key: cord-0982829-uzjgdxj0
authors: Watson, Kaitlyn E.; Waddell, Jason J.; McCourt, Elizabeth M.
title: “Vital in today's time”: Evaluation of a disaster table-top exercise for pharmacists and pharmacy staff
date: 2020-07-08
journal: Res Social Adm Pharm
DOI: 10.1016/j.sapharm.2020.07.009
sha: 3f0b81ab3ef0fb59aa2e28649358b1075f78669f
doc_id: 982829
cord_uid: uzjgdxj0

BACKGROUND: While the importance of pharmacists’ involvement in disaster management is becoming increasingly recognised in the literature, there remains little research on methods for preparing pharmacists and pharmacy staff for disasters. Objective(s): To investigate the use of a table-top disaster exercise to improve disaster awareness and preparedness for pharmacists and pharmacy staff attending The Society of Hospital Pharmacists of Australia (SHPA) Medicine Management conference 2019. METHODS: A table-top disaster exercise was developed by the research team and presented as a workshop at the SHPA's annual conference in 2019. The workshop presented attendees with the hypothetical ‘Cyclone Oma’ that was tracking across the fictional state of ‘New Cardiff’. Each workshop table was assigned a different hospital and was required to respond to Cyclone Oma as the scenario evolved. Workshop attendees were invited to complete a pre- and post-survey assessing their perceptions of disaster management and preparedness for pharmacists and pharmacy staff. RESULTS: The pre- and post-workshop survey was completed by 41 out of the 47 attendees. Participants’ assessments of their understanding of disaster management activities increased after attending the workshop (p < 0.001). Most participants felt the workshop improved their understanding of their role in a disaster (87.8%, 36/41) and allowed them to identify their strengths and weaknesses in disaster management (90.2%, 37/41). The workshop was well received with 92.7% (38/41) of participants stating they would like further continuing professional development opportunities in disaster management. CONCLUSIONS: This is the first disaster table-top exercise in Australia targeted specifically at the pharmacy workforce to be conducted and evaluated. The exercise improved understanding of disaster management and was well received by the participants. This research calls for further education and training opportunities in disaster management targeted at the pharmacy workforce.

Pharmacists provide essential services in disasters and ensure the ongoing health of their 48 community through the supply of essential medications, devices, and services. In recent 49 years, the importance of pharmacists' involvement in disaster management and response 50 has become increasingly recognised in both general media 1-4 and the literature. 5,6 Despite 51 the acknowledgment of the importance of pharmacists' roles in disasters and emergencies, 52 there is no research on how to best train and prepare the pharmacy workforce (pharmacists 53 and pharmacy staff) for disasters. The majority of research focuses on training exercises for 54 pharmacy students only, and most of these studies take place in the United States (US). 7,8 55 While preparing pharmacy students for disasters as part of their pharmacy degree is an 56 important step forward in integration of pharmacists into disaster management, it is only 57 one aspect of a prepared pharmacy workforce. It is also important to consider that by only 58 targeting pharmacy students, the established pharmacy workforce is missed in being 59 prepared for disasters. For pharmacists and pharmacy staff (such as pharmacy technicians, 60 interns, and students) to respond effectively in a disaster it is important that everyone is 61 prepared for a disaster or emergency. Unfortunately, reviews in the Australian context 62 demonstrated that there were few opportunities for pharmacy students, technicians, or 63 pharmacists to prepare themselves for disasters. 9,10 Research has identified that in order to 64 prevent significant staff shortages and complications during disasters, it is important that 65 front-line staff are well-equipped and prepared to respond to a disaster or emergency. 11 66 Disaster The all-hazard approach to disaster management recognises that while the types of 93 disasters may vary, they impact systems in similar ways. Therefore, preparing for any type of 94 disaster will assist with planning and response to another type of disaster. 14,15 While this 95 scenario was based on a cyclone, there were other themes discussed as the scenario 96 unfolded such as flooding, storm surges, pandemic/infectious disease outbreak, staffing, 97 chronic diseases, vulnerable populations, and resource sharing. (Table 1) . They included metropolitan, rural, and regional hospital profiles as well as public 133 and private facilities. 134 Evolving scenarios 136 The workshop was broken up into two main activities. After participants were seated in 137 their groups and familiarised with the format of the workshop, the first activity began. This activity was designed to provide background understanding of the fictional land of 'New 139 Cardiff' and the hospital profile assigned to the table. During the first activity, participants 140 were asked to consider their hospital profile and identify the risks to the pharmacy 141 department as well as prevention or risk mitigation strategies that could be employed. They 195 The paper surveys were manually entered into a database and exported to SPSS Version 25 196 Software. The data was analysed using both univariate and bivariate analyses. Frequencies 197 were reported and Likert scales were analysed using Mann-Whitney U test and Wallis test depending on the data ability to meet the assumption criteria. (Table 3 ). There was no statistically significant difference 219 between participants' responses to any survey items depending on their years of 220 experience, state/territory, or the location of their workplace. However, there was a 221 statistically significant difference between those with disaster experience and those without 222 disaster experience in pre-workshop assessments of understanding of disaster management 223 activities and the capability of each individual pharmacist to respond and recover from a 224 disaster (Table 4) . Interestingly, previous experience did not influence the participant's 225 perceived capability of preparing for a disaster at their workplace. There was no difference 226 in those with experience and those without in any other survey items. 227 Most participants felt the workshop improved their capability to prepare, respond, and 266 recover from a disaster. Those with previous disaster experience had higher pre-workshop 267 assessments of their capability to respond and recover from a disaster. It was interesting 268 that in the pre-workshop survey those with experience did not differ significantly in their 269 assessment of their capability to prepare for a disaster compared to those who did not have 270 experience. It could be that preparing for the unknown of a disaster is harder to 271 substantiate than responding or recovering. For example, in responding and recovering 272 pharmacy staff would likely be mostly utilising skills they are highly trained in and roles they 273 are familiar with in a more austere environment. However, preparing may require more 274 unfamiliar tasks such as writing a plan, moving work environments, or sandbagging. The 275 tasks required to prepare may be unclear if the disaster type is uncertain or the severity 276 unknown. It could also be that those with disaster experience did not have the opportunity 277 to prepare for the events that they encountered, thereby making them uncertain of their 278 capability to prepare. These factors, while poorly investigated in the literature, may explain 279 why no difference in preparedness capability existed between those with and without 280 disaster experience. 281 It was interesting to note that while there were some differences in responses to survey 282 items between those with and without disaster experience, there were no differences in workshop survey stated that they would revise their initial assessment of their capabilities in 298 undertaking disaster preparedness, response, and recovery activities in their place of work. 299 However, there was no difference in responses between those with and without disaster 300 experience, indicating that experience did not influence an individual's assessment of their 301 capabilities. Given the time constraints of this TTX this concept could not be fully explored. 302 It could be that people mis-assess their initial understandings or capabilities due to lack of 303 disaster education, or knowledge. This should be a consideration for those running and 304 assessing disaster TTX and needs to be further explored in future research to determine 305 how it may impact the reliability of pre-survey assessments of an individual's capabilities 306 and understanding. 307 When training and preparing for a disaster, it is essential to include all pharmacy staff. For 308 pharmacists to work to the best of their abilities and within their full scope in a disaster, 309 they require the support of pharmacy technicians and assistants. This research provides an 310 initial understanding of the benefits of a disaster TTX in the Australian context for pharmacy 311 staff and demonstrates the acceptability of this type of training for the pharmacy workforce. 312 The results suggest that there is a good appetite among the tertiary pharmacy workforce for 313 disaster focused CPD opportunities with almost all participants agreeing that they would like 314 more CPD opportunities to learn about disaster preparedness, response, and recovery. In 315 addition to this, almost all participants felt that disaster preparedness, response, and 316 recovery activities were important for pharmacy staff. This indicates that pharmacy staff 317 would like more CPD opportunities and that they feel disaster management is an important 318 and worthwhile topic. 319 The importance of disaster training was summarised nicely by one participant who stated 320 training was "very vital in today's times." When this TTX was being conducted it was the 321 beginning of the 2019-2020 bushfire season in Australia which saw widespread devastation 322 across many communities in Australia. The extinguishing of these fires was quickly followed 323 by the rise of the COVID-19 pandemic. These two events in quick succession have resulted in 324 pharmacy staff across Australia being under pressure or feeling the effects of disasters for 325 several long months. Before these events, there was poor accessibility to training for 326 pharmacy staff to prepare themselves for disasters. 10 It will be interesting to see how this 327 will change given the recent events in Australia. 328 It should be noted that there is potential that the results presented here may be skewed 329 because participants had to nominate to attend the workshop. It is likely those who did 330 attend had an interest in or felt the topic was important. However, this still provides support 331 for CPD providers and professional pharmacy organisations to consider developing disaster 332 training and education for pharmacy staff. It should be noted that while the development of 333 the TTX was somewhat time intensive, once developed the exercise was not financially 334 expensive to conduct.

To improve this TTX for future workshops, we would review the material provided to the 337 participants and condense the information required to be understood at the beginning of 338 the workshop. Some of the participants were allocated to a hospital profile that was 339 different from their usual work settings. As one participant put it ""There were lots of 340 different workbooks, bits of info, which made it hard to follow. The envelopes were great but 341 perhaps the workbook and background info could be streamlined." In future, we would give 342 the documents to participants to review and become familiar with before the workshop. We 343 attempted to reduce the printing required by making the participant workbook available 344 electronically, but many did not find this useful compared to paper. The other aspect of the 345 TTX we would tweak for future workshops was with four different hospital profiles, the 346 participants only became familiar with their allocated hospital and did not get to experience 347 the other profiles during the workshop. This could be overcome with longer debriefing time 348 for the different tables to discuss their approach and challenges. The prevention phase of 349 the disaster management cycle was not included as the workshop was only 3 hours in 350 duration and it began with the scenario unfolding. We suggest future workshops begin with 351 prevention before the disaster scenario unfolds to include this element of the disaster cycle, 352 as prevention steps and activities are generally required to be implemented in peace times. 353 Something that worked well with this TTX was allowing the tables to progress through their This work provides insight into the viability and effectiveness of a disaster TTX for pharmacy 393 staff. The workshop was well received by participants and provided improvements in 394 disaster understanding and capabilities. While the TTX was time intensive to develop, it was 395 not financially expensive to run and could provide a cheap intervention targeted at 396 improving pharmacy staff's disaster management abilities. This work is the first of its kind to 397 target a TTX for all pharmacy staff. This inclusive approach is important for disaster 398 management as it is not one profession that manages the complexity of a disaster and its 399 aftermath. This research calls for further education and training opportunities for pharmacy 400 staff to become prepared for disasters globally. 

Pharmacists Play Critical Role After Natural Disasters

Roles for pharmacists in disasters. Australian Pharmacist. 2020

COVID-19: Skip doc, see pharmacist for renewals: B.C. pharmacists authorized to 408 issue prescription renewals and emergency refills

The Public Are Looking To Pharmacy To Stand Up In This Crisis

Defining pharmacists' roles in disasters: A 416 Delphi study

Examining Roles Pharmacists Assume in Disasters: A Content 418

Disaster Medicine And Public Health Preparedness

Preparedness Modules in Introductory Pharmacy Practice Experiences. American journal of 421 pharmaceutical education

Evaluation of a Tabletop Emergency Preparedness 423 Exercise for Pharmacy Students

Does Australian Pharmacy Curricula Prepare 426 Students to Play a Role in Disasters? Prehospital and Disaster Medicine

Does Australian Continuing Professional 429

Development Activities Prepare Pharmacists to Play a Role in Disasters? Prehospital and 430 Disaster Medicine

Factors associated with willingness to 432 respond to a disaster: a study of healthcare workers in a tertiary setting

World Health Organisation. WHO Simulation Exercise Manual. Geneva: World Health 435 Organisation

Disaster preparedness in an Australian urban trauma center: Staff 437 knowledge and perceptions

World Health Organization Regional Office for Europe. Disaster preparedness and response: 439 Policy

Action plan to improve public health preparedness and response 442 in the WHO European Region

World Health Organisation. WHO Simulation Exercise Toolbox: Table Top Exercise (TTX)

Strengthening health security by implementing the International Health Regulations

Assessment of community healthcare 449 providers ability and willingness to respond to emergencies resulting from bioterrorist 450 attacks

Survey of Factors Affecting Health Care Workers' Perception 452

Towards Institutional and Individual Disaster Preparedness. Prehospital and Disaster 453 Medicine

Enhanced pharmacy training for counter-terrorism and disaster 455 response