Drug Topics - October 8, 2007 - (Page 39)

39 cist’s ability to administer vaccines such as tetanus and diphtheria in a first-responder role will depend on local, federal, and state regulations and may be covered under existing collaborative practice protocols. Case consultation with other clinicians in emergency clinics In the aftermath of a large-scale disaster, it is likely that medical relief efforts will at times take on makeshift forms and operations. For example, after Hurricanes Katrina and Rita struck the coast of Mississippi in 2005, dozens of emergency walk-in clinics emerged to augment the relief efforts provided by hospitals, Disaster Medical Assistance Teams (DMATs), and so on. These emergency clinics were staffed by healthcare professionals who volunteered their services. Many of these volunteers were local residents, while others were from out of the area. Typically, emergency clinics were visited by victims who were not in urgent medical need. Rather, the typical victim/patient presented with problems that would be fairly routine under other circumstances. Medication issues were very common, and pharmacists were in short supply and very much needed. The emergency clinic environment is often chaotic and hectic, and multiprofessional cooperation on cases is essential. Pharmacists may be involved in cases in which a patient needs a medication refill, but the patient is unable to clearly articulate the name, dose, indication, and so forth of the medication (e.g., “I take lots of pills. One of them was white and round.”). Even when the needed medication information is known, the drug itself may not be on hand; pharmacists are able to consult on generic substitution or complex cases of pharmacologic interchangeability, when the first, second, or even third choice of medication is unavailable. Also, it is likely that a pharmacist in an emergency clinic will encounter preexisting medication errors; that is, patients who were perhaps prescribed suboptimal treatment regimens before the disaster itself. An especially important challenge in disaster clinics is the case of a victim who either needs or requests pain medication. Pain medications are in short supply and tightly controlled after mass disasters, and drug-seeking behavior is not uncommon. Pharmacists have considerable expertise to offer through consulting on such cases. and stored properly in order to be of use. This was a monumental task for pharmacists in the area and would likely occur again in a future mass disaster. Several challenges may emerge. First, some donated medications may be unsafe, perhaps because they have expired or have not been transported properly. Identifying these and disposing of them safely is difficult. Second, the pharmacist may encounter a large supply of short-dated drugs. These would need special attention to ensure that they are used effectively and safely. Third, the R.Ph. in a disaster situation should expect to find that there are large supplies of unneeded medications donated as well. These need to be organized and stored as well, yet the volume of esoteric or unneeded medication can be a source of frustration. Fourth, over-the-counter medications may be donated in large volume as well and these are often sorely needed throughout the disaster area. The safe storage of medications can be challenging in the absence of climate control, electricity to run refrigeration units, potable water, and the like. For example, tetanus vaccine needs to be stored at a low temperature but should not be frozen. Storing the vaccine in a cooler with ice could result in the vaccine’s becoming frozen; freezing tetanus vaccine has been shown to decrease its potency. Dispensing medications is another challenge. Often, bottles, child-proof containers, labels, etc. are not available. Pharmacists may be forced to improvise yet still dispense medication within the guidelines of local, state, and federal laws. In Mississippi after the hurricanes, pharmacists used air-tight plastic sandwich bags, name tag labels, and black markers to provide medications to patients. There are some medications that put the clinic and pharmacy at risk of criminal activity. Security is a major concern if the pharmacy is to store opiates, hypnotics, anxiolytics, or other medications prone to abuse. Without dedicated, continuous law enforcement protection, it may be unwise to store such medications at an emergency pharmacy. Some emergency clinics in post-Katrina Mississippi posted signs stating “Free Clinic—no pain medication here!” DMATs and other government-supported pharmacies maintain armed security, so patients may be referred there. Mobile outreach Implementation of temporary pharmacies to provide Rx refills to victims Medications are sometimes essentially “dumped” into disaster areas. In Mississippi after the 2005 hurricanes, donated medications arrived to the area in large boxes and bags, often alongside clothing, food, toiletries, etc. These donated medications had to be checked, sorted, After a large-scale disaster, it may be unrealistic to expect that all victims in need find their way to emergency clinics. Further, some victims who merit medical attention may not seek it out, because they are attending to other more emergent needs (such as procuring food, water, shelter, and clothing). Pharmacists can assist in bringing care to victims be-

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Drug Topics - October 8, 2007 Latebreakers Latebreakers in Depth Letters Rx Care Community Practice JP at Large 150 Years of American Pharmacy Hospital Practice Are You Getting Pharmacy's Message Across? Self-Care Government and Law Legal Q&A The Pharmacist as First Responder in Disaster Relief Technology Update New Products Advertisers Index Statement of Ownership Classified Viewpoint

Drug Topics - October 8, 2007

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