NWN Push Partner Plan

Transcription

1 NWN / Public Health Push Partner Initiative NWN Push Partner Plan Plan for the Distribution of Medication to NW Natural Employees in a Public Health Emergency February 10, 2010 (Updated July 9, 2010)

2 Table of Contents Table of Contents... 2 Plan Description and Scope... 3 Overview of the Process... 3 NWN Staff Roles and Responsibilities... 4 Notification of Employees... 6 Plan Specifics... 6 Contact Information... 7 Attachments... 8 Sample POD layout and traffic flow... 8 Job Action Sheet - Push Partner Coordinator... 9 Job Action Sheet Private POD Manager Job Action Sheet Greeter/Educator Job Action Sheet Screener Job Action Sheet - Dispenser Job Action Sheet Medical Evaluation Medication Labels (sample) Staff Instructions (sample) NWN Contact and POD Resource Sheet Sample Drug Information sheet (sample for exercise; M&M Nutrition Sheet) Client Instructions (sample for exercise) Point of Dispensing (POD) Signage... 20

3 Plan Description and Scope The Push Partner Program Agreement, established through the Cities Readiness Initiative, is designed to provide prophylaxis medication to NW Natural (NWN) personnel and their families in the event of a region-wide health emergency such as an anthrax attack or other event which would require immediate dispensing of medication to a large population. This agreement with Public Health partners will enhance the rapid distribution of life-saving medications to NWN employees and their families, and ease the burden on the public health distribution system. NWN has signed an agreement with the Push Partner Program to allow NWN personnel to establish a Point of Dispensing (POD) in various NWN facilities to administer such medications. Most events requiring mass prophylaxis are regional in nature and may affect one or more NWN facilities. The NWN Health Emergency Coordination Team (HECT) is responsible for implementing and executing this plan. Specific roles within the HECT have been assigned for plan execution. Roles and responsibilities for staff are outlined in Job Action Sheets attached to this plan. Overview of the Process In the event of plan activation, the following will be the course of events: 1. Public Health officials will announce a public health emergency and notify the NWN Push Partner Point of Contact (POC) via or telephone. The current NWN Push Partner POC is Robbie Roberts. See NWN Contact and POD Resource Sheet (attachment to this plan) for contact information. 2. Upon concurrence of NWN, the NWN / Push Partner agreement will be activated. 3. The POC will notify and assemble the NWN HECT to meet and discuss strategy for execution of this plan. 4. The NWN Push Partner Coordinator or designee will contact and coordinate execution of this plan with NWN Push Partner physician, Dr. Carole Gunn with whom NWN has an informal case by case contract.

4 5. Public Health will send required paperwork (intake forms, etc.) and notify NWN staff when and where to pick up medication. 6. NWN personnel pick up medications from Public Health as directed. 7. NWN personnel establish a POD at a NWN facility (OPS and/or Resource Centers in affected areas). 8. NWN staff will prepare (gather, copy blank forms, maintain and return to Public Health) all paperwork and provide proper accounting for medications received / dispensed. 9. NWN staff will receive just in time training to screen medication recipients and dispense medication. 10. NWN staff will process, screen, and dispense medication to NWN employees and family. 11. NWN staff will return intake (screening) forms and unused medications to Public Health as directed. NWN Staff Roles and Responsibilities NWN staff includes: 1. Health Emergency Coordination Team (HECT) The NWN HECT (composed of members from Safety, Facilities, HR, Corporate Communications, Risk, and Business Continuity and Security) will be responsible for this plan, communication to internal and external stakeholders, and the implementation and execution of the Push Partner agreement when requested by Public Health. HECT members are trained and will provided required Just-in-Time training to additional staff. 2. Push Partner Coordinator Coordinate and supervise the overall Push Partner effort at NWN. 3. POD Manager Supervise and coordinate the activities of the POD staff. 4. Greeter / Educator Answer questions and educate clients as appropriate for the event and ensure that only NWN employees are allowed into the POD. 5. Screener Conduct initial screening of medical screening form for contraindications and refer client to Medical Evaluator is required. 6. Dispenser

5 Ensure completion of intake forms, screen for contraindications, dispense appropriate medication, provide educational materials and maintain proper documentation. 7. Medical Evaluator (physician or medical professional) Assess contraindications, determine appropriate medication and/or refer to a physician (if necessary). 8. NWN Resource Center Supervisors (when required) Assist NWN HECT and Push Partner staff in establishing and operating POD at a NWN Resource Center NOTE: Additional staff from NWN will be required in order to adequately establish and operate a POD. For example, a minimum of 14 employees are required and will be selected at the time of the event to operate a POD at One Pacific Square (OPS). These employees will receive Just-in-Time training as required from HECT members. In the event of a wide-spread incident, several NWN facilities could be used as PODs for NWN employees and their families. Resource Center Supervisors will be responsible for assisting the NWN Push Partner Coordinator Resources: The following documents provide a description of roles and responsibilities and specific information for NWN staff establishing and operating a NWN POD and are attached to this plan. a. Job Action Sheets These documents outline the roles and responsibilities of all NWN Push Partner staff members. Upon implementation of this plan, Job Action Sheets will be provided to all staff members as appropriate. b. Staff Instructions Staff instructions provide specific duties in a checklist format for required actions. c. NWN Contact and POD Resource Sheet This document identifies the NWN Point of Contact and Alternate (Push Partner Coordinator) and provides a checklist for useful supplies, etc. in setting up the NWN POD. d. Sample POD Layout and traffic flow This drawing provides a typical layout for a POD. Note that client flow through the POD, from intake to departure is one-way traffic. Also note the importance of providing a secure location for the storage and actual dispensing of the medication.

6 Notification of Employees In the event this plan is activated, the HECT will meet and coordinate the NWN internal employee notification process. Corporate Communications will take the lead in this effort. Time is of the essence in this task. All available methods will be used including the MIR3 notification system, NWN Employee Emergency Information Hotline, The Hub, and direct phone calls to identified Resource Center Supervisors. Prior to releasing any information to employees regarding the emergency, the HECT will make decisions regarding where and when to set up a POD at a NWN facility. This information should be released to those employees who are affected by the public health emergency. If for example, the health emergency is in the City of Portland, employees in outlying Resource Centers would not necessarily be offered medication. Close cooperation and coordination with Public Health officials from the affected area must be maintained to ensure the target group of employees and family members (and no others) are served. Plan Specifics The execution of this plan will be coordinated with staff from Cities Readiness Initiative / Public Health and with Dr. Carole Gunn (NWN contract physician) in order to ensure a pragmatic response to the implementation of the Push Partner agreement. The following is a general outline for the flow of an actual event. 1. An event will be initiated by a call from Public Health (Cities Readiness Initiative staff member) to announce a health emergency involving a public health emergency (i.e. Anthrax attack). Public Health will notify NWN that antibiotics are indicated to prevent illness and inform NWN where to pick up the medication. Public Health will contact the NWN Push Partner Coordinator as indicated on the NWN /Push Partner Agreement contract. 2. The NWN Push Partner Coordinator will notify the HECT to assemble and will brief the team regarding the situation. Decisions will then be made regarding individual roles for activating the POD. All staff members will be given a copy of the Job Action Sheets and one member will be selected to actually pick up the medication and required documentation from Public Health. The NWN Push Partner POD Manager will coordinate POD activation and medication dispensing with the NWN contract physician, currently Dr. Carole Gunn. 3. While the medication is being obtained, the remainder of the HECT will:

7 Set up the POD in the designated NWN facility, place signs to establish the flow of clients through the POD and set up tables, chairs, etc. A sample POD flow chart and signs are included in the attachment section of this plan. In addition, Just-in-Time training will be provided to selected staff members. Communicate to all employees via immediate voic , Employee Emergency Information Line, The Hub, company-wide , etc. information regarding the emergency and the steps employees need to take to obtain medication for themselves and their families. This is a time-critical task. Make sufficient (+/- 500) copies of required forms which have been sent by Public Health. Inventory control is critical to the process. Security and accountability for all medication is required. Note that all unused medication and completed intake forms are to be returned to Public Health at the completion of the distribution from the POD or disposed of as directed by Public Health. Contact Information NW Natural: Name Push Partner Coordinator (o) (c) (e) NW Natural: Name- Push Partner Deputy Coordinator (o) (c) (e) NW Natural: Name- NWN Physician (contract) (o) (f) (e) Washington County Public Health: Cristin Corcoran Program Specialist (o) (e) Multnomah County Public Health: Name Emergency Preparedness (o) (c) (e)

8 Attachments Sample POD layout and traffic flow This is an example for the 4 th Floor Hospitality Room (Center and West) at One Pacific Square (OPS). A similar flow pattern should be developed for other NWN facilities. This NWN POD requires a minimum of fourteen (14) staff members to operate. Signs must be produced and posted to clearly mark the flow of the POD for the clients. 3. Clients fill out Intake forms 4. Screening table 3 Secure space for meds Tables Rover 1 staff To screening 5. Dispensing & storage of Meds 5 staff 2. Check in Table 3 staff Exit 6. Medical Evaluator Entrance 1. Greeter table 1 staff Medical Evaluator. If possible, station in a separate, private room.

9 Job Action Sheet - Push Partner Coordinator Position Assignment: Push Partner Coordinator Staff Name: Mission: Coordinate the overall Push Partner effort at your agency. Get Ready Read this entire Job Action Sheet Receive notification from local Public Health authority that the Push Partner Registry is activated (via /phone/website) Obtain contact information for the Public Health supervisor to whom your organization reports Review your Push Partner Dispensing Plan Inform employees that the Plan is activated and assign tasks Provide orientation and position training to those assisting the dispensing effort Prepare the site; get basic supplies and vehicles ready Communicate with your employees and clients that you will be dispensing medications Get Medications Send an authorized staff member to the Push Partner Distribution Site to pick up medications Lock medication in secure location away from extreme heat or cold; inventory initial supply Copy dispensing materials (intake forms, drug information sheets, others) Dispense the Medications Monitor dispensing of medications both on and off-site Dispense medication to staff who are responsible for dispensing to others, first Ensure appropriate screening and drug dispensing Ensure distribution of drug information sheets Request additional medications from the local Public Health authority if initial estimates are insufficient Update your Public Health supervisor with distribution status and forecast estimates according to the prescribed schedule or as needed Follow up Return all intake forms and inventory control forms to Public Health JOB ACTION SHEET DISPENSER

10 Job Action Sheet Private POD Manager Position Assignment: Private POD Manager You report to: Private POD manager Staff Name: Mission: Coordinate the PRIVATE POD effort at your agency. Get Ready Read this entire Job Action Sheet Receive notification from local public health authority that your Private POD is activated (via /phone/website) Obtain contact information for the public health liaison supporting your organization Review your Private POD Dispensing Plan Inform your organization that the Private POD is activated and assign tasks Provide orientation and position training to those assisting the dispensing effort Prepare the site, obtain basic supplies and get vehicles dispatched (if required) Communicate to your agency that you will be dispensing medications Get Medications Send an authorized staff member to the Private POD Distribution Site to receive medications Lock medication in secure location away from extreme heat or cold; inventory initial supply Copy dispensing materials (medical screening forms, drug information sheets, others) or post to website for internal downloading by staff. Dispense the Medications Monitor dispensing of medications Dispense medication to Private POD staff first Ensure appropriate screening and drug dispensing Ensure distribution of drug information sheets Request additional medications from the local public health authority if required Update your Public Health liaison with dispensing status and forecast estimates according to the prescribed schedule or as needed Follow up Return all medical screening forms and inventory control forms to Public Health liaison IF YOU ENCOUNTER A PROBLEM, CONTACT YOUR PUSH PARTNER COORDINATOR OR PUBLIC HEALTH LIAISON IMMEDIATELY

11 Job Action Sheet Greeter/Educator Position assignment: Greeter/Educator You report to: Private POD Manager Staff name: Mission: To answer questions and education clients as appropriate for the event. Get Ready Read this entire Job Action Sheet Receive assignment, orientation and position training from Private POD Manager Familiarize self with Private POD layout, especially noting restrooms, emergency exits and POD flow Make copies of medical screening forms and educational material Set up station with medical screening forms, clipboards, pens and educational material (Fact Sheets) Receive medication for self and family first before dispensing to others; take first dose Dispense the Medications Set up station with appropriate materials Greet clients as they enter and provide necessary medical screening forms, fact sheets, and any other printed material necessary Answer client questions within scope of training and qualifications Direct clients to Screening Maintain adequate supply levels. Provide routine reports to Private POD Manager Report disruptive client behavior to team leader Performs other duties as assigned by Private POD Manager Follow Up Brief replacement as necessary Return all materials to Private POD Manager Demobilize station, as directed by Private POD Manager Participate in after-action meetings, as directed Sign-out after approval from Private POD Manager IF YOU ENCOUNTER A PROBLEM, CONTACT YOUR PRIVATE POD MANAGER IMMEDIATELY

12 Job Action Sheet Screener Position Assignment: Screener You report to: Private POD manager Staff Name: Mission: Conduct initial screening of medical screening form for contraindications. Get Ready Read this entire Job Action Sheet Receive briefing from Private POD Manager Familiarize self with screening forms and Fact Sheets procured from greeters Receive medication for self and family first before dispensing to others; take first dose Duties Review client medical screening form for completeness Scan medical screening form for contraindication if a yes answer is answered on any portion of the form, direct to Medical Evaluation; otherwise direct to Dispensing Direct clients with medical questions that can not be answered from the Fact Sheets to Medical Screening Follow up Brief replacement as necessary Debrief with team leader Demobilize station, as directed by Private POD Manager Participate in after-action meetings, as directed Sign-out after approval from Private POD Manager IF YOU ENCOUNTER A PROBLEM, CONTACT YOUR PRIVATE POD MANAGER IMMEDIATELY

13 Job Action Sheet - Dispenser Position Assignment: Dispenser You report to: Private POD manager Staff name: Mission: Set up POD, ensure completion of intake (screening) forms, screen for contraindications, dispense appropriate antibiotic, and provide educational materials. Get Ready Read this entire Job Action Sheet Receive assignment from Private POD manager Receive orientation and position training from Private POD manager Familiarize self with screening and dispensing process (including algorithms) Set up station, or prepare supplies needed if dispensing in the field Receive medication for self and family first before dispensing to others; take first dose Dispense the Medications Assure that each client completes an intake form (sometimes called a screening form) Weigh children as needed and note weight on intake form Review form for contraindications. If no contraindications, dispense as directed. If contraindications exist, follow algorithms for dispensing Depending upon the severity of the disease and the regimens available, clients that may be at risk for drug interactions may need to be instructed to alter their dosage of another drug; contact clients physician for instruction. Remove lot # labels from pill bottles or label sheet. Put one on clinic intake (screening) form and one label on drug information sheet (or write lot # on both forms) Fill out information on prescription label and adhere to pill bottle or to drug information sheet. Dispense appropriate medication and record medication dispensed on intake (screening) form, initial the intake (screening) form and retain form Give client drug information sheet Remind client to complete the entire dosing regimen Provide distribution status updates to your Private POD manager as she/he requires Follow Up Return all materials to Private POD manager including intake (screening) forms and any unused medication IF YOU ENCOUNTER A PROBLEM WHILE DISPENSING, CONTACT YOUR PUSH PARTNER COORDINATOR IMMEDIATELY

14 Job Action Sheet Medical Evaluation Position Assignment: Medical Evaluation You are or you report to: Medical Personnel Coordinator Staff Name: Mission: Assess contraindications and determine appropriate medication. Get Ready Read this entire Job Action Sheet Receive briefing from Private POD Manager Familiarize self with screening forms and Fact Sheets procured from greeters Receive medication for self and family first before dispensing to others; take first dose Duties Review client medical screening form for contraindications Determine appropriate medication based on algorithms and annotate on medical screening form Direct client to Dispensing Follow up Brief replacement as necessary Debrief with team leader Demobilize station, as directed by Private POD Manager Participate in after-action meetings, as directed Sign-out after approval from Private POD Manager IF YOU ENCOUNTER A PROBLEM, CONTACT YOUR PRIVATE POD MANAGER IMMEDIATELY

15 Medication Labels (sample) MULTNOMAH COUNTY PUBLIC HEALTH Portland, Oregon 24 hour Info line: XXXXXXXXXXXX (would be available in an ACTUAL emergency) Date: MULTNOMAH COUNTY PUBLIC HEALTH Portland, Oregon 24 hour Info line: XXXXXXXXXXXX (would be available in an ACTUAL emergency) Date: Patient Name: MULTNOMAH COUNTY PUBLIC HEALTH Portland, Oregon 24 hour Info line: XXXXXXXXXXXX (would be available in an ACTUAL emergency) Date: Patient Name: MULTNOMAH COUNTY PUBLIC HEALTH Portland, Oregon 24 hour Info line: XXXXXXXXXXXX (would be available in an ACTUAL emergency) Date: Patient Name: MULTNOMAH COUNTY PUBLIC HEALTH Portland, Oregon 24 hour Info line: XXXXXXXXXXXX (would be available in an ACTUAL emergency) Date: Patient Name: MULTNOMAH COUNTY PUBLIC HEALTH Portland, Oregon 24 hour Info line: XXXXXXXXXXXX (would be available in an ACTUAL emergency) Date: Patient Name: MULTNOMAH COUNTY PUBLIC HEALTH Portland, Oregon 24 hour Info line: XXXXXXXXXXXX (would be available in an ACTUAL emergency) Date of Event : Patient Name: MULTNOMAH COUNTY PUBLIC HEALTH Portland, Oregon 24 hour Info line: XXXXXXXXXXXX (would be available in an ACTUAL emergency) Date: Patient Name: Patient Name:

16 Staff Instructions (sample) The following is the step-by-step procedure for processing a client from arrival to departure at the remote Point of Dispensing (POD); 1. Client fills out Point of Dispensing Intake (screening) Form for self and entire family. 2. Staff member reviews intake (screening) form and screens for contraindications. a. If issuing drug is contraindicated, refer client to a physician 3. Dispense appropriate medication based on dispensing algorithms a. Write drug lot # or attach drug label to intake (screening) form and drug info sheet b. Initial the intake (screening) form (lower right hand corner) c. Keep intake (screening) form for return to Public Health 4. Give client a drug info sheet 5. Have the client take first dose immediately 6. Keep an inventory of medication received / issued 7. Give status updates to the assigned Public Health supervisor as directed 8. Return intake (screening) forms, inventory forms and unused meds to Public Health

17 NWN Contact and POD Resource Sheet Site Name NWN One Pacific Square Site Address 220 NW Second Avenue Portland OR Date of Survey Sq. Feet Facility Point of Contact Name/Title: Work Phone: MF Robbie Roberts x3556 Access to facility keys? X Yes Home Phone: No r4r@nwnatural.com Cell/Pager: Alternative Point of Contact Name/Title: Diane Lancon Access to facility keys? X Yes No Work Phone: x5427 Home Phone: d6c@nwnatural.com Cell/Pager: Adequate Parking* (ADA accessible from parking lot to clinic area) Facility Information Separate Entrance/Exit* Lockable storage area for medications* Adequate HVAC capacity* Telephone Availability Refrigeration for medication (if necessary) ADA Accessible restrooms Nearby break rooms for staff Hand washing facilities Electricity Backup Power Source Tables and chairs Clipboards Suggested Equipment and Supply List Janitorial supplies (i.e. toilet paper, paper towels, soap, etc) First Aid Kit with equipment for measuring vital signs File folders and file boxes Extension cords Gloves latex and vinyl Notepads Wastebaskets and trash bags Envelopes or small bags (to hold multiple bottles of medicine) Paper Facial tissues 1-2 cots (if available) Pens (prefer blue/black ink) Hand sanitizer Automated External Defibrillator (AED) Staplers TV/VCR (if available) (should only be used with proper training) Computer and printer Signs to identify each station: Greeting/Registration Screening Dispensing List of emergency numbers: Local Public Health Police Emergency Medical Services

18 Sample Drug Information sheet (sample for exercise; M&M Nutrition Sheet) Note: This sample sheet represents the information sheet which would be issued along with medication in the event of an actual distribution of antibiotic drugs.

19 Client Instructions (sample for exercise) First, let me thank you for participating in this important exercise of our plan to ensure prompt distribution of lifesaving medication in the event of a public health emergency. It is critical to train and practice in order to be fully prepared for an actual emergency. Your participation in this exercise should take no more than 30 minutes. You will be notified of a health emergency and directed to receive a supply of appropriate medication for you and your family members. Once you arrive at the NWN Point of Dispensing (POD) on the 4 th Floor at OPS, simply follow the directions below: 1. Follow the signs and enter the POD (OPS, 4 th Floor Hospitality Room) 2. Follow directions of the staff and fill out the Intake (screening) Form for self and entire family. NOTE: Please make up a name for yourself and family members however, answer the screening questions honestly. All forms will be destroyed at the end of the exercise. 3. A NWN Staff member will review your intake (screening) form and check for drug contraindications. a. If drug to be issued is contraindicated, you will be referred to a physician b. You will still receive medication for your family members, if appropriate 4. Once approved by the NWN Staff, follow the signs to receive your supply of medication a. You will receive sufficient medication for you and your family b. You will receive an information sheet regarding the medication c. You will be directed to take your first dose of medication immediately NOTE: M&M candies will be used to represent medication. You will be issued sufficient M&Ms (medication) to supply you and your family members for a full course of treatment. 5. You might be asked to go through the line twice in order to provide sufficient training for the staff. If so, please fill out another Intake (screening) Form.

20 Point of Dispensing (POD) Signage The following link will display helpful signage for the POD. Select and print signs as required to ensure smooth traffic flow through the POD. H:\Exercises\Push Partner Exercise\Signs.pdf