Just in Time POD Training Part 2

Roles and Responsibilities

Facility Manager

Employee of the physical facility (e.g. school system employee) with adequate knowledge of building layout and access to available equipment, systems and utilities.

POD Manager

Coordinates and manages all functions required to set-up, operate and demobilize a POD through the Department Operations Center at JCDH

POD Manager

Duties include but are not limited to:• Staff direction• Coordination with EMA and JCDH management• Coordination of support services (food, supplies)• Working with facility owner/manager• Maintain client throughput by adjusting POD

flow as needed • News media (as directed by PIO)

Triage Clinicians

• Every client/representative must go through Triage to determine where medication will be dispensed

• MD/CRNP/RPh will triage and mark/initial appropriate drug for Express dispensing

• DUR, Family and Support Services will be referred to expedite the triage process

Clinician in ChargeDuties include but are not limited to:• Staff assignments, orientation and JITT (Just in Time

Training)for triage clinicians• Communicates staffing and supply needs to POD

manager• Functions as Triage Clinician if needed• Maintains smooth flow of operations• Makes appropriate referral if client cannot receive

medications available at the POD• Functions as First Aid/Emergency medical services if

needed• Assists with demobilization

Team Leader-ClinicianDuties include but are not limited to:• Assist Clinician in Charge with staff assignments,

orientation and JITT for triage clinicians• Communicates staffing and equipment needs to Clinician

in Charge• Maintains smooth flow of operations for the team• Functions as Triage Clinician• Monitors team for S/S (signs/symptoms) of stress and

fatigue• Coordinates breaks and lunch with Clinician in Charge• Assists with demobilization

Clinician

• Reviews client history form for completeness• Determines and documents what dispensing line

client should be directed to• If EXPRESS-determines, documents and initials

medication(s) to be dispensed according to the ADPH Algorithm and directs client to a Guide

• If Support Services, Family or DUR- marks form and directs client to a Guide

Nurse in Charge

Coordinates with the POD manager and EMA to help prepare the site for client assessment and dispensing operations-may also function in a regular nursing role

Nurse in Charge

Duties include but are not limited to:• Staff assignments, orientation and JITT including

appropriate labeling and documentation of medication dispensed

• Communicates staffing and equipment needs to POD manager

• Maintains smooth flow of operations• Monitors nursing staff for S/S of stress and fatigue• Schedules breaks and lunch • Fills in as needed in any other nurse position• Assist with demobilization

Team Leader-Nurse

Duties include but are not limited to:

• Functions in the nursing role

• Assists Nurse in Charge with staff assignments, orientation and JITT including appropriate labeling and documentation of medications dispensed

• Communicates staffing and equipment needs to Nurse in Charge

• Monitors team for S/S of stress and fatigue

• Coordinates breaks/lunch with Nurse in Charge

• Assists with demobilization

Dispensing Nurses-Express

• Reviews client history form and determines if antibiotic chosen is appropriate (e.g. Client has marked allergy to Cipro and Cipro has been ordered-take the client history form to the Nurse Team Leader)

• Provides abbreviated counseling to client and reinforces verbally the importance of completing the entire regimen and follow-up instructions

Dispensing Nurses-Express

• Answers any client questions• Instructs the client to sign the client history form• Completes documentation and labeling including

BCP precaution sticker• Dispenses medication, drug information sheet

and PCP referral form (green form)• Requests supplies as needed using “Supplies

Needed” Sign

Dispensing-Family

• Client history form will be reviewed by Pharmacist/Pharmacy Student and appropriate medication determined

• Review Doxy crushing instructions and dosing chart based on weight for children. If weight is unknown, estimate.

• Mark appropriate dosage on the instruction sheet and include each child’s name

• Provide abbreviated counseling to client and reinforce verbally the importance of completing the entire regimen and follow-up instructions

Dispensing-Family

• Answer any client questions

• Instruct client to sign client history form

• Complete documentation and labeling

• Dispense medication with drug information sheet and PCP referral form (green form) at Pharmacist’s direction

Dispensing-Support Services

• Social Worker, Interpreter or other POD worker may provide assistance as needed in this area (such as completing client history form, assisting with translation or help with unaccompanied minors)

• Client history form will be reviewed by Pharmacist or Pharmacy Student and appropriate medication determined

• Provide abbreviated counseling to client and reinforce verbally the importance of completing the entire regimen and follow-up instructions

Dispensing-Support Services

• Answer any client questions

• Instruct client to sign client history form

• Complete documentation and labeling

• Dispense medication with drug information sheet and PCP referral form (green form) at Pharmacist’s direction

Clinical Supply Coordinator

• Answers directly to POD Manager• Supervises runners• Establishes separate storage area for supplies• In charge of all drugs, forms, supplies and equipment• Receives, organizes and documents drugs/supplies• Maintains adequate security in drug/supply area• Coordinates replenishment orders• Coordinates breaks and lunch for supervised staff• Assists with demobilization

Runners

• Watch for “Supplies Needed” signs to be displayed at any station

• Provide supplies as requested• Recycle POD items as needed• Report any problems with supplies to

Coordinator• Assist with any additional needs identified

including the Support Services area

Social Worker in Charge

• Responsible for JITT and supervision of non-medical staff, including volunteers if utilized

• Monitor individuals exhibiting extreme signs of distress, including staff

• Make appropriate referrals if needed• Provides assistance with support services• Assist with client flow if needed• Provide staff support if needed• Coordinates breaks and lunch with supervised staff

Social Worker

• Monitor individuals exhibiting extreme signs of distress, including staff

• Make appropriate referrals if needed• Provides assistance with support services• Assist with client flow if needed• Provide staff support if needed• Coordinates breaks and lunch with supervised

staff

Clerk in Charge

• Coordinates POD worker registration process (this includes sign in/sign out and vest pick up/return)

• Responsible for JITT and supervision of clerks in all areas of the POD

• Maintains clerical supplies (clipboards, forms, pens, etc.)• Ensures signage is properly displayed• Maintains staffing/shift rosters• Observes clerks for signs of stress/fatigue• Schedules regular breaks• Assists with demobilization

Team Leader-Clerk

• Assists Clerk in Charge with POD worker registration process

• Maintains clerical supplies (clipboards, forms, pens, etc.)

• Ensure signage is properly displayed• Observe clerks for signs of stress/fatigue• Coordinate breaks and lunch for clerical staff

with Clerk in Charge• Functions as a Clerk

Clerk

• Assists with POD worker registration process• Assist clients with the registration process-this

includes forms, educational material, pens, labels for medication

• May assist clients with completion of form• Directs clients to Greeter and POD entrance• Maintain clerical supplies-request additional

supplies from runner as needed

Greeter in Charge

Duties include but are not limited to:• Staff assignments, orientation and JITT for Greeter staff

and Team Leaders• Communicates staffing and equipment needs to Social

Worker in Charge• Maintains smooth flow of operations (this may include

areas outside of the POD)• Coordinate breaks and lunch for supervised staff• Fill in as needed in Greeter position• Assist with demobilization

Greeter in Charge

*Note: For this exercise only, the Greeter in Charge will be responsible for Traffic Control and will answer directly to the POD Manager. In a real event, traffic control would be the responsibility of the Local Law Enforcement Agency.

Team Leader-Greeter

Duties include but are not limited to:• Assisting Greeter in Charge with staff assignments,

orientation and JITT for Greeter staff• Communicates staffing and equipment needs to Greeter

in Charge• Maintains smooth flow of operations (this may include

areas outside of the POD)• Functions in the Greeter position• Assists with demobilization

Greeter

• Greet clients as they arrive and answer any initial questions

• Direct client flow to appropriate areas (may include areas outside of the POD)

• Identify any issues or needed assistance that may need to be addressed

• Assist in any other area as directed by Greeter in Charge

Guide in Charge

Duties include but are not limited to:• Staff assignments, orientation and JITT for Guide staff

and Team Leaders• Communicates staffing and equipment needs to Social

Worker in Charge• Maintains smooth flow of operations-(this may include

areas outside of the POD) • Coordinate breaks and lunch for supervised staff• Fill in as needed in Guide position• Assist with demobilization

Team Leader-Guide

Duties include but are not limited to:• Assists Guide in Charge with staff assignments,

orientation and JITT for Guide staff• Communicates staffing and equipment needs to Guide in

Charge• Maintains smooth flow of operations-this may include

areas outside of the POD• Coordinate breaks and lunch for supervised staff• Functions in Greeter position• Assists with demobilization

Guide• Serves as gatekeeper and admits

clients into appropriate areas as they become available

• Assists with client flow-notifies Guide in Charge of any problems (bottleneck)

• May escort clients needing assistance to the appropriate area

Forms

Client History Form

This form is available at http://adph.org/CEP/assets/SNS_NAPH_Form.pdf

Forms Review Flow Chart

Notification to Primary Care Provider

Referral Form

Doxy client Information Sheet

Patient Information Leaflet Doxycycline 100 mg tablet

State Public Health Organization: _________________Alabama Department of Public Health______________ 24-Hour Information Telephone Number: _______________________________________________________

Doxycycline is an antibiotic belonging to the group of drugs called tetracyclines. This drug has been given to you for protection against possible exposure to infection-causing bacteria. This drug prevents __________ ___ ___ . You have been given a limited supply of medicine. Public health officials will inform you if you need more medicine after you finish this supply. If so, at your next visit you will be told how to get more medicine. You will be told if no more medicine is needed. You may also be switched from this medicine to a different medicine based on laboratory tests. Since the disease associated with __ _____ can develop quickly and be life threatening, it is very important that you take all the medicine given to you exactly as recommended by the public health officials. How should you take this medicine?

Take one tablet by mouth twice a day unless instructed otherwise. Keep taking the medicine even if you feel okay unless your health care provider tells you to stop. If you

stop taking this medicine too soon you might become sick. You may take this medicine with or without food or milk, but food or milk may help you avoid stomach

upset. If you miss a dose, take the missed dose as soon as possible. If it is almost time for your next dose of

medicine wait until then to take the medicine and skip the missed dose. Do not take two doses at the same time.

This medicine has been prescribed for your current condition only. Do not give it to someone else or save it for use at another time with another infection.

Do NOT take this medication if:

You have had an allergic reaction to any tetracycline antibiotics such as demeclocycline, doxycycline, minocycline or oxytetracycline.

If you have liver disease, if you are or might be pregnant, or if you are breastfeeding, tell the emergency health care worker before you take this medicine.

Other precautions:

This medicine increases the chance of sunburn; avoid prolonged exposure to sunlight or tanning equipment. If you have to be in the sun make sure to use sunscreen (SPF 15 or higher) to protect your skin.

Women may get vaginal yeast infections from taking this medicine. An over-the-counter vaginal antifungal product will help with this problem, or check with your physician or pharmacist.

Serious side effects – call your doctor or go to an Emergency Room:

If you experience any of these: skin rash, hives or itching; wheezing or trouble breathing; swelling of the face, lips or throat.

Other side effects:

Rare side effects can occur that usually do not need medical attention. These side effects may go away while your body adjusts to the medicine. These side effects include: diarrhea, upset stomach, nausea, sore mouth or throat, sensitivity to sunlight,

or itching of the mouth or vagina lasting more than 2 days. If you get diarrhea consider adding yogurt or lactobacillus to your diet. A re-hydration solution such as Pedialyte® is helpful if you have severe diarrhea. Talk with your doctor or pharmacist if any of these side effects become bothersome.

Cipro client Information Sheet

Patient Information Leaflet Ciprofloxacin 500 mg tablet

State Public Health Organization: Alabama Department of Public Health____________ 24-Hour Information Telephone Number _____________________________________________ Ciprofloxacin is an antibiotic belonging to the group of drugs called quinolones. You have been given this drug for protection against possible exposure to infection-causing bacteria. This drug prevents ___ ____________ _ ___ . You have been given a limited supply of medicine. Public Health officials will inform you if you need more medicine after you finish this supply. If so, you will be told how to get more medicine. You will be told if more medicine is needed. You may also be switched from this medicine to a different medicine based on laboratory tests. Since the disease associated with _____________ can develop quickly and be life threatening, it is very important that you complete the full course of therapy recommended by public health officials. How should you take this medicine?

Take one tablet by mouth twice a day unless instructed otherwise. Special dosing instructions for children will be provided Keep taking your medicine even if you feel okay, unless you doctor tells you to stop. If you stop taking this

medicine too soon, you may become ill. You should take this medicine will a full glass of water. Drink several glasses of water each day while you are

taking this medicine. It is best to take this medicine 2 hours after a meal. If this medicine upsets your stomach, you may take it with food. However, do not take this medicine with dairy

products such as milk, yogurt, or cheese. If you miss a dose, take the missed dose as soon as possible. If it is almost time for your next dose of medicine,

wait until then to take the medicine and skip the missed dose. Do not take two doses at the same time. This medicine has been prescribed for your current condition only. Do not give it to someone else or save it for

use at another time with another infection. Do NOT take this medication if:

You have had an allergic reaction to ciprofloxacin or other quinolone antibiotics such as gatafloxacin (Tequin®), levofloxacin (Levaquin®), norfloxacin (Noroxin®), ofloxacin (Floxin®) or nalidixic acid (NegGram®).

Other precautions:

If you have epilepsy, kidney disease, or if you are pregnant, become pregnant or are breastfeeding, notify emergency healthcare workers before you start taking this medicine.

Until information is obtained about which drug is most effective against ______ ___ , medical experts from the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists recommend children and pregnant and breastfeeding women receive ciprofloxacin to prevent life-threatening complications of _______ __ . If you are currently breastfeeding and have concerns about exposing your baby to ciprofloxacin, you may consider discarding the breast milk until you have finished the medication.

This medicine may make you dizzy or lightheaded. Avoid driving or using machinery until you know how it will affect you.

This medicine increases the chance of sunburn. Avoid prolonged exposure to sunlight or tanning equipment. If you have to be in the sun, make sure to use sunscreen (SPF 15 or greater) to protect your skin.

Serious side effects – call your doctor or go to an Emergency Room:

Skin rash or hives; swelling of the face, throat, or lips; shortness of breath or trouble breathing; seizures; or severe diarrhea.

Other side effects:

Rare side effects can occur that usually do not need medical attention These side effects may go away while your body adjusts to the medicine

Doxy Crushing Instructions

Labeling and Documentation

Doxycycline 100mg

SNS label includes:

•Name of Drug•Strength•Dosage•Quantity

Doxycycline 100 mg

SNS tear off labelfor client History FormIncludes:

•Name of Drug•Quantity Dispensed•Lot Number•Expiration Date•Prescription Number•National Drug Code

For this exercise….

Colored-coded labels (shown below) will be used to simulate the SNS tear off label. *Do not tear off SNS label.

Doxycycline 100 mg#20 tabs

Ciprofloxacin 500 mg#20 tabs

Labeling for Dispensing

ADPH-Donald Williamson, MDEmergency Prescription-June 5,

2014For questions call 1-866-543-9899client________________________

This label will be provided at registration-client will write in name. In a real event, this label would be affixed to the medication bottle, but not for this exercise.

This Antibiotic may decrease the effectiveness of birth control pills

This sticker will beadded to medicationif client marks “Yes”to Birth Control Pills

Labeling for Dispensing

Documentation

Client history should be completely filled out. This includes client name, address, phone number and medical history on each person represented on the form. Weights and birthdates for children may be estimated. Forms should be checked at every step of the POD process for completion. Form must be authorized and signed by the client picking up the medications at the time of dispensing.

At Triage, the Clinician will determine if the client and all household members are eligible to receive medication through EXPRESS dispensing. If so, the clinician will determine the medication to be dispensed, circle it and initial. Then he/shewill circle EXPRESS at the bottom of the form and send the client to a Greeter. Clients not eligible for EXPRESS dispensing will be sent to theappropriate line for dispensing by a Pharmacist.

Documentation

Documentation

Documentation

The Dispensing Nurse or Pharmacist will have the client sign the form, apply the appropriate label for the medication dispensed, print and sign his/her name, fill in

POD location and date.

Questions?

Call or email:

Julie Cobb, RN

Jefferson County Department of Health

Emergency Preparedness and Response

205-558-2124

Julie.cobb@jcdh.org