Transcript Medical Material and Supply Chain Management in

Medical Material and Supply
Chain Management in
Disasters
Al Cook, CMRP, FAHRMM
Director Healthcare Product Development
Integrated Business Systems and Services
October 9, 2008
Supply Chain Background
Al Cook
Worked in both Materials Management and sales in
Healthcare since 1972.
In 1999, was appointed chair of the Y2K committee
and reviewed distribution and manufacturing
capacity in medical supply chain.
This work with the Y2K preparedness committee
resulted in a much deeper understanding of the
medical supply chain and the ability for the
supply chain to be somewhat elastic in the
distribution community while very rigid in the
manufacturing capacity.
Supply Chain Background
Al Cook
In September 2001, Al was President
Elect of AHRMM and was contacted
by HIDA to co-chair a group that was
to review the events that occurred
with supplies during 911 in the
attempt to provide advice to OEM
and FDA regarding the supply chain
and what could be done to make the
supply chain more efficient in the
event of another WMD attack in the
US.
Supply Chain Background
Al Cook
The group reviewing the events affecting
the supply chain included ADVAMED,
HIGPA, HIDA, ASHP, Medical Laboratory
distributors, AHA and others. This group
reviewed with participants the events and
the problems associated with those
events. This group then developed a
recommended response and a suggested
generic supply listing for the types of
CBRNE events that were being considered.
Medical Surgical Supply Formulary
for Disaster Planning
Co-Sponsored by HIDA, AHRMM,
HIGPA.
Entire Formulary still on AHRMM’s
website-www.ahrmm.org.
Gives general guidelines and
indicates that this is a tool to use
during planning and that this tool
needs to be refined for each hospital
specific to product and equipment.
Disaster Preparedness Formulary
Provides a core formulary for any of
the Chemical, Biological,
Radiological, Nuclear, or Explosion
(CBRNE) scenarios
Provides individual formularies for
each of the events
Provides a separate pediatric
formulary for these events
Disaster Preparedness Formulary
Provides a planning guide that indicates
that these are starting points for hospitals
in the planning stage.
Suggests that through planning, hospitals
have to be self sufficient for up to 72
hours after an event.
Each hospital, after identifying the specific
products that they will need, have to
examine the hospital’s internal supply
chain and identify where product might be
available that might be shut down in the
event of an emergency.
Disaster Preparedness Formulary
Identification of internal surplus that
could be diverted to first point of
contact.
Estimation of how much in terms of
time, internal supply chain will
support.
Work with distributors to determine
transportation time and pick time for
pre-established orders based on
numbers of casualties expected.
Disaster Preparedness Formulary
If the internal supply chain is insufficient
in any products to support the hospital
until first delivery, a “bulge” in the
hospital’s working inventory has to be
established.
If the distributor is unable to provide
support for any of their hospitals to get
them through the first wave of casualties,
then the distributor has to create a
“bulge” in their working supply chain to be
able to support their customers.
Disaster Preparedness Formulary
A major catastrophic event is not a
hospital event, it is a “Community”
event. As a community event, local
community sources of medical
surgical products should be
identified. Local pharmacies should
be included in the planning as well as
any of the alternate care medical
providers and the planning should be
done on a community wide basis.
Disaster Preparedness Formulary
A single source of communication
should be identified for the
community to coordinate the flow of
needed supplies and equipment to
the areas of highest need and to
avoid duplication of orders from
multiple sources within those
facilities.
Disaster Preparedness Formulary
The plan has to be practiced with the
community and with the supply chain
participants to find the weaknesses
and to strengthen the plan.
The real danger is not to plan for the
unthinkable.
Classification
Emergency Planning
Recommendations for the
Local Office of Emergency
Management and Material Managers
A document prepared by theHealth and Human Services National Medical Materials Coordinating
Group with
the Support of Department of Health and Human Services
FINAL DRAFT
Version 0.5
November 18, 2004
This document was prepared for authorized distribution only.
It has not been approved for public release.
MMCG HISTORY
Met with OEM, FDA several times in an
unofficial capacity to try to get their
endorsement of the supply formulary and
put it in the hands of planners.
In 2003, HHS invited the members of this
group to participate in a “private sector
advisory group” regarding Medical
Materials.
In 2004, this became the “Medical
Materials Coordinating Council” (MMCG)
to the department of HHS. Again the
mission of the group was to work with the
federal agencies to provide advice on
medical supply chain management
MMCG
We were asked to identify potential
barriers to management of the
supply chain in the event of a
disaster. We indicated:
– Communication and lack of universal
identifiers.
– Clear lines of communication so that
multiple requests for the same items
were not issued.
– Lack of the ability to transport the
goods into the affected areas.
MMCG relationship to HHS
Private sector group representing
medical distributors, medical
manufacturers, and medical
providers.
Non government funded, meet
quarterly to identify potential
barriers to supply chain management
and to identify critical infrastructure
There is a Public sector group that
represents the federal agencies that
also provide HHS with input
MMCG relationship to HHS
The private sector and public sector
will meet together twice a year to
discuss the issues that affect both
and to be briefed on any new
objectives of HHS in regards to
supply chain management
HHS is not required to follow the
advice of either group as it forms
policies to deal with health and
safety issues.
HSCC Status: Organization
Healthcare Sector Coordinating Council (HSCC)
The HSCC is comprised of representatives and alternates from each subcouncil. Issue will be identified by Subcouncils. Coordination across
Subcouncils and with the HPHGCC will be organized through the HSCC.
Healthcare and Public
Health Sector Government
Coordinating Council
(GCC)
High-level federal, state and
local government officials
available to interact with
HSCC
Cross-cutting Work Groups will be established to address priority issues that cut across sub-councils
Healthcare
Personnel
Insurers,
Payers, HMOs
Information
Technology
Laboratories
and Blood
Mass Fatality
Mgt Services
Includes:
Includes:
Includes:
Includes:
Includes:
Doctors, nurses,
pharmacists,
dentists,
emergency
medicine and
other clinicians
and practitioners
with direct
involvement in
healthcare
delivery
Representative
s of third-party
payers for
medical
treatment and
healthcare
delivery
including
insurance
companies,
HMOs and
others
All IT systems,
capabilities and
networks
supporting
delivery of
healthcare
services
Laboratories
and lab
support
services
separate from
medical
treatment
facilities, and
companies
and
associations
from the
blood, tissue
and organ
industry
Medical
examiners,
coroners, funeral
directors,
cremationists,
cemeterians,
clergy, and
manufacturers
and distributors
of funeral,
memorial, and
cremation
supplies
Medical
Materials
Coordinating
Includes:
Manufacturers
, suppliers,
and
distributors of
medical
supplies and
equipment, as
well as health
care materials
managers
Medical
Treatment
Occupational
Health
Pharma and
Biotech
Includes:
Includes:
Includes:
Hospitals,
clinics, and
other
organizations/
entities that
deliver medical
treatment
Occupational
health
physicians and
nurses,
industrial
hygienists,
and other
occupational
health
professionals
Manufacturers,
suppliers and
distributors of
generic and
branded
pharmaceuticals
and biological
equipment
Each sub-council is responsible for organizing itself
Sample Priority Issues for Sub-Councils: Emergency Preparedness, Emergency Response; Vulnerability Assessment / Prioritization; Communication & Information
Sharing among members, with HHS and DHS, and with other sectors
Healthcare Sector Coordinating Council (HSCC)
The HSCC is comprised of representatives and alternates from each subcouncil. Issue will be identified by Subcouncils. Coordination across
Subcouncils and with the GCC will be organized through the HSCC.
Cross-cutting Work Groups will be established to address priority issues that cut across sub-councils
Healthcare
Personnel
Insurers,
Payers, HMOs
Information
Technology
Laboratories
and Blood
Mass Fatality
Mgt Services
Medical
Materials
Coordinating
Includes:
Includes:
Includes:
Includes:
Includes:
Includes:
Doctors, nurses,
pharmacists,
dentists,
emergency
medicine and
other clinicians
and practitioners
with direct
involvement in
healthcare
delivery
Representative
s of third-party
payers for
medical
treatment and
healthcare
delivery
including
insurance
companies,
HMOs and
others
All IT systems,
capabilities and
networks
supporting
delivery of
healthcare
services
Laboratories
and lab
support
services
separate from
medical
treatment
facilities, and
companies
and
associations
from the
blood, tissue
and organ
industry
Medical
examiners,
coroners, funeral
directors,
cremationists,
cemeterians,
clergy, and
manufacturers
and distributors
of funeral,
memorial, and
cremation
supplies
Manufacturers,
suppliers, and
distributors of
medical
supplies and
equipment, as
well as health
care materials
managers
Medical
Treatment
Occupational
Health
Pharma and
Biotech
Includes:
Includes:
Includes:
Hospitals,
clinics, and
other
organizations/
entities that
deliver medical
treatment
Occupational
health
physicians and
nurses,
industrial
hygienists,
and other
occupational
health
professionals
Manufacturers,
suppliers and
distributors of
generic and
branded
pharmaceuticals
and biological
equipment
Each sub-council is responsible for organizing itself
Sample Priority Issues for Sub-Councils: Emergency Preparedness, Emergency Response; Vulnerability Assessment / Prioritization; Communication & Information
Sharing among members, with HHS and DHS, and with other sectors
AHRQ
CDC
CMS
FDA
HRSA
IHS/TRIBAL
NIH
SAMHSA
DOD
Healthcare and Public Health Sector Government Coordinating Council (GCC)
VA
STATE/LOCAL
KATRINA
Hurricane Katrina hit the Gulf Coast
Monday, August 29th 2005.
7:00AM CDT – KATRINA MAKES LANDFALL
AS A CATEGORY 4 HURRICANE
8:00AM CDT Mayor Nagin reports that
water is flowing over levee.
KATRINA
KATRINA
KATRINA
KATRINA
The medical response to
Hurricane Katrina was
plagued by confusion, a
lack of supplies and
breakdowns in
communications,
according to a new
congressional report
prepared for Democrats
and released on Friday
It also said medical
supplies from the
Strategic National
Stockpile failed to get
into the hands of
medical teams within 12
hours, as stipulated
under disaster plans, but
took three days to get to
New Orleans _ and then
there were far too few.
AHRMM’s part in Katrina
Assistance
September 1, 2005 HHS asks for
help with supply chain
The planning that we had put in
place for disaster support was put in
effect.
AHRMM’s part in Katrina
Assistance
HHS asks for assistance in organizing
the requests coming from various
agencies for supplies. Many
agencies were making individual
contacts within the distribution
community for the same items.
AHRMM’s part in Katrina
Assistance
CDC had listing of supply
components for field hospitals but
the item number identification
numbers were the numbers used in
the federal supply system.
Some of the supplies requested were
from a single source manufacturer
and the manufacturer was unable to
meet the increased demand on short
notice.
AHRMM’s part in Katrina
Assistance
Conversion lists had to be built for
each item on the supply list and the
identification number for each
distributor had to be researched and
entered on a large spreadsheet.
In some cases, generic equivalent
descriptions had to be developed and
researched at the distributor level to
identify where product could be
located.
AHRMM’s part in Katrina
Assistance
Distribution locations were identified that
could ship large volumes without
negatively impacting existing care and
large amounts of goods were picked and
palletized on Sunday the 3rd of
September.
The supply listing was for a bed capacity
of 250 beds and we were told how many
beds to pick for but not where the supplies
were being shipped to.
AHRMM’s part in Katrina
Assistance
AHRMM served as the linkage
between the distribution community
and the agencies that were
requesting supplies. We would
convert the information from the
spoken language into the
computerized numbers that the
distributors needed to find large
amounts of goods that could be
dispatched without disturbing the
supply chain in unaffected areas.
Katrina Lessons Learned
Horizontal distribution was
problematic and many roads were
closed or impassable.
Fuel availability was a significant
issue for the drivers that were
dispatched to the area.
Katrina Lessons Learned
Field hospital addresses were not in the
DEA registry nor were the registry
numbers available. The “ship to”
addresses were not usable in the vendor’s
data base due to the computer’s on line
verification process for DEA numbers and
location addresses. The “customer” was
not clearly identified as the orders were
coming from HHS, DHS, FEMA, CDC, and
others. Some time was lost in having
several knowledge workers engaged in the
same problems from multiple agency
requests for the same item.
Katrina Lessons Learned
1. Communication and lack of
universal identifiers.
2. Clear lines of communication so
that multiple requests for the same
items were not issued.
3. Lack of the ability to transport the
goods into the affected areas.
That was then, what’s new??
Katrina alerted HHS/DHS that
planning had to be for CBRNE as well
as natural hazards.
This was the onset for an “All
Hazards” response plan that included
man made events as well as natural
events. This included the pandemic
response planning.
Pandemic Event
CDC predicts wide
spread status
within 8 weeks of
entry into U.S.
High demand for
healthcare at the
same time a
widespread
shortage of
capability due to
absenteeism
Pandemic Event
High demand for
respiratory
supplies and
Personal Protective
Equipment (PPE)
Increased demand
for specific
respiratory related
equipment
(Volume
Ventilators)
Pandemic Event
High mortality rate
combined with
significant numbers
infected will
produce
unmanageable
demand on end of
life services and
increase demand
on cold storage
capability
Pandemic Event
Demand on medical
products will be
both in the health
sector as well as
the private sector.
The need for certain
kinds of medical
protective gear will
be expanded to
include critical
services and
manufacturing.
Pandemic Event
Estimates on
duration will be 1220 weeks.
Manufacturing
capacity will be
stressed with both
the increased
demand as well as
the shortage of
resources and raw
materials to produce
products.
Pandemic Event
Planning efforts are
underway now to
determine best
alternatives in
preparation
It may take
superhuman effort
to plan before
responding.
So what should we do????
Stay tuned to
AHRMM and the
pandemic
advisories that will
come from them.
Evaluate your
current stocking
levels on PPE,
particularly N95
masks.
So what should we do????
Determine the
supply in terms of
days of demand on
hand.
Consider with the
medical staff the
possible impact of
a pandemic on the
daily demand rate
for respiratory
products.
So what should we do????
Identify those PPE
products which can
be freely
substituted by
brand
Determine in
advance where
alternative
products might be
considered or
where re-usable
might be prudent
So what should we do????
Work closely with
your distributors
and manufacturers
and understand
their response
plans to a
pandemic. Work
with your
community
planners and
understand their
response plans to a
pandemic.
AHRMM Pandemic Flu Guidelines
for Materials Managers
May 8, 2006
Stages of Preparedness Level for
Materials Managers related to
Pandemic Flu Levels
(This includes the Avian Flu; a.k.a. H5N1, H5, or
bird flu.)
Interpandemic
Pandemic
Alert
Pandemic
Postpandemic
Interpandemic
Impact
Community
Supplies
(see slide
7)
Equipment
Staffing
Funding
Risk of human infection or disease is considered to be low
Develop direct communication with disaster or bio-terrorism
coordinator in your facility, county, or region to ensure duplication
of activity is limited or eliminated
Maintain normal supply level, stay in close contact with distribution
channel for planning, obtain a copy of the distributor's disaster
plan to ensure supply lines to the customers, and please
DO NOT HOARD SUPPLIES
Ventilator/Respirators and IV Pumps undergo preventative
maintenance checks. Prepare a list of local medical equipment
rental companies and inquire on availability of specific equipment
such as ventilators/respirators
Prepare list of alternate workers in the event of staff shortages in
Materials Management. Consider cross training of staff. Update
phone records and prepare your protocol for calling in relief
workers
Check with local, state and governmental agencies for funding
opportunities. This may fall under the responsibility of your
facility's disaster coordinator
Pandemic Alert
Impact
Human-to-human spread is still localized, suggesting that the
virus is becoming increasingly better adapted to humans
but may not yet be fully transmissible (substantial
pandemic risk)
Community
Align planning with clinical leaders and disaster coordinator(s),
prepare for support of satellite treatment centers that may
be utilized to keep flu patients away from medical centers
if possible
Supplies
(see list below)
Increase in flu patients will place pressure on supplies within
medical facilities, increase supply quantities accordingly,
again, please
DO NOT HOARD SUPPLIES
Equipment
All ventilators/respirators and IV Pumps ready for service
Staffing
Monitor the need for calling on relief workers
Funding
Focus on supply needs
Pandemic
Impact
Increased and sustained transmission in the general population,
likely that 30% or more of population infected
Community
Full activation of supply acquisition and distribution related to
high volume of flu patients
Supplies
(see list
below)
Continue to increase purchases and frequency to handle the
increased volume without hoarding, realize that this may last
4-8 weeks
Equipment
All available ventilators/respirators and IV Pumps are in active
service; maintaining, cleaning, and turnaround are critical.
Rental equipment ordered and in use.
Staffing
Monitor the need for calling on relief workers
Funding
Focus on supply needs
Postpandemic
Impact
Return to Interpandemic stage
Community
De-commission of community services, move back to focus on
main activity centers
Supplies
(see list
below)
Supply levels should taper down with decreased patient activity
Equipment
Disinfecting, repair and maintenance after high activity
Staffing
Return staff to normal duties
Funding
Check with local, state and governmental agencies for funding
opportunities. This may fall under the responsibility of your
facility's disaster coordinator
Supply List
Gloves Exam
Suction Catheters
Gowns Disposable Isolation
Suction Canisters
Masks N95
Oxygen Masks
Masks Procedure
Ventilator Tubing
Masks Surgical
Shields Face
Respiratory Etiquette signs
Stethoscopes
Disposable
Tissues
Gel Hand Alcohol Based - personal
size
Disposable Blood Pressure Cuffs
Wipes Disinfectant for Surfaces
Disposable Thermometers
Vaccines/anti-viral Medications
Morgue Packs
IV Supplies
Note that quantities should increase based on patient volume
changes in most cases and not by simply increasing by "weeks" or
"months" of supplies", this should be managed via close
communication with the distributors
Links for More Information:
Main
http://www.pandemicflu.gov
Overview
http://www.pandemicflu.gov/plan/pdf/panflu20060313.pdf.
Medical Office Checklist
http://www.pandemicflu.gov/plan/pdf/medofficesclinics.pdf
The Latest News 2-08
DHS ANNOUNCES
RELEASE OF
APPLICATION GUIDANCE
FOR OVER $3 BILLION IN
GRANT PROGRAMS
The Latest News 2-08
Homeland Security Presidential
Directive 21
1.
2.
3.
4.
5.
Establishes the need for all hazards planning
Establishes specific timelines and responses
Establishes a need to work with the private sector
when practical
Establishes the need for mass casualty to be included
in the planning effort.
Establishes the need to be capable of distributing
countermeasures within 48 hours of authorization
The Latest News 6-08
OSHA releases Guidelines
for Business Continuity
1. Estimates the volumes that would be needed
in private industry and in healthcare.
2. Suggests that businesses might consider
building individual stockpiles of PPE
equipment for those who will have to interface
to the public
3. OSHA asks for comments
The Latest News 6-08
MMCG responds to OSHA
suggestions
MMCG points out that the suggestion of changing N95
masks four times per 8 hour shift severely
underestimates the demand.
This sudden uncontrolled demand may destabilize the
supply chain causing concerns with current care
demands.
Shelf life of masks is not indefinate and businesses
have no method of stock rotation since they do not
normally consume these products daily. Questions
about storage conditions and obsolesence need to be
addressed.
Contact Information
Al Cook, CMRP, FAHRMM
Director Healthcare Product
Development
Integrated Business Systems and
Services
Office: 803-736-5595 x135
Cell: 803-378-9260
[email protected]
Questions???