Communication between Pharmacists and Victims in a Disaster
Mari HARADA
Department of Pharmacy, Japanese Red Cross Society Musashino Hospital
Vice-chair Disaster Relief Committee of Japanese Red Cross Pharmacist Association
Fundamental Principles
Humanity Impartiality Neutrality
Independence Voluntary Service
Unity Universality
ICRC
IFRC National Societies
International Red Cross & Red Crescent Movements
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Japanese Red Cross Society
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
92 Red Cross Hospitals
JRCS Musashino Hospital Founded : Nov. 19. 1949 Location : Musashino city, Tokyo Medical district population : 947,000
• Beds : 611
(General 546, ICU 8, HCU 22, CCU 6, SCU 9, Infection 20)
• Clinical division : 24
223 Doctors, 736 Nurses, 35 Pharmacists
(Total 1,431 Staff)
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
talk about・・・
Lessons learned from relief activities in the Great East Japan Earthquake and Tsunami
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Japan Earthquake & Tsunami 2011 Background:
• March 11. 2011 14:46
• Epicenter
latitude 38.0 N
longitude 142.9 E
• Depth 24km
• Magnitude 9.0
Features of the disaster:
triple incident disaster (Earthquake, Tsunami, Nuclear accident )
Large scale disaster
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Number of death:15,883 people
Number of missing:2,656 people
Number of injured:6,145 people (June 9, 2013 National Police Agency of Japan)
Cause of deaths: 92.5% Drowning
65.2% of fatalities: over the age of 60
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Situation Life Line × Weather Condition:cold, snowy, windy Evacuation Centers:more than 300 places Medical Facility: Ishinomaki Red Cross Hospital ○ Local pharmacy× Wholesaler × (for three days)
Situation of the disaster site
Cooperate with hospital pharmacy and community pharmacy
To cover the shortage of medicine
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Situation at a hospital in the disaster site
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Mission of medical relief team:
Set up aid station to treat triage green patients
protect hospital capacity ↓
save many lives
Aid station in front of the hospital
Lots of patients who need
regularly taking medication
A long cue for entering hospital
to get medicines 4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Living condition of affected people
Place to live: evacuation center
Lifeline: × Food : △ Water: △
Toilet, Sanitation:× Space & privacy: ×
At a school gymnasium
Lack of nutrition, Hypoglycemia
Dehydration, constipation Skin problem, Asthma,
Allergy Infection diseases, Stress, Insomnia,
Deep-vein thrombosis etc.
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Vulnerable people in a disaster
• Babies and Children
• Pregnant and parturient women
• Elderly people
• Physical and/or mental disability
• People with chronic diseases
Diabetic Asthma epilepsy schizophrenia Cardiac disease Cancer Dialysis patient etc.
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Difference between disaster and non-disaster phase
Medical Resource
Needs &
Patients
Medical Resource
Needs &
Patients
Best treatment for each Best treatment for many
Non-disaster phase Disaster phase
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Difference between disaster and non-disaster phase
Non-disaster phase Disaster phase
Medicine ― Disaster relief medicine kit
Choice of medicine ○ limited
Days of prescription ○ Limited (depend on situation)
Chronic diseases medicine ○ △
Pediatric medicine ○ △
Patients request ○ △
Doctor examine Specific disease Variety of disease
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Medical aid Station at evacuation center Temporary Medical Clinic
(24hours open)
2 medical relief teams(2 Pharmacists) & local medical staff
Junior high school (evacuees1,000)
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Flow of the treatment at medical aid station
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
①Reception ②Waiting space
③Examination space ④Pharmacy
Make patient’s medical chart
Interview by nurse Vital check
Examination by doctor Treatment
Prescribe medicine
Dispensing by pharmacist Explain to patient
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Roles of Pharmacist in a Disaster
• Management of medicines
• Dispensing medicines
• Assistance for prescribing medicines
• Provide medication information to Patients
• Advice on public health sanitation
• Cooperate with medical coordinator
• Collaborate with local stakeholders
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22%
17%
5% 7%
3% 1% 3%
42%
The breakdown of consultation
呼吸器疾患 消化器疾患 精神疾患 外傷 皮膚疾患 婦人科系 その他 常備薬希望
Data of medical aid station • Numbers of Patients: Ave. 230/day • Numbers of referrals: Ave. 5/day • who lost their regular medications:About 40%
Understanding medical needs ⇓
Activities according to the needs
Respiratory disease
Gastrointestinal disease
Psychiatric disease
External injury
Dermatological disease
Obstetrics
Others
lost their regular medications 4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Acute Phase(4-8days)
Sub acute Phase(12-15days)
Chronic Phase(28days-)
5
20
15
10
25
30
No
of
pre
scri
bed
(%
)
Changing Medicine needs and phase
(The Great East Japan Earthquake, JRCS Musashino hospital)
Chronic medicine As the time passed many health care facilities recover
Medicine for cold People live closely together in a small space
Anti-allergic Getting close to recovery phase, there is lots of dust.
Understanding medicine needs
Collect information about medicines ⇒ Analysis ⇒ Sharing information
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
0
10.000
20.000
30.000
40.000
50.000
60.000
70.000
80.000
90.000
100.000
No
of
med
icin
e
支援医薬品(3/12~4/3) 救護班提供医薬品(3/12~6/30)
385,999 122,444
Medicine used at medical relief teams donated Medicine
(Data from the Great East Japan Earthquake, Ishinomaki Red Cross Hospital)
Gap of donated medicine and medicine needs
Name of medicine category
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Problems of medicine donation
Donated medicine which we cannot use
Enough to waste a
truck(4.5t) of medicine
Gap between medicine needs information and donated medicine
Misunderstanding of medicine donation
Expired/short expiry medicine Medicine from overseas
(written with different languages) Problems with quality
Medicine not in hospital formulary Health insurance issues
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Communication between teams Left over medicine
by medical relief teams
Internal med 119 External med 76 Injectable 68 Disinfectant 17
3 months activity several teams working together
Management of medicine by each teams ⇓
Management of medicine by unit of an medical aid station System of sharing information of medicine
Left over=No needs Take it back with team
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Point of medicine management
Medicine management from early stage
Sharing information
Unify Medicine management
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Communication with doctors • Provide list of medicines
• Support prescribing medicine
• Days of prescription
• Set of medicines
• Rule of pediatric medicine
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Advantage of Pharmacist Wide range of knowledge of medicine
Generalist &
Professional
Check point for prescription in a disaster
• Check
Medication history
Past history, Allergy, Side-effect
• Determination
- Necessary for continuation of medicine
- Temporary discontinuation of medicine
possible or necessary
Affected people’ living condition Limited stock and choice of medicine
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Communication with patients • Understanding the situation of the disaster site • Understanding the change of affected people’ living condition • Consider the affected people’ emotional changes
Negative words× vague×
Advice on which possible for patients ○
Tell patients to go to health facilities when it is reopened.
Do not exaggerate anxiety Explain about medication
and give written information
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Provide information to patients Sharing information between teams
× Fragmentary medical services ×
×telling patients different things by different teams ×tell each teams, same things every time is stressful
○ Consecutive medical services ○
○use medical chart, prescription, medication history book, bag of medicine to give written information to patients ○share information between teams 4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Communication tool with patients
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
• Medication History Book
Allergy Past history
Side effect Personal data
Medication information
Communication with local
Coordination meeting (medical staff meeting)
Local medical association Local pharmacy association Local public health nurse Medical relief teams etc.
Sharing information Situation changing
Medical needs changing Direction of activity
Locality based activities
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Situation of the disaster site
lifeline ○ logistics ○ medical supply ○ Health care facilities: hospital △ pharmacy ○
Medical services gradually back to local
providers
Collaborate with local pharmacy association
Doctor of relief team prescribed ⇓
Dispensing medicine at local pharmacy by local pharmacist ⇓
Deliver medicine to patients living in evacuation center
check prescription by pharmacist of
relief team
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Mobile Clinic To visit people who cannot come to
hospital or medical aid station
●evacuation center School, store, temple etc.
●where people gather Airport, train station etc.
●where people live House, elderly home etc.
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Collaborate with local hospital Lots of people required chronic disease medicine
⇓ Difficult to respond to the requests
with limited stock and choice of medicine
Local hospital became an medicine supply center Consolidate information of medicine from teams
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Collaborate with hospital pharmacists and community pharmacists
Visit evacuation center Interview patients about medication
Dispensing
Deliver medication to patients
Prescription
Mobile pharmacy
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Exchange ticket Special prescription for disaster
Collaborate with local pharmacist and volunteer pharmacist
Working together
with medical relief team
Everything for
Affected people
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Community Pharmacy BCP(Business Continuity Plan)
Medical Association
Pharmacy Pharmacy Pharmacy
Aid Station
Government
Hospital
Pharmacy Association
4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
Medicine
Conclusion
Pharmacists’ Capabilities
Pharmacists Point of View
Collaborate & Cooperate
Everything for affected people 4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada
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