Appendix B: Dispensing Plan Template for Closed POD

Supporting the Memorandum of Understanding (MOU) for Closed Point of Dispensing (POD) in Clark County, OH

This organization is prepared to dispense medications by creating a dispensing plan that addresses our organization’s specific needs. Each organization is unique in the number and type of its employees and in its business operations and/or the type of services offered and clients served. All of these factors will affect an agency’s plan to dispense medications to the employees and clients.

1. Closed POD Primary & Back Up Coordinators:Primary Contact for PODPosition/TitleEmailWork PhoneCell Phone / PagerHome PhoneAny additional contact notes:

Secondary/Alternate Contact for PODPosition/TitleEmailWork PhoneCell Phone / PagerHome PhoneAny additional contact notes:

2. Medications Will Be Dispensed To:Estimated # of Staff/Workforce:

Estimated # of Staff/Workforce Family members:Note: estimate 2.49 family members per staff/workforce member, unless historical data or other justification provide a more accurate number

Estimated # of Clients:

Not Applicable

Estimated Total # Served through this POD:

What percentage of this total number do you estimate to be: Children under 12 years of age and weighing less than 99 lbs

What percentage of this total number do you estimate to be: Children over 98 lbs Adults 18 years of age and older

3. Communications with Our Employees and ClientsAs a Closed POD, it is important to communicate with our employees and clients before the event, during the event, and after the event.

Before the event, we will communicate with our employees about: The agency’s participation as a Closed POD – that we will provide medications to them during some large-scale

public health emergencies. Our organization’s dispensing plan. The plan is readily available to all employees, especially those employees

who will have key roles during an emergency. Roles and responsibilities of employees in an emergency involving Closed POD. Basic information on how medications will be dispensed to employees, their family members, and clients. Information that employees, clients or family members should bring when the medications are dispensed to

assist in screening for possible allergies and/or contraindications. This will assist in assuring that each person gets the appropriate antibiotic.

How they can keep informed (e.g., radio and TV).Describe how you will communicate with your employees before the event (and who is responsible): The administrator will be responsible for communicating with employees before the event. If at work, employees will be informed via an internal staff meeting. Employees off work will be contacted via phone or upon return to next shift.

During the event, we will communicate with our employees and clients about: Employees:

− Where and when to report to work.− Their Closed POD jobs and how to perform those jobs.

Employees/Employees’ Families/Clients:− Where and when they will receive their medications.− What information they should have in order to receive their medications.− Drug information sheets for the medications, including actions to take if they have a negative reaction to the medication.− How they can keep informed about the emergency.

Mark all communication methods used:Y/N Method Notes

TelephoneExternal Communication LineCall centerFacility call down

ElectronicWebsite postingMass email message/fax

In PersonMeeting/presentationVisits to clients’ homes

Radio/TVWhat Station(s)/Channel(s)

Other

Describe how you will communicate to your employees and clients during the event (and who is responsible):

Items checked off above will be used to communicate with employees and clients during the event. The administrator will be responsible for ensuring HR gets the information out.

After the event, we will communicate with our employees and clients about: The importance of taking the entire prescribed regimen. The outcome of your organization’s dispensing effort. Any questions or concerns they may have and how to find further information, as needed.

Describe how you will communicate with your employees and clients after the event (and who is responsible):

The director of nursing will ensure that all key communication is passed onto staff and clientele.

4. Preparing To Receive and Dispense MedicationsOnce notified that the Closed POD has been activated, we will be given instructions on when and where to pick up medications. It is important that this information not be disclosed to others. The pick-up site information will be forwarded to both the primary and back-up contacts. We will be notified via an automated phone call from public health officials. Public health is responsible for facilitating the process, inventorying, and supporting a certain number of Closed PODs.

Here are the steps to prepare our organization to receive and dispense medications (This is a guide; feel free to modify it to fit your organization):

Alert staff (see Communications with Your Employees and Clients - During an Event) Assign tasks (see Job Action Sheets Attachment A)

Closed Pod Coordinator: [Enter name of person]Closed POD Coordinator Back-up: [Enter name of person]*Screening Function: [Enter Name of person filling this position] *Dispensing Function: [Enter Name of person filling this position]

* Smaller locations may require only one or two individuals for the entire operation. Larger facilities may require more than one individual per position.

We will need to have medical personnel available who can legally dispense medications. We may have medical personnel on staff, or we may use personnel who normally dispense medication in our facility to supervise the distribution process. Under an emergency declaration by the governor the standards for legally dispensing medications may be relaxed or waived.

Describe how you will select and prepare employees to screen for and dispense medications and carry out other Closed POD responsibilities. In some instances, you may pre-assign tasks to certain organizational job titles.

We will use the Director of Nursing, or designee, as the lead during the dispensing of meds. She will assign tasks to personnel according to work schedules and Family needs. Administrative staff will assist as needed.

Prepare the dispensing siteThe amount of site preparation will depend on the number of people we plan to dispense medications to at our organization and how we plan to dispense. The site should be large and open and is easily found by users. An ideal site would have a separate entrance and exit, able to accommodate tables, chairs and large numbers of people, and able to accommodate people with disabilities, such as a large meeting room or cafeteria. We also need a place to secure medications.Identify a dispensing site:Primary and Secondary dispensing site

Enter name of Primary Dispensing site: Enter name of secondary dispensing site:

How will you arrange your site? See flowchart below for patient flow

Picking up or receiving medications and forms from designated site (to be determined at the time of the event). The primary and back-up (Point of Contact) coordinators are automatically considered ‘authorized’ to pick up medications for our organization. They must present state or federally issued ID in order to pick up or receive medications. If we assign someone else to pick up medications, they will need to present 1) state or federally issued ID and 2) an organization ID or signed letter from the Director of your organization (on organization letterhead) explicitly authorizing this individual to pick up the medications.

Storing medicationsMedications should be stored in a secure location (a locked room or locked cabinet where few individuals have access) and kept away from extreme heat or cold.

Where will the medications will be stored:Medications will be maintained and secured in room 17B and will only be accessible to medical staff. Storage Room: Enter Building #, Room #, any additional informationAuthorized Staff: Enter names of Authorized medical individuals

Prepare materialsThis involves copying enough required materials for the number of people to whom we will be dispensing medications. We will receive the initial forms from public health when we pick up our medications. Forms provided will include drug information sheets for the antibiotics and intake forms. Other forms that may be included are inventory control forms, FAQ sheets, drug algorithms, and others. We will receive the same forms that are handed out at the PUBLIC dispensing sites.

List of translated languages requested from public health (from enrollment form)

Add others as needed:Requested? Y/N

Language

Spanish

Where is the copier located and who is responsible for making copies? Enter copier locations: Enter name or function responsible for making copies:

5. Receiving and Managing InventoryHow much will we receive?It is expected that initially, each organization will receive a 10-day supply (one bottle) of pills per person. Some circumstances require treatment regimens of 30-60 days. When more supplies arrive, public health will notify Closed PODs when/where they can pick up additional antibiotics.

Store medications in a secure location and away from extreme heat or cold.Keep an inventory of medications we receive. If no inventory forms are provided, we can use our own inventory control forms or create a simple one on notebook paper. This information, along with any unopened medication, will need to be returned to Clark County Combined Health District.

6. Screening for contraindications and dispensing medicationsStaff assigned to POD positions will be treated first. This will allow employees to dispense to potentially exposed individuals without having to worry about their own risk and feel confident that their family members are protected.

Screening: Each person receiving medications must complete an intake form (staff can assist clients who are unable to write).

o Intake forms are used to: screen for contraindications to taking the medication, determine the appropriate antibiotic, and to track medication dispensed.

o Intake forms need to be returned to public health for every person receiving medication. o Your employees can pick up medications for their families; they can complete one intake form, but must fill it out

completely for each family member. This is called the Head of Household model in dispensing. Ask employees and clients to bring/have ready a list of medications (prescription and over-the-counter drugs, vitamins,

minerals, and antacids) they take and any known drug allergies for every person who will get a course of medication. The dispenser will review the intake form for any contraindications and dispense the appropriate medication. Algorithms

can guide the dispenser on which drug is best for each individual.

What will you do to be sure that a screening form is completed for each person to whom you give medications? Medication will only be provided upon full completion of the screening form. The completed screening form will be

collected at the dispensing table. Forms will be collected and forwarded back to CCCHD.

Dispensing: Once we have determined the appropriate antibiotic in the screening process, we will give the client a 10-day supply bottle

of pills. Give the appropriate drug information sheet (doxy or cipro) with the medications. For employees who are picking up

medications for family members, it is only necessary to give one drug information sheet for each drug that they are picking up.

Have available other materials that public health may have provided, such as FAQ sheets, and be ready to answer questions about where they can go for more information (local public health authority web site, call center, their doctor, etc).

Advise employees and clients that they should not stop taking the drug unless they are having an allergic reaction to it. In this case, they need to call their medical care provider.Maintain initial intake form so that it can later be returned Clark County Combined Health District.

What will you do to be sure that the correct antibiotic is dispensed to each person getting medications and that they get the correct drug information sheet for the drug dispensed (doxy or cipro)?

Medical staff at the dispensing table will provide medication as well as the correct drug information sheet. Combining the two at this location will greatly enhance the likelihood of this task being completed.

Here is a simple step-by-step procedure:1. Employee/client fills out intake form (NAPH See Attachment B)2. Review intake form and screen for contraindications3. Dispense appropriate medication based on dispensing algorithms

a. Adhere one label to intake form and one label to drug information sheet (if no labels are used, then write the lot # on both forms)b. Medical personnel Initial formc. Keep form

4. Give drug information sheet(s) to employee/client5. Ask employee/client to take the first dose right away6. Keep inventory of medications (‘supply closet’ inventory forms and intake forms)7. Provide status updates to Clark County Combined Health District as directed8. Return intake (NAPH) forms, inventory forms, and unopened bottles to Clark County Combined Health District.

Attachment A: Job Action Sheets

JOB ACTION SHEETPOD Manager (primary contact)

Mission: Act as lead contact person for public health. Coordinate the overall Closed POD dispensing effort.

Get Ready Receive notification from public health contact that the Closed POD is activated (via

email/phone/website) Obtain contact information for the public health contact your organization reports

to Review your Closed POD Dispensing Plan Read this entire Job Action Sheet Inform employees that the Plan is activated and assign tasks Provide orientation and just-in-time training to those assisting the effort Prepare the site, get basic supplies and vehicles ready Communicate with your employees that you will be dispensing medications

Get Medications Send an authorized staff member to the public health distribution site to pick up medications Lock medications 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 medication 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 public health if initial estimates are insufficient Update you public health contact 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 SHEETDispenser

Mission: Ensure completion of intake forms, screen for contraindications, dispense appropriate antibiotic and provide educational materials.

Get Ready Receive assignment from POD Manager Read this entire Job Action Sheet Receive orientation and just-in-time training from POD Manager Familiarize self with screening and dispensing process (including algorithms) Set up station Receive medication for self and family first before dispensing to others; take first dose

Dispense the Medications Assure that each patient completes an intake form (NAPH form) Weigh children as needed and note 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, patients that may be at risk for

drug interactions may need to be instructed to alter their dosage of another drug; contact patients’ physician for instruction

Remove lot # labels from pill bottles or label sheet. Put one on intake form (NAPH) and one label on drug information sheet. 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 form, initial intake form

and retain form Give patient drug information sheet Remind patient to complete the entire dosing regimen Provide distribution status updates to the POD Manager as he/she requires.

Follow up Return all materials to the public health contact, including intake forms and any unused medication

Attachment B: NAPH Form

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