BETHESDA, MD 30 November 2012—Pharmacy directors at hospitals near the New Jersey shore credit preparedness and teamwork for carrying them through the worst of Hurricane Sandy and its aftermath.
"I think we did a great job, the facilities did a great job, the hospital did a great job. The people working here were fantastic," said Thomas Egan, director of pharmacy at 560-bed Jersey Shore University Medical Center in Neptune.
"I've been through three-foot snowstorms, and that's nothing compared to this," he said.
Egan said day-shift pharmacy staff were asked to stay overnight on Monday, October 29, the day of Sandy's expected arrival, to cover for evening staff who would not be able to make it to work.
"But, actually, a lot of the evening staff did come in, so we had pretty much a full staff most of the time," he said. "It was real dedication getting in here."
Egan cited road closures and downed trees and power lines as some of the obstacles faced by people trying to travel between work and home after the storm.
At presstime, New Jersey was still calculating its losses from Sandy. Egan said he owned beach property in a building that was condemned after taking on more than five feet of water. He said other hospital employees, including some of the pharmacy staff, lost their homes or cars in the storm.
"Everybody had little or big things that happened to them. There's nobody that wasn't touched by this, nobody," Egan said.
Before the storm. Sandy's well-heralded approach gave hospitals time to cancel nonurgent procedures and discharge some stable patients before the storm made landfall near Atlantic City on the evening of October 29.
Indu Lew, vice president of corporate pharmacy education and research for West Orange-based Barnabas Health, a health system with three facilities near the Jersey shore, said reducing the hospitals' census helped them prepare for an expected influx of patients during and after the storm.
"We had to anticipate that our house was going to be packed, [that] we were going to have more patients than we typically see," Lew said.
At 775-bed Hackensack University Medical Center, room was made for patients who were temporarily transferred from Palisades Medical Center in North Bergen after that hospital's generator failed.
"We knew these patients were going to hit our doors around 7:00 in the morning" of October 30, said Nilesh Desai, director of pharmacy at Hackensack.
He said the Palisades patients were assigned to an area that the hospital uses for backup capacity. "So we pretty much started getting the Pyxis machines ready, loaded with medications . . . so that when these patients came, the care would be almost seamless," Desai said.
Although Palisades was back to full operation by the evening of October 31 and soon took back the transferred patients, other capacity issues arose at Hackensack.
"In the emergency department, one of the things that was a real surprise to me was how many patients came in because they lost their power," said Brian Faley, emergency medicine clinical pharmacist at Hackensack. "There are a lot of patients in the area who are home-oxygen dependent and require electricity."
Faley said that although the hospital expects such "social hold" patients to come in when they lose power, the length of time they needed to remain during the widespread power outages was not anticipated. He said the county eventually opened up shelter space to accommodate oxygen-dependent patients.
Stocking up. To minimize expected supply disruptions, Egan, Lew, and Desai each said their pharmacies placed larger-than-normal orders for medications and supplies before Sandy hit and then worked closely with wholesalers to get those shipments in.
"I really want to praise the pharmacy directors in our facilities and their leadership in planning," Lew said.
Michael Talucci, pharmacy systems and purchasing manager at Hackensack, said the storm made an already tight supply chain worse.
"Many medications are on back order right now. Of those that are not on back order, many are allocated," He said. "With the storm, and the surge of people, and the prospect of not knowing what deliveries we were getting, it was tough. Because on Tuesday this storm was so big that it basically cut off corridors to hospitals for deliveries from wholesalers."
Talucci said pharmacy staff were in cell phone communication with delivery truck drivers to help route them around areas that were dangerous or impassable after the storm.
And when a truckload of supplies rolled in late in the evening of October 30, he said, the pharmacy staff came through.
"Everybody down to the last person in the pharmacy department was ready to do what they had to do to get the medications in," he said.
Power and gas. A big factor in riding out the storm was the ability to maintain generator power.
"We never lost power in our facilities," Barnabas Health's Lew said on November 7. "All the backup generators went on, and they never failed. And then the power started coming back on last week for different facilities."
Egan, at Jersey Shore University Medical Center, said his hospital started its generator around midday on October 29 and transitioned smoothly to full generator power after the town's electricity failed. Neptune Township estimated just after the storm hit that it could take 15 days for full electric service to be restored to the area.
The lack of power in town meant that local pharmacies could not fill prescriptions.
"When the electricity went out, everything went out here—traffic lights, 24-hour pharmacies, everything. They tried to stay open as long as they could, but some people didn't have generators," Egan said.
With community pharmacies down, the hospital pharmacy gave patients who were awaiting discharge a three-day supply of medications. Egan said the inpatient pharmacy isn't set up to handle outpatient prescriptions and had to process them by hand, which prolonged the discharge process.
Egan also said some of the hospital's office-based physician practices brought medications that required cold storage to the hospital, and the pharmacy staff catalogued and secured all those medicines.
Gasoline was in extremely short supply after the storm throughout the state, with gas rationing in effect.
"One thing that most people in this state did not anticipate was the gas shortage," Lew said. "People really didn't anticipate . . . the gas lines, early, being 200, 300 cars long, and waiting on line for two or three hours."
Lew and the pharmacy directors said their hospitals worked with local filling stations to ensure that the hospitals and critical staff had access to gasoline.
But she emphasized that gas shortages and other inconveniences pale in comparison to what many in the state have endured since the storm struck.
"So many people that we work with are displaced, and that's heart-wrenching to see," she said.