Educated Guesswork, Pressure on Vendors Help Determine Pandemic Supply Levels

An innate challenge to pandemic planning is tracking supply inventories during a response.

On June 15, The Boston Globe reported that in some cases, hospitals ran into obstacles obtaining necessary supplies to combat early H1N1 cases, such as N95-type respirators and antiviral medications.

Medical center purchasing departments, perhaps worried about the prospects of a long-term H1N1 outbreak, tried to stock up on supplies, which occasionally led to competition among hospitals and even within hospitals to get the orders in first.

"I definitely would not use the word 'hoarding,' but there was aggressive ordering of supplies early on in the outbreak and that caused uneven distribution," Paul Biddinger, MD, told the Globe. Biddinger is associate director of the Harvard School of Public Health Center for Public Health Preparedness in Boston.

Part of the problem stems from the fact there isn't a proven metric to determine how many extra supplies a hospital will need during a pandemic or other emergency. An unscientific approach may help, though, said Marge McFarlane, PhD, CHSP, MS (Risk Control), MS (ENPH), MT(ASPC), founder of Superior Performance Consulting, LLC, in Eau Claire, WI. She spoke recently at HCPro's Hospital Safety Center Symposium in Las Vegas.

McFarlane suggested taking the following approach:

• Determine your hospital's current census
• Figure out the necessary supplies to handle that census
• Consider those same needs if the census suddenly doubled

The Joint Commission's emergency management standards mandate that hospitals document and annually evaluate inventories of resources and assets that might be needed during a disaster. These resources include, but aren't limited to, the following:

• Personal protective equipment (e.g., respirators)
• Water
• Fuel
• Medical and surgical materials
• Pharmaceuticals

For the past year, The Joint Commission has been warning accredited hospitals about limited access to supplies, particularly utilities, during emergency responses. George Mills, FASHE, CEM, CHFM, senior engineer at the commission, often notes his frustration at the lack of realistic utility contingency plans at healthcare facilities.

Memorandums of understanding (MOUs) between hospitals and vendors lay the groundwork for supply and utility back-ups during emergency response. But MOUs may be insufficient when a real disaster strikes, particularly if several hospitals in a region rely on the same vendor for help.