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.
At the American Society for Healthcare Engineering's 2008 conference in National Harbor, MD, Mills suggested neighboring hospitals get together, compare their MOUs, and collectively make a series of calls to a vendor to test the agreements simultaneously.
Mills told an anecdote about a city water plant that went out of service: Several hospitals in the area had MOUs with a sole vendor to receive 10,000-gallon water bladders as a back-up. At 2 a.m. the next day, a manager at one of the hospitals called the vendor about the bladder and had the item delivered at 6 a.m. The other hospitals called later asking for their bladders, only to find the only available bladder had already gone out, Mills said.
There is much talk these days among hospital emergency planners about the need to engage community partners when developing hospital response procedures. Typically, these partners include police and fire departments and local health departments.
But hospitals should also put vendors on the list of community entities to plan with, particularly when it comes to supply chains. Talking ahead of time with vendors may help eliminate bottle-necks in the demand for supplies when an emergency or H1N1 outbreak occurs.