Guidelines for Mass Dispensing in Emergencies

1. MASS DISPENSING RULES AND GUIDELINESMay 2011

2. Dispensing Assumptions • These guidelines are not the accepted Standards of Care and can only be used in a State of Emergency declared by Arizona (federal and local declarations do not count!) • In addition to the State of Emergency, the Governor will need to sign a waiver allowing non-licensed, but trained in POD dispensing, personnel to screen and dispense

3. Dispensing Assumptions If Arizona does not declare a State of Emergency, all the usual rules and statutes apply: • Patients must be seen by a licensed provider • Prescriptions must be written on an individual basis • Dispensing by licensed professional must take place

4. Dispensing Assumptions Under either scenario, the Food and Drug Administration (FDA) has labeling requirements that must be followed: • The label must have the name, strength and quantity of medication on it • The label must have the directions on it • The label must contain a medication expiration date

5. Dispensing Assumptions In addition, • The label must have the patient’s name on it • The label must have the prescriber’s name and information on it – exception, in mass dispensing under a Standing Order

6. EVERYONE Contributes to Fast and Accurate Dispensing! POD SCREENERS: • Determine correct medication and dose (for pediatrics) for those who cannot take the standard adult drug of choice • Need four things to do their job: • A completed patient information form • A brand name/generic list • A dispensing algorithm • A pediatric dosing chart

7. EVERYONE Contributes to Fast and Accurate Dispensing! POD DISPENSERS give the correct medication as determined by the Screeners

8. 1. Head of Household Form

9. 2. Brand/Generic Name List

10. 3. Dispensing Algorithm

11. 4. Pediatric Dosing Chart

12. Choosing the Right Medication Do the easy ones first! For all people on the form who have answered “NO” to all the questions Circle the adult Drug of Choice (most likely Doxycycline) on the form

13. Choosing the Right Medication • For anyone with “YES” answer to antibiotic allergy: • Use brand/generic name cheat sheet • If any doubt about an allergy, assume it is a true allergy • Use ALGORITHM to determine drug to give • Circle adult drug to give on HoH form

14. Once you determine the drug to give and dose: • Clearly indicate it for each person on the HoH form, • Return the form to the client, • Instruct them to move forward to Dispensing to receive the medication.

15. DISPENSERS will need: • Supply of all medications (total of 6) • Doxycycline (adult and pediatric suspension) • Cipro (adult and pediatric suspension) • Amoxicillin (adult and pediatric suspension) • Supply of Drug Information Sheets for each medication • Supply of Agent Fact Sheets • Specific to the event • Crushing Instructions for Doxycycline in case suspension demand larger than supply

18. Dispensers • Record the lot number on the HoH form • Keep the HoH form • Give the client: • The medications (all with names and any pediatric dosing on them!) • 1 Drug Information Sheet for each medication • 1 Agent Fact Sheet • If persons present looking or complaining of illness, also give them the Local Treatment Center sheet • Doxycycline Crushing Instructions (if necessary)

19. Dispensers Once you have: • Added patient names and any pediatric dosing to the bottles • Completed the HOH form by adding the lot stickers • You have kept the form • The client has been given the medication and information sheets, Then direct them to exit the POD

20. Express Dispensers • Quickly review HoH form to ensure all answers are “NO” • Remember: no screening in the express line • Record the lot number of the HoH Form • Keep the HoH Form • Give bottles, one (1) Drug Information Sheet and one (1) Agent Fact Sheet to the driver • If persons present looking or complaining of illness, also give them the Local Treatment Center sheet

22. The Medication Algorithm • Used by the Screeners • Used ONLY for households where there is • An allergy to antibiotics, • Or a child under 9 years old • If no allergy or children under 9, give Doxycycline • Do not need to use the algorithm

23. Using the Medication Algorithm • Locate START on the algorithm • Determine if a TRUE ALLERGY exists to the Doxycycline by asking the driver if the person is allergic to Tetracycline and if so, what was the reaction: • Nausea, vomiting, diarrhea are NOT indicators of a true allergy • True allergy is hives, rash, swelling, difficulty breathing, anaphylactic shock • If not a true allergy but person insists it is, act as if a true allergy • Document on the HoH form what symptoms the person had

24. Using the Medication Algorithm When checking about allergies: • Ask first if allergic to Tetracycline – use sheet with trade names if unfamiliar • Ask what were the symptoms of the allergy • Ask if any rash, hives, difficulty breathing, swelling, or shock • Document on the HoH form what symptoms they had • If true allergy to Doxycycline, repeat the process for Ciprofloxacin/Quinolones then for Amoxicillin/Penicillin if necessary

25. Using the Medication Algorithm If not a true allergy, follow the algorithm • If not an allergy and is an adult, give Doxycycline adult dose • If not an allergy but needs a pediatric dose, refer to pediatric dosing chart (we will get to that soon…)

26. Using the Medication Algorithm If a true allergy to Tetracycline exists, follow the algorithm to determine allergy to Ciprofloxacin/Quinolones • If no allergy, give Cipro • If yes, document on HoH form and move on to Amoxicillin/Penicillin • If allergic to all, give Doxycycline and tell them to contact their healthcare provider before taking any • Document on the HoH form • Have the Screening Supervisor confirm

27. Using the Medication Algorithm • Once you have determined what medication the patient is to receive, circle the correct medication on the HoH form under their name • If an allergy has been indicated and it is not a true allergy, BRIEFLY document your discussion about allergies on the HoH form

29. JackSmith 602 555-1212 125 MainStreet Phoenix AZ 85009 Jack Jill Jackie

30. JackSmith 602 555-1212 125 MainStreet Phoenix AZ 85009 Jack Jill Jackie EXPRESS DISPENSING

31. JackSmith 602 555-1212 125 MainStreet Phoenix AZ 85009 Jack Jill Jackie EXPRESS DISPENSING

32. Barbara Jones 602 555-1212 125 MainStreet Phoenix AZ 85009 Barb Joe Kelly Kelly Kelly Kelly

33. Barbara Jones 602 555-1212 125 MainStreet Phoenix AZ 85009 Barb Joe Kelly Kelly Kelly Kelly Allergic reaction was hives all over body SCREENING/DISPENSING

34. Barbara Jones 602 555-1212 125 MainStreet Phoenix AZ 85009 Barb Joe Kelly Kelly Kelly Kelly Allergic reaction was hives all over body SCREENING/DISPENSING

35. John Anderson 602 555-1212 125 MainStreet Phoenix AZ 85009 John Sue Hannah Tyler

36. John Anderson 602 555-1212 125 MainStreet Phoenix AZ 85009 Nauseated By Tetracycline John Sue Hannah Tyler Rash fromQuinolones/Cipro SCREENING/DISPENSING

37. John Anderson 602 555-1212 125 MainStreet Phoenix AZ 85009 Nauseated By Tetracycline John Sue Hannah Tyler Rash fromQuinolones/Cipro SCREENING/DISPENSING

38. Julie Barker 602 555-1212 125 MainStreet Phoenix AZ 85009 Julie David Kelly Kelly Kelly

39. Julie Barker 602 555-1212 125 MainStreet Phoenix AZ 85009 Has asthma and diabetes Julie David Kelly Kelly Kelly EXPRESS DISPENSING

40. Julie Barker 602 555-1212 125 MainStreet Phoenix AZ 85009 Has asthma and diabetes Julie David Kelly Kelly Kelly EXPRESS DISPENSING

41. Barbara Martin 602 555-1212 125 MainStreet Phoenix AZ 85009 Barbara John Kelly

42. Barbara Martin 602 555-1212 125 MainStreet Phoenix AZ 85009 Barbara John Kelly Kelly Kelly Shortness of breath with Tetracycline SCREENING/DISPENSING

43. Barbara Martin 602 555-1212 125 MainStreet Phoenix AZ 85009 Barbara John Kelly Kelly Kelly Shortness of breath with Tetracycline SCREENING/DISPENSING

44. Pediatric Dosingin Children <9 Years Old

45. Children • < 9 years old: • Need smaller dose of medication • Based on age/weight • Screeners: mark on HoH Form the required dose, using: • Algorithm first, then • Pediatric dosing chart – use the chart that matches the medication to be given!!!!!

46. One More Time • Use: • Algorithm first, then • Pediatric dosing chart – use the chart that matches the medication to be given!!!! • If weight is available, use it over age • Use age if weight not available • ALL HoH forms with children less than 9 years old MUST go through SCREENING/DISPENSING

47. Choosing the Medication • For anyone with “YES” answer to child under 9 years old: • Patient will be given a suspension so the dose can be adjusted downward from regular adult dose • Use the ALGORITHM followed by the PEDIATRIC DOSING CHART • First determine correct medication via algorithm • Then determine correct dose via dosing chart • Base dose on child’s weight if provided • If weight not available, use child’s age • Circle the Drug to Give and write in the dose CLEARLY on the HoH form

50. Parent tells you the child had rash with Tetracycline 3 years/30lbs