During disasters supply chain vulnerabilities such as power, transportation and communication may affect the delivery of medications and medical supplies, and hamper the ability to deliver critical care services. Disasters also have the potential to disrupt information technology (IT) in healthcare systems, resulting in interruptions in patient care, particularly critical care, and other healthcare business functions. The suggestions in this chapter are important for all of those involved in a large scale disaster or pandemic with multiple critically ill or injured patients including front line clinicians, hospital administrators, and public health or government officials.
The Business and Continuity of Operations Panel followed the American College of Chest Physicians’ (ACCP) Guidelines Oversight Committee’s methodology in developing key questions regarding medication and supply shortages, and the impact disasters may have on healthcare IT. Task force members met in person to develop the13 key questions felt to be most relevant for Business and Continuity of Operations. A systematic literature review was then performed for relevant articles and documents, reports, and grey literature reported since 2007. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions utilizing a modified Delphi process.
Eighteen suggestions addressing mitigation strategies for suppy chain vulnerabilities including medications and IT were generated. Suggestions offered to hospitals and health system leadership regarding medication and supply shortages include: 1) purchase of key medications and supplies from more than one supplier, 2) substituted medications or supplies should ideally be similar to those already used by an institution’s providers, 3) inventories should be tracked electronically to monitor medication/supply levels, 4) consider higher inventories of medications and supplies known or projected to be in short supply 5) institute alternate use protocols when a (potential) shortage is identified, and 6) support government and non-governmental organizations in efforts to address supply chain vulnerability. Healthcare IT can be damaged in a disaster, and hospitals and health system leadership should have plans for urgently reestablishing local area networks. Planning should include utilizing portable technology, plans for providing power, maintenance of a patient database that can accompany each patient, and protection of patient privacy. Additionally, long-term planning should include prioritizing servers and memory disk drives, and possibly increasing inventory of critical IT supplies, in preparedness planning.
The provision of care to critically ill or injured during a disaster or pandemic is dependent on key processes such as the supply chain and infrastructure such as IT systems. Hospitals and health systems will help minimize the impact of medication and supply shortages with a focused strategy using the steps suggested. IT preparedness for maintaining local area networks, functioning clinical information systems, and adequate server and memory storage capacity will greatly enhance preparedness for hospital and health system clinical and business operations.