Preparing for Medication Safety, Accessibility During a Natural Disaster

Hurricanes, flooding, wildfires, tornadoes, blizzards and other natural disasters can happen at any time. Having an emergency plan helps pharmacists, pharmacies, and patients protect themselves and their medications, during a disaster event and in the aftermath.

Pre-planning is especially important for patients on a prescription drug regimen, as nonadherence may be life-threatening for certain conditions. According to the FDA, pharmacists play an important role in planning for emergencies like those that can be created by dangerous storm situations, like Hurricane Florence could create in the Carolinas this week. Pharmacists must ensure their patients are informed about how to keep themselves and their medications safe.¹

“An emergency plan is especially important for those with health concerns, particularly if the power goes out,” said pharmacist Henry Yu, in a Drug Info Rounds video from the FDA.² “Taking precautions for storing medications and supplies is key to being prepared.”

According to the FDA, pharmacists should advise patients to:²

• Keep a current list of medications on hand, including dose and indication.
• Keep a log of how much medication they have.
• Receive early refills in the event of limited pharmacy access.
• Place medication in water-tight containers to prevent exposure to floodwater.
• Have ice handy for refrigerated medications.

Following a natural disaster, a loss of power or flooding may affect medications. Prescription drugs can be altered after exposure to extreme temperatures that can occur with power loss, and prescription drugs may be contaminated by flood water or broken pipes.³

Pharmacists can assist patients in examining medications for damage and discard the treatment if necessary. For medications that must be reconstituted, pharmacists should advise patients to only use bottled water if clean water is otherwise unavailable. In addition, if the power has been out for an extended amount of time, refrigerated products should be discarded.³

For patients on life-sustaining drugs, such as insulin, an unrefrigerated drug be may used until new doses are available. Since temperature-sensitive drugs may lose potency if unrefrigerated, they should be replaced immediately, FDA officials recommend.³

In circumstances where the containers of life-saving medications have been exposed to floodwater and other treatments are not available, pharmacists can determine if the drug should be used, as long as the contents appear to be unaffected, according to the FDA. However, the agency has warned that once replacement drugs are available, potentially contaminated drugs should be disposed of and patients should begin treatment with non-contaminated drugs.³

Click here to read how pharmacists in Texas prepared for Hurricane Harvey and assisted patients.

In 2017, a variety of types of natural disasters affected communities across the United States, including hurricanes in Puerto Rico, Florida, and Texas. During a presentation at Asembia’s Specialty Pharmacy Summit 2018 in Las Vegas, Nevada, Gary Rice, RPh, MS, MBA, CSP, executive vice president of operations for Diplomat Pharmacy Inc, Flint, Michigan, said sustained challenges persisted in some cases, and ongoing hurricane recovery efforts in Puerto Rico underscores the importance of long-range and advance planning.⁴

An effective disaster preparedness plan incorporates 3 elements, said Asembia presenters: emergency response, disaster recovery, and business continuity. The highest priority is the lives and safety of patients and employees, followed by inventory and equipment that can be moved or rescued, and, finally, facilities.⁴

In addition to threats to their own lives and safety, employees may face other challenges during or after a disaster.⁴ A pharmacy should consider whether a facility will be operating and if employees will be able to work, according to Rice. Prior to a disaster, he said, companies need to have human resource policies and procedures in place that address these situations, such as the amount of time off from work afforded to staff to take care of their homes and families. Finances might become an issue, as well. “Employees want to know certain things,” he said, “like ‘Am I going to get paid during a disaster?’”

Local geography should also be considered. Inaccessible roads or flooding can affect employees’ ability to get to work, as well as whether medications and supplies can be delivered. “How do we best support our patients? We have to get the product to them,” Rice said, during the presentation.⁴ In some cases, such as for patients living in temporary housing, it may be more efficient to provide medications through a doctor’s office or by mailing them to a post office box instead of an uninhabitable residence.

In Houston, Texas, employees of Southside Specialty Pharmacy prepared for Hurricane Harvey by ensuring patients would have access to medication. When 1 patient in need of miltefosine for treatment of a rare condition could not obtain the drug locally, Southside staff first attempted to obtain a shipment for the manufacturer. However, weather made shipment impossible. Instead, Southside’s director of nursing flew to Florida and back to retrieve the drug, which made it to the patient within an hour of its arrival in Houston.⁵

The full story of Southside’s efforts during Hurricane Harvey can be found at SpecialtyPharmacyTimes.com.

In addition, technology plays an important role during disaster recovery. In the event of an emergency, pharmacies should be able to access a data center with patient information, a call center that allows staff to communicate with patients, and a fulfillment area that can facilitate prescriptions.⁴

Redundancy is key for pharmacies during long-term recovery efforts, Rice said. Backup licensed facilities and pharmacists, systems, and data access can help maintain service during an emergency and aftermath. Experts recommend running through disaster scenarios with staff members, who should be prepared and able to identify areas that need improvement.⁴

“This is all about being prepared. It’s not just the planning but [also] doing those desktop scenarios and challenging your team so that they really understand some of those weather conditions,” Rice said.

According to Asembia presenters, Diplomat has learned from its own experiences with natural disasters, including a weather event in Florida. As a hurricane approached, the company prepared by sending some inventory from Florida to Michigan, Rice said, but faced an unforeseen issue returning the inventory when the delivery route became inaccessible.

Through such experiences, Diplomat recognized that its process was effective in the short term but needed to expand capabilities for longer-term recoveries. In response, the company created a new fulfillment and distribution center that provides data redundancy capabilities for servicing operations across the country. ⁴

References

• Toich L. How Pharmacists Can Help Patients Plan for Natural Disasters. Specialty Pharmacy Times. https://www.specialtypharmacytimes.com/news/how-pharmacists-can-help-patients-plan-for-natural-disasters. Published September 8, 2017. Accessed September 12, 2018.
• Transcript: Emergency Preparedness — Keeping Medications Safe (Feb 2016). FDA website. https://www.fda.gov/Drugs/ResourcesForYou/HealthProfessionals/ucm486323.htm. Updated February 18, 2016. Accessed September 12, 2018.
• Toich L. Pharmacists Play Critical Role After Natural Disasters. Specialty Pharmacy Times. www.specialtypharmacytimes.com/news/pharmacists-play-critical-role-after-natural-disasters. Published September 11, 2017. Accessed September 12, 2018.
• Crossley K. How Specialty Pharmacies Can Be Prepared When Disaster Strikes. Specialty Pharmacy Times. www.specialtypharmacytimes.com/publications/specialty-pharmacy-times/2018/2018-asembia-recap/how-specialty-pharmacies-can-be-prepared-when-disaster-strikes. Published June 25, 2018. Accessed September 12, 2018.
• Toich L. Hurricane Harvey Shows Why Specialty Pharmacies Matter During Natural Disasters. Specialty Pharmacy Times. www.specialtypharmacytimes.com/news/hurricane-harvey-shows-why-specialty-pharmacies-matter-during-natural-disasters. Published September 1, 2017. Accessed September 12, 2018.