by Timothy K. Glennon R.N., MSN, MBA, CMRP

The first order of business for supply chain professionals is to study pandemic flu and access the many resources available to guide preparedness efforts. "The amount of available information can be a bit overwhelming, but a good place to start is the U.S. Department of Health and Human Services’ Web site ‘Pandemic Influenza Planning’ at www.pandemicflu.gov," said Christopher O’Connor, FACHE, executive vice president of GNYHA Ventures. "In addition, the GNYHA Web site, www.gnyha.org, has a wealth of information on emergency preparedness for healthcare facilities."

The "Pandemic Influenza Planning" site emphasizes evaluating the existing system for tracking available medical supplies in the hospital to determine if it can detect rapid consumption of items such as personal protective equipment (e.g., gloves, masks). "FluSurge" software packages  (www.cdc.gov/flu/flusurge.htm) are also available to project resource demand during an influenza pandemic.

GNYHA’s Senior Vice President and General Counsel Susan Waltman, who coordinates GNYHA’s response to New York City area hospitals’ needs during emergencies and disasters, stresses the importance of communication in effective response to states of emergency. "Timely, accurate, and reliable information is key," she said. "Communication flow among hospitals and all local, state and federal agencies is critical to maintain order, maximize efficiency, and ensure that specific needs are met as quickly as possible."

To accomplish this, GNYHA formed its Emergency Preparedness Coordinating Council, which meets regularly and brings together representatives from healthcare institutions, other provider groups, and federal, state and local health departments and emergency management agencies. Post-9/11, Waltman led GNYHA in developing, in concert with the New York State Department of Health, the nationally recognized Health Emergency Response Data System (HERDS), which enables immediate communication across the entire hospital network, and rapid reporting of key data elements between and among hospitals. HERDS also tracks bed occupancy, staffing, and availability/shortages of supplies.

Interagency cooperation and collaboration at all levels is ensured through the New York City Office of Emergency Management (OEM), which maintains a command center that is activated in the event of an emergency. All relevant local, state and federal agencies have a desk at the OEM command center. As OEM’s hospital agency representative, GNYHA ensures that hospital needs are communicated immediately, and has immediate access to all other agencies that could potentially be involved in any needed response. If bridges are closed into Manhattan, GNYHA can communicate with the New York City Police Department or the transportation agencies to permit critical supply shipments to hospitals. If a power outage occurs at a facility in the Bronx, GNYHA’s OEM representative can walk across the room to alert the Consolidated Edison representative of the emergency. If a hospital in Queens is running low on facemasks or gloves, GNYHA can immediately assess the availability of inventory in other hospitals by calling their respective command centers.

Specific to supply chain support, GNYHA Services/Premier, the regional GPO for member hospitals, is frequently called upon by GNYHA’s OEM representative to help hospitals obtain needed supplies and to alert suppliers of specific needs. Developing regional interagency relationships such as these, with communication systems in place (emergency contact directory, two-way radios, etc.) to facilitate dialogue among them, is critical to a prompt, focused response to states of emergency, including pandemic flu.

Although a controversial strategy, the "Pandemic Influenza Planning" Web site urges hospitals to consider stockpiling enough consumable resources such as masks and other critical items for the duration of a pandemic wave (6-8 weeks). Consumable and durable goods required during a pandemic would include:

Consumable resources

• Hand hygiene supplies (antimicrobial soap and alcohol-based, waterless hand hygiene products)

• Disposable N95, surgical and procedure masks

• Face shields (disposable or reusable)

• Gowns

• Gloves

• Facial tissues

• Central line kits

• Morgue packs

• Needles and syringes for vaccination use

Durable resources

• Ventilators

• Respiratory care equipment

• Beds

• IV pumps

Stockpiling is a challenging issue for many hospitals because they have progressively grown to depend on their distributors for "just-in-time" deliveries, and many have limited storage capacity for additional stock. Also, stockpiling is often discouraged due to fears of hoarding and other potential negative impacts to the supply chain. Still, a gradual "ramp up" of extra quantities for key supplies, spread over several months, seems prudent. It will minimize supply chain disruption while spreading the cost.

Involving the local distributor and key suppliers is critical to any hospital’s disaster preparedness, and communication and collaboration with your local distributor is key to pandemic planning. Don’t be deluded into thinking that if you can’t do everything, you can’t do anything. Talk with your neighboring hospitals. Determine what kind of storage capacity you all have available. Ask questions. Are you using space inefficiently? Do you have excess inventory in non-critical supply categories? If yes, work with your distributors and suppliers to get those stock levels down and free up that space. Build up critical inventory levels gradually, computing need by looking at last year’s volume and by using a tool like FluSurge to anticipate additional volume during the flu wave.

Keep in mind that as you ramp up your volume on highly critical products like face masks and gloves, as of this writing N95 masks are only recommended by the Centers for Disease Control and Prevention for direct patient care situations for patients with known or suspected pandemic flu. Surgical facemasks are acceptable in other patient care situations, and gowns are not required in all circumstances. Clearly, the supply chain executive’s knowledge of the federal pandemic guidelines is critical to making the right decisions on inventory levels. Check these guidelines often, as they are continually revised and updated as new epidemiological information becomes available. The latest information can be found at www.pandemicflu.gov/pla/healthcare/maskguidance.

Also, having surveyed many suppliers on their pandemic plans, we have learned that stockpiling is not something suppliers are individually doing. They are producing to capacity and responding to consumer demand. A gradual increase in demand to build up a reasonable reserve could reduce any panic buying and spot shortages later on.

For durable goods, develop a first-name relationship with your local rental company. Ask if they are developing plans to address a surge in demand. Assess anticipated needs for consumable and durable resources, and determine a trigger point for ordering extra resources. Now is the time to make sure that all durable good inventory is in good repair and maintained appropriately. On the pharmacy side, anticipate needs for antibiotics to treat bacterial complications of influenza, and determine how supplies can be maintained during a pandemic. Don’t forget to gradually stock up on needles and syringes; injectables can’t be given without available injection supplies.

Finally, it’s important to maintain perspective. Speaking as a nurse, I can say with confidence that we have the ability now to make a major difference in the future by developing healthy infection control habits. Seasonal, non-pandemic flu kills 36,000 people in the U.S. each year. Practicing and teaching the simple measures of proper and frequent hand washing and cough-shielding by sneezing into the crook of the elbow rather than the palm of your hand can significantly reduce the flu’s spread. And the importance of healthcare worker flu immunization each season cannot be over-emphasized. There is absolutely no risk of contracting the flu from the immunization, yet less than half of all healthcare workers get their flu shot.