point of dispensing: the spectrum
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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
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