The rain that hasn't let up in the last three days is causing flooding in your healthcare facility's supply room and is threatening to ruin a good portion of your inventory.
An ice storm is wreaking havoc on your city or town's electrical grid and has caused widespread outages, which has eliminated your ability to order supplies electronically.
Hurricanes. Tornadoes. Blizzards. Earthquakes.
These are all "acts of God" that can happen to your healthcare facility at a moment's notice, and hospital leaders need to be prepared for the ensuing problems. A lack of planning could result in the loss of supplies, insufficient supplies, or even worse: compromised healthcare services and patient safety.
To be as well prepared as possible, here are some important tips.
Conduct a Risk Assessment
It's important to understand both external and internal vulnerabilities. Externally, make sure every one of your suppliers has an action plan in place for disaster recovery. Both the hospital and supplier should know exactly who to contact in the event of a disaster, and the supplier's plan needs to include alternate methods of communication to account for possible lost phone or Internet service. Suppliers also need to have alternate delivery plans in place in case roads are closed or conditions prevent normal delivery methods.
Hospital leaders can save a lot of time and resources by knowing which suppliers will and will not be able to deal with certain disaster conditions. Conversely, hospital staff can save themselves from the logistical problems associated with over-ordering supplies during a disaster because it wasn't clear which suppliers would be able to meet delivery demands.
Internally, ensure your supply chain and the systems that support it are part of an overall recovery plan. If this isn't the case, put a plan together immediately. Developing a comprehensive recovery plan is time consuming and demands a vision for operational department excellence.
The Association for Healthcare Resource and Materials Management and the Health Industry Distributors Association offer appropriate reference materials and starting points for emergency preparedness. However, to be truly effective, disaster planning requires customization and organization-specific information. Possible vulnerabilities that need to be checked include a facility's reliance on technology, geographical location, and proximity of vendors.
Employ Risk-Minimizing Strategies
Identifying and understanding a facility's weaknesses and vulnerabilities is half the battle to being prepared in the event of a catastrophic event. Every hospital will have different areas of concern, but one common operational weakness is the physical location of a facility's materials department. Many hospitals have a materials storage location in the basement, a very susceptible location for flooding--a lesson learned from Hurricane Katrina. Therefore, supplies, including generators and back up generators should be kept in an above-ground location.
From a technical standpoint, consider using an outsourced vendor to help after the disaster occurs. Such a company can reload systems, implement proper paperwork to revert to a manual system, and help put a plan in place to quickly move the supply chain around, if that becomes necessary.
Downtime Strategies and Procedures
Planned downtime is a common occurrence with the goal of ensuring maximum system performance and preventing future system failures. However, the game changes when a catastrophic event occurs and there's unplanned or emergency downtime. Review your downtime policies on a regular basis to ensure they're updated and current.
An essential element to assist in an emergency downtime action plan is to conduct a catastrophic event simulation. Hospital leaders should conduct run-throughs to better understand what procedures would be necessary if systems were to go down. This type of planning will make developing corresponding policies much easier.
A positive outcome from Katrina and the aftermath of 9/11 is that more and more facilities are conducting simulations.
Prepare "Just-in-Case" Inventories
Many healthcare facilities have just-in-time inventories, or day-to-day supplies that the facility needs to function on a normal level, such as Band-Aids[R], gauze, tongue depressors, and standard surgical supplies.
Just-in-case (JIC) inventories, however, are those critical supplies that allow hospitals to exist after a catastrophic event. The type of JIC supplies that you should have in place will vary by geographic location. For instance, leaders of a community hospital in the Midwest, which would be susceptible to tornadoes, need to make sure their JIC inventories include bottled water, ready-to-eat meals, and flashlights, whereas leaders of an urban or large medical center, which might be more likely to suffer a terrorist attack, should make sure that JIC supplies include things such as gas masks and radiation suits.
In the Absence of Electricity and Connectivity
No matter what the catastrophic event, loss of electricity is probably the most common side effect that a healthcare facility will endure. Since we all rely heavily on technology, it's critical to assess nontechnical readiness. It is essential that staff understand how to revert to a manual process if power is lost.
Make sure there's a back-up plan that includes a printed catalog, or a record of necessary universal product code numbers, so that orders can be manually placed for supplies. Additionally, it's necessary to calculate the time it would take to recover from not having access to the technical and electronic tools that hospital staff normally use.
Avoid Selecting Suppliers Solely Based on Close Proximity
It's not uncommon for small, community hospitals to choose local suppliers to reduce shipping fees. Yet from a disaster readiness perspective, that can be very risky. If a facility were impacted by a disaster, then the local supplier could be impacted as well.
No matter what the size of the healthcare facility, leaders should make sure a secondary, out-of-region supplier is in place--in addition to having local vendors. This will reduce the likelihood of being unable to receive supplies because vendors have been impacted by the same catastrophe that has hit the hospital.
Proper Insurance for Loss of Materials
Most healthcare facilities have insurance, but it's important to have adequate insurance to recoup inventories lost in a disaster. Make sure your insurance pays replacement costs, and that your facility is covered by business interruption insurance.
This insurance covers the loss of materials and the costs associated with storing supplies in an alternate facility or trailer. Progressive healthcare facilities already have separate buildings for materials management and IT.
Remember the "People" Factor
It's important to understand that disaster recovery plans are designed for situations that are more or less controllable. While it's important to have such a plan, there will be disasters that are beyond control, such as the recent crushing tornado that destroyed most of Sumter Regional Hospital in Americus, Ga.
Remember to use common sense and take into consideration the "people factor." Some employees' homes might be severely impacted by a disaster, or road conditions could make commutes difficult. In those cases, don't expect all employees to be available to work.
Most important, recognize that the odds of a catastrophe to your healthcare facility are more likely than you might think, and being well prepared for whatever comes your way will help you to maximize the effectiveness of your supply chain management.
Ralph Fargnoli, Jr. is president and CEO of Beacon Partners, Inc., a consulting practice that deals in IT, strategic, and operations issues within the healthcare industry (rpf@beaconpartners.com).
RELATED ARTICLE: At a Glance
* Develop a comprehensive recovery plan that encompasses the supply chain.
* Make sure every one of your suppliers has an action plan in place for disaster recovery.
* To avoid flooding-related losses, ensure that supplies, including generators and back-up generators, are stored in an above-ground location.
* Review your downtime policies on a regular basis to ensure that they are updated and current.
* Conduct run-throughs to better understand what procedures would be necessary if systems were to go down.
* Stock a just-in-case inventory, or critical supplies that allow your hospital to exist after a catastrophic event.
* Make arrangements with secondary, out-of-region suppliers in the event that your local suppliers are impacted by a catastrophe.
* Ensure that your insurance pays replacement costs, and your facility is covered by business interruption insurance.
RELATED ARTICLE: Disaster Supply Core Formulary
Formularies for the type of supplies that hospitals need to have on hand have been put together through a partnership among the Association for Healthcare Resource & Materials Management, the Health Industry Distributors Association, and the Health Industry Group Purchasing Association. The organizations emphasize that the amount of products needed will depend on the individual hospital. The formulary for core products is listed here. The remaining formularies--those for dealing with chemical, biological, radiological, nuclear, and explosive disasters, as well as formularies for pediatrics and staff--can be downloaded at www.ahrmm.org.
Instruments/Equipment
Blood pressure cuffs, disposable blood pressure manometer
Batteries: AA, AAA, B, C, 1 gross per incident
Artificial resuscitator bag, 10% child, 5% infant
Sharps: NDL/Syringes
10cc needless syringes
60cc needless syringes
3cc 23G1" safety syringes
3cc 22G11/2" safety syringes
TB syringes
Insulin syringes
Blunt plastic cannula
Level lock cannula
18G 11/2" safety needles
20G 1" safety needles
Sharps container
20G IV start catheter
18G IV start catheter
Winged infusion set 23GA & 25GA
Irrigation Solutions
Normal saline irrigation solution 2000cc
Sterile water irrigation solution 2000cc
IV Access/Supplies
IV start kits
Micro drip tubing
Adult drip tubing
Blood administration tubing
Disposable IV pressure bag
Metri set tubing
Arterial line tubing
IV Solutions
LR 1000cc
NS 1000cc
Central vein catheter kit
Multi lumen central catheter kit
Long arm board
Short arm board
Stopcock
Linen
Disposable sheets
Disposable pillows
Disposable pillow covers
Hand Hygiene
Providine/iodine scrub brushes
PCMX scrub brushes (1 box per 100 capsules)
Patient Personal
Care Supplies
Bath basin
Emesis basin
Facial tissues
Bedpan
Urinal
Belonging bag
Regular soap
Mouth care supplies
Miscellaneous
Sterile lubricant
Alcohol wipes
PVP wipes
Tongue depressors
5 in 1 connectors
Garbage liners
Blood glucose testing supplies
Waterproof markers
Body bag (25 per 100 casualties)
Blank labels/tags
Individual bottled drinking water
Source: Association for Healthcare Resource and Materials Management. Reprinted with permission.
