key: cord-0879233-g6vk36ip
authors: Griebe, Kristin; Jiang, Christine; To, Long; Peters, Michael; MacDonald, Nancy C
title: Pharmacy emergency preparedness training as a PGY2 longitudinal rotation
date: 2021-02-17
journal: Am J Health Syst Pharm
DOI: 10.1093/ajhp/zxab044
sha: b9f476e9926f2a41fc89f8eca4b17d8ba15c2ab2
doc_id: 879233
cord_uid: g6vk36ip

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

M a n u s c r i p t Existing emergency preparedness publications describe training for midlevel nurse manager and physician residency programs, including emergency medicine. [1] [2] [3] These programs identified emergency preparedness training as an important element for these clinicians and increased staff comfort and knowledge of various emergencies. Pharmacists also have a key role in preparing for and responding to emergencies, as seen in previous mass casualty events and the recent 2019 coronavirus disease 2019 (COVID-19) pandemic. Emergency management leaders at the local, state, regional, and federal levels rely on pharmacists to maintain medication supplies and pharmacy services during these events. Health-system pharmacists are responsible for the mitigation of and preparation for as well as response to these emergencies. The American Society of Health-System Pharmacists (ASHP) has published various documents that outline the pharmacist's role in planning for emergency preparedness, sustaining pharmacy services during emergencies, responding to disasters and managing a surge in patients. [4] [5] [6] [7] [8] [9] [10] The recommendations from the ASHP Practice Advancement Initiative (PAI) 2030 11 also suggest that pharmacists participate in and assume key roles on emergency response teams, further reinforcing the hospital and health-system pharmacist's role in emergency preparedness and management.

Emergency preparedness training requires pharmacists to understand the 4 phases of disaster management (mitigation, preparedness, response, and recovery) to prepare for mass casualty and pandemic events. Additionally, pharmacists should understand regulatory requirements related to emergency management to ensure that hospitals meet elements of performance required for certification. Emergency preparedness training for future pharmacists is incorporated into the goals and objectives for some residency programs, including critical care and pharmacotherapy. 12, 13 However, the objectives tied to emergency preparedness are not required (Box 1), and consequently, not all of these programs formally A c c e p t e d M a n u s c r i p t teach and evaluate these objectives. During the residency programs that occurred between 2017 and 2020, critical care programs evaluated the elective emergency preparedness objectives less than 7% of the time and pharmacotherapy programs less than 25% of the time (McCreadie S, McCreadie Group, Inc., personal communication, August 7, 2020).

Although there are ASHP practice management standards, PAI recommendations, guidelines for health-system pharmacists, and training goals and objectives related to emergency preparedness, literature that describes training to achieve these residency goals and objectives is lacking. A c c e p t e d M a n u s c r i p t and recovery) for internal and external emergencies. This includes regularly updating departmental emergency preparedness policies and procedures, performing pharmacy department drills, evaluating staff response to drills and real emergencies, and providing staff education. The coordinator is a member of the institution's emergency management committee and the state's regional healthcare coalition. Both residents become members and actively participate in these hospital and regional meetings. Quarterly evaluations are used to assess each resident's progress and achievement of related goals and objectives.

Emergency preparedness activities. The residents perform the activities for the pharmacy department, hospital and/or health system, region, and state, and they teach all phases of disaster management ( Table 1 ). The pharmacy department activities include reviewing and updating the departmental emergency preparedness policies and procedures, performing pharmacy drills, and educating pharmacy team members. The residents also assist in performing a hazard vulnerability assessment for the pharmacy department. This assessment is used to proactively identify potential hazards to the department, the severity of the impact, and the resources needed during emergencies. The information is then used to update the departmental policies and procedures and to develop staff education.

The residents plan and perform drills for the pharmacy department. The coordinator identifies drill content based on after-action reports from previous emergencies, areas for improvement from recent hazard vulnerability assessments, regulatory requirements, and pharmacy staff input. The residents identify relevant procedures and policies related to the drill, conduct staff education sessions during biweekly staff huddles, perform drills for each shift, identify improvements needed, conduct follow-up staff education sessions, and complete after-action reports.

A c c e p t e d M a n u s c r i p t

The residents learn the importance of a multidisciplinary, collaborative approach to planning by participating in the institution's emergency management committee. This interdisciplinary committee includes nursing, medical, pharmacy, security, environmental services, hospital administration, quality, facilities, radiology, and communications personnel. The residents participate in monthly meetings to discuss hospital, health-system, local, and national threats; mass casualty events; public health events; and general hospital emergency preparedness for these events. As members of this committee, they help complete a hospital hazards vulnerability assessment and plan hospital exercises to evaluate employee response. They also serve as the pharmacy representatives for hospital tabletop exercises, in which members of the committee verbally describe their department role and responsibility in responding to the event. Such exercises help identify policy or procedure gaps that can be addressed before exercise implementation. Through this local committee, the residents gain an understanding of the pharmacy's role in preparing for mass casualty events and other system vulnerabilities as well as the pharmacist's role on the institution's multidisciplinary committee.

Lastly, the residents participate in the regional emergency management committee to understand and contribute to risk mitigation and planning on a much broader scale. The Michigan Region 2 South (R2S) Coalition is a multidisciplinary team with representatives from 35 hospitals, 92 emergency medical services (EMS) agencies, 4 EMS medical control authorities, and 4 health departments within the southeastern region of Michigan. This committee is responsible for ensuring regional readiness and providing support for public health emergencies. The residents participate in tabletop exercises and an annual statewide Strategic National Stockpile ordering exercise, in which hospitals are given a mock mass A c c e p t e d M a n u s c r i p t casualty scenario and are required to order additional supplies and medications using the online portal. Following this exercise, the residents complete and submit an after-action report. This exercise teaches the residents about the pharmacist's role in responding to mass casualty events. Their completed after-action report is used to support the Joint Commission regulatory requirements for hospital emergency preparedness exercises. 14 Emergency management training certifications. The residents are required to complete training certifications that further describe the emergency management cycle (Box 1). They attend a Basic Disaster Life Support class, which is offered for free from the R2S Coalition.

Using interactive case scenarios and discussions, the course teaches participants to identify, triage, and manage public health emergencies and disasters. After completing the course, residents are better prepared to manage a broad range of events. They also complete online training for 2 independent study classes through the Federal Emergency Management surveyed, they recommended prospective candidates seek PGY2 critical care residencies with emergency preparedness activities. This recommendation suggests that these residency goals and objectives should be mandatory for critical care residency programs.

Emergency preparedness role after completion of residency training. Trainees who were hired to work at the hospital after graduation continue to have a role in the department's emergency preparedness planning and staff education. They mentor the residents in planning and executing pharmacy drills and serve as experts in the department. During the aforementioned network downtime event, these pharmacists took leadership roles to ensure department downtime procedures were implemented appropriately. They also helped complete the after-action report and design emergency preparedness tools to support redesigned clinical and operational services. During the pandemic surge, they helped manage critically ill patients, optimize medication therapy for patients with COVID-19, redesign critical care pharmacy services to support an increase in critical care patients, and modify medication protocols. Previous emergency preparedness training helped these pharmacists understand the rapidly changing environment and the need to continually reassess where pharmacy services were needed the most to sustain optimal care.

A c c e p t e d M a n u s c r i p t Summary. There are gaps in emergency preparedness training for health-system pharmacists, as evidenced by the low percent of critical care and pharmacotherapy residency programs that evaluate elective emergency preparedness objectives. Recent mass casualty events, including the COVID-19 pandemic, heighten the need for this training and involvement. Participating in the emergency preparedness longitudinal rotation creates an opportunity for the critical care and pharmacotherapy residents to learn the pharmacist's roles and responsibilities and to achieve residency objectives. After completing this longitudinal experience, residents are equipped with the skills necessary to apply the 4 phases of disaster management (mitigation, preparedness, response, and recovery) to mass casualty and public health emergencies as well as to ensure pharmacy services are sustained during such events. Other residency programs can use this longitudinal rotation as an example of how to achieve emergency preparedness goals and objectives. It can also be used as a guide to design emergency preparedness training for pharmacy staff as pharmacists advance their roles on emergency response teams.

Emergency preparedness training for hospital nursing staff

Emergency preparedness: addressing a residency training gap

Development of an interactive curriculum and trainee-specific preparedness plan for emergency medicine residents

ASHP statement on the role of health-system pharmacists in emergency preparedness

ASHP statement on pharmacy services to the emergency department

ASHP guidelines: minimum standard for pharmacies in hospitals

Pharmacist leader's role in hospital emergency preparedness planning

Pharmacist readiness roles for emergency preparedness

Patient surge management during a pandemic: toolkit for hospital and health system pharmacy

ASHP COVID-19 pandemic assessment tool for health-system pharmacy departments

Practice advancement initiative 2030

Required competency areas, goals, and objectives for postgraduate year two (PGY2) critical care pharmacy residencies

Required competency areas, goals, and objectives for postgraduate year two (PGY2) pharmacotherapy residencies

M a n u s c r i p t A c c e p t e d M a n u s c r i p t /media/assets/professional-development/residencies/docs/pgy2-pharmacotherapy-2017.ashx 14. The Joint Commission. Emergency management. Accessed May 26, 2020.https://jointcommission.org/en/resources/patient-safety-topics/emergencymanagement/ A c c e p t e d M a n u s c r i p t