Pharmacy Business Plan Template

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					BHCPCT Pharmacy Emergency/ Business Continuity Plan Template V2




                              (Name of Pharmacy)


                            (Address of Pharmacy)



                                       PHARMACY

             Emergency / Business Continuity Plan
              (Incorporating Pandemic Influenza).



Author
Date of issue
Date tested
Date of review
Date of next review
Version No




Kevin Claxton May 2008
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BHCPCT Pharmacy Emergency/ Business Continuity Plan Template V2



Contents
INTRODUCTION………………………………………………………………………….4

DOCUMENT REVIEW ARRANGEMENTS……………………………………………5

TRAINING AND EXERCISING………………………………………………………….5

1. ACTIVATION OF THE PLAN…………………………………………………..........6

2. EMERGENCY RESPONSE TO MAJOR INCIDENTS…………………………….6

3. MEDICAL SUPPORT AT REST, EVAC AND SURVIVOR
CENTRES….............................................................................................................7

4. COORDINATION OF SUPPORT FROM GPS AND PRIMARY CARE
TEAMS DURING A MAJOR INCIDENT…………………………………………........7

5. CHEMICAL BIOLOGICAL RADIOLOGICAL AND NUCLEAR (CBRN)
INCIDENTS……………………………………………………………………................8

6. BUSINESS CONTINUITY…………………………………………………...............9

7. LOSS OF PHARMACY BUILDING…………………………………………............9

8. INITIAL CONSIDERATIONS AND ACTIONS………………………………...10-11

9. FAILURE OF IT SYSTEMS…………………………………………………...........11

10. FAILURE OF TELECOMMUNICATIONS………………………………….........11

11. FAILURE OF ELECTRICITY SUPPLY………………………………………12-13

12. FAILURE OF GAS SUPPLY………………………………………………...........14

13. FAILURE OF WATER SUPPLY………………………………………….......14-15

14. FUEL SHORTAGES………………………………………………………….........15

15. DISRUPTION TO SUPPLIES……………………………………………….........15

16. FIRE…………………………………………………………………………….........16

17. DAMAGE RESULTING FROM FLOOD OR EXTREME WEATHER…….......17

18. BREAK-IN, THEFT AND CRIMINAL DAMAGE………………………………...17

19. DELIBERATE ACTS OF EXTREME VIOLENCE………………………………18

20. STAFF SHORTAGE……………………………………………………………18-19



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BHCPCT Pharmacy Emergency/ Business Continuity Plan Template V2


21. PROTOCOL FOR PANDEMIC INFLUENZA………………………………..20-22

22. COMMUNICATING WITH THE CLIENTS…………………………………........22

23. REFERENCES………………………………………………………….................23

ANNEX A – CONTACTS LIST………………………………………………………...24

Staff Contacts…………………………………………………………………….........24

PCT Contacts…………………………………………………………………………...24

Utilities/Service Contacts…………………………………………………………….24

Tradesmen………………………………………………………………………………24

Suppliers of products/drugs etc…………………………………………………….25

ANNEX B RPSGB BUSINESS CONTINUITY CHECKLIST




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BHCPCT Pharmacy Emergency/ Business Continuity Plan Template V2



Introduction
In the year 2000 following the events of floods, fuel crisis and foot and mouth, and
the subsequent disruption caused, the government made moves to strengthen the
resilience of the UK. This need was further highlighted in 2001 with the terrorist
attacks on the USA and the subsequent attacks within the UK. These incidents
gave rise to the review of (what used to be called) „Civil protection‟, and resulted in
the Civil Contingencies Act 2003.

The act prescribed duties and responsibilities of agencies. Primary Care Trusts
are listed as „Category 1 responders‟ under the act. They have duties to ensure for
the delivery of health services, and to ensure that health providers engage in
contingency and business continuity planning, to ensure as far as possible their
continued operation during a crisis. PCT‟s must therefore ensure that those
organisations delivering services on their behalf (e.g. contracted-out services) or
capabilities that underpin services, can deliver to the extent required in the event
of an emergency 1.

The Royal Pharmaceutical Society of Great Britain developed a Business
Continuity template for Pharmacies in 2006, and awareness of it has been in
existence since then. This template is an updated version, building in Emergency
Planning and Pandemic Influenza issues.

This template should be regarded as a basic template. Accompanying this
template is a new RPSGB checklist (pdf document), which includes Flu
Pandemic issues, and which will guide the plan author through the planning
process. The checklist should be used to further adapt this template to suit
the needs of your pharmacy or group of pharmacies.

It should be noted that a pharmacy or group of pharmacies may be struck by or
involved in either a major emergency (i.e. City centre terrorist bomb), or a major
infrastructure incident (i.e. loss of power). Many situations can result from either a
„big-bang‟ incident (flooding) or a „creeping tide‟ incident (pandemic flu).

This plan therefore covers three broad types of incident. These are the response
to an incident by the local NHS as a whole; the business continuity of the
pharmacy during a widespread incident affecting the community; and the business
continuity of the pharmacy in the event of an internal incident affecting its business

Brighton & Hove City PCT takes these duties seriously, and has a Resilience
Manager whose role includes the maintenance of the PCT‟s own Emergency &
Business Continuity Plans, as well as the liaison with the providers of contracted-
out services to offer help and advice on resilience matters. Such advice can be
obtained from;

Kevin Claxton (Resilience Manager)                  Tel      01273 545489
Brighton and Hove City Teaching PCT                 Fax      01273 545470
Prestamex House
171 - 173 Preston Road                              E-mail kevin.claxton@bhcpct.nhs.uk
Brighton
BN1 6AG

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BHCPCT Pharmacy Emergency/ Business Continuity Plan Template V2



Document Review Arrangements
This document should be reviewed on an annual basis, or whenever there is a
change in the working systems of the pharmacy or changes to the contact
arrangements of staff or suppliers that affect the content.

The date of the review will be recorded on the front of the document along with the
date of the next review. This will be the responsibility of (insert post-holder).


Plan Owner / Plan Location.
This plan will be owned by (Insert person name / postholder title)

Plan copies will be held by:
1. (Insert person name / postholder title)
2. (Insert person name / postholder title)
3. (Insert person name / postholder title)


Training and Exercising
The emergency and business continuity response arrangements within this plan
have little value if the staff that are expected to implement them at the time of an
emergency, but are unaware of them. To this end all staff will be made aware of
the plan as part of their induction training. If there are any significant changes to
the plan that affects the way in which staff respond these must be communicated
to them.

This plan and the arrangements which underpin it must be tested / exercised at
least once a year. This will validate the plan‟s effectiveness and highlight any gaps
in the plan, which must then be amended.


Action cards.

The use of action cards is highlighted as good practice, and should be
adopted wherever possible. Action cards should list actions required of key
staff in the event of plan activation. They should be laminated, added to this
plan as appendices, and copied for those concerned.




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1.       Activation of the Plan
Community pharmacies offer a wide range of important services to patients and
the general public. Table 1 features a list of the services that this pharmacy
provides in order of priority.

In the event of an emergency or service disruption this pharmacy will endeavour to
maintain services at acceptable standards. Should this not become possible, the
pharmacist on duty will decide which priority services must be continued and
which can be reduced or suspended.

Any decisions made to reduce or stop services must be reported to the
Community Pharmacy Development Manager in the Medicines Management
Team of the PCT (insert relevant PCT contact),

Table 1 (Example):

 Dispensing service
 Full dispensing service
 Public Health service
Repeat dispensing service
Medicines Use Reviews
Enhanced Services
 Daily dispensing and supervised administration of methadone / buprenorphine
 Minor Ailment Service
 Needle exchange
 Services to Care Homes
 Rota and Out of hours service
 Compliance aids
 Model schemes

 Over the Counter (OTC) sales

(Add all the core and enhanced services you provide in priority related to customer
need)


2.       Emergency Response to Major Incidents
Primary Care Trusts are responsible for harnessing and effectively utilising the
primary care resources where needed to support for example, the establishment of
ad hoc emergency triage / treatment facilities or emergency vaccination
programmes2, other requests from GP and primary care support may be for a
pharmacist to assist at Local Authority rest / evacuation or survivor centres.




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BHCPCT Pharmacy Emergency/ Business Continuity Plan Template V2




3.       Medical Support at Rest, Evacuation and Survivor Centres
In the NHS Guidance on Major Incidents3 Primary Care Trusts have a
responsibility to provide medical support to rest, evacuation and survivor centres,
on request. Within Sussex the Sussex Ambulance Service NHS Trust will initially
assess the medical needs at either of the above centres and, if it is deemed
necessary, Acute NHS trusts may be asked to provide a team, and the PCT would
implement „Command & Control‟ arrangements.

It has been recognised that when people are caught up in a major incident,
whether directly involved in the incident or as a secondary impact of being
evacuated, that they will arrive at the centre without their medication. In these
instances a local pharmacy may receive a request for support, to assist in the
process of prescribing and supplying medications.


4.       Coordination of support from Pharmacists during a Major
         Incident
This response will be coordinated by the Primary Care Trusts to prevent
duplication and maximise the overall response. To assist in this the NHS will set
up its command and control structure. This comprises an emergency control
centre (ECC) being established within each PCT affected, and where there is
more than one PCT area involved the Lead PCT (West Sussex PCT) will establish
an overarching Health ECC for Sussex. This ECC will be responsible for
“coordination of health and social care economy, operational and public health
response” 4

The pharmacy may receive a request for support from the PCT during a local or
national crisis.


For this (name of Pharmacy) the PCT coordinating the response is Brighton &
Hove City Primary Care Trust. In the event of a Major Incident the contact will be
01273 295490 during office hours. Out of hours please page 07659 162184.




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5.       Chemical Biological Radiological and Nuclear (CBRN)
         Incidents
In the event of an overt release of contaminated material at an identified site, the
emergency services have plans to establish cordons to contain the contamination
and contaminated casualties, but there is always the possibility that casualties will
have left the scene before the emergency services arrive. If there is a covert
release of CBRN contamination, then it may be some hours or days later that
those contaminated, as well as those they have been in contact with since the
release, start experiencing signs and symptoms.

As soon as the authorities are aware of an incident involving CBRN release and
possible self-presentation of contaminated casualties at any entry to the health
system, all responding agencies will be informed and will work together under
agreed multi-agency protocols. It is highly likely that a major incident will be
declared.

It is not inconceivable that if there was ever a CBRN incident within our area a
pharmacy may find people self-presenting patients to in a desperate attempt to de-
contaminate themselves.

In the event that a contaminated casualty presents at the pharmacy the following
steps should be taken.

1        Contain the casualty away from others, and keep all staff at a distance.
2        Consider also containment for those who have already come into contact
         with the casualty.
3        Call the Ambulance Service, stating that you have a potential / confirmed
         contaminated casualty at the pharmacy.
4        Ask the casualty to remove their clothing, as this has been shown to reduce
         the contamination by up to 80% of contaminant. Provide a plastic bag for
         the casualty to place the clothes in.
5        Provide the casualty a 10Lt bucket of warm water containing 10ml of
         washing up liquid and a sponge, encourage the casualty to wash their
         whole body. Eyes should be washed with plain water, they should blow their
         nose and wash their mouth out with water.
6        Provide a blanket or similar or whatever may be available for use as
         clothing, once decontamination is complete and the ambulance service is
         awaited.

Remember all efforts must be taken to prevent further contamination of others.




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6.       Business Continuity
As previously mentioned in the introduction, ensuring that pharmacies are able to
maintain business continuity in the event of an emergency or business
interruption, is essential.

In this section, the plan will endeavour to cover the areas where the pharmacy
potentially could be required to implement business continuity arrangements.

Business continuity management (BCM) is not just simply having a plan, the
Business Continuity Institute describe the five stages as: -
          understanding your business,
          business continuity strategies,
          developing and implementing a BCM response,
          developing a BCM culture and
          exercising and maintenance and audit5.
This same approach has been recommended in the Civil Contingencies Act
guidance 2 .

(it is recommended that you use this five step approach and the attached pdf
checklist in preparing your content to this plan when personalising it for your
pharmacy. Details can be found at the references indicated.)


7.       Loss of main pharmacy building
If the pharmacy building is uninhabitable for any reason the services will be
provided in suitable alternative premises. If the pharmacy is located within a
shopping centre / mall, alternative premises may need to be found outside the mall
if the entire area is affected. Any relocation requires approval by the RPSGB and
by the PCT under the current NHS regulations governing the provision of
pharmaceutical services.

The nominated person for this pharmacy to decide whether the plan or any part of
the plan is activated will be (either a named person or a post, if a post is used this
will not need changing when if the post holder changes) and the deputy in case of
their absence or unavailability will be (name of post). Contact details are (insert
contact details for primary and deputy).

The decision to activate all or part of this entire plan can be done using the
following process insert pharmacy-specific process.




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BHCPCT Pharmacy Emergency/ Business Continuity Plan Template V2




8.       Initial Considerations and actions.
If your premises is the scene of an incident, (regardless of the type of
incident), the main considered priorities are;

     o To evacuate the building if necessary

     o To establish whether anyone has been hurt and to get them
       appropriate medical attention

     o To call the appropriate emergency services immediately


The following general guidance applies to all incidents;

     o What, if any, emergency services need to be called?

     o If the building is in use during an incident, is it necessary to evacuate all or
       part of the building?

     o Is the building accessible generally or should access be restricted?

     o Is it necessary to keep everyone out of the building until professional advice
       has been sought? (The building, or part of it, may be a ‘crime scene’
       and must be kept ‘sterile’).

     o Are any specialist contractors needed to restore the service?

     o Can any personnel be sent home for safety?

Other actions which may need to be taken as a priority are;

     o Send a member of staff to the front door to restrict access. Customers
       should not be allowed to enter the building unless it has been established
       that it is safe to do so.

     o Contact one of the medicines management staff or community pharmacy
       development at Brighton & Hove City PCT to inform them of any loss of
       service.

     o In the event that any incident occurs when nobody is in the building, the first
       person arriving must make every effort to contact a senior member of staff,
       trying each of the listed people in the following order;

             Person 1                                     Person 2
             Person 3                                     Person 4
             Person 5                                     Person 6

(Numbers are listed at the end of this policy and key members of staff have been
advised to keep the numbers programmed in to their mobile phones.)


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In the event of an emergency or business interruption this pharmacy will
endeavour to maintain services to usual or as close to usual standard, but it may
be evident that this is not possible, at this point the (post title) will decide which are
the priority services that the pharmacy must continue and which will be reduced or
stopped.


9.       Failure of IT systems
Recording data
If there is a failure in the IT system or any stand alone computer, for important
data, the staff will change to a paper back-up system to capture that data so this
can be recorded on system retrospectively. Templates for recording information
when the system is unavailable can be found (Think of all the data that you input,
where there is s need to capture this information while the system is unavailable,
produce a template and have these available in a designated place)

Dispensing Labels
Labels will need to be hand written if these cannot be printed. A typewriter could
be considered as backup. All required cautionary labels still need to be included.

Loss of hardware or software
If the pharmacy experiences loss of either a computer or software through theft or
damage, (insert designated post within pharmacy) will contact (insert systems
provider help line and hardware supplier..

Protection of servers
During periods of extreme heat ensure that the server is maintained at a
temperature that will not cause overheating and subsequent failure.


10.      Failure of Telecommunications
The telephone system is rented from (insert name of provider BT etc and contact)
the lines are supplied by (insert name of network, BT etc and contact).

In the event of a fault with the line it should be reported to (insert name of network
BT etc) if there is no fault on the line then contact the system provider if different to
network.

If the system is dependant on electrical supply check the supply if found to be an
electrical problem follow the instructions for loss of electricity.

If the land line fails redirect all calls into the pharmacy to (insert designated mobile
phone.) This will require staffing.




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11.      Failure of Electricity supply
The electrical fuse box for this practice is located (insert location of fuse box)

In the event of failure in the electricity supply our supplier is (insert supplier) and
their emergency contact is (insert emergency contact).

The emergency torches if required are stored in (it is recommended that you have
a store of torches both hand and head mounted, with spare batteries)

In the event of a power failure first check the trip switches in the fuse box, if this is
not the cause, contact the supplier and report the failure. Ask if they are able to
give an estimated length of time the power will be off, for planning purposes.

A decision should be made as to whether the pharmacy business can be
continued safely, or if relocation to an alternative site will be required to maintain
business.

Contact the PCT on (insert contact) to inform them that you have a power failure
affecting the practice and what business continuity measures you are putting in
place to maintain service.

If it is an electrical fault within the pharmacy contact (insert name and contact your
chosen electrician or if the premises are rented this may be the landlord or owner).

The systems and appliances that will be affected during a power failure are:

        Lighting
        IT System
        Telephones (this may not be the case - delete)
        Heating (this may not be the case - delete)
        Refrigerators
        Diagnostic equipment (this may not be the case – delete, otherwise list)
        Alarm systems

Each of the above will require consideration and you should follow the section
specific to the system.

Clinical refrigerators – if the failure is for a significant period, (which will be
detrimental to the contents), the contents must be assessed. Any temperature
critical drugs or vaccines must be relocated to (insert contingency arrangements)
to maintain them at optimum temperature.

Minimise the need to open the refrigerator whilst the power is off in order to try and
maintain the internal temperature. The NPA Information Department can provide
information on stability of medicines stored outside recommended temperatures
for various periods.




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BHCPCT Pharmacy Emergency/ Business Continuity Plan Template V2


Heating - If heating is lost, assess the effect of the loss of heating related to time
of year and general temperature, included forecast temperature. If it is felt that the
pharmacy‟s business will be affected by loss of heating contact (If the premises
are rented the landlord / owner to request they provide alternative heating) Or if
premises are owned by the pharmacy (insert contact of companies within the area
who hire out portable heating appliances. NB these will need to run off gas
cylinders) Assess the risk to staff required to work in such conditions.




Computers

During a mains electrical failure please switch off the computers to protect them
from power surge when the power is restored.


Diagnostic (or other) Equipment

If such equipment does not have internal re-chargeable batteries consider the
implications of not having it at your disposal. If equipment does have internal re-
chargeable batteries, ensure you know the length of time the equipment can be
used. See Table 2

Table 2 (insert equipment)

Equipment                        Internal Batteries               If Yes duration/times it
                                 Yes/No                           can be used




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12.      Failure of Gas supply
The gas shut off valve for the pharmacy is located (insert the location)

If there is a failure in the gas supply, contact (insert the emergency contact) to
report the failure and to request if they are able to give an estimate of the length it
will be off, for planning purposes.

If heating is lost, assess the effect of the failure related to time of year and general
overall s, including forecast temperature. If it is felt that the pharmacy‟s business
will be affected by loss of heating contact (If the premises are rented contact the
landlord / owner to request they provide alternative heating) or if premises are
owned by the pharmacy contractor (insert contact of companies within the area
who hire out portable heating appliances NB these will need to run off gas
cylinders or electricity). Assess the risk to staff required to work in such
conditions.


13.      Failure of Water supply
The mains water shut off within the pharmacy is located (insert location), and the
mains water stopcock external to the pharmacy is located (insert location).

The water supplier for this pharmacy is (insert name of supplier), and their
emergency contact is (insert emergency number).

For internal plumbing emergencies contact (If the premises are rented this may be
the landlord or owner in not the name and contact of your designated plumber.
NB make sure they can respond to emergencies or have cover when they are
away)

In the event that water supply fails assess the impact on the pharmacy. Consider:

        Toilets
        Hand Hygiene
        Drinking water
        Heating systems
        Reconstitution of medicines e.g. antibiotics


Toilets

If toilets will be unavailable for a significant length of time arrange for portaloos to
be hired from (insert name and contacts of hire companies).




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Hand Hygiene

Ensure that self washing soaps are available e.g. hand gels that do not require
water


Drinking Water

The pharmacy have a store of bottled drinking water, and water to reconstitute
antibiotic mixtures for use in an emergency situation. (Insert storage location).
(Insert post) will be responsible for monitoring the expiry dates and replenishing
stocks.


14.      Fuel Shortages

In the event of a fuel shortage the ability to maintain services may be affected
either by staff being unable to carry out services such as home visits, or being
able to travel to the pharmacy.

Each PCT will have a fuel crisis contingency plan, which will be integrated with the
multi agency plans, and the National Emergency Plan for Fuel (NPE-F). The
arrangements for obtaining fuel will be communicated by the PCT.

However it is unlikely that Pharmacies or staff will be provided with the
means to obtain fuel from emergency schemes.

Pharmacy procedures should therefore be agreed to minimise the effects of fuel
shortages, in advance of any fuel disruption. Insert agreed procedures here….

15.      Disruption to supplies and consumables.
During a major emergency there may be interruptions in the supply of
consumables and equipment required by the pharmacy. This may be a primary
cause of an incident, i.e. a supplier factory fire, or disruption to the transport
network such as in a fuel crisis.

In such an event, the (insert post) will be responsible for assessing the impact on
the business of the pharmacy.

If there is a need to obtain supplies from another source the options are:

        Mutual aid from another pharmacy or the PCT.
        From the hospital pharmacy network co-ordinated by the PCT
        Contact another supplier. ( list all your suppliers and alternative suppliers in
         annex A)




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16.      Fire

On discovering a fire or on suspicion of a fire i.e smell of burning, raise the alarm
by (insert alarm operation) and call 999, clearly stating the full address of the
premises.

In the event of the fire alarm sounding this will be a (insert fire alarm sound and
type i.e siren/ bell continuous etc). All staff have a responsibility to evacuate the
premises ensuring that all patients and visitors are assisted via the identified fire
exits (see table 3). All persons will congregate at the fire evacuation assembly
point (insert designated assembly point), where the (insert post title) will check that
all persons have been evacuated.

If you suspect that there are persons still inside do not re-enter the
premises. On arrival of the Fire and Rescue Service (insert post) will greet them
and give the following information:-

        Location of fire or suspected fire.
        Persons suspected of still being inside, with possible location
        Location of any inflammable materials / oxygen cylinders
        Plan of interior of the premises (if available. It may help to have this
         available)

The exits are located (insert exits in Table 3).

Area of premises                                 Nearest identified Exit




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17.      Damage resulting from flood or extreme weather conditions

Measures to be taken must include the following steps;

    o Immediately restrict access to the affected areas

    o Immediately call any emergency service as required

    o Ascertain the extent of the damage

    o Move or save records / valuable equipment provided it is safe to do so

    o Assess whether it is safe for any or part of the building to continue to be
      used

    o Assess the long term impact, if any, on the running of the building and
      service provision.


18.      Break in, theft or criminal damage

In the event that break in, theft or criminal damage does occur, measures to be
taken must include the following steps;

    o Immediately restrict access to the affected areas and instruct all people
      using the building not to touch, move or otherwise disturb any property that
      has been disturbed or damaged during the theft.

    o Immediately contact the police to report the criminal activity and ascertain
      the likely time for response.

    o Ascertain from the police, any special measures to be taken such as
      identifying what is missing and/or damaged, what can and cannot be
      touched and who will be required to speak to the police on their arrival.

    o Assess the long term impact, if any, on the running of the building and
      service provision.




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19.      Deliberate acts of extreme violence
In the event of any act of violence which is deemed serious, the first priority must
be to seek medical attention for anyone who has been injured, and If possible
move the person away from danger. Call an ambulance, and a police response at
the same time. If this is not possible, someone should remain with the injured
person but only if it is safe to do so.

Staff must ensure that, if the perpetrator remains in the building, then they must
not put themselves or anyone else in danger by approaching or attempting to
communicate with him/her.

Staff should try and use a standard evacuation procedure as they would in the
event of a fire but only if it is safe to do so.

As these situations are rare and unpredictable, staff should do whatever they can
to keep themselves safe.

The senior member of staff may not be available or able to co-ordinate a response
so staff may choose to stay in their office until instructions arrive from the police.


20.      Staff Shortage
There may be occasions when individual staff are incapacitated for a variety of
reasons. Their absence will have a varying effect depending on the role they are
responsible for. In some cases roles can be covered by other staff by ensuring that
knowledge and skills are shared between groups of staff. Other roles may be
highly specialised and cover will need more thought and planning especially if a
service depends on that person alone.

There may also be the scenario when a number of staff are all incapacitated at the
same time such as in an influenza pandemic situation, or during severe adverse
weather conditions.

On discovering there is going to be a shortage of staff inform (insert post) who will
be responsible for assessing the impact on the business of the pharmacy and the
contingency to be employed to maintain continuity of service.

Options available:

        The absence of staff for a short period does not have a significant impact
         on the business of the practice – monitor the situation only.
        The absence of staff will have direct impact on the front line services/
         business of the practice, - divert workload to or between other staff that are
         capable of covering.
        The absence of staff will have a direct impact on the front line services/
         business where there is no other employee who is able to cover the role(s).
         Seek appropriate bank/agency staff to cover.


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       The impact of one or a number of staff being incapacitated is such that the
        pharmacy is unable to continue services - (insert post) will be responsible
        for assessing the capabilities of the pharmacy and possibly which services
        will be reduced (see list of services in priority above) or through mutual aid
        arrangements be diverted to other pharmacy. (If you are going to invoke
        mutual aid arrangements with other pharmacirs these will need to be pre-
        arranged, insert these arrangements)
If there is any reduction in patient services, (insert post) will contact the PCT to
inform the Community Pharmacy Development Manager of the situation as soon
as possible.




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21.      Guidance for Pandemic Influenza
Background

An influenza pandemic is likely to occur when an influenza virus, such as Avian
Flu, undergoes a major change and a new influenza virus emerges that is
markedly different to recently circulating strains, and to which humans are not
immune. A pandemic will occur if the new virus:
       Infects people
       Spreads from person to person
       Causes illness in a high proportion of people infected
       And spreads widely.

Disaster Committee

In the event of a declaration of pandemic flu, a disaster committee (minimum 2
persons), should be convened. The committee will consist of (names).

Frequency of meetings

The senior member of staff and any member of the committee can call a meeting
to decide whether the guidance should be implemented. This will normally happen
when the Pandemic is „declared‟ by the Department of Health / Health Protection
Agency, according to the criteria of a World Health Organisation (WHO) scale.
However there may well be regional or local variations, and if 50% of staff or more
are absent from work due to flu infection, a pharmacy may consider that a meeting
should be called. Thereafter the situation should be monitored closely, and further
meetings called as necessary.


Aims of the guidance

The aim is to ensure that the pharmacy is prepared for the possibility of a flu
pandemic. For those suffering from flu, the emphasis on patients attending
pharmacies may change may change to the attendance of many of them or their
„flu buddy‟ to a vaccination centre, having taken advice from a national „flu – line‟.

One of the largest issues affecting pharmacies will be arrangements
required for issues surrounding cleanliness and infection control.




Impact on Pharmacies during a flu pandemic

The emphasis on meeting customer‟s needs will change from the current
arrangements. Numbers may decline and be limited to those reduced numbers
treated at nearby surgeries for Influenza-like illness (ILI), on non-flu related. This




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BHCPCT Pharmacy Emergency/ Business Continuity Plan Template V2


will require a different mindset to that currently employed whereby patients are
encouraged to visit their Health Centre if at all possible.

As mentioned above, the basic aim of procedures put in place at pharmacies
will be the need to restrict or the passing if flu from one person to another as
possible in order to prevent the infection of others and to keep the pharmacy
operating.

Pharmacies should understand that during a flu pandemic, routine appointments
with GP‟s may no longer be offered for minor illness. The patients will be asked by
the receptionists making the appointment if the appointment is really necessary,
and will be told that doctors will not see patients with minor conditions in this time
of great emergency. They will be asked to make an appointment when the
emergency is over. There may be some resistance in this approach initially,
although as the scale of the epidemic grows, it will become clear to everybody that
such requests are inappropriate

It is now believed that the role of the GP in this crisis will be to visit triage patients
both at the surgery and at home where necessary, assessing whether these
patients are seriously ill and need hospital admission, antiviral therapy and/or
antibiotics. This is expected to take up most of the GP‟s working day. There will
be very little time to see routine patients in the surgery.

This will have an impact on the routine business of the pharmacy, for instance a
pharmacy may see a reduction in terms of the number of normal prescriptions
issued by local GP‟s, but may also see an increase in people with minor ailments
seeking pharmacist‟s advice who may have failed to get access to their doctor.
The impacts for this pharmacy are:

Arrangements therefore need to be put in place to limit infection. Full guidance is
provided within the DH document „Infection control in hospitals and primary
settings‟ 8. Training material is also available (9 and 10), as are posters and
information leaflets on hand washing and coughs and sneezes ( 11 and 12).

Patient information

Large notices should ideally be prepared in advance informing customers of any
special arrangements at the pharmacy, and providing practical advice.
Consideration should be given to taking out an advertisement in the local
newspaper and inform the patients by local radio. (Action: Pharmacy Manager?)

In the event that a business interruption is so severe that alternative arrangements
for the provision of services need to be communicated to the clients of the
pharmacy, this will be done in collaboration with the PCT.

In the event that support from the PCT is required in publicising the alternative
arrangements (insert position) will contact the BHCPCT Communications Manager
at the earliest possible moment to allow as much time as possible to achieve
communication with clients.




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BHCPCT Pharmacy Emergency/ Business Continuity Plan Template V2


Where clients knowing contingency plans in advance would help to mitigate the
effects of business interruption, arrangements within this plan will be shared with
them in patient information regarding the practice. It is important to maintain
communication with clients during any period of business interruption; the aim of
the practice will be to reassure the clients with regular information on the progress
made in returning to normality.

Pharmacy staff

Staff should be encouraged to attend although it is possible that they will have sick
relatives at home to care for, which may prevent or reduce their attendance. In
shop / counter areas, the air conditioning should not be used, as this re-circulates
air which may become contaminated. Counter staff should consider the wearing
of barrier masks.

Annual Leave

From the declaration of the emergency, consideration should be given to
requesting staff not to take pre-booked normal annual leave, short notice holidays,
or unpaid leave. However the pharmacy‟s procedures should look favourably on
staff members caring for sick relatives or for bereavement reasons.

Equipment and Clothing

All staff coming into contact with ILI patients must be provided with personal
protective equipment including aprons, appropriate masks and gloves as laid out
in the HPA guidance. Advance arrangements should be agreed within the
pharmacy and (insert post-holder) will have responsibility for ensuring that staff
adhere to agreed pharmacy arrangements for customer contact and protection.

(Such arrangements may include ordering / maintaining stocks of cleaning
equipment / protective clothing etc, as well as arrangements to minimise staff /
customer contact.)

Antiviral Prophylaxis
Guidance has been issues and can be found within the „UK Operation Framework
for Stockpiling, Distribution and Using Antiviral Medicines in the event of Pandemic
Influenza‟. 13

22.      Communicating with Clients.

Many of the issues mentioned in this plan will result in the need to communicate
with Clients / customers. (These may include nearby GP‟s surgeries etc). Methods
of communication should be agreed in advance, and could include notices in
surgeries / on local radio / in local newspapers.

Where possible templates notices and messages should be agreed and stored.
These are held by (insert name) / these are contained in (insert location).




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23.      References
    1 NM Government (2005) Emergency Preparedness – guidance on Part 1 of
      the Civil Contingencies act 2004 its associated regulations and non-
      statutory arrangements.
      http://www.ukresilience.info/ccbill/index.htm

    2 Department of Health (2003) Handling Major Incidents: An Operational
      Doctrine. DOH.
      http://www.dh.gov.uk/PolicyAndGuidance/EmergencyPlanning/fs/en

    3 Department of Health Planning for Major Incidents: the NHS guidance –
      Primary care Trusts, Version 10-24 September 2002.
      http://www.dh.gov.uk/PolicyAndGuidance/EmergencyPlanning/fs/en

    4 Business Continuity Institute (2005) Business Continuity management,
      Good Practice Guidelines.
      http://www.thebci.org/BCIGPG2005.htm

    5 Health Protection Agency (2004)

    6 Health Protection Agency (2004)

    7 Pandemic Influenza National Framework and PCT and Healthcare in the
      Community Setting
      www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicya
      ndguidance/DH_080734

    8 Infection control for hospitals and primary care settings
      www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicya
      ndguidance/DH_080771

    9 Infection control training material
      www.dh.gov.uk/en/pandemicflu/DH_078752

    10 Department of Health Infection control training Video
       http://www.coionline.tv/singleVideo.php?vID=videos/flu.flv

    11 Department of Health Hand Washing poster
       http://www.teachernet.gov.uk/_doc/11487/NHS_handwashposter.pdf

    12 NHS “Coughs and Sneezes” poster
       http://www.teachernet.gov.uk/_doc/11488/NHS_coughssneezesposter.pdf

    13 UK Operational Framework for Stockpiling, Distribution and Using Antiviral
       Medicines in the event of Pandemic Influenza
       http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publications
       PolicyAndGuidance/DH_4119491




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Annex A - Contacts List
Activation of the Plan

Primary                          (Position or Name)               (Contact Details)
Deputy


Staff Contacts

Name                             Position                         Contacts




(add rows as required)


PCT Contacts

Reason for contact               Department                       Contacts
Emergencies                      On-Call Director                 07867 978169
Reduction in practice /          Resilience Manager               01273 545489 /
business Continuity /                                             07856 917007
advice




Utilities / Services Contacts

Service                          Provider                         Contacts
IT systems
Telecommunications
Electricity
Gas
Water
(add rows as required)

Tradesmen

Trade                    Provider                Contacts
Electrician
Plumber
Heating Engineer
Builder
(add rows as required, you may want to list more than one)




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BHCPCT Pharmacy Emergency/ Business Continuity Plan Template V2


Other Practices with whom we have mutual aid arrangements

Mutual aid available             Practice                         Contacts




(add rows as required)

Suppliers of products / drugs etc

Product                          Supplier                         Contacts




(add rows as required)




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Description: Pharmacy Business Plan Template document sample