Pharm-Resources-Update-HCC-Terriff-112113

Report
Regional Pharmaceutical Resources
Colleen Terriff, PharmD, BCPS (AQ-ID), MPH (soon)
Clinical Associate Professor
Washington State University College of Pharmacy
Deaconess Hospital and Rockwood Health Systems
November 21, 2013
History of Involvement
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1999 hoax anthrax letter
Y2K preparation for hospitals
Poster at Midyear and AJHP publication
MMRS Spokane City/County Pharmaceutical
Coordinator (2000- present)
• Sept 11, 2001
• Participation in variety of exercises:
– Mass vaccination
– Mass dispensing
– Mass casualty
Pharmaceutical Coordinator
• CDC CHEMPACK med exchanges
• Assist with public health
• Stockpiling:
– Decisions: location, medications, ancillary supplies
– Distribution
– Dosing and preparation information
– Inventory
– Destruction
Pharmaceutical Resources
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MMRS Stockpiles
CHEMPACKS
SNS Antiviral Cache
VA Cache
HRSA Employee Cache
Hospital Inventory for SRHD
Community Pharmacy Inventory as needed
Bioterrorism Planning
Agent
Prophylaxis
Treatment
Plan
Anthrax
Antibiotics
Antibiotics
Local and SNS
Botulinum
Observe
Antitoxin
Supportive care
SNS
Plague
Antibiotics
Antibiotics
Local and SNS
Smallpox
Vaccine
Invest. Drugs
Supportive care
SNS
Tularemia
Antibiotics
Antibiotics
Local and SNS
VHF
Invest. Drugs
Invest. Drugs
Supportive care
SNS
Local Bioterrorism
Pharmaceutical Plan (MMRS)
• Agents
– Levaquin IV/PO, doxycycline IV/PO, gentamicin IV
• Others
– dosing syringes, sterile water for injection
• Considerations
– pediatrics, pregnancy, elderly,
immunocompromised
– first-responders and healthcare professionals
– prophylaxis vs. treatment
Chemical Terrorism Planning
Agent
Treatment
Plan
Nerve Agents
2-PAM, atropine,
diazepam
Local (CHEMPACK)
and SNS
Vesicants
Supportive care
(BAL for Lewisite)
SNS- BAL
Industrial
Chemicals
Supportive care
(Cyanide antidotes)
Local and SNS
Riot Agents
Supportive care
Local and SNS
Local Chemical Terrorism
Pharmaceutical Plan (MMRS)
• Nerve agent antidotes:
– 2004:
• MARK-1 and diazepam autoinjectors with “sprinklings” of 2PAM vials, diazepam carpujects
• ALS transport (AMR and Medstar) and non-transport (fire)
– 2009:
• Duodotes
• Cyanide antidotes (hydroxocobalamin)
– fire chief rigs
– Expired: AMR
CHEMPACK Program
• Nerve agent antidotes
– antidotes more readily available
– improve local response time
– treat thousands of patients
(including peds)
• Federally owned cache
– decrease cost to local areas: initial
and replacement
– Shelf-Life Extension Program (SLEP)
Shelf-Life Extension Program
• Previously- military
• SNS in conjunction with the FDA may extend
shelf-life of meds (expiration date)
• Strict criteria:
– storage and security
• Meds from CHEMPACK:
– regardless of dating on vials/packages….
– ensured potency!!
• Just implemented for Tamiflu susp.
CHEMPACK Distribution
Eastern Washington
• Hospital:
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Deaconess
Holy Family
Sacred Heart
Valley
• EMS:
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AMR (x2)
Valley Hospital
Colville
Pullman
Strategic National Stockpile Program
• CDC/Federal Government assistance
• Stockpile (4 components):
– 12 hour push package
• antibiotics (IV and PO) and antidotes
• fluids, bandages, IV supplies, supportive care meds
– Vendor Managed Inventory- drug or equip.-specific
– Vaccine and Antitoxin
– CHEMPACK program- pilot: NY, SD, WA
• Additional resources: personnel, $$
Antivirals Spring 2009
• CDC released 25% of SNS antivirals
• DOH received antivirals and then distributed
to sites identified by local HD
• Local:
– Hospitals
– Retail/chain with expanded access
• Issues:
– storage (physical)
– short expiration of suspension
– different packaging
Antiviral Issues Continued…
• Locals now own stockpile
• Who is the “gatekeeper” of access?
• Need to use up local supply (in pharmacies)
first, then can utilize SNS
• Ancillary supplies…
VA Stockpile
• Large facilities
• Small facilities:
– Spokane
• Mass casualty
• Color coded
• Includes supportive
care meds
• 2008 Directive
HRSA Employee Cache
• Ciprofloxacin
• Doxycycline
• For employees and
families and hospitalbased EMS providers
• Maintained by area
hospitals
Deaconess Stockpiles
1. MMRS- ill patients (i.e. IV meds)
•
ED provider can access
2. MMRS- POD
– SRHD or Spokane EOM- to be sent to POD
3. CHEMPACK plus expired meds
4. Antiviral SNS cache
5. Employee cache
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Antibiotics and antivirals
HRSA grants
Hospital Pharmacy Inventory
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Deaconess and Shriners
Holy Family and Deer Park
Sacred Heart
Valley
VA
Antibiotics, chemical exposure treatment, antivirals
Estimation
SRHD listed resource
Community Pharmacy Inventory
• Enroll help of:
– WSU College of Pharmacy Drug Information Center
– Spokane Pharmacy Association
• Limited meds
• Dispensing to community
MOU’s with Pharmacy
• State-wide initiative community pharmacies:
– Chains
– Independents
• SRHD with WSU COP:
– Mass dispensing
– Mass vaccination
Medication Destruction
• Partnering with law enforcement (SPD)
• Coordinating stockpile destruction with other
incineration needs for LE
• Mainly MMRS chemical terrorism meds
Moving Forward
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MMRS defunct
CHEMPACK program will continue until ?
Local stockpiles expired
Keep expired meds until funding changes

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