VA Pharmacy Goes Mobile

[November 1, 2007, AJHP News]

Kate Traynor

BETHESDA, MD, 16 October 2007—When Robert A. Grasso joined the Department of Veterans Affairs (VA) as director of Emergency Pharmacy Services in 2005, one of the first tasks assigned to him was to procure a new disaster-response vehicle.

But VA was not looking for the kind of transportation available at an automobile dealership. Instead, the department needed a fully functioning mobile pharmacy, with a satellite link to VA's consolidated mail-order pharmacy (CMOP) outpatient formulary database, to provide outpatient services to veterans affected by a hurricane or other disaster.

The prototype, a 40-ft-long, custom-built shipping container dubbed the deployable pharmacy unit (DPU), was unveiled September 11 in front of VA's Washington, D.C., headquarters building, along with the department's new deployable medical unit.

The DPU features solid steel construction that Grasso said can withstand winds from a category 3 storm, which can reach 130 mph. Inside, the unit is divided into five compartments, including pharmacy workspaces for drug preparation and dispensing and an entryway that can be made accessible to patients. Also inside is a sleeping area with six bunks and a bathroom and shower for VA personnel who would staff the DPU during deployment.

Grasso said that medications can be handed outside through one of the DPU's windows to an area sheltered by the unit's large, retractable awning. This would eliminate the need for most patients to enter the pharmacy, which could pose a security risk.

The area under the awning contains data and electrical ports and halogen lights to allow the staff to work outside day or night. The DPU's several doors can be written on with a grease pencil to convey important information to patients and staff.

"We've tried to design a reasonable amount of overlap, flexibility, and redundancy in the vehicle," Grasso explained.

During a disaster, the DPU would travel with a pickup truck or sport-utility vehicle and a 21-ft drug-delivery trailer that can also be converted to a makeshift pharmacy, if necessary, Grasso said.

"The plan is that that auxiliary trailer will meet [the DPU] wherever the disaster is," Grasso said. "It will be loaded with the satellite dish, medications, water, bug spray—all the stuff that you need to take. Camping lanterns. Really simple stuff that sometimes you just don't think of."

Grasso said the DPU would be used to provide veterans with some, but not all, of the medications on VA's outpatient formulary.

"Our intention is to provide outpatient critical medications to veterans," he said. "In a disaster, like [Hurricane] Katrina, you could go without your cholesterol meds for a couple of days, a week. But you probably can't go without your insulin. So that's really been our focus—to carry as much as we can of, say, the VA's top 500...critical medications."

Through a soon-to-be-tested satellite connection to VA's CMOP system, pharmacists in the DPU would access veterans' prescription data during an emergency and supply needed medications onsite. Grasso said VA's seven CMOP sites would also be able to send replacement medications by mail or other carrier service to a patient's temporary address during an emergency.

"VA has the ability to prioritize large numbers of prescriptions to a CMOP and potentially deliver to a veteran's temporary address within a one- to two-day period," Grasso stated. "VA is committed to ensuring our veteran patients treated during an emergency receive their care and prescriptions as soon as possible."

The initial field test of the DPU took place this spring during Operation Double Threat, an emergency-preparedness exercise held in Fort Indiantown Gap, Pennsylvania. The disaster scenario included an 8.4-magnitude earthquake affecting the northeastern United States, followed immediately by a pair of category 3 hurricanes that menaced the mid-Atlantic region and the southeastern coast.

To staff the DPU in preparation for the exercise, Grasso said he turned to VA's existing database of emergency-management personnel. He also consulted with the department's pharmacy chiefs, who put out a call for volunteers.

"What I was really looking for during the first deployment of this vehicle was pharmacists who have had experience in disasters," Grasso said.

The deployment team for Operation Double Threat included pharmacists and pharmacy technicians who had worked in Houston or New Orleans during the 2005 hurricane season, Grasso said. The rest of the DPU team consisted of pharmacists and pharmacy technicians from the Veterans Integrated Services Network 4 Emergency Medical Response Team, which serves veterans in Pennsylvania, Delaware, and parts of West Virginia, Ohio, New Jersey, and New York.

Grasso said he is not sure whether he trained the team or the team trained him, but by the end of the exercise he had three pages of ideas for improving the DPU. Some suggestions involved structural improvements, such as adding another door and reconfiguring the electrical outlets and adding more storage space. Others were related to making the DPU more comfortable for the staff, such as adding a mirror and a place to hang a coat and redirecting the shower head to keep it from spraying into the hallway.

Grasso said VA pharmacy staff from all over the country have registered for service on the DPU, and about six pharmacists, including himself, have already completed training and can deploy on short notice.

He said future plans for the DPU include a test of the satellite link and the creation of a DPU with a "recreational vehicle footprint" that would not need to be hauled by a truck.

VA plans to take the DPU on the road in December for ASHP's Midyear Clinical Meeting in Las Vegas, where the unit will be on display in the exhibit hall.

According to VA, the DPU concept arose from departmental recommendations after an assessment of the response to the 2005 hurricane season.

"This is a national initiative," Grasso said. "Our plan right now is to have no less than three of these vehicles."

Grasso said VA envisions stationing one DPU at the department's consolidated mail-order pharmacies in Charleston, South Carolina; Murfreesboro, Tennessee; and Dallas, Texas.

"We think that that will give us enough coverage to basically respond with one or more vehicles to any disaster in the country," Grasso said. "We may end up with more than that, depending on how this is received."

"So far, everyone that's seen it has loved it," Grasso added.