- Email: [email protected]
Pharmacist-based intervention to prepare residents of assisted-living facilities for emergencies
Research notes
Pharmacist-based intervention to prepare residents of assisted-living facilities for emergencies Brett Feret and Jeffrey Bratberg
Abstract Objective: To assess views of disaster preparation and readiness of assisted-living residents after a comprehensive program developed and presented by pharmacists on the importance of preparing for an emergency, specifically regarding organizing of medical information. Methods: Four assisted-living facilities were identified throughout Rhode Island to participate in a 30-minute program conducted by two pharmacists who were involved in disaster preparedness on both a national and state level. A survey assessed the participants’ possession of a disaster kit, medical form, and personal plan, as well as their knowledge of their facilities’ possession of a kit, form, and plan. Participants were also surveyed on their attitudes regarding current preparedness and on the disasters (e.g,, hurricanes, bioterrorism, avian influenza, floods, fire) about which they were most concerned before the program began. Student pharmacists and faculty assisted residents in the completion of the survey. At the conclusion of the program, all participants were asked to retake the survey to assess the impact of the program. Results: 58 preprogram and 42 postprogram surveys were returned anonymously. A statistically significant change in preparedness was observed for hurricane, avian influenza, bioterrorism, and flood, and a statistically significant change in concern was seen for avian influenza and bioterrorism. Conclusion: Elderly assisted-living residents are at increased risk of adverse effects in disasters; however, this growing population lacks baseline preparedness items such as a simple emergency preparedness kit. Educational programs by pharmacists can increase levels of preparedness for and defuse concerns about disasters in this population. Pharmacists also can educate elderly patients about preparedness for potential disasters specific to their location. Keywords: Elderly, emergency preparedness, disasters, bioterrorism, hurricanes, surveys. J Am Pharm Assoc. 2008;48:780–783. doi: 10.1331/JAPhA.2008.07068
A
ccording to the 2005 Census, the elderly population in Rhode Island is increasing. Approximately 13.9% of Rhode Island’s population is older than 65 years of age, making the state sixth in the nation in that category.1 Lessons learned from Hurricane Katrina in the Gulf Coast have shown us that advanced preparation is extremely important, especially in the elderly, considering that 60% of victims identified from Hurricane Katrina were aged 61 years or older.2 After the terrorist attacks on September 11, 2001, elderly individuals waited for up to 7 days for assistance from medical teams that responded to New York.3 Emergency preparedness planning for the elderly should be a high priority. Responding to and caring for the elderly is a complex challenge, especially during emergency situations. Often, elderly individuals can have difficulty understanding the importance of the event, and many times communication with loved ones is limited and erratic. Disaster-related environmental factors, such as dehydration, hypothermia, and infectious disease, seriously affect frail elderly patients with acute and chronic medical conditions. Many seniors are taking several prescription and nonprescription medications to treat multiple medical conditions. Access to these medications may be severely limited during an emergency. This difficult situation is compounded for older individuals when key information on their complex medication regimens is not readily available to those providing medical response during the disaster. The International Longevity Center–USA provides several potential solutions to emergency preparedness for the elderly.3 These include an educational campaign, detailed list of medications and drug-related allergies, emergency contact communication list, and the creation of a portable disaster kit.
Objective Our objective was to assess views of disaster preparation and readiness of residents of assisted-living facilities after a Received June 21, 2007, and in revised form October 22, 2007. Accepted for publication April 29, 2008. Brett Feret, PharmD, is Associate Professor of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston. Jeffrey Bratberg, PharmD, BCPS, is Associate Professor of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, and Assistant Professor of Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Correspondence: Brett Feret, PharmD, University of Rhode Island, College of Pharmacy, 144 Fogarty Hall, Kingston, RI 02881. Fax: 401-874-2717. E-mail: [email protected] Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria. Acknowledgments: To Brian Quilliam, BPharm, PhD, for statistical expertise and to Karen Peck, RN, at Horizon Bay for her help in and access to study assisted-living facilities. Funding: Support provided by the University of Rhode Island Council of Outreach and CVS/Caremark.
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Research notes
are large clinics designed to rapidly screen and dispense the appropriate medications. The efficiency of these POD sites for the elderly can be improved using the information from the completed health screening form. Before the educational program, pharmacy faculty briefly introduced the purpose and details of a survey that each participant was asked to complete (see Appendix 1 in the electronic version of this article, available online at www.japha. org). This voluntary survey was approved by the University of Rhode Island Institutional Review Board. The survey assessed the participants’ possession of a disaster kit, medical form, and personal plan, as well as their knowledge of their facilities’ possession of a kit, form, and plan. Participants also were asked to rate their current level of preparedness and to identify the disasters about which they were most concerned before the program began. The disasters specified on the surveys included hurricanes, bioterrorism, avian influenza (referred to in the survey by its common name, “bird flu”), floods, and fire. Survey responses were based on a 7-point Likert-type scale. Student pharmacists and faculty assisted residents in the completion of the survey. At the conclusion of the program, all participants were asked to take the survey again to assess the impact of the program.
comprehensive program developed and presented by pharmacists on the importance of preparing for an emergency, specifically regarding organization of medical information.
Methods Four assisted-living facilities were identified throughout Rhode Island to participate in the program. The assisted-living facilities were chosen in conjunction with a representative from the company that owned and operated the facilities. Residents of each facility were invited by flyers and through word of mouth by staff at the specific assisted-living facility. The program was approximately 30 minutes in length and was conducted by two pharmacists who were involved in disaster preparedness on both a national and state level. The program focused on major emergency preparedness issues, such as having a plan, developing a communication and support network, assembling an emergency kit, the importance of having your medical and pharmacy information organized and readily available, and the different types of disasters that could affect the state of Rhode Island, including different public health emergencies such as a bioterrorist attack or a pandemic influenza outbreak. At the end of the program, residents received a disaster kit containing a first aid kit, a flashlight, a medical health form, and a selection of over-the-counter (OTC) medications. These medications were chosen to treat common disaster-related conditions and included acetaminophen, diphenhydramine, hydrocortisone cream, and ibuprofen. Student pharmacists on advanced practice experiences and faculty also personally helped residents complete a comprehensive health form that included sections on health conditions, medications, vaccination history, contact information, special need requirements, and other demographic data. They also screened for allergies or specific contraindications to the OTC medications and removed them from the emergency bag if necessary. The health form also had a detailed section related to the state’s plan for bioterrorism preparedness. In the event of a bioterrorist attack with anthrax or plague, the population across the state will most likely be prescribed the antibiotic ciprofloxacin or doxycycline, depending on the agent released, and the antibiotic sensitivities performed by the Centers for Disease Control and Prevention and the Rhode Island Department of Health. During an outbreak, the state has developed a medication distribution strategy to dispense antibiotics to all residents in 36 hours at points of distribution (PODs), which
Results A total of 58 preprogram and 42 postprogram surveys were returned anonymously. Baseline preparedness results are shown in Figure 1. The results of the surveys are detailed in Tables 1 and 2. A statistically significant change in preparedness was observed for hurricane, avian influenza, bioterrorism, and flood, and a statistically significant change in concern was seen for avian influenza and bioterrorism.
Discussion To the best of our knowledge, this is the first report to assess emergency preparedness and concern in residents of assisted-living facilities. Previously, only fire safety knowledge and practices were assessed in this population.4 This is also the first article to detail the assessment of pharmacist intervention on disaster preparedness and concern. This survey sought to collect data on an important and growing public health message and need: emergency preparedness. Communications from both federal and state governments, as well as other organizations, have continually stressed the importance of being prepared and aware of the potential for di-
Table 1. Change in concern regarding disaster among elderly assisted-living residents Disaster type Hurricane Avian influenza Bioterrorism Flood Fire
Mean preprogram (n = 58)
Mean postprogram (n = 42)
4.39 3.98 4.22 4.21 4.58
4.12 3.19 3.28 3.74 4.40
P
0.49 0.05 0.02 0.24 0.67
Responses based on a 7-point Likert-type scale (1, least concerned; 7, most concerned).
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Table 2. Change in disaster preparedness of elderly assisted-living residents Disaster type Hurricane Avian influenza Bioterrorism Flood Fire
Mean preprogram (n = 58) 3.17 2.22 2.22 2.60 4.03
Mean postprogram (n = 42) 4.09 3.54 3.61 3.73 4.69
P 0.01 <0.01 <0.01 <0.01 0.19
Responses based on a 7-point Likert-type scale (1, least prepared; 7, most prepared).
sasters. This project sought to assess levels of awareness and concern for disasters and to prepare and educate a vulnerable population. Data from the surveys performed in the current study demonstrated that, although many assisted-living residents expressed concern for disasters, few were aware of the need to prepare. We found that our educational intervention significantly decreased the mean anxiety related to avian influenza and bioterrorism, which was likely a result of our discussion of pharmacologic interventions for these emergencies. Accordingly, no change in mean anxiety was observed for hurricane or fire. Significant increases in mean preparedness levels were seen in all categories except fire. This is likely because of our multifaceted intervention, including an on-site interactive preparedness education presentation with a question-and-answer session followed by one-on-one interviews and the provision of emergency kits. This approach prepared residents for widespread disasters (e.g., flu, flood, hurricane, bioterrorism) but not for localized disasters (e.g., fire).
Limitations This study has several limitations. Selection bias is present because the assisted-living population assessed does not represent the range of socioeconomic levels of Rhode Island residents, particularly those seniors living in poverty who likely have fewer resources to prepare for disasters. Changes in concern and preparedness may be skewed because fewer postprogram surveys (n = 42) than preprogram surveys (n = 58) were returned. Lastly, this study examined disasters and disaster-related anxiety specific to Rhode Island’s assisted-living populations. Pharmacists should prioritize their interventions based on their location.
Conclusion Elderly assisted-living residents are at increased risk of adverse effects in disasters; however, this growing population lacks baseline preparedness items such as a simple emergency preparedness kit. Interactive, hands-on educational programs by pharmacists can increase levels of preparedness for and defuse concerns about disasters in this population. Commu-
Figure 1. Facilities’ and residents’ baseline preparedness 782 • JAPhA • 4 8 : 6 • N o v / D e c 2 0 0 8
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nity and consultant pharmacists’ frequent contact and accessibility to the elderly puts them in an ideal position to reduce anxiety and provide focused, timely, up-to-date preparedness strategies for older patients. Despite 24-hour nationwide access to pharmacy profiles, evacuees from Hurricane Katrina often showed up in areas that couldn’t access their information.5 Pharmacists are responsible for creating redundant, proactive information solutions to mitigate these inevitable situations and to provide advice and tools for assembling an emergency kit. Pharmacists should also make a concerted and consistent effort to educate their elderly patients about preparedness for potential disasters specific to their location.
References 1. Louisiana Department of Health and Hospitals. Vital statistics of all bodies at St. Gabriel Morgue, 11/18/2005. Baton Rogue, LA: Louisiana Department of Health and Hospitals; 2005. 2. O’Brien N. Issue brief: emergency preparedness for older people. Accessed at www.ilcusa.org, June 21, 2007. 3. U.S. Census Bureau. State & County QuickFacts: Rhode Island. Accessed at http://quickfacts.census.gov/qfd/states/44000.html, June 21, 2007. 4. Jaslow D, Ufberg J,Yoon R, et al. Fire safety knowledge and practices among residents of an assisted living facility. Prehosp Disaster Med. 2005;20:134–8. 5. The Markle Foundation. Lessons from KatrinaHealth. Accessed at http://katrinahealth.org, October 22, 2007.
Northeastern Illinois Watermill • Antioch, IL • July 4, 2008 • George E. MacKinnon III, PhD, BPharm, FASHP
Journal of the American Pharmacists Association
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JAPhA • 783
Pharmacist-based intervention to prepare residents of assisted-living facilities for emergencies Brett Feret and Jeffrey Bratberg
Abstract Objective: To assess views of disaster preparation and readiness of assisted-living residents after a comprehensive program developed and presented by pharmacists on the importance of preparing for an emergency, specifically regarding organizing of medical information. Methods: Four assisted-living facilities were identified throughout Rhode Island to participate in a 30-minute program conducted by two pharmacists who were involved in disaster preparedness on both a national and state level. A survey assessed the participants’ possession of a disaster kit, medical form, and personal plan, as well as their knowledge of their facilities’ possession of a kit, form, and plan. Participants were also surveyed on their attitudes regarding current preparedness and on the disasters (e.g,, hurricanes, bioterrorism, avian influenza, floods, fire) about which they were most concerned before the program began. Student pharmacists and faculty assisted residents in the completion of the survey. At the conclusion of the program, all participants were asked to retake the survey to assess the impact of the program. Results: 58 preprogram and 42 postprogram surveys were returned anonymously. A statistically significant change in preparedness was observed for hurricane, avian influenza, bioterrorism, and flood, and a statistically significant change in concern was seen for avian influenza and bioterrorism. Conclusion: Elderly assisted-living residents are at increased risk of adverse effects in disasters; however, this growing population lacks baseline preparedness items such as a simple emergency preparedness kit. Educational programs by pharmacists can increase levels of preparedness for and defuse concerns about disasters in this population. Pharmacists also can educate elderly patients about preparedness for potential disasters specific to their location. Keywords: Elderly, emergency preparedness, disasters, bioterrorism, hurricanes, surveys. J Am Pharm Assoc. 2008;48:780–783. doi: 10.1331/JAPhA.2008.07068
A
ccording to the 2005 Census, the elderly population in Rhode Island is increasing. Approximately 13.9% of Rhode Island’s population is older than 65 years of age, making the state sixth in the nation in that category.1 Lessons learned from Hurricane Katrina in the Gulf Coast have shown us that advanced preparation is extremely important, especially in the elderly, considering that 60% of victims identified from Hurricane Katrina were aged 61 years or older.2 After the terrorist attacks on September 11, 2001, elderly individuals waited for up to 7 days for assistance from medical teams that responded to New York.3 Emergency preparedness planning for the elderly should be a high priority. Responding to and caring for the elderly is a complex challenge, especially during emergency situations. Often, elderly individuals can have difficulty understanding the importance of the event, and many times communication with loved ones is limited and erratic. Disaster-related environmental factors, such as dehydration, hypothermia, and infectious disease, seriously affect frail elderly patients with acute and chronic medical conditions. Many seniors are taking several prescription and nonprescription medications to treat multiple medical conditions. Access to these medications may be severely limited during an emergency. This difficult situation is compounded for older individuals when key information on their complex medication regimens is not readily available to those providing medical response during the disaster. The International Longevity Center–USA provides several potential solutions to emergency preparedness for the elderly.3 These include an educational campaign, detailed list of medications and drug-related allergies, emergency contact communication list, and the creation of a portable disaster kit.
Objective Our objective was to assess views of disaster preparation and readiness of residents of assisted-living facilities after a Received June 21, 2007, and in revised form October 22, 2007. Accepted for publication April 29, 2008. Brett Feret, PharmD, is Associate Professor of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston. Jeffrey Bratberg, PharmD, BCPS, is Associate Professor of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, and Assistant Professor of Medicine, Warren Alpert Medical School, Brown University, Providence, RI. Correspondence: Brett Feret, PharmD, University of Rhode Island, College of Pharmacy, 144 Fogarty Hall, Kingston, RI 02881. Fax: 401-874-2717. E-mail: [email protected] Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria. Acknowledgments: To Brian Quilliam, BPharm, PhD, for statistical expertise and to Karen Peck, RN, at Horizon Bay for her help in and access to study assisted-living facilities. Funding: Support provided by the University of Rhode Island Council of Outreach and CVS/Caremark.
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Research notes
are large clinics designed to rapidly screen and dispense the appropriate medications. The efficiency of these POD sites for the elderly can be improved using the information from the completed health screening form. Before the educational program, pharmacy faculty briefly introduced the purpose and details of a survey that each participant was asked to complete (see Appendix 1 in the electronic version of this article, available online at www.japha. org). This voluntary survey was approved by the University of Rhode Island Institutional Review Board. The survey assessed the participants’ possession of a disaster kit, medical form, and personal plan, as well as their knowledge of their facilities’ possession of a kit, form, and plan. Participants also were asked to rate their current level of preparedness and to identify the disasters about which they were most concerned before the program began. The disasters specified on the surveys included hurricanes, bioterrorism, avian influenza (referred to in the survey by its common name, “bird flu”), floods, and fire. Survey responses were based on a 7-point Likert-type scale. Student pharmacists and faculty assisted residents in the completion of the survey. At the conclusion of the program, all participants were asked to take the survey again to assess the impact of the program.
comprehensive program developed and presented by pharmacists on the importance of preparing for an emergency, specifically regarding organization of medical information.
Methods Four assisted-living facilities were identified throughout Rhode Island to participate in the program. The assisted-living facilities were chosen in conjunction with a representative from the company that owned and operated the facilities. Residents of each facility were invited by flyers and through word of mouth by staff at the specific assisted-living facility. The program was approximately 30 minutes in length and was conducted by two pharmacists who were involved in disaster preparedness on both a national and state level. The program focused on major emergency preparedness issues, such as having a plan, developing a communication and support network, assembling an emergency kit, the importance of having your medical and pharmacy information organized and readily available, and the different types of disasters that could affect the state of Rhode Island, including different public health emergencies such as a bioterrorist attack or a pandemic influenza outbreak. At the end of the program, residents received a disaster kit containing a first aid kit, a flashlight, a medical health form, and a selection of over-the-counter (OTC) medications. These medications were chosen to treat common disaster-related conditions and included acetaminophen, diphenhydramine, hydrocortisone cream, and ibuprofen. Student pharmacists on advanced practice experiences and faculty also personally helped residents complete a comprehensive health form that included sections on health conditions, medications, vaccination history, contact information, special need requirements, and other demographic data. They also screened for allergies or specific contraindications to the OTC medications and removed them from the emergency bag if necessary. The health form also had a detailed section related to the state’s plan for bioterrorism preparedness. In the event of a bioterrorist attack with anthrax or plague, the population across the state will most likely be prescribed the antibiotic ciprofloxacin or doxycycline, depending on the agent released, and the antibiotic sensitivities performed by the Centers for Disease Control and Prevention and the Rhode Island Department of Health. During an outbreak, the state has developed a medication distribution strategy to dispense antibiotics to all residents in 36 hours at points of distribution (PODs), which
Results A total of 58 preprogram and 42 postprogram surveys were returned anonymously. Baseline preparedness results are shown in Figure 1. The results of the surveys are detailed in Tables 1 and 2. A statistically significant change in preparedness was observed for hurricane, avian influenza, bioterrorism, and flood, and a statistically significant change in concern was seen for avian influenza and bioterrorism.
Discussion To the best of our knowledge, this is the first report to assess emergency preparedness and concern in residents of assisted-living facilities. Previously, only fire safety knowledge and practices were assessed in this population.4 This is also the first article to detail the assessment of pharmacist intervention on disaster preparedness and concern. This survey sought to collect data on an important and growing public health message and need: emergency preparedness. Communications from both federal and state governments, as well as other organizations, have continually stressed the importance of being prepared and aware of the potential for di-
Table 1. Change in concern regarding disaster among elderly assisted-living residents Disaster type Hurricane Avian influenza Bioterrorism Flood Fire
Mean preprogram (n = 58)
Mean postprogram (n = 42)
4.39 3.98 4.22 4.21 4.58
4.12 3.19 3.28 3.74 4.40
P
0.49 0.05 0.02 0.24 0.67
Responses based on a 7-point Likert-type scale (1, least concerned; 7, most concerned).
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Table 2. Change in disaster preparedness of elderly assisted-living residents Disaster type Hurricane Avian influenza Bioterrorism Flood Fire
Mean preprogram (n = 58) 3.17 2.22 2.22 2.60 4.03
Mean postprogram (n = 42) 4.09 3.54 3.61 3.73 4.69
P 0.01 <0.01 <0.01 <0.01 0.19
Responses based on a 7-point Likert-type scale (1, least prepared; 7, most prepared).
sasters. This project sought to assess levels of awareness and concern for disasters and to prepare and educate a vulnerable population. Data from the surveys performed in the current study demonstrated that, although many assisted-living residents expressed concern for disasters, few were aware of the need to prepare. We found that our educational intervention significantly decreased the mean anxiety related to avian influenza and bioterrorism, which was likely a result of our discussion of pharmacologic interventions for these emergencies. Accordingly, no change in mean anxiety was observed for hurricane or fire. Significant increases in mean preparedness levels were seen in all categories except fire. This is likely because of our multifaceted intervention, including an on-site interactive preparedness education presentation with a question-and-answer session followed by one-on-one interviews and the provision of emergency kits. This approach prepared residents for widespread disasters (e.g., flu, flood, hurricane, bioterrorism) but not for localized disasters (e.g., fire).
Limitations This study has several limitations. Selection bias is present because the assisted-living population assessed does not represent the range of socioeconomic levels of Rhode Island residents, particularly those seniors living in poverty who likely have fewer resources to prepare for disasters. Changes in concern and preparedness may be skewed because fewer postprogram surveys (n = 42) than preprogram surveys (n = 58) were returned. Lastly, this study examined disasters and disaster-related anxiety specific to Rhode Island’s assisted-living populations. Pharmacists should prioritize their interventions based on their location.
Conclusion Elderly assisted-living residents are at increased risk of adverse effects in disasters; however, this growing population lacks baseline preparedness items such as a simple emergency preparedness kit. Interactive, hands-on educational programs by pharmacists can increase levels of preparedness for and defuse concerns about disasters in this population. Commu-
Figure 1. Facilities’ and residents’ baseline preparedness 782 • JAPhA • 4 8 : 6 • N o v / D e c 2 0 0 8
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Journal of the American Pharmacists Association
Research notes
nity and consultant pharmacists’ frequent contact and accessibility to the elderly puts them in an ideal position to reduce anxiety and provide focused, timely, up-to-date preparedness strategies for older patients. Despite 24-hour nationwide access to pharmacy profiles, evacuees from Hurricane Katrina often showed up in areas that couldn’t access their information.5 Pharmacists are responsible for creating redundant, proactive information solutions to mitigate these inevitable situations and to provide advice and tools for assembling an emergency kit. Pharmacists should also make a concerted and consistent effort to educate their elderly patients about preparedness for potential disasters specific to their location.
References 1. Louisiana Department of Health and Hospitals. Vital statistics of all bodies at St. Gabriel Morgue, 11/18/2005. Baton Rogue, LA: Louisiana Department of Health and Hospitals; 2005. 2. O’Brien N. Issue brief: emergency preparedness for older people. Accessed at www.ilcusa.org, June 21, 2007. 3. U.S. Census Bureau. State & County QuickFacts: Rhode Island. Accessed at http://quickfacts.census.gov/qfd/states/44000.html, June 21, 2007. 4. Jaslow D, Ufberg J,Yoon R, et al. Fire safety knowledge and practices among residents of an assisted living facility. Prehosp Disaster Med. 2005;20:134–8. 5. The Markle Foundation. Lessons from KatrinaHealth. Accessed at http://katrinahealth.org, October 22, 2007.
Northeastern Illinois Watermill • Antioch, IL • July 4, 2008 • George E. MacKinnon III, PhD, BPharm, FASHP
Journal of the American Pharmacists Association
w w w.j a p h a . o r g
Nov/ D e c 2 0 0 8 • 4 8 : 6 •
JAPhA • 783