Point of Dispensing: The Spectrum

Leah Matteson MS, RN, CNS

New York State Department of Health Bioterrorism Epidemiology Program

lmm20@health.state.ny.us

518-486-2151

Point of Distribution Standard Operating Guide

n  CD n  Compilation of Best Practices n  Uniformity of PODs across the State n  Counties and Healthcare Organizations n  Placed on Commerce System-HIN-SNS n  Ongoing Working Plan n  Able to individualize specific components

Point of Distribution Standard Operating Guide

n  Guide n  Attachment List and Descriptions of

Attachments n  Template Version 1 and 2 n  Attachment 19-Medication Information

State POD

Purpose

1.   Develop Capacity to Provide Prophylaxis to Critical Infrastructure Personnel

2.   Provide support to LHDs and Healthcare Facilities

Dispensing – The Most Critical Action

What is a POD?

n  It is a place to dispense prophylactic (disease preventing) medications or vaccines to large numbers of people as rapidly as possible

n  It is not a place for treating the ill!

Goal of Dispensing Program

n  Provide medication to X population in Y time

n  Decrease the pool of individuals who may get ill n  Provide Information

Phases of a Dispensing Program

n Phase 1 n  Notification and recall of critical infrastructure

n Phase 2 n  Prophylaxis of critical infrastructure and families

n Phase 3 n  Set up of POD network

n Phase 4 n  Public Notification and Opening of PODs

Issues to Consider When Designing Your Dispensing Campaign

n  Time n  Population n  Staffing n  48-hour goal n  Number of PODs and Uniformity of PODs n  Treatment Center Coordination n  Push and Pull Methods

The POD should be the foundation of your dispensing campaign.

Determining the Number of PODs

TP ÷ (HPP-S) ÷ PPH = PODs n TP = total population requiring prophylaxis n HHP = the number of hours to provide

prophylaxis n S = the time required to set-up the clinic n PPH = persons per hour

Assumptions with this Formula

n The PODs operate 24 hours a day n The population is equally distributed n The PODs perform at 100% capacity at all

times n A constant flow of people enter and leave n Staffing is constant, trained and adequate

POD Site Selection

n  Site selection n  Walk-to accessibility by public n  Under cover/out of weather n  A/C and heat/AEDs n  Adequate bathrooms, water, electricity n  Ample parking n  Served by mass transit n  Geographically dispersed

POD Site Selection - 2

n  Hours of Operations n  Opening of all sites

n  Security n  Ensure that POD workers are aware of security concerns n  Controllable entrance and exit sites

n  Based on n  Epidemiology of event n  Population distribution

Pre-Event Policy Issues

n  Adult pick-up for family members and information required for that

n  Medication Receipt/Signature Authority/Prescribing Agent/Pediatric Care

n  24-hour phone number n  Data Collection n  Worried Well n  Family Movement n  Unaccompanied Minor

Pre-Event Policy Issues - 2

n  Hours of Operation n  Prophylactic Regimen n  Who can dispense? n  Segmented vs. non-segmented n  MOU/MOA n  Critical Infrastructure n  Medication Caches for First Responders

Spectrum of Dispensing

n Cities Readiness Initiative (CRI)

n  The goalposts have moved….. U.S. intelligence agencies assess that a large-scale aerosol release of anthrax is well within the technical capability of al-Qa’ida and other foreign or domestic terrorist organizations.

Hours

Days

DELAY in Detection

Time is Critical

Shorter (1-2 Days)

Longer (4+ Days)

DURATION of Campaign

POD Network Pull to Sites Push to Sites Mobile Dispensing Sites Drive Through Sites Postal Option

Spectrum of Dispensing

People come to where the pills are

Taking the pills to where the people are

The “Weights” of Dispensing

Patient Education

Legal Requirements

Parking

Epidemiology Security

Patient Tracking

Clinical Accuracy

Mental Health

Staffing

Screening/ Triage

IND

Medical Records

Transportation

Quality Control

Inventory Storage

Hours of Operations

Registration

Labeling

Length of Regimen

Balancing the Weights of Dispensing

n  Theory of Dispensing

D → W → P

POD Components/Stations

n  Command & Control ICS -Remain at Command Center

n  Greet-Provide Forms-Provide Education n  Triage-Fast Track - Green/Red

n  move families together!

n  Medical Evaluation n  Dispensing/Pharmacy n  Exit/Form Collection n  Remember-Time and Efficiency!

POD Components/Stations

Med

ical

Eva

luat

ion

Triage

Command andControl

Pharmacy

Dispensing

Web Site References

n  SNS Version 10 https://commerce.health.state.ny.us/hpn/hanweb/sns/sns.shtml

n  BERM http://www.ahrq.gov/research/biomodel/index.asp

http://www.hospitalconnect.com/aha/key_issues/disaster_readiness/resources/vaccinationmodel.html

Spectrum of Dispensing

QUESTIONS / COMMENTS