERVICES

Normal inpatient procedures during a disaster will apply as much as possible. In the event that the disaster period is prolonged or short-staffed, the director of pharmacy service or his representative may elect to bypass the system normally used. This will be determined by circumstances at the time.

 

F. AMBULATORY CARE PATIENTS

  1. In the event that an emergency is called after regular ambulatory care center hours, the Assistant Director for OPC Pharmacy will be called at home. The Assistant Director will determine the manpower requirements needed to provide the necessary out-patient pharmacy services.
  2. Outpatient prescription services will be supplied for victims on release or for hospitalized patients who may be discharged to provide beds for disaster victims.

 

G. INTERNAL DISASTER

Many decisions made during an internal disaster will depend on what parts of the building are affected and what utilities are affected. The same authority schedule will be followed as for an external disaster.

  1. Extra/replacement drugs and supplies will be obtained from the off-site warehouse and/or prime vendor.
  2. Automatic dispensing machines will be handled according to policy for loss of power.
  3. IV fluids will be prepared in the nearest available clean area or in the ACRC/OPC IV preparation areas if available.
  4. Deliveries to nursing units will be made by runners using available access to the various units.
  5. Supplies will be sent to the "yellow" area and the "green" area as stated above if needed.

 

H.    SPECIAL SUPPLIES

In the event of Code Yellow or Code Pathogen, the pharmacy will be called upon to furnish treatment related to the type of exposure.  Toxicology treatment stock and/or antibiotic stock should be inventoried by Pharmacy supply.  No stock will be released to other hospitals without approval from the Director of Pharmacy in collaboration with the Incident Command Center.

 

I.    CODE PINK RESPONSE

  1. Any personnel who are out of the pharmacy and hear the over-head announcement should immediately call 686-6221 and alert Pharmacy Staff of the incident.
  2. All office staff and supply staff shall immediately participate. All dispensing personnel shall immediately participate with the exception of 1 pharmacist and 1 technician in each of the dispensing and sterile preparation areas.
  3. Staff shall work in pairs using procedures as directed in the UAMS Code Pink instructions. Be familiar with these instructions.
  4. The pharmacy should cover the following exits:
    1. The stairs outside the sterile preparation room at the first floor landing exit.
    2. The area in the lobby of both sets of elevators for ground floor Ward Tower.
    3. The exit doors going to the back parking lot by the cafeteria with visualization of the stairs coming from the 1st floor.
    4. The exit doors going to the VA Medical Center.
    5. The intersection of the white hallway and the hall to Shorey so that the halls, Shorey elevator and the stairs can all be visualized.
    6. All other available people shall spread out into the various hallways of the Ground floor until the Code Pink is over.

 

Remember that time is critical in the response to Code Pink (Infant Abduction) because the abductor will move quickly. Do not hesitate in getting to the hallways and exit sites.